BACKGROUND: The number of reported cases of Legionnaires' disease, a severe pneumonia caused by the bacterium Legionella, is increasing in the United States. During 2000-2014, the rate of reported legionellosis cases increased from 0.42 to 1.62 per 100,000 persons; 4% of reported cases were outbreak-associated. Legionella is transmitted through aerosolization of contaminated water. A new industry standard for prevention of Legionella growth and transmission in water systems in buildings was published in 2015. CDC investigated outbreaks of Legionnaires' disease to identify gaps in building water system maintenance and guide prevention efforts. METHODS: Information from summaries of CDC Legionnaires' disease outbreak investigations during 2000-2014 was systematically abstracted, and water system maintenance deficiencies from land-based investigations were categorized as process failures, human errors, equipment failures, or unmanaged external changes. RESULTS: During 2000-2014, CDC participated in 38 field investigations of Legionnaires' disease. Among 27 land-based outbreaks, the median number of cases was 10 (range = 3-82) and median outbreak case fatality rate was 7% (range = 0%-80%). Sufficient information to evaluate maintenance deficiencies was available for 23 (85%) investigations. Of these, all had at least one deficiency; 11 (48%) had deficiencies in ≥2 categories. Fifteen cases (65%) were linked to process failures, 12 (52%) to human errors, eight (35%) to equipment failures, and eight (35%) to unmanaged external changes. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Multiple common preventable maintenance deficiencies were identified in association with disease outbreaks, highlighting the importance of comprehensive water management programs for water systems in buildings. Properly implemented programs, as described in the new industry standard, could reduce Legionella growth and transmission, preventing Legionnaires' disease outbreaks and reducing disease.
BACKGROUND: The number of reported cases of Legionnaires' disease, a severe pneumonia caused by the bacterium Legionella, is increasing in the United States. During 2000-2014, the rate of reported legionellosis cases increased from 0.42 to 1.62 per 100,000 persons; 4% of reported cases were outbreak-associated. Legionella is transmitted through aerosolization of contaminated water. A new industry standard for prevention of Legionella growth and transmission in water systems in buildings was published in 2015. CDC investigated outbreaks of Legionnaires' disease to identify gaps in building water system maintenance and guide prevention efforts. METHODS: Information from summaries of CDC Legionnaires' disease outbreak investigations during 2000-2014 was systematically abstracted, and water system maintenance deficiencies from land-based investigations were categorized as process failures, human errors, equipment failures, or unmanaged external changes. RESULTS: During 2000-2014, CDC participated in 38 field investigations of Legionnaires' disease. Among 27 land-based outbreaks, the median number of cases was 10 (range = 3-82) and median outbreak case fatality rate was 7% (range = 0%-80%). Sufficient information to evaluate maintenance deficiencies was available for 23 (85%) investigations. Of these, all had at least one deficiency; 11 (48%) had deficiencies in ≥2 categories. Fifteen cases (65%) were linked to process failures, 12 (52%) to human errors, eight (35%) to equipment failures, and eight (35%) to unmanaged external changes. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Multiple common preventable maintenance deficiencies were identified in association with disease outbreaks, highlighting the importance of comprehensive water management programs for water systems in buildings. Properly implemented programs, as described in the new industry standard, could reduce Legionella growth and transmission, preventing Legionnaires' disease outbreaks and reducing disease.
Authors: Don Weiss; Christopher Boyd; Jennifer L Rakeman; Sharon K Greene; Robert Fitzhenry; Trevor McProud; Kimberlee Musser; Li Huang; John Kornblum; Elizabeth J Nazarian; Annie D Fine; Sarah L Braunstein; Daniel Kass; Keren Landman; Pascal Lapierre; Scott Hughes; Anthony Tran; Jill Taylor; Deborah Baker; Lucretia Jones; Laura Kornstein; Boning Liu; Rodolfo Perez; David E Lucero; Eric Peterson; Isaac Benowitz; Kristen F Lee; Stephanie Ngai; Mitch Stripling; Jay K Varma Journal: Public Health Rep Date: 2017-01-31 Impact factor: 2.792
Authors: Dick van der Kooij; Geo L Bakker; Ronald Italiaander; Harm R Veenendaal; Bart A Wullings Journal: Appl Environ Microbiol Date: 2017-02-15 Impact factor: 4.792
Authors: Sammy Zahran; Shawn P McElmurry; Paul E Kilgore; David Mushinski; Jack Press; Nancy G Love; Richard C Sadler; Michele S Swanson Journal: Proc Natl Acad Sci U S A Date: 2018-02-05 Impact factor: 11.205
Authors: Olivia C Tran; David E Lucero; Sharon Balter; Robert Fitzhenry; Mary Huynh; Jay K Varma; Neil M Vora Journal: Public Health Rep Date: 2018-07-13 Impact factor: 2.792
Authors: Dick van der Kooij; Harm R Veenendaal; Ronald Italiaander; Ed J van der Mark; Marco Dignum Journal: Appl Environ Microbiol Date: 2018-11-30 Impact factor: 4.792