Editor' S Note: NERA strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, we feature this column on environmental health services from the Centers for Disease Control and Prevention (CDC) in every issue of the Journal.
In these columns, authors from CDC's Water, Food, and Environmental Realth Services Branch, as well as guest authors, will share insights and information about environmental health programs, trends, issues, and resources. The conclusions in these columns are those of the author(s) and do not necessarily represent the official position of CDC.
LCDR Candis Hunter and CDR Jasen Kunz are environmental health subject matter experts for Legionnaires' disease at CDC's National Center for Environmental Health and the Water, Food, and Environmental Health Services Branch. CDR Laura Cooley is an epidemiology subject matter expert for Legionnaires' disease at CDC's National Center for Immunization and Respiratory Diseases and the Division of Bacterial Diseases.
Legionnaires' disease (LD) is a severe respiratory illness caused by breathing in aerosolized water containing Legionella bacteria. Legionella-related outbreaks account for almost 60% of reported potable water outbreaks and for all of the deaths related to potable water outbreaks in the U.S. during 2013-2014 (Benedict et al., 2017). The number of reported LD cases has increased 350% since 2000 (Figure 1), and cases occur throughout the U.S. (Figure 2). The reason for this increase is unknown but is likely multifactorial and due to increased susceptible populations, opportunities for Legionella growth in the environment, or awareness with improved testing and reporting.
Based on the association of Legionella with water in built environments, implementation of effective water management programs (WMPs) has been cited as an important LD prevention measure, particularly in buildings at increased risk with complex plumbing systems such as healthcare facilities (Garrison et al., 2016; Lucas, Cooley, Kunz, & Garrison, 2016; Soda et al., 2017). Health departments might not have the environmental expertise or resources, however, to provide WMP guidance. A memo from the Centers for Medicaid and Medicare Services that requires certain healthcare facilities to have WMPs has further underscored the need for public health jurisdictions to have the capacity to advise stakeholders regarding LD prevention (Centers for Medicaid and Medicare Services, 2017).