Insuring Legionella Risks.

• Author: David, Jeannette
• Position: FOREFONT

In 1976, the first identified outbreak of Legionnaires' disease sickened over 220 and killed 34 American Legionnaires attending a convention in Philadelphia. Caused by Legionella pneumophila bacteria, the disease is a severe form of pneumonia that results in cough, high fever, nausea, vomiting, diarrhea and shortness of breath. It has an average mortality rate of 10% and even those who survive can sustain serious permanent injury from prolonged sepsis and organ failure. A less severe form of legionella infection called Pontiac fever does not result in pneumonia and usually resolves without medical intervention. Collectively, both Legionnaires' disease and Pontiac fever are called Legionellosis.

Legionnaires' disease continues to make headlines today. Between June and August of 2018, the disease sickened 18 hotel guests and caused one death at a popular beach resort in Hampton, New Hampshire. In July, an outbreak in an apartment complex in New York City left 25 tenants hospitalized and one dead. Two months later, another 15 cases including a fatality were diagnosed in Sioux Falls, South Dakota. On Nov. 28 yet another outbreak was confirmed at a hospital in Madison, Wisconsin, sickening 11 and killing one person. These are but a snapshot of the cases reported each month to local health departments around the United States.

Legionella bacteria is common in all forms of water. In most circumstances, it exists at such low concentrations that it will not cause disease. However, certain conditions allow bacteria to amplify rapidly, such as stagnation and water temperatures in the range of 90[degrees] to 115[degrees]F. But even at high concentrations, legionella does not threaten human health until it is aerosolized within a mist of water droplets fine enough to be inhaled into the lungs, where it gains an infectious foothold. Recognized sources of aerosolization include cooling towers, showerheads, faucets, fountains, swimming pools, hot tubs, humidifiers, misters and medical respiratory devices. Hotels, condominiums, restaurants, grocery stores, hospitals, senior living facilities, health spas, fitness centers and any large building with a centralized potable water system are potential sites for amplification of legionella. In fact, a review of Legionnaires' disease outbreaks between 2000 and 2014 revealed that 34% were associated with hospitals or long-term care facilities.

The number of Legionnaires' cases reported to the CDC has been on the...