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Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires' Disease - North America, 2000-2014.
MMWR Morb Mortal Wkly Rep. 2016 Jun 10; 65(22):576-84.MM

Abstract

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.

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Publisher Full Text (DOI)

Authors

Garrison LE
No affiliation info available
Kunz JM
No affiliation info available
Cooley LA
No affiliation info available
Moore MR
No affiliation info available
Lucas C
No affiliation info available
Schrag S
No affiliation info available
Sarisky J
No affiliation info available
Whitney CG
No affiliation info available

MeSH

Disease OutbreaksHumansLegionnaires' DiseaseNorth AmericaWater MicrobiologyWater Pollution

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27281485

Citation

Garrison, Laurel E., et al. "Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires' Disease - North America, 2000-2014." MMWR. Morbidity and Mortality Weekly Report, vol. 65, no. 22, 2016, pp. 576-84.
Garrison LE, Kunz JM, Cooley LA, et al. Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires' Disease - North America, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016;65(22):576-84.
Garrison, L. E., Kunz, J. M., Cooley, L. A., Moore, M. R., Lucas, C., Schrag, S., Sarisky, J., & Whitney, C. G. (2016). Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires' Disease - North America, 2000-2014. MMWR. Morbidity and Mortality Weekly Report, 65(22), 576-84. https://doi.org/10.15585/mmwr.mm6522e1
Garrison LE, et al. Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires' Disease - North America, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016 Jun 10;65(22):576-84. PubMed PMID: 27281485.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires' Disease - North America, 2000-2014. AU - Garrison,Laurel E, AU - Kunz,Jasen M, AU - Cooley,Laura A, AU - Moore,Matthew R, AU - Lucas,Claressa, AU - Schrag,Stephanie, AU - Sarisky,John, AU - Whitney,Cynthia G, Y1 - 2016/06/10/ PY - 2016/6/10/entrez PY - 2016/6/10/pubmed PY - 2017/1/12/medline SP - 576 EP - 84 JF - MMWR. Morbidity and mortality weekly report JO - MMWR Morb Mortal Wkly Rep VL - 65 IS - 22 N2 - 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. SN - 1545-861X UR - https://www.unboundmedicine.com/medline/citation/27281485/full_citation DB - PRIME DP - Unbound Medicine ER -