• Hot Tubs Eyed as Another Case of Legionnaires' Reported

    June 13, 2017


    Big buildings, hot tubs and warm weather might have led to the conditions that resulted in several local cases of Legionnaires’ disease, medical and building experts said.

    A day after news broke of four cases of Legionnaires’ disease tied to two LA Fitness gyms in Orlando, Lake County health officials confirmed a seniors community in Clermont is also being investigated.

    Health investigators are also focusing on hot tubs, which may help spread the deadly bacteria, at the Summit Greens community in Clermont....

    Buildings with large water systems can be susceptible to Legionella growth and hot tubs can help spread bacteria, said Bill Pearson, senior vice president of Special Pathogens Laboratory in Pittsburgh.

    “When the bacteria is able to find favorable conditions to multiply, it becomes a health hazard,” he said.

    (Excerpt from Orlando Sentinel)

  • SPL Changes to Suite Number 401 on August 29

    August 22, 2016

    On August 29, SPL's new address will be: 1401 Forbes Ave., Suite 401, Pittsburgh, PA 15219  
















  • 40 years after the Legionnaires’ Disease Outbreak in Philly (Listen to Radio Times interview with Dr. Janet Stout)

    August 01, 2016

    Learn more about the historic Legionnaires' disease outbreak in WHYY's  Radio Times' interview on August 1. Forty years ago, dozens of American Legion members fell ill with a mysterious disease. The 1976 annual conference of thousands of veterans in Philadelphia and the sickness that followed lead to 34 deaths. Discussion includes the illness that was later identified and named after those afflicted veterans: Legionnaires’ disease. Get a first-hand account of the tension and fear that gripped the region from the doorman at the Bellevue Hotel at the time. Learn more from David Fraser, a Philadelphia area native who led the CDC’s federal field investigation. And Legionella expert Dr. Janet Stout, president and director of the Special Pathogens Laboratory and research associate professor at the the University of Pittsburgh Swanson School of Engineering, explains the new standard and regulations for Legionnaires' disease prevention.

  • Legionnaires' Disease Making a Comeback

    July 06, 2016


    Older Americans are at higher risk for the bacterial pneumonia.

    by Lisa Esposito | Staff Writer July 6, 2016, at 9:26 a.m.

    Legionnaires' disease is back on the rise, with several new outbreaks in June alone. A Hawaiian island resort, a Pittsburgh hospital and a Maryland senior-living community are all battling pneumonia-causing Legionella bacteria in their water systems. Older adults are at higher risk for getting sick after breathing in water droplets containing Legionella. Here's what you should know about this respiratory illness.

    Outbreak Response

    The first case in May could have been a coincidence. Just four days after moving into The Lutheran Village at Miller's Grant, a continuing care retirement community, a resident was diagnosed with Legionnaires' disease. On June 10, the Ellicott City, Maryland, facility informed residents and staff of what was then a single case of pneumonia.

    It was unclear whether the resident had been exposed in the community or elsewhere. But a second and then a third resident (who also recently moved in) developed Legionnaires' disease. By then, administrators had brought in a consultant, Janet Stout, director of the Special Pathogens Laboratory in Pittsburgh, and were already taking precautions.

    The facility "pulled out all the stops" to address the issue, says Stout, an associate research professor at the University of Pittsburgh and a Legionnaires' expert. That meant restricting access to tap water and providing bottled water to drink; adapting ways of cooking, tooth-brushing, shaving and showering; and bringing in a team to assess the water distribution system and test water samples. Treating water systems with extra chlorine is the first step for reducing Legionella bacteria, Stout says.

    In a three-hour meeting, Stout spoke with residents and staff members to address their many questions. "Can someone get Legionnaires' disease from somebody else who has it?" was a major concern. No, she told them. There's no person-to-person transmission with Legionella. Also reassuring: In general, people who've had Legionnaires' usually won't get it a second time.

    continued on US News & World Report website 

  • Special Pathogens Laboratory Approved for Legionella Testing by New York State Health Department ELAP

    June 30, 2016

    The New York State Department of Health (NYSDOH) ELAP has approved Special Pathogens Laboratory for Legionella testing in both the Nonpotable and Potable Water categories.

    Prior to the New York City Legionella regulation, there was no specific Legionella ELAP certification. Since then, the NYDOH has implemented a certificate program using the ISO 11731 standard, Water Quality – Detection and Enumeration of Legionella. Upon fulfilling the requirements, the NYDOH is issuing  "interim approvals" until an on-site inspection is conducted to receive full certification. 
    The Legionella testing approval we received on June 24, 2016 is in addition to our ELAP certifications for Coliforms, E. coli and HPC testing, as well as our A2LA accreditation specifically for Legionella testing as a field of testing. To view our interim ELAP approval and other accreditations, please click here.
    The NYSDOH ELAP also instituted a new requirement for Legionella sampling and handling, specifically that sample analysis cannot exceed two days from the time of collection. For our updated Legionella sampling and shipping instructions, click here.

    If there is anything we can do to assist you in meeting these new requirements or if you need more information, please call us at 412-281-5335.

    We appreciate your business and look forward to helping you promote safer water through managing risk from Legionella and other waterborne pathogens.

  • CDC concerned over growth in Legionnaires' cases

    June 11, 2016

    June 7, 2016 | By Sean D. Hamill / Pittsburgh Post-Gazette

    “The CDC has a long history of recommending not looking for Legionella as a prospective element to assess risk,” Dr. Stout said.

    The CDC has said for decades that it believed testing regularly for Legionella would give building owners a false sense of security since people have contracted the disease when there were no signs of the bacteria in the water system.

    Dr. Whitney said there is no testing recommendation in the Vital Signs study because “we didn’t want to get into it.”

    But she said because the ASHRAE standards now recommend testing water, the CDC has now changed its position on testing since last summer.

    “We are not against testing” water for the presence of Legionella, she said. “We think it has its place, particularly in healthcare facilities.”

    Legionnaires’ cases in the United States quadrupled from 2000 to 2014, with about 5,000 people a year — and probably many more — now being infected by the deadly form of pneumonia, but the exact reason for the growth is unclear, officials with the federal Centers for Disease Control and Prevention said Tuesday.

    And too many of those cases occur during an outbreak, CDC Director Tom Frieden said Tuesday in a phone call with reporters to announce the publication of a comprehensive study on outbreaks published on the CDC’s Vital Signs webpage.

    “I’ll give you the bottom line [of the study] right off the top: Almost all Legionnaires’ disease outbreaks are preventable with improvements in water system management,” he told reporters.
    During that 15-year period of 2000 to 2014, the CDC investigated 27 confirmed, land-based — as opposed to ship-based — Legionnaires’ outbreaks.

    Those outbreaks included the 2011 and 2012 Veterans Affairs Pittsburgh Healthcare System that the CDC determined infected 22 people and led to the deaths of six of them. Overall, 415 people were infected in the 27 outbreaks, and 65 of them died, the CDC said.

    The CDC study found that in 23 of the 27 outbreaks it investigated there were “gaps in maintenance that could be addressed with a water management program to prevent Legionnaires’ disease outbreaks…”

    There were many more people sickened and killed during other outbreaks the CDC was unable to investigate during that timeframe. It noted in the study that from just 2000 to 2012, it had requests to investigate about 160 outbreaks.

    CDC officials said this new study was prompted by two factors: First, the public notoriety of cases over the last three years that included, first, the Pittsburgh VA, then a cooling tower outbreak in New York City, and, last year, the outbreak in Flint, Mich.

    In addition, last summer, after nearly a decade of work, the American Society of Heating, Refrigerating and Air-Conditioning Engineers — known as ASHRAE — completed its recommendations for dealing with the water-borne disease of Legionella in building water systems.

    ASHRAE’s recommendations are expected to eventually find their way into many of the country’s state or local building codes, carrying the power of law. Since last summer, though, the CDC “heard the ASHRAE standards weren’t easy to understand unless you were a building engineer,” Dr. Frieden said.

    As a result, the CDC on Tuesday also released an online “Toolkit” that it hopes will make adopting the ASHRAE standards easier for building owners and managers. The Toolkit was piloted in Flint, where the CDC took it to building owners and managers who were impacted by the outbreak there that infected 91 people — including 50 cases in a local hospital.

  • Health Department Announces Plan to Reduce Risk of Legionnaires’ Disease Outbreaks in the City

    June 07, 2016

    Toughest cooling tower regulations in nation supported by increased inspection staff, enhanced capacity, lab improvements  

    Inspection of cooling towers in high-risk neighborhoods, including areas of last summer’s outbreaks, are already undergoing   

    All cooling towers in the South and East Bronx are prioritized for inspection

    “New York City has surpassed CDC and ASHRAE by producing a proactive public health regulation that requires specific measures for cleaning, treatment and testing of cooling towers for Legionella.  New York has redefined best practices for controlling Legionella in cooling towers to prevent Legionnaires’ disease,” said Janet E. Stout, PhD, President and Director of Special Pathogens Laboratory.

    June 7, 2016 – Ahead of the summer, the Health Department announced a comprehensive plan to reduce the risk of Legionnaires’ disease outbreaks in the city, including implementation of the toughest cooling tower regulations in the nation, the hiring of more inspectors and training of existing City personnel to inspect towers if needed, and improvements that will speed up community notification and lab testing if outbreaks occur.  

    The cornerstone of the City's preparedness is rigorous oversight and enforcement of the new cooling tower requirements outlined in Local Law 77, which focuses on preventive maintenance of the city’s cooling towers, which took effect on May 9, 2016. Last year, Mayor de Blasio signed Local Law 77, the strictest regulations in cooling tower oversight in the nation. The new requirements allow the City to quickly identify and remediate problematic towers, which are potential sources of Legionnaires’ disease. This year, the City is investing more than $7 million to increase staff for oversight, doubling the number of inspection teams this summer and more than tripling the inspection staff by 2017.

    “New York City has done more than any other city in the nation to regulate cooling towers and reduce the risk of Legionnaires’ disease,” said Health Commissioner Dr. Mary T. Bassett. “Since last summer, we have developed strict regulations for cooling tower maintenance, augmented our disease control infrastructure to better address Legionella in the city, and diminish the risk of community outbreaks. Although we know that there will always be cases of Legionella disease, we are confident that we are taking the steps necessary to reduce the risk of outbreaks.” 

    “We’re proud to support our partners at the Health Department in tracking cooling towers to protect New Yorkers’ health. Since last summer, the Health Department and DOB have registered more than 5,500 cooling towers citywide to make sure that building owners properly maintain their equipment,” said Buildings Commissioner Rick D. Chandler, PE.

    “New York City has surpassed CDC and ASHRAE by producing a proactive public health regulation that requires specific measures for cleaning, treatment and testing of cooling towers for Legionella.  New York has redefined best practices for controlling Legionella in cooling towers to prevent Legionnaires’ disease,” said Janet E. Stout, PhD, President and Director of Special Pathogens Laboratory.

    “The NYCDOH-MH was an excellent partner in addressing the Legionella outbreak in our Bronx communities last year. We look forward to working closely with the DOH and other partners in proactively putting in place Legionella prevention strategies for this season,” said Dr. Belinda Ostrowsky, Director of Epidemiology, Stewardship and Infection Prevention at Montefiore Health System, and associate professor of Medicine at Albert Einstein College of Medicine. 

    “With the summer months upon us, I applaud the NYC Department of Health for taking wide-ranging measures to reduce the risk of Legionnaires’ disease in our communities in the Bronx and throughout the city,” said Rep. Joe Crowley. “Making sure our cooling towers systems are properly maintained while implementing a comprehensive plan to improve our response to possible outbreaks are reassuring steps that let New Yorkers know their health is our number one priority.” 

    “I commend the New York City Health Department for their efforts to keep New Yorkers safe. As the cooling season approaches, it is critical that we assure residents and their families that every preventive measure is being taken to protect air quality so they can have a safe and enjoyable summer season,” said New York State Assembly Speaker Carl Heastie.

    “I am proud to see the New York City Department of Health develop a robust and proactive plan to address Legionella. This is a critical investment of resources to ensure the safety of our community. I commend the New York City Department of Health for prioritizing areas in the Bronx where there have been outbreaks and where there is the highest risk. This shows that we all must continue working together to serve the needs of those we serve,” said New York State Assembly Member Carmen E. Arroyo.

    “Last summer, the Council and Administration worked hand in hand with DOHMH and the CDC to address an outbreak of Legionnaire’s Disease and craft legislation that has set the standard for cooling tower regulation.  The work we have done will minimize Legionnaire’s outbreaks this summer and in the years to come,” said Chair of the Committee on Public Safety Council Member Vanessa L. Gibson. “As the weather heats up, I urge all those maintaining cooling towers to continue to adhere to the sterilization standards set forth by the Council and thank them for being our partners in protecting the public’s health and wellbeing, 

    “Given last year’s events, I’m glad that the East Bronx is being prioritized with regards to cooling tower inspections,” said Council Member James Vacca. “I’m encouraged that the City is being proactive in their efforts to prevent a major outbreak and to provide New Yorkers with as much information as possible. I will continuously work with the Department of Mental Health & Hygiene on Legionnaires’ Disease prevention and monitoring.”

    “I appreciate the de Blasio administration's concerted efforts to mitigate the potential impact of a possible Legionnaire's disease outbreak, via Local Law 77. Given the more aggressive and proactive initiatives being implemented--most notably, in targeted sections of the Bronx--ensuring that our cooling towers are fully operational, I am confident that we are as prepared as possible to contend with the vectors that cause this disease, and that affect some of our most at-risk residents,” said Council Member Annabel Palma. 

    "While we had a scare in the Northeast Bronx last year, I am pleased that it has lead our city to become a nationwide leader in setting higher standards for cooling tower regulations codified in law.  With the hiring of additional inspectors and additional training for City personnel to inspect towers, I am confident New York City is prepared in the event of an outbreak this summer. I want to commend the Health Department for its diligence to reduce the risk of Legionnaire’s Disease," said Council Member Andy King.

    “In anticipation for the summer, I am appreciative for the proactive action being taken by the New York City Health Department to continue its plan to treat and reduce the risk of the Legionella bacteria - especially for the hundreds of South Bronx families impacted by the disease last year," said Assemblywoman Latoya Joyner (D-Bronx, 77th AD). "Building upon local efforts to impose stringent regulations for inspections related to cooling towers in the Bronx and being able to locate registered cooling towers in buildings more easily is appropriate protocol to limit this major public health issue. On the state level, I have introduced legislation that will allocate funding to ensure that resources and measures are in place so that future generations do not have to worry about this preventable disease."

    “I support the Health Department's proactive stance to protect the health of New Yorkers, especially Bronx residents, by giving South and East Bronx neighborhood priority for inspections,” said Council Member Fernando Cabrera.

    Enforcement of NYC Cooling Tower Rules - Local Law 77 

    Effective May 9, 2016, the New York City cooling tower rules are the toughest oversight regulations in New York State and the nation. The law requires the registration of new and existing cooling towers with the NYC Department of Buildings (NYC DOB). Under the law, more than 3,500 buildings with at least one cooling tower must adopt protocols for the cleaning and disinfection of all towers in New York City. 

    The law mandates all cooling towers to be tested for Legionella every 90 days and requires the development of new maintenance and management plans to reduce the likelihood of outbreaks. The rules detail requirements for operations, quarterly inspections, reporting to the Health Department when testing detects increased levels of Legionella bacteria, and annual certification that the owner has complied with requirements. Failure to comply with requirements are subject to stiff penalties; cumulative violations can total up to $25,000. 

    The New York City Department of Buildings has registered a total of 5,544 cooling towers and received 25 notifications of towers that have discontinued operating in the same period.  

    Cooling Tower Inspections

    High Priority Inspections: In addition to required routine inspections, the Department will conduct yearly independent unannounced random spot inspections of cooling towers across the city. High priority inspections target cooling towers that tested positive for Legionella in 2015. All cooling towers in the South and East Bronx have been prioritized for inspection. Additionally, the City inspection schedule will prioritize cooling towers in neighborhoods where Legionnaires’ disease has been more prevalent. These neighborhoods are typically in high-poverty areas where infrastructure may be older and residents have a higher prevalence of chronic disease.  

    Increased Staffing for Inspections: To meet inspection targets, the City is adding staff to increase the number of teams in the field inspecting cooling towers. Additionally, more than 50 staff from sister agencies have been trained and will be made available to assist in various response activities, including water sampling.    

    Increased Testing Capacity

    The City funded five new lab positions to expand testing of Legionella and make the process more efficient. The new capacity will allow the department to conduct PCR testing – last summer it only had capacity to test water by culture. PCR is a laboratory method used to amplify trace amounts of DNA on almost any liquid or surface. In addition, environmental testing will be now in the electronic lab information system, making reporting more efficient.

    Multi-Agency Coordination 

    Data Sharing, Management and Transparency: The City’s plan enhances multiagency collaboration in data sharing and management to allow for a prompt and well-coordinated response to signs of Legionnaires’ disease. The Health Department and the Department of Buildings share a database of cooling tower registrations and inspections. The inspection system notifies the Department of Buildings when unregistered cooling towers are found in the field. The system generates monthly reports of inspected cooling tower locations and provides a list of inspected towers. City agencies, including DCAS, HPD, DEP, NYCEM and NYCHA, will be provided a list of known cooling towers. Cross-agency data sharing and management will also provide greater transparency to the public. Notices of violations adjudicated by the Environmental Control Board will be available for searching on NYC Open Data. 

    Community Communication

    Communication to Communities Affected: The Health Department has developed reporting procedures for an ongoing Legionnaires’ disease investigation, and, for suspected outbreaks, will notify landlords, residents, visitors and staff at buildings affected, providing timely updates and instructions on how to handle the disease. 

    Assessing Cooling Towers in an Affected Zone: Identifying quickly the source or sources of Legionnaires’ disease requires an aggressive assessment of cooling towers in an affected area. The process for assessing cooling towers in an affected zone involves reviewing inspection records, performing a physical inspection and taking samples for testing. The cooling tower samples will be taken to the Public Health Lab to be tested by Polymerase Chain Reaction (PCR) test and culture.  

    About Legionnaires’ Disease 

    There are 500-600 cases of Legionnaires’ disease in New York State annually, and 200-400 of these cases are in New York City. In 2015, there were 438 cases of Legionnaires’ disease in New York City, including 138 from the South Bronx outbreak. In 2013, there were about 4,500 cases of Legionnaires’ disease reported in the U.S., but it is likely the true count is between 8,000-18,000 cases annually.
    Cooling towers have been associated with large community outbreaks. An important way to reduce large community outbreaks of the disease is to maintain cooling tower systems so that they limit the growth of Legionella bacteria. In response to the Legionnaires’ outbreaks of 2015, the Mayor and City Council passed Local Law 77 to reduce and contain Legionella growth in cooling towers, becoming the first U.S. municipality to adopt a set of robust requirements to ensure cooling tower maintenance. 

    Legionnaires’ disease is caused by Legionella, a bacteria that grows in warm water. Legionnaires’ disease cannot be spread from person to person. Groups at high risk for Legionnaires’ disease include people who are middle-aged or older – especially cigarette smokers – people with chronic lung disease or weakened immune systems and people who take medicines that suppress their immune system.  

    Symptoms resemble other types of pneumonia and can include fever, chills, muscle aches and cough. Some people may also have headaches, fatigue, loss of appetite, confusion, or diarrhea.  Symptoms usually appear two to 10 days after significant exposure to Legionella bacteria. Those with symptoms should call their doctor and ask about testing for Legionnaires’ disease. To learn more about Legionnaires’ disease and the City’s plan to keep the disease in check, visit nyc.gov/health. 



    MEDIA CONTACT: (347) 396-4177
    Christopher Miller: pressoffice@health.nyc.gov

  • In the Lead 2016 Profile: Bill Pearson 'an advocate that Legionnaires’ disease is preventable'

    May 16, 2016

    May 16, 2016
    By Adam Smeltz / Pittsburgh Post-Gazette

    As many as 18,000 people nationwide end up hospitalized each year with Legionnaires’ disease, a nasty type of pneumonia that spreads through waterborne Legionella bacteria. Hundreds of those patients die.

    But that doesn’t have tobe the case, said Bill Pearson, a water treatment executive who joined the Uptown-based Special Pathogens Laboratory this spring as senior vice president of business development. The firm is angling to stop the disease, in large part by controlling Legionella that lurk in indoor pipes.

    “I’ve always been an advocate that Legionnaires’ disease is preventable. That is the exact philosophy, the exact mission statement of Special Pathogens Lab,” said Mr. Pearson, 67, of Wilmington, N.C. He remains based there but will spend about a week each month in Pittsburgh, where researchers Janet E. Stout and Victor L. Yu established SPL as a private agency in 2007.

    While the group has long helped hospitals and other clients monitor and prevent bacteria in their plumbing, Ms. Stout said the dangers of Legionella are now gaining more attention. Part of that stems from high-profile Legionnaires’ outbreaks, including one in the South Bronx that killed 12 people in 2015. Investigators tied at least six deaths to an earlier outbreak in the Veterans Affairs Pittsburgh Healthcare System in 2011 and 2012.

    Also drumming up awareness is a voluntary Legionella guideline that an engineering association approved last year. Standard 188 from the American Society of Heating, Refrigerating and Air-Conditioning Engineers encourages Legionella risk management for a variety of buildings, including retirement homes and health clinics. Recognized prevention methods include copper-silver ionization treatments, monochloramine and other disinfectants.

    “The United States finally caught up with the rest of the world in having a standard for the prevention of Legionnaires’ disease,” said Ms. Stout, who served with Mr. Pearson on a panel that developed the guideline. She predicted the standard, 10 years in the making, could make its way into mandatory building codes. Portions appear already in standards for New York City.
    For Mr. Pearson, who just finished a 40-year career at Southeastern Laboratories Inc. in Goldsboro, N.C., joining SPL means a chance to educate water treatment companies about the new guideline. 

    “Now we have the tools out there to say, ‘Let’s look at our man-built water systems that have the potential to harbor Legionella and implement a water-management system.’ That’s the essence” of the standard, Mr. Pearson said. “All of this is to make the goal of ending Legionnaires’ disease.”

  • Health Department Finalizes Cooling Tower Rules to 
Reduce the Risk of Severe Legionnaries’ Disease Outbreaks

    April 07, 2016

    Better maintained cooling towers will reduce the likelihood of Legionnaires’ disease outbreaks
    Rules detail new requirements for the operation and maintenance of cooling towers; regulations will take effect in 30 days.

    April 7, 2016 – The Health Department today published final rules governing the operation and maintenance of cooling towers. The local law – created in partnership with the City Council in response to the Legionnaires’ disease outbreak last summer – authorized the Health Department to establish rules to enforce the measures outlined in the bill. The City estimates that 3,500 buildings have at least one cooling tower and are affected by the announced regulations. Last August, Mayor Bill de Blasio signed first-in-the-nation legislation that required the registration of all cooling towers, development of maintenance and management plans, quarterly inspections, reporting to the Health Department when testing detects increased levels of Legionella bacteria, and annual certification that the owner has complied with these requirements. The legislation also mandated the disinfection of cooling towers with levels of Legionella that pose potential health risks. Violations of these requirements are subject to civil penalties up to $10,000. Failure to disinfect towers with increased microbes are classified as misdemeanors, punishable up to $25,000. The rules can be found here and will go into effect Monday, May 9th.
    “These rules continue the Administration’s aggressive approach to ensuring cooling towers are properly maintained,” said Health Commissioner Dr. Mary T. Bassett. “I thank Mayor de Blasio and the City Council for their commitment to establishing these comprehensive and fair regulations that were developed with input from cooling tower operators, building owners and health scientists. New York City will lead the nation in its oversight of cooling towers, which here and elsewhere have been associated with large community outbreaks.”
    "The City's leadership on this issue is in keeping with the Department of Health's distinguished tradition, going back generations, of protecting public health," said Assembly Member Richard Gottfried, Chair of the New York State Assembly Committee on Health.
    “As chair of the Committee on Housing and Buildings, I’m pleased that the Department is moving forward on better protecting the people of New York against outbreaks of Legionnaires,” said Council Member Jumaane D. Williams. “With the legislation adopted in the Housing committee and the full Council, combined with these new rules, New Yorkers can feel greater confidence that the 3,500 buildings with cooling towers will no longer serve as breeding grounds for an unfortunate – albeit treatable- disease, Legionnaires.”
    “Forty years after its discovery, we know that Legionnaires’ disease can be prevented by stopping the growth of Legionella bacteria in water systems like cooling towers,” said Janet Stout, PhD, President and Director of the Special Pathogens Laboratory in Pittsburgh. “The simple proactive steps described in the New York City rules will prevent outbreaks, save lives and serve as a national public health model for the prevention of Legionnaires’ disease associated with building water systems.”
    “With release of the new regulations, the NYC Health Department is demonstrating  strong leadership in decreasing contamination of cooling towers and protecting the public from Legionnaires' disease," said Dr. Ruth L. Berkelman, Director for the Center for Public Health Preparedness and Research at Emory University.
    The new rules include requirements that building owners perform a risk assessment and develop a comprehensive plan detailing the personnel responsible for performing daily, weekly, quarterly and annual activity to mitigate identified risks. Building owners need to test water chemistry at least three times a week, install devices to help reduce the drift of mist, maintain continuous disinfection, test for Legionella bacteria at least once every 90 days, and fully clean the towers at least twice a year. Additionally, cooling towers and evaporating condensers that had been shut down for winter must be cleaned and disinfected before starting up again. The new rules require that cleaning and disinfection shall occur within 15 days before the cooling tower is activated.

    The proposed rules were subject to a public comment period in January 2016. Many of the received comments were incorporated into the final rules.

  • Deadly Legionnaires’ disease outbreak in Michigan highlights surveillance issues

    March 16, 2016

    Infectious Disease News, March 2016

    “Our proactive message is seek Legionella out and you will protect your patients. ... Health care facilities should be testing for Legionella, especially in Genesee County.”    Dr. Janet E Stout

    A recent outbreak of Legionnaires’ disease in Genesee County, Michigan, underscored surveillance issues surrounding the sometimes deadly lung infection, according to experts.

    The outbreak — involving both area health care facilities and the community — is thought to have been caused by municipal water originating from the Flint River, which also was shown to have carried high levels of lead into the homes of area residents. The outbreak infected 87 people between 2014 and 2015, killing nine.

    “The United States has lagged far behind the rest of the world in having some kind of standard or requirement for addressing Legionella in building water systems,” Janet E. Stout, PhD, president of Special Pathogens Laboratory in Pittsburgh, told Infectious Disease News.

    Research by Stout and others has shown the potentially lifesaving benefits of protecting against outbreaks of Legionnaires’ disease by proactively testing water for Legionella, an approach she has been recommending for more than 30 years.

    However, national guidelines regarding Legionella are generally reactive, according to Stout.

    “The increase in chance of death happens when there’s a delay in diagnosis and a delay in initiating appropriate therapy,” she said.

    The benefits of proactive testing
    Stout and colleagues showed in a 1982 study that during an outbreak of Legionnaires’ disease, Legionella was more widely distributed at a Veterans Affairs hospital in Pittsburgh than previously believed. The hospital’s water distribution system was identified as the reservoir for the pathogen.

    In a 2005 study, Stout and colleagues demonstrated that guidelines favoring a proactive approach significantly decreased the number of nosocomial Legionnaires’ disease cases in Allegheny County, Pennsylvania, even as there was an increase in community-acquired cases in the area. The county recommended routine testing of the hospital water distribution systems even in the absence of reported cases — a departure from national guidelines.

    Flint outbreak follows switch to river water source
    In April 2014, the city of Flint, Michigan, switched its primary water source from the Detroit water system to the Flint River. The switch was to last 2 years while construction of a pipeline from Lake Huron was completed. However, amid an outcry over the levels of lead in the water, Flint was reconnected to the Detroit water system on Oct. 15, 2015.

    Two outbreaks of Legionnaires’ disease were detected in Genesee County during the time Flint was getting its water from the river, according to the Michigan Department of Health and Human Services (MDHHS). The first, between June 2014 and March 2015, included 45 confirmed cases, with five associated fatalities. Between May and October 2015, there were 42 confirmed cases and four deaths. The average number of Legionnaires’ disease cases reported in Genesee County over the previous 4 years was between six and 13.

    According to the MDHHS, 36% of the patients in the outbreaks used Flint city water in their homes, and 48% had stayed overnight in an area hospital in the 2 weeks before the onset of their symptoms.

    During the initial increase between June 2014 and March 2015, more than half of cases had contact with McLaren Medical Center within 2 weeks of symptom onset. McLaren, where Stout has been consulting since August 2015 after working with the county health department, gets its water from the City of Flint. She said the lessons learned from the outbreak are clear.

    “Our proactive message,” she said, “is seek Legionella out and you will protect your patients. ... Health care facilities should be testing for Legionella, especially in Genesee County.”