22 July 2014 | Commentary
The agency’s reactive approach to Legionnaires’ disease causes thousands of preventable infections every year.
... Legionella, the cause of Legionnaires’ disease, was originally identified after an outbreak at an American Legion Convention in a Philadelphia hotel in 1976 that killed 34 and sickened 221. The bacterium lurks at low levels in natural fresh water sources (such as rivers, lakes and streams) in virtually every part the world, most often with little impact on humans. It becomes hazardous when it survives municipal water treatments and subsequently contaminates and grows in man-made building water systems such as hot tubs, decorative fountains, shower heads and cooling towers. Left undetected in these locations, it can multiply to high concentrations. People become sickened after inhaling contaminated aerosol droplets generated from these sources.
Unlike most other pneumonias caused by microorganisms, this disease is not transmitted person-to-person; it is purely of environmental origin.
The only way to determine whether a water source is a high-risk Legionella-contaminated system is to take samples of the water to see whether the bacteria grow in a simple and inexpensive culture test in a laboratory.
Although they receive little attention, outbreaks are not uncommon. By far, however, most cases of Legionnaires’ disease are individual sporadic cases that are not known to be associated with larger outbreak clusters, although this may be due to the fact that most sporadic cases are never thoroughly investigated. (Legionnaires’ disease symptoms are similar to other pneumonias and can only be diagnosed by specific laboratory tests.) Estimates of the number of cases annually in the United States range from 8,000 to more than 25,000.
An obvious question is what federal health officials are doing to protect Americans from this disease. The answer is both complicated and puzzling. The approach of the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD), which has the responsibility for Legionnaires’ disease prevention, is flawed. Perhaps that is not surprising, given that prevention appears not to be NDIRD’s strong suit; its officials also recommended eliminating the fourth booster dose for the childhood pneumococcal vaccine although that would reduce the efficacy of vaccination and result in the death of children (the subject of a previous Forbes article).
The CDC’s recommendations for preventing Legionnaires’ disease have been predominantly focused on what might termed a disease surveillance strategy–a reactive process that relies on screening for disease after cases are detected, at which time a response is quickly undertaken to prevent further infections. Although this strategy works well for person-to-person transmissible diseases where the source of the disease is another infected individual, it is not well suited to situations in which the source of disease is in the environment...