Legionnaires’ Disease

Water management problems can lead to Legionnaires’ disease outbreaks.

What causes Legionnaires’ disease outbreaks that CDC investigates?⁴

• About 1 in 2 (48%) are due to more than one of these problems.
• About 2 in 3 (65%) are due to process failures, like not having a Legionella water management program.
• About 1 in 2 (52%) are due to human error, such as a hot tub filter not being cleaned or replaced as recommended by the manufacturer.
• About 1 in 3 (35%) are due to equipment, such as a disinfection system, not working.
• About 1 in 3 (35%) are due to changes in water quality from reasons external to the building itself, like nearby construction.

Where do people get Legionnaires’ disease?

• CDC investigations of building-associated outbreaks show the most common places for getting the disease are hotels, long-term care facilities, and hospitals.⁴ Cruise ships are another place where Legionnaires’ disease outbreaks can happen.
• In these types of buildings, the most likely sources for spreading water droplets contaminated with Legionella include:^4,6
• Showers and faucets.
• Cooling towers, which are parts of large centralized air conditioning systems.
• Hot tubs.
• Decorative fountains and water features.

Who’s most at risk for getting Legionnaires’ disease?⁷

• Adults 50 years or older.
• Current or former smokers and people with a chronic lung disease, such as emphysema.
• People with a weakened immune system caused by diseases or medicines.

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The Federal government is:

• Providing tools for building owners and managers to understand how to develop water management programs to reduce the risk of Legionnaires’ disease.
• Working with health, academic, and industry partners to develop and evaluate guidelines and standards to prevent Legionnaires’ disease.
• Working towards including Legionnaires’ disease prevention practices in national building and public health codes.
• Improving health care for veterans by requiring plans for prevention of Legionnaires’ disease at Veterans Health Administration hospitals and long-term care facilities.
• Tracking Legionnaires’ disease and responding to outbreaks to find the source and help prevent future infections.

Building owners and managers can:

• Learn about and follow newly published standards for Legionella water management programs. http://bit.ly/1Ph3wQP
• Determine if the water systems in their buildings are at increased risk of growing and spreading
• Develop and use a Legionella water management program as needed. cdc.gov/legionella/WMPtoolkit
• Monitor and respond to changes in water quality.

State and local officials can:

• Incorporate Legionella water management programs into licensing and accreditation requirements for healthcare facilities.
• Consider changing building and public health codes to include Legionella water management programs.
• Provide tools and information to help local building owners and managers carry out Legionella water management programs.
• Investigate reports of Legionnaires’ disease promptly to prevent more people from getting sick.

Healthcare providers can:

• Tell patients if they are at increased risk for pneumonia, including Legionnaires’ disease and to seek care quickly if they develop symptoms of pneumonia.
• Test for Legionnaires’ disease in people with serious pneumonia, especially those requiring intensive care or who recently stayed in a healthcare facility or hotel or on a cruise ship. Use a urinary antigen test and a culture from a lower respiratory specimen (e.g., sputum).
• Report positive Legionnaires’ disease lab tests to local public health authorities quickly.