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Legionnaires' disease, a pneumonia caused by the Legionella bacterium, is the leading cause of reported waterborne disease outbreaks in the United States. Legionella occur naturally in water from many different environmental sources, but grow rapidly in the warm, stagnant conditions that can be found in engineered water systems such as cooling towers, building plumbing, and hot tubs. Humans are primarily exposed to Legionella through inhalation of contaminated aerosols into the respiratory system. Legionnaires' disease can be fatal, with between 3 and 33 percent of Legionella infections leading to death, and studies show the incidence of Legionnaires' disease in the United States increased five-fold from 2000 to 2017. Management of Legionella in Water Systems reviews the state of science on Legionella contamination of water systems, specifically the ecology and diagnosis. This report explores the process of transmission via water systems, quantification, prevention and control, and policy and training issues that affect the incidence of Legionnaires' disease. It also analyzes existing knowledge gaps and recommends research priorities moving forward.
Contents
- The National Academies of SCIENCES • ENGINEERING • MEDICINE
- COMMITTEE ON MANAGEMENT OF LEGIONELLA IN WATER SYSTEMS
- WATER SCIENCE AND TECHNOLOGY BOARD
- Preface
- Summary
- 1. Introduction
- 2. Diagnosis, Ecology, and Exposure Pathways
- 3. Quantification of Legionnaires' Disease and Legionella
- 4. Strategies for Legionella Control and Their Application in Building Water Systems
- 5. Regulations and Guidelines on Legionella Control in Water Systems
- Acronyms
- Appendix. Biographical Sketches of Committee Members and Staff
Suggested citation:
National Academies of Sciences, Engineering, and Medicine. 2020. Management of Legionella in Water Systems. Washington, DC: The National Academies Press. http://doi.org/10.17226/25474.
Digital Object Identifier: http://doi.org/10.17226/25474
Library of Congress Control Number: 2019954617
Cover credit: Kyoko Kurosawa
Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu/.
Printed in the United States of America
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- Legionnaires' Disease Outbreaks and Cooling Towers, New York City, New York, USA.[Emerg Infect Dis. 2017]Legionnaires' Disease Outbreaks and Cooling Towers, New York City, New York, USA.Fitzhenry R, Weiss D, Cimini D, Balter S, Boyd C, Alleyne L, Stewart R, McIntosh N, Econome A, Lin Y, et al. Emerg Infect Dis. 2017 Nov; 23(11):1769-76.
- A Supervised Statistical Learning Approach for Accurate Legionella pneumophila Source Attribution during Outbreaks.[Appl Environ Microbiol. 2017]A Supervised Statistical Learning Approach for Accurate Legionella pneumophila Source Attribution during Outbreaks.Buultjens AH, Chua KYL, Baines SL, Kwong J, Gao W, Cutcher Z, Adcock S, Ballard S, Schultz MB, Tomita T, et al. Appl Environ Microbiol. 2017 Nov 1; 83(21). Epub 2017 Oct 17.
- Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires' Disease - North America, 2000-2014.[MMWR Morb Mortal Wkly Rep. 2016]Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires' Disease - North America, 2000-2014.Garrison LE, Kunz JM, Cooley LA, Moore MR, Lucas C, Schrag S, Sarisky J, Whitney CG. MMWR Morb Mortal Wkly Rep. 2016 Jun 10; 65(22):576-84. Epub 2016 Jun 10.
- Review Environmental sources of community-acquired legionnaires' disease: A review.[Int J Hyg Environ Health. 2018]Review Environmental sources of community-acquired legionnaires' disease: A review.Orkis LT, Harrison LH, Mertz KJ, Brooks MM, Bibby KJ, Stout JE. Int J Hyg Environ Health. 2018 Jun; 221(5):764-774. Epub 2018 Apr 30.
- Review Review of Legionnaires' disease.[AIHAJ. 2000]Review Review of Legionnaires' disease.Shelton BG, Kerbel W, Witherell L, Millar JD. AIHAJ. 2000 Sep-Oct; 61(5):738-42.
- Management of Legionella in Water SystemsManagement of Legionella in Water Systems
- Chain A, N-alpha-acetyltransferaseChain A, N-alpha-acetyltransferasegi|1727108743|pdb|6AG4|AProtein
- AGER advanced glycosylation end-product specific receptor [Homo sapiens]AGER advanced glycosylation end-product specific receptor [Homo sapiens]Gene ID:177Gene
- 177[uid] AND (alive[prop]) (1)Gene
- 6030442K20Rik RIKEN cDNA 6030442K20 gene [Mus musculus]6030442K20Rik RIKEN cDNA 6030442K20 gene [Mus musculus]Gene ID:115487119Gene
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