Legionella Resources
terns, United States, 1992–2018. Emerging Infectious Diseases , 28 (3), 527–538. https:// doi.org/10.3201/eid2803.211435 Clopper, B.R., Kunz, J.M., Salandy, S.W., Smith, J.C., Hubbard, B.C., & Sarisky, J.P. (2021). A methodology for classifying root causes of outbreaks of Legionnaires’ dis- ease: Deficiencies in environmental control and water management. Microorganisms , 9 (1), Article 89. https://doi.org/10.3390/ microorganisms9010089 Dooling, K.L., Toews, K.-A., Hicks, L.A., Gar- rison, L.E., Bachaus, B., Zansky, S., Car- penter, L.R., Scha¤ner, B., Parker, E., Petit, S., Thomas, A., Thomas, S., Mansmann, R., Morin, C., White, B., & Langley, G.E. (2015). Active bacterial core surveillance for legionellosis—United States, 2011– 2013. Morbidity and Mortality Weekly Report , 64 (42), 1190–1193. https://doi. org/10.15585/mmwr.mm6442a2 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. Mor- bidity and Mortality Weekly Report , 65 (22), 576–584. https://doi.org/10.15585/mmwr. mm6522e1 =6lore 9/e8e l0418 9o le(r4 more (bou9 9/e Legionella 4;0ro4me49(l 88e88 me49 orm (4+ o9/er Legionella rel(9e+ re8our*e8 • <<<*+*.o;le.0o4ell( +o<4lo(+8le.0o4ell(e4;0ro4me49(l (88e88me4966+- • (r104. u0+e <<<*+*.o; le.0o4ell(+o<4lo(+8le.0o4ell( e4;0ro4me49(l(88e88me49m(r104. .u0+e 86+- • re;e4904. e.0o44(0re8 08e(8e #r(0404. <<<*+*.o;4*e/e/8 ele(r46re;e49 9r(0404./9ml • "(m6l04. (4+ 4;0ro4me49(l 8 8e88me49 V0+eo8 <<<*+*.o; le.0o4ell(;0+eo8/9ml • ++090o4(l Legionella (4+ e.0o4 4(0re8 08e(8e !e8our*e8 <<< *+*.o;4*e/e/8<(9erle.0o4ell( 04+e=/9ml
edge to perform an assessment and complete the assessment form. Information from LEAF should be paired with relevant epidemiological information such as who was exposed or infected and where and when the exposure possibly hap- pened. This information can guide the user to determine which environmental deficiency might have occurred and help them decide if environmental sampling is necessary and where sampling should occur. In addition, findings from LEAF can also be used to implement preventive measures in areas at high risk for Legionella growth or spread, and they might be used to develop or improve a water management program. To learn more, visit our website for addi- tional information and resources at www.cdc. gov/nceh/ehs/water/legionella/index.html. Corresponding Author: LCDR Nakia S. Clem- mons, National Center for Environmental Health, Centers for Disease Control and Pre- vention, 4770 Buford Highway NE, Atlanta, GA 30341. Email. xbj4@cdc.gov. References Barskey, A.E., Derado, G., & Edens, C. (2022). Rising incidence of Legionnaires’ disease and associated epidemiologic pat- Photo 2. Sta from the Centers for Disease Control and Prevention (CDC) inspect a poorly maintained cooling tower during a Legionella outbreak investigation. Inadequately maintained cooling towers can aerosolize water containing Legionella bacteria. Photo courtesy of Nakia Clemmons, CDC.
In addition, CDC created the LEAF Mark- ing Guide to provide users with instructions and additional considerations for each LEAF question. These considerations provide more context and background on relevant risk fac- tors for Legionella growth and spread, and they educate users conducting the assess- ment. The marking guide includes key defi- nitions, in-depth details about each question, and information that can help the user col- lect appropriate data. LEAF data can help improve water management programs, iden- tify the need for environmental sampling, and develop life-saving interventions. Using Legionella Assessment Tools Improve Environmental Health Decision Making A Legionella environmental assessment should be performed by an environmental health spe- cialist or epidemiologist who is knowledgeable of Legionella ecology, building water systems, and water treatment. The assessment should also involve a person, such as a facility man- ager, who is familiar with the building’s sys- tems and maintenance. Environmental health specialists or epidemiologists who have taken CDC’s PreventLD training, watched our sam- pling videos, and studied the Legionella Con- trol Toolkit will have the appropriate knowl- Photo 1. Sta from the Centers for Disease Control and Prevention (CDC) visually inspect a hot tub during a Legionella outbreak investigation. Legionella can grow and multiply in hot tubs that are not disinfected, cleaned, and properly maintained. Photo courtesy of Nakia Clemmons, CDC.
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