The Alliance to Prevent Legionnaires’ Disease (APLD) remains concerned about the continued detection of legionella bacteria in the water system operated by Trenton Water Works. The Alliance calls on New Jersey officials to address the systemic conditions in the public distribution system that contribute to this alarming problem.
According to the New Jersey Department of Health, “legionella bacteria was identified in water samples collected from more than half of 30 homes within several municipalities served by Trenton Water Works.” This includes homes sampled in Trenton, Ewing, and parts of Lawrence and Hopewell Township served by Trenton Water Works. This study follows the release of an investigation of homes in Hamilton Township earlier this summer, which similarly found legionella bacteria in more than 50% of the sampled homes.
Both investigations are consistent with a recent EPA study finding approximately 50% of the household taps tested positive for legionella. The current issues within the Trenton Water Works water supply and the many cases and tragic deaths reported are not unique. Over the last few years, at least three dozen cases and six deaths attributed to separate clusters of Legionnaires’ disease were reported throughout Union County. Multiple cases of the disease and the presence of legionella bacteria in the water supply were also reported in Newark, and West Orange among many others reported throughout the state. New Jersey averages about 350 cases of Legionnaires’ disease per year and sadly about 10% of those cases are fatal.
“We need to focus on legionella reduction plans that will allow us to address the root cause that drives the individual, sporadic cases, which comprise 96% of all Legionnaires’ diagnoses, like we’ve seen in New Jersey in recent years,” said APLD Board Member and Director of Integrated Resource Management, Inc. Bob Bowcock. “We must evolve beyond narrowly focused policies that have done nothing to bring down rates and begin to adopt comprehensive responses, including investigations into all cases of the disease and reporting mechanisms for our public water systems that account for source water changes, water main breaks, service interruptions, construction, heavy rainfall, and disinfectant levels – all of which can lead to an increased presence of this bacteria entering our homes.”
The tragic cases of Legionnaires’ disease and the legionella bacteria found in water supplies throughout New Jersey make it clear that we must undertake a robust review of all sources of legionella and implement a comprehensive approach that includes effective upstream water management to control legionella bacteria before it is delivered to residents. The Alliance is urging lawmakers to swiftly pass pending legislation S1006/A2836 (Sen. Ruiz/Asw. Speight), which would more effectively prevent Legionnaires’ disease cases by, among other important protections, requiring public water systems to minimize the growth and transmission of legionella bacteria within the system, to prevent it from ever entering our homes.
“The American family uses an average of 300 gallons of water a day in their homes, where they shower drink, wash, and play in water,” said APLD Director of Technology and Science Daryn Cline. “In addition, our most vulnerable immune compromised populations tend to be significantly more homebound with daily risk of exposure. And, our most at-risk residents are often located in some of the oldest neighborhoods with the most dilapidated and least reliable water infrastructure more prone to bacterial development.”
The failures in water distribution system management have become more apparent as our infrastructure grows older, as evidenced by the significant uptick in cases over the last 15 years. The Alliance calls for a swift improvement of New Jersey’s water management and investigation in order to improve public health, and ultimately reduce the human and financial costs associated with legionella bacteria in our water supply.
Washington, D.C. – The Alliance to Prevent Legionnaires’ Disease issued the following statement on Governor Gavin Newsom’s veto of SB 1144:
“We applaud Governor Newsom’s decision to veto SB 1144. Legionnaires’ disease is caused by the waterborne bacteria, legionella, and as such, must be addressed systemically as a water quality issue, beginning at the root cause- our water source and public water distribution system. Senate Bill 1144 fails to do so. Instead, it takes a very limited and narrow approach focused only on certain buildings and water-using equipment. This completely ignores the individual, sporadic cases, which comprise 96 percent of all Legionnaires’ disease cases, according to the CDC.”
“In his veto message, Governor Newsom stated, ‘Improving the quality of drinking water in our state’s buildings and schools is a priority we share. California’s Safe Drinking Water Act tasks the State Water Board with ensuring that public water systems provide uncontaminated, quality, potable water to consumers.’’
“Accordingly, we urge California officials to go back to the drawing board and pass a policy to address
Legionnaires’ disease as a water source and quality issue first and foremost. This means ensuring that our drinking/potable water is properly treated, disinfected, monitored, and managed against legionella bacteria before it enters our homes and facilities for daily uses that create human exposure. Only then can we be confident that Californians are protected against Legionnaires’ disease- which those who are immunocompromised, have respiratory illness, and the elderly are at greatest risk.”
“The approach taken in SB 1144 is the equivalent of trying to use a bucket to solve the problem of a leaky roof. A bucket can stop water from getting on the floor, but it does nothing to solve the problem of why the water is getting into one’s home in the first place.”
“The truth is SB 1144 would have done little to prevent the spread of Legionnaires disease, but if enacted would add great cost to taxpayers as Governor Newsom has rightfully recognized. SB1144 was estimated to cost California taxpayers more than $300 million per year with little evidence of a meaningful reduction of Legionnaires’ disease in the state. As an ongoing cost, the bill would have cost billions of dollars over the next decade and beyond.
“Such resources should go toward prioritizing prevention and a comprehensive, holistic approach, to protect the most vulnerable and susceptible members of our population from Legionnaires’ disease. Californians deserve this.”
The Alliance to Prevent Legionnaires’ Disease is a non-profit organization dedicated to reducing the occurrence of Legionnaires’ disease by promoting public research and education on the disease, and best practices and policy for its prevention.
By: Dr. Hung Cheung
It seems the only time that the deadly bacterial pneumonia known as Legionnaires’ Disease makes the news is when there is an apparent outbreak.
But the sobering reality of Legionnaires’ Disease is that outbreaks represent only 4% of total cases. The other 96% are individual and sporadic cases. In New Jersey, there have been 1,416 confirmed Legionnaires’ Disease cases in the last five years, according to the Centers for Disease Control.
Unfortunately, due to the media scrutiny of outbreaks, most of our public policy related to Legionnaire’s Disease is aimed at reacting to outbreaks rather than preventing the growing number of individual cases.
We must take the necessary steps to address the 96% of cases because the people most at risk of are the most vulnerable members of our society. Legionnaires’ Disease preys on senior citizens, individuals with compromised immunities and those who live in low-income, older neighborhoods with the least reliable water infrastructure, which is more prone to bacterial development risks.
Here in New Jersey, there are legislative efforts to take on the 96% of cases.
Senate Bill 1006, authored by Senator Teresa Ruiz, and Assembly Bill 2836, authored by Assemblywoman Shanique Speight, create a framework to minimize Legionella bacteria (the bacteria that causes Legionnaires’ Disease), and to prevent and control cases of Legionnaires’ disease. It does this by putting in safeguards at the various points that water travels from the source to the tap.
The primary way people contract Legionnaires is from aspiration or inhalation of water containing the microorganism. Such exposures are most common in our homes where we are in contact with water daily. Legionella can live and build up in the biofilm and can then travel throughout an entire water system when there is a disruption in the biofilm.
Disruptions to the water distribution system such as water main breaks, flooding, maintenance, construction, and treatment changes can disrupt those biofilms, and release free-floating bacteria downstream to points of human exposure in our homes, facilities, and workplaces.
Importantly, S-1006 and A-2846 provide for public notification of these water system conditions and an accessible reporting database, which will allow residents, especially those most susceptible to Legionella, to know when extra diligence is needed to protect against exposure. This legislation essentially requires everyone involved in water systems to do their part to ensure proactive measures are being taken to prevent the buildup of legionella bacteria and other contaminants.
Equally important, a comprehensive approach to prevention is critical.
Specifically, we need to improve water management to eliminate Legionella bacteria from our water. According to an article in the March 2022 edition of the International Journal of Hygiene and Environmental Health co-authored by a current and retired New Jersey Department of Health officials a minimum disinfectant level is needed throughout the entire water system, so the water delivered to the last home in the system would be just as disinfected at the appropriate levels as the first home, which is what this legislation seeks to do.
While other states such as Illinois, Pennsylvania and Louisiana have adopted some of the provisions in the New Jersey legislation, the reality is that the proposal lawmakers are considering in Trenton is the first of its kind to address both the individual and sporadic cases of Legionnaires’ disease.
Lawmakers have an opportunity to be proactive when it comes to Legionnaires’ disease. It is an opportunity to make real progress in reducing this disease.
Dr. Hung Cheung is a board member of the Alliance to Prevent Legionnaires’ Disease. He is also founder and president of Cogency.
SPRINGFIELD, IL / April 20, 2022 – The Illinois General Assembly recently enacted new legislation requiring water utilities to notify healthcare and senior living facilities of water supply disruptions that could lead to water quality and microbial risks, such as legionella and other pathogens.
“With the passage of this legislation, Illinois is building on its leadership efforts to proactively manage water supply quality by ensuring closer coordination between water utilities and facilities with the most vulnerable residents and visitors,” said Brad Considine, the Alliance to Prevent Legionnaires’ Disease Director of Strategic Initiatives.
While water systems are generally well-managed, disruptions caused by water main breaks, flooding, construction, changes in water treatment, pressure and flow changes can dislodge biofilm in the distribution systems and release bacteria and contaminants downstream to high-risk populations.
Notifications from water utilities of disruptions as required under HB 4988 helps healthcare facilities to manage the water they receive and protect their occupants from waterborne bacteria such as legionella and other contaminants.
“House Bill 4988 is designed to help proactively mitigate risks associated with water disruptions,” State Representative Natalie Manley (D-Romeoville) said. “The bill does not require specific testing but simply requires water utilities to warn senior care facilities when disruptions occur so the caretakers can take appropriate steps to protect their residents and patients.”
State Representative Manley and State Senator Meg Loughran Cappel (D-Plainfield) sponsored House Bill 4988 to better protect seniors, the immunocompromised and people suffering comorbidities who are susceptible to waterborne pathogens. Working in collaboration with the Alliance to Prevent Legionnaires’ Disease, water utilities and healthcare facility operators, the sponsors were able to develop the legislation, with all parties recognizing the benefits of enhanced communications to protect the most vulnerable populations.
“It’s the kind of targeted, common-sense legislation that I believe Illinoisans expect from their elected representatives,” Cappel said. “It recognizes that our water supply, healthcare facilities, and residences are all part of one water system that must be managed as a system.”
In 2018, Illinois implemented sweeping new water management guidelines for water utilities to ensure high water quality and better prevent waterborne illness issues. In addition, most healthcare facilities are required by the Joint Commission that approves accreditation and the federal government to have water management plans in place to control legionella risks.
“Illinois has made great strides in proactive water management in recent years,” Considine said. “The upgraded water management guidelines implemented a few years ago along with these notification requirements are a model for states across the nation. Most importantly, the cooperative spirit between Illinois water utilities and healthcare facilities promises ongoing improvements in our collective efforts to protect our most vulnerable populations. We strongly urge Governor JB Pritzker to sign this important water quality measure into law.”
House Bill 4988 has passed both the House and the Senate and awaits the Governor’s signature.
###
WASHINGTON, D.C. – The Alliance to Prevent Legionnaires’ Disease is hosting a national virtual conference to focus on the need to “Tackle the 96 Percent.” 96 percent of all Legionnaires’ disease cases are single and sporadic – not associated with an outbreak.
“It is absolutely critical that we focus time, energy and resources in addressing the root cause of the vast majority of Legionnaires’ disease cases, which are the individual cases that unfortunately are largely ignored,” said environmental activist Erin Brockovich. “We need to listen to the people whose lives have been upended by this disease and that is exactly what the Alliance’s upcoming conference will allow people to do.”
While outbreaks tend to make national headlines, the truth is about 96% of Legionnaires’ cases are individual and not associated with an outbreak of two or more cases from a common location and timeframe. Unfortunately, individual cases do not receive the investigations, media coverage, or policy response that outbreaks do, despite accounting for virtually all cases each year. The only meaningful way to reduce cases of Legionnaires’ disease is to better understand what drives sporadic Legionnaires’ disease and address by prioritizing root cause water management awareness, practices, and policies.
The free, virtual conference is scheduled for October 19, 2021, from 1:00 p.m.-4:30 p.m. EDT. Participants can expect to gain a greater appreciation and understanding of sporadic Legionnaires’ disease, the current gaps in research and response to sporadic Legionnaires’ disease, and root-cause prevention approaches that seek to address these individual cases as well as outbreaks. The speaker lineup includes:
The Alliance to Prevent Legionnaires’ Disease is a national nonprofit organization that advocates for better public understanding about and comprehensive handling of risk factors around the waterborne Legionnaires’ disease. For more information about the conference and to register to attend, visit the Alliance’s website: https://register.gotowebinar.com/register/4636336387223000588
WASHINGTON, D.C. – The Alliance to Prevent Legionnaires’ Diseases is hosting a national virtual conference to challenge legislators, legislative staff members, health advocacy officials, water management experts and health reporters to “Tackle the 96 Percent.”
“Too often the focus is on outbreaks rather than on the vast majority of Legionnaires’ cases which are sporadic individual cases,” said Marcy Savage, APLD’s Director of Policy and Government Relations. “This conference is an opportunity to have a frank discussion with national experts about factors and root causes that likely impact the 96 percent of Legionnaires’ cases that are not a direct result of outbreaks.”
While outbreaks tend to make national headlines, the truth is about 96% of Legionnaires’ cases are individual and not associated with an outbreak of two or more cases from a common location and timeframe. Unfortunately, individual cases do not receive the investigations, media coverage, or policy response that outbreaks do, despite accounting for virtually all cases each year. The only meaningful way to reduce cases of Legionnaires’ disease is to better understand what drives sporadic Legionnaires’ disease and address by prioritizing root cause water management awareness, practices, and policies.
The free, virtual conference is scheduled for October 19, 2021, from 1:00 p.m.-4:30 p.m. EDT. Participants can expect to gain a greater appreciation and understanding of sporadic Legionnaires’ disease, the current gaps in research and response to sporadic Legionnaires’ disease, and root-cause prevention approaches that seek to address these individual cases as well as outbreaks.
The virtual conference is aimed at health advocacy organizations, government policymakers and regulators, water utility managers, building owners and managers, insurance and risk managers, legislators, health reporters, and anyone interested in learning more about the challenges in stopping the spread of Legionnaires’ disease.
“We are encouraging not only traditional stakeholders such as water utility managers and health advocacy officials to participate in this conference but legislators, their staff and the people who report on health-related issues in the media,” Savage said. “We need an all-hands-on deck approach to tackling the 96 percent.”
The Alliance to Prevent Legionnaires’ Disease is a national nonprofit organization that advocates for better public understanding about and comprehensive handling of risk factors around the waterborne Legionnaires’ disease. For more information about the conference and to register to attend, visit the Alliance’s website: https://register.gotowebinar.com/register/4636336387223000588.
The Alliance to Prevent Legionnaires’ Disease is deeply concerned about the sporadic Legionnaires’ cases announced recently by health departments across the country. This summer alone, there were 107 cases across Michigan, 49 cases in Chicago, Illinois, and 8 cases in Essex County, New Jersey. Rhode Island also announced 30 cases since the beginning of June, a significant increase over recent years.
Sporadic Legionnaires’ disease cases, those not associated with an outbreak – defined as two or more cases from a common source or location– comprise 96% of all LD cases. Typically, sporadic cases do not receive full investigations, missing critical opportunities to properly identify the root cause of an individual’s illness. This also prevents a better understanding of the bacteria’s presence in our homes, workplaces and public water distribution systems, which means we are always chasing the next case, rather than preventing it.
The Alliance to Prevent Legionnaires’ Disease is urging public health officials responding to Legionnaires’ diseases cases to thoroughly investigate every case, as we recently called for in Michigan. Investigations should look comprehensively at recent conditions that could upset local water systems and water source changes that could affect the water’s chemistry and system dynamics so the water that millions use and consume every day is safe and free from legionella, the bacteria that causes Legionnaires’ disease.
While the risk of contracting Legionnaires’ disease is generally low, individuals who are over 50, smoke or have a weakened immune system are more susceptible to contracting the illness and we urge anyone experiencing flu-like symptoms to seek immediate medical attention and ask about Legionnaires’.
MICHIGAN – The Alliance to Prevent Legionnaires’ Disease, a national organization dedicated to reducing the occurrence of Legionnaires’ disease, today issued the following statement in response to the recent announcement by the Michigan Department of Health of 107 sporadic cases of Legionnaires’ disease across 25 counties in Michigan occurring between July 1 and July 14, 2021:
“Michigan has faced far too much tragedy with unsafe drinking water and Legionnaires’ disease, with the Flint Water Crisis that has drawn national attention. The Alliance is glad to see and recognize the Michigan Department of Health (MDOH) for proactively alerting the public to the rise in cases and citing possible disruptions in the public water distribution system as key potential factors.
The Flint water crisis occurred in 2014 when the city switched its drinking water supply from Detroit’s system to the Flint River. The change resulted in a variety of water supply system disruptions, changes in water flows, inadequate treatment, and increased organic and corrosion content that feeds bacteria such as legionella that causes the bacterial pneumonia known as Legionnaires’ disease.
The MDOH providing early notice of the recent increase in cases across a broad area in the state is a critical step to help the individuals most susceptible to respiratory illness take steps needed to reduce their risk and to seek immediate medical attention at the first sign of symptoms.
MDOH stated that with the current spike in cases ‘recent weather trends including rain, flooding and warmer weather may be playing a role.’ The Alliance shares those concerns based on cases across the country where similar conditions upset the public water distribution system, releasing legionella from biofilm that coats water distribution pipes and sending it downstream into homes and facilities where humans are exposed and can become ill. The health consequences can be serious, with one in 10 individuals contracting Legionnaires’ disease ultimately dying from it.
The Alliance to Prevent Legionnaires’ Disease urges Michiganders to be acutely aware of possible home-based exposure, through water during showering, bathing, faucet and other use. Legionnaires’ outbreaks draw news headlines, but 96 percent of all cases are individual and sporadic not tied to outbreaks – defined as two more cases from a common source or location over a short period of time.
The wide geographic spread of these sporadic cases indicate drinking water system factors are involved, and the Alliance calls on public health officials to quickly and fully investigate the water that serves millions of people. The investigation should look comprehensively at recent conditions that could upset local water systems and water source changes that could affect the water’s chemistry and system dynamics. The Alliance encourages environmental testing of the public water distribution system as well as the homes of all individuals diagnosed with Legionnaires’ disease. Too often, sporadic cases are not fully investigated, and we miss critical opportunities to understand and properly identify the root causes behind how the disease developed to truly end the spike in cases and prevent others from getting sick.
The Michigan Department of Health did the right thing by quickly alerting the public to this concerning increase in cases. The Alliance welcomes the opportunity to support public awareness and education about the disease and its development, including offering our expertise in any investigation to prevent additional cases from development.
We must learn from the tragic lessons of Flint and act now to prioritize Michigan’s water quality and safety.”
#####
The Alliance to Prevent Legionnaires’ Disease (APLD) is a national nonprofit organization formed to reduce cases of Legionnaires’ disease through education, holistic and systemic root cause solutions, and improving public policy by informing public officials about the science and investments needed to promote a more comprehensive, proactive approach to fighting waterborne disease.
Legionnaires’ disease draws national headlines with each outbreak, causing concern in communities with each case that results in death or serious illness. The Alliance to Prevent Legionnaires’ Disease created this brief toolkit of our best research and arguments to help you understand the basics of this waterborne disease and how to prevent it from developing and spreading.
Our partners: https://preventlegionnaires.org/partners–experts/
Legionnaires’ disease is a severe form of pneumonia caused by aspirating or inhaling small droplets of water contaminated with Legionella bacteria. Symptoms include fever, headache, aching joints and muscles, diarrhea, fatigue, loss of appetite, cough, difficulty breathing, shortness of breath, chills and chest pain. Consult your doctor with questions and at the first sign of symptoms.
