Deadly bacteria can make their way to your tap. So let’s fix our water system. | Opinion

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.

Illinois Passes Bill to Better Protect Seniors and At-Risk Residents from Waterborne Health Risks

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.

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Virtual Conference to Address Prevention of Individual Legionnaires’ Disease Cases

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:

  • Hung Cheung, MD, MPH, FACOEM, who will lead a discussion on Sporadic Legionnaires’ Disease: Focusing on the 96%
  • Gwen Hanlon, a working mom of two children and advocate for clean water and the prevention of Legionnaires’ disease. She will discuss Why We Must Turn the Tide on the 96%: The personal impact of Legionnaires’ disease
  • Tim Keane, Legionella Risk Management, Inc. He will lead a discussion on a recent Case Study of Legionnaires’ Disease in Quincy, Illinois
  • Bob Bowcock, Integrated Resource Management, Inc. He will lead a discussion with a panel of experts on Upstream Water Management to Address Sporadic Legionnaires’ Disease Cases

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

Alliance Virtual Conference on Legionnaires’ Disease Focuses on Addressing Individual Cases Which Make Up of 96 Percent of All Legionnaires’ Cases

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.

Alliance to Prevent Legionnaires’ Disease Statement on High Prevalence of Sporadic Cases of Legionnaires’ Disease Across the United States

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’.

National Legionnaires’ Organization: Michigan DOH Applying Lessons from Flint Water Crisis in Analysis of Spike in Legionnaires Cases

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.”

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ABOUT APLD: LEGIONNAIRES’ 101

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/partnersexperts/

APLD Virtual Conference Executive Summary

Final Report on the National Summit on Waterborne Disease

Alliance Virtual Conference on Legionnaires’ Disease Risks During and After COVID-19 Pandemic Aug. 19-20

WASHINGTONAug. 6, 2020 /PRNewswire/ — A nationwide advocacy group is bringing together top public health officials, water management experts and noted advocate Erin Brockovich in August to continue its important work on reopening the country safely during and after the coronavirus shutdowns.

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. Legionella bacteria often develops and spreads in stagnant water, and its risks are heightened as many buildings and homes reopen from COVID-19 shutdowns and water is flowing through pipes again.

APLD is leading a two-day, free virtual conference on Wednesday-Thursday, Aug. 19-20, titled: “Recognizing and Mitigating Legionnaires’ Disease Risks During & After the COVID-19 Pandemic.” Sessions will run from 9 a.m. to 1:30 p.m. EDT each day and will include:

  • An update on COVID-19 and patient susceptibility from Dr. Vickram Tejwani of the Johns Hopkins University School of Medicine
  • How Legionnaires’ disease and COVID-19 compare and affect patients, led by experts in respiratory medicine and infectious disease
  • Why Legionnaires’ disease develops and how it should be managed from water source to tap, with APLD Board Member and nationally recognized water expert Bob Bowcock
  • How public health response and water management can be improved to reduce the spread of waterborne disease and deliver safe water, led by the Allergy & Asthma Network and a national COVID-19 reopening expert
  • The steps building owners should take to protect their tenants and themselves from COVID-19 and Legionnaires’ Disease exposure and liability, with noted risk management and legal experts
  • A call to action from Brockovich, a prominent consumer advocate and environmental activist profiled with a Hollywood movie who has worked closely with APLD in recent years to raise awareness of Legionnaires’ disease

The conference is aimed at public health officials, government policymakers and regulators, water utility managers, building owners and managers, insurance and legal risk officials and anyone interested in learning more about the connections between COVID-19 and Legionnaires’ disease.

Brad Considine, APLD’s Director of Strategic Initiatives, said the conference is an outgrowth of the Alliance’s ongoing work to keep attention on the dangers of Legionnaires’ disease amid the pandemic. The Alliance earlier this spring used a national alert to call for renewed attention to Legionnaires’ spread as people begin using water sources that have been idle during shutdowns to slow COVID-19.

“Legionnaires’ disease is the worst kind of silent killer because of how quietly it can develop in our water pipes and how easily it can spread into our homes and businesses and lead to serious illness and even death,” Considine said. “We know from COVID-19 that when people are aware of the threat and see the deadly consequences, they will take the actions needed to prevent these problems.

Our hope is this conference will continue our work to spur productive conversations around the country on addressing Legionnaires’ disease risk throughout the water system: as water is treated and managed at our community water systems and then travels through the pipes into our homes and businesses. With schools and colleges reopening this month and as we continue to get back to more normal ways of life, it’s critical we take Legionnaires’ prevention seriously and proactively. Lives and our public health depend on it.”

For more information about the conference and to register to attend, visit the Alliance’s website: https://preventlegionnaires.org/event-virtual-conference/. A Legionnaires’ 101 Toolkit of resources is found below with handy information on the issue.

ABOUT APLD: LEGIONNAIRES’ 101
The Alliance to Prevent Legionnaires’ Disease (APLD) is a national nonprofit organization formed to educate 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.

Experts: Community Water Testing Needed to Reduce Legionella Threat

WASHINGTON, D.C. – Community water supplies nationwide must do more to slow the spread of bacteria that cause the deadly waterborne Legionnaires’ disease, engineering and technical experts warn in a new article published in ASHRAE Journal, a prominent national engineering and standards publication.

“The call for stronger federal regulations on community water systems is even more urgent with COVID-19 economic shutdowns,” argues Daryn Cline, Technology and Science Director for the Alliance to Prevent Legionnaires’ Disease (APLD) and co-author of the article. “Bacteria buildup in water utility distribution systems can occur during water stagnation caused by lower water consumption, and then are released during increased water flow demand as economic activity restarts.”

Legionnaires’ disease is a form of pneumonia caused by inhaling or aspirating small water droplets containing Legionella bacteria, which builds in community water systems and spreads to people through fountains, showers, faucets, humidifiers and other water use equipment and appliances.

“We’re also concerned that people contracting Legionnaires’ disease from their water systems may be misdiagnosed as COVID-19 patients, which makes prevention efforts in our community water systems even more critical,” added Cline.

Current U.S. Environmental Protection Agency regulations do not require community water systems to test directly for Legionella in their systems. Because it is not an enforceable requirement, water systems do not have to monitor for or take action to minimize Legionella. Treatments that virtually eliminate many microbes are expected to also remove or neutralize Legionella, but key research indicates that it does not happen.

“Typically, after Legionnaires’ disease outbreaks, water suppliers state that the water ‘meets all EPA regulations.’ This may be true, but that does not mean that the water is Legionella-free,” authors Cline and Sarah Ferrari write.

They point to three key national studies of hundreds of water samples from water storage tanks, tap water, and cooling towers – all along the water pipeline after leaving the community facility to reaching the end user. The studies found collectively that one-third of drinking water samples tested positive for Legionella pneumophila bacteria, including more than one-quarter positive for the most lethal strain of bacteria responsible for 90 percent of Legionnaires’ cases.

The authors recommendation that water systems monitor and test for Legionella bacteria at the water plant and along the distribution system will complement the work of states like Illinois, Louisiana and Pennsylvania that have improved state regulations to require stronger antimicrobial treatment throughout the water system, from source to tap.

“A focus on efforts to better control pathogens in the public water supply upstream by strengthening USEPA requirements is the rational approach to addressing the increased threat of waterborne pathogenic bacteria-related disease cases in the future,” they write.

The authors’ full article, along with many other important resources on Legionnaires’ disease, is available at the APLD website as the first report listed here: https://preventlegionnaires.org/category/pdf-report/. A list of resources in a Legionnaires’ 101 toolkit is below, including recent guidance from APLD urging steps to be taken to reduce Legionnaires’ risk as the country reopens from the coronavirus shutdown.

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ABOUT APLD: LEGIONNAIRES’ 101

The Alliance to Prevent Legionnaires’ Disease (APLD) is a national nonprofit organization formed to educate 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.