Albany, NY (October 4, 2018)—New Yorkers continue to contract Legionnaires’ disease at a record-setting pace. Data recently released by the Center for Disease Control and Prevention (CDC) shows that more than 128 cases of Legionnaires’ disease were reported across New York State within the past three weeks. In fact, during the same period of time, 348 cases were reported throughout the entire country. New York accounted for 37 percent of the nationwide cases.
“The citizens of New York should demand that each case be thoroughly investigated to help identify the root source and for comprehensive ‘source to tap’ solutions to be implemented,” said Brad Considine, Director of Strategic Initiatives for the Alliance to Prevent Legionnaires’ Disease.
New York water systems are not specifically tested for Legionella bacteria and cases of Legionnaires’ disease that are not part of a building (two or more cases) or neighborhood outbreak are not investigated. In addition, New York City is one of only a handful of water systems in the nation that receives a waiver from the Environmental Protection Agency allowing the City to avoid filtering most of its drinking water.
2018 year-to–date totals of Legionnaires’ disease cases across New York State continue to climb; outpacing the record-high totals experienced in 2017, and other recent years per CDC data presented in the graph at left.
“The explosive increase in Legionnaires’ cases demonstrates that there is a greater need to monitor and treat the public water system to keep Legionella bacteria out of the homes and workplaces of New Yorkers,” said Tonya Winders, President and CEO of Allergy & Asthma Network.
“New York regulations focused solely on building equipment have had no impact on reducing the rate of Legionnaires,” added Considine. “Solving this perennial problem is going to take a proactive and system-wide approach. We stand ready to help develop solutions that prevent future infections.”
It’s unfortunate, but this outbreak was inevitable. And while the outbreak in Washington Heights is the latest episode in a sad saga, the real story is that New York repeatedly leads the nation in Legionnaires’ disease cases with the vast majority of individual cases being substantially ignored.
The City will continue to have an ongoing problem with Legionella bacteria unless they take their heads out of the sand and realize prevention requires a source to point-of-use solution.
The failure of our public officials to test the public water system for Legionella bacteria is a problem as our own sampling has shown Legionella bacteria can be readily found in areas like public fountains. The narrow scope of the City’s investigations to find the source of outbreaks and sporadic cases is also an issue.
New Yorkers should not accept that hundreds of Legionnaires’ disease infections every year is considered normal. It’s time to implement a real solution to this perennial problem.
Washington D.C. (January 22, 2018)—In August 2015, New York recorded the worst outbreak of Legionnaires’ disease in the state’s history when 133 Bronx residents contracted the disease resulting in 16 deaths. Emergency state and city regulations were enacted and celebrated as decisive steps to address the threat. More than two years later, New York has posted a record number of cases and a significantly higher rate of Legionnaires’ disease than any other state in the country per capita.
“Unfortunately we continue to see cases of Legionnaires’ disease climb in New York,” said APLD Spokesperson Daryn Cline. “This is especially troubling since New York is holding itself out as the leader in Legionnaires’ disease prevention. The truth of the matter is their emphasis on water management inside the building has not had an impact on decreasing the rate of disease.”
“We are convinced that any meaningful reduction in Legionnaires’ disease in New York requires a focus on the complete water distribution system that supplies our homes and workplaces—from source to consumption,” added Cline.
New York led the nation again with 1,009 cases reported to the CDC—a 38 percent increase in cases compared to 2016. Of the state total, New York City recorded 441 cases—a 65 percent increase over 2016. In fact, New York City’s 2017 case total outpaced 2015—the year of the worst outbreak in New York City’s history.
“These continuous increases are exactly why more resources must be dedicated to better understand the relationship between waterborne pathogens such as Legionella and our public water supply and distribution system,” said Tonya Winders, President and CEO of Allergy & Asthma Network, and APLD member. “The fact remains that water containing Legionella bacteria from the public water supply is entering homes and buildings, and—as a result—people are getting sick. Some are dying.”
The Alliance has been critical of the New York City and State’s response to preventing cases of Legionnaires’ disease since regulations were put in place after the Bronx outbreak in 2015. The group’s main contention is that the regulations are too narrowly focused on building equipment and do not address the source problem—Legionella entering buildings from the public water supply and distribution system.
“Building equipment uses the same water source that supplies our showerheads and faucets. Without addressing the bacteria entering our buildings from the public distribution system, the issues we face with Legionella are not going to end,” said John Letson, Vice President of Plant Operations at Memorial Sloan Kettering Cancer Center. “According to the CDC, 35 percent of Legionnaires’ disease outbreaks can be attributed to conditions and disruptions to water service outside of the building. In order to keep people safe, especially those with compromised immune systems and patients receiving out-patient care, more must be done to remove the threat of Legionella in our public water.”
Another key criticism of New York’s current approach is the failure to properly address individual, sporadic cases of Legionnaires’ disease which—according to the CDC—make up approximately 96 percent of the total recorded cases nationally. By focusing only on building equipment, New York’s regulations only address a portion of the four percent of cases attributed to outbreaks—leaving hundreds of New Yorkers at continued risk of infection.
“Our public policies are being driven by outbreaks which generate news and political pressure,” added Cline. “There were only two known events in New York City that were classified as outbreaks in 2017— with the highest infecting 13 people. Yet, in 2017 an average of 19 people contracted Legionnaires’ disease each week across the New York state. During one week alone, there were 27 new cases in New York City, which went largely unnoticed. Worse yet, they were not fully investigated to understand the sudden spike or how to prevent similar spikes in the future.”
Among other things, the APLD is a staunch advocate of mandating that every case of Legionnaires’ disease undergoes a comprehensive investigation in an effort to better understand how to prevent the disease. The group also urges for more resources to be allocated to gain a better understanding of how aging infrastructure, heavy rain and flooding events, and the wider implementation of low-flow appliances are impacting the increase.
“The most important thing to remember is that Legionnaires’ disease is a waterborne illness so water must be the focus of any preventive measure,” added Winders. “Any solution that doesn’t address the bacteria entering our homes and buildings from the public water supply and distribution system is not a solution at all.”
The Alliance to Prevent Legionnaires’ Disease is a non-profit organization comprising public health/medical professionals, building engineers, water treatment professionals and manufacturers of cooling technologies to advocate for comprehensive approaches to limit the growth and spread of Legionella bacteria and other waterborne pathogens. For more information about the Alliance, please visit www.preventlegionnaires.org.
The Alliance to Prevent Legionnaires’ Disease, a non-profit public health organization advocating a comprehensive approach to disease prevention, welcomes the recent decision by the Pennsylvania Department of Environmental Protection and the state’s water utilities to take steps to advance the safety of the water supply and distribution system. Requiring water systems to maintain a 0.2 mg/L chlorine residual throughout the distribution system should reduce the risk of human infection, including from legionella bacteria, caused by ingestion or other means such as inhalation and blood contact. In general the Alliance believes water distribution endpoints (prior to water entering our homes and building) are a critical area in waterborne disease prevention.
The Alliance concurs with the rationale provided by the state in the Pennsylvania Bulletin Proposed Rule from February 20, 2016 which states, “The distribution system is the remaining component of the public water supplies yet to be adequately addressed in National efforts to eradicate waterborne disease.” We encourage other states who do not have similar minimal chlorine residual requirement throughout the system to consider the steps taken in Pennsylvania. Adopting similar rules and guidelines will better protect their residents, particularly those with compromised immune systems, from the risks associated with a wide variety of waterborne pathogens in water distribution systems.
The Alliance to Prevent Legionnaires’ Disease expresses its concern over the recent Legionnaires’ disease outbreak in Orange County, including unfortunately a death associated with the disease. The presence of Legionella bacteria in two cooling towers suggests that the bacteria was present in the supply water feeding the cooling towers and other water fixtures in the park, which could also serve as transmission modes.
We strongly urge the Orange County Health Department to continue the investigation of this case to determine what steps can be taken to monitor and reduce Legionella bacteria entering plumbing devices and equipment from the water distribution system. A thorough investigation requires testing of all potable and non-potable water sources for the bacteria to identify the bacteria’s source so it can be treated to minimize its growth. The Alliance encourages maintenance of water devices consistent with industry-best practices in ASHRAE Standard 188 and the “Developing a Water Management Program to Reduce Legionella Growth and Spread in Buildings” guidelines provided by the CDC.
The Alliance to Prevent Legionnaires’ Disease expresses its concern over the recent Legionnaires’ disease outbreak in Orange County, including unfortunately a death associated with the disease. The presence of Legionella bacteria in two cooling towers suggests that the bacteria was present in the supply water feeding the cooling towers and other water fixtures in the park, which could also serve as transmission modes.
We strongly urge the Orange County Health Department to continue the investigation of this case to determine what steps can be taken to monitor and reduce Legionella bacteria entering plumbing devices and equipment from the water distribution system. A thorough investigation requires testing of all potable or non-potable water sources for the bacteria to identify the bacteria’s source so it can be treated to minimize its growth. The Alliance encourages maintenance of water devices consistent with industry-best practices in ASHRAE Standard 188 and the “Developing a Water Management Program to Reduce Legionella Growth and Spread in Buildings” guidelines provided by the CDC.
First and foremost, Legionnaires’ disease is fundamentally a water issue. The New York City Department of Health and Mental Hygiene—if truly committed to finding disease source—must expand its investigation to consider all possible transmission points potentially infected with the Legionella bacteria coming from the water distribution system and not singularly focus on one piece of equipment. The Department should follow a thorough investigation protocol for Legionnaires’ disease outbreaks that calls for a comprehensive epidemiological approach, and not short circuit the investigation by solely testing cooling towers.
New York’s current policy and actions to address a growing Legionnaires’ disease problem in the City is unfortunately not working. Since the summer of 2015 when Local Law 77 went into effect, disease rates are actually on the rise. How many more outbreaks must occur and how many people must contract the disease before the City will acknowledge that it is time to take a broader approach? Only when working together with experts, communities and stakeholders will we make progress on preventing this disease.
This latest investigation into the water system at the Parker Towers apartment complex in Forest Hills, Queens is yet another example that the City’s narrowly focused and misguided regulations are failing to prevent New Yorkers from contracting Legionnaires’ disease (LD). This is the fourth instance since August 1, 2017, where residents in apartment buildings in Flushing, Rego Park, Lindenwood and now Forest Hills have been advised by the City’s Health Department to take precautions when using water in their homes. The rate of new LD cases is unacceptable and additional lines of prevention must be considered.
There have been 302 cases of Legionnaires’ already this year, a 100% percent increase in the amount of cases when compared to the same time period in 2016. In fact, by this same time in 2015–a year that prompted our elected officials to take immediate action–300 New Yorkers had been infected with LD, including the South Bronx outbreak which infected more than 130 and the Morris Park outbreak that infected another 13. The eight cases in Lenox Hill earlier this summer remains the only major outbreak (a cluster of two or more individuals) in 2017; but yet, we have already surpassed the number of cases at this point in 2015—a year that has been regarded as one of the worst years for LD cases in recent New York City history.
The facts remain that LD is a waterborne illness, 96 percent of cases are single and sporadic in nature and New York City’s regulations are doing nothing to address this reality. People in New York City are just as at-risk today as they were more than two years ago before ineffective regulations were put in place.
There is no more important issue than ensuring the safety of our water supply. It is time to stop kicking the can down the road and pursue real solutions so people, particularly those with compromised immune systems, can stop needlessly worrying if the water coming out of their showers and faucets contains a potentially deadly bacteria. Let’s start working together to develop policies, including consideration of a minimum chlorine residual level throughout the water distribution system, and encourage investments that will provide clean, safe water to our buildings and homes.
The ongoing investigation into two recent Legionnaires’ disease cases at a Rego Park apartment building is sadly another example proving the Health Department’s current narrow policy to prevent this disease is ineffective and that a more comprehensive and proactive approach is necessary. It’s unfortunate that a second victim had to be hospitalized before the City was willing to test the building’s water system–especially considering this additional case might have been prevented if the water system was tested when the first case was originally reported.
Not including this most recent diagnosis, 212 people in New York City have reported cases of Legionnaires’ disease to the CDC so far in 2017. That’s an 81 percent increase in cases over the same amount of time in 2016. It is unacceptable that hundreds of New Yorkers continue to be infected with this potentially deadly, but preventable disease every year. New York City can and should do better.
It is time for the City and the Health Department to reconsider their narrow-minded approach to Legionnaires’ disease prevention. Its singular focus on building equipment is failing to keep the public safe. By not routinely testing the water entering our homes and buildings–especially those housing older and immune-compromised populations–for Legionella bacteria and testing water systems after each and every reported case of Legionnaires’ disease, people in New York City will continue to get sick and cases will continue to climb.
The New York City Health Department announced that trace amounts of Legionella bacteria have been found in some of the cooling towers it recently tested in Lenox Hill. As it closed its investigation, the City stated that it is unlikely to discover the source of the outbreak. Rather than closing the investigation, the Alliance strongly urges the City to do a more comprehensive investigation.
One very important, unanswered question is how does Legionella bacteria enter a cooling tower? Every feature in a building that uses water is supplied with, and uses, the same water from the same source–the public water distribution system. If one device tests positive for Legionella, it’s more than likely other points throughout the building will also test positive. Why is the water that enters homes and buildings not being tested as part of the Health Department’s outbreak investigation?
Approximately 30 blocks from Lenox Hill, two police officers at the 23rd precinct recently contracted Legionnaires’ disease, and the potable water was tested. During this time, officers were advised not to use the precinct’s water for drinking or bathing until the water system was disinfected and further tests were completed. Yet, those in Lenox Hill were not provided with this same warning and didn’t have a single water system tested or disinfected.
The Health Department states that they had 100 of their personnel working on the Lenox Hill outbreak investigation; however, to our knowledge, there was not one water sample taken from outside or within any of the patients’ homes. Without conducting a comprehensive investigation, which includes the public water distribution system and the plethora of potential exposure points that exist throughout an affected area, the New York City Health Department will continue to miss the opportunity to collect the data necessary to proactively advance effective solutions that will decrease the number of cases and keep New Yorkers safe.
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.
