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.