Statement from the Alliance to Prevent Legionnaires’ Disease on NASEM Water Report

WASHINGTON, D.C. – The Alliance to Prevent Legionnaires’ Disease, a national organization dedicated to reducing the occurrence of Legionnaires’ disease by promoting public research, education, best practices for water management, and advocating for comprehensive policies to combat and investigate this preventable disease, today issued the following statement in response to the release of the Management of Legionella in Water Systems report from the National Academies of Sciences, Engineering, and Medicine (NASEM):

Today’s NASEM report highlights many of the reasons that we’ve seen no progress in slowing or eliminating the dramatic increases in Legionnaires’ Disease around the world. While the report states that the sources for 96% of all cases of Legionnaires’ Disease are not known and acknowledges that a major factor in the significant spike in cases is aging infrastructure, water main breaks, water conservation and other environmental factors, it rehashes a range of largely premise-plumbing solutions that have not proven to reduce Legionnaires’ disease consistently.

The Alliance appreciates the complexity of the challenge to control Legionella bacteria, however the path to ultimately reduce the rates of disease requires an updated and comprehensive understanding of the source to tap challenges that must be addressed. The Alliance welcomes opportunities to engage NASEM, its committee members and the federal government agencies that funded this initiative to advance this discussion further as we continue on our long road toward meaningful solutions.

When NASEM announced it would take on this Management of Legionella in Water Systems report in late 2017, the Alliance to Prevent Legionnaires’ Disease jumped at the chance to participate. Our team of experts from throughout the country have worked in and with water systems for many years, studying what causes Legionnaires’ cases and outbreaks, who is most likely to be at risk of Legionnaires’ infection, and what conditions encourage the spread of this bacteria.

We spent many hours providing valuable research and testimony to the NASEM task force from our members’ varied perspective, and we appreciate the opportunity to share our expertise. Our testimony included:

• The critical importance that the global Legionella problem is effectively and comprehensively defined so that true solutions can be developed to eliminate or reduce the tragic rates of Legionnaires’ Disease.
• How narrow perspectives in the fight against Legionella for more than 40 years have led to band-aid solutions that have only exacerbated the problem.
• We must move from an outbreak mentality (4% of U.S. Legionnaires’ Disease cases) to an ongoing source-to-tap mentality to address the fact that 96 percent of cases nationwide, according to the Centers for Disease Control – of Legionnaires’ cases are individual and sporadic. The only way to address this challenge is through active source-to-tap water management.
• A limited focus on building equipment’s role in the spread of Legionella ignore some obvious realities. The CDC found that 56% of Legionnaires cases were contracted from the drinking water, the same water used in most building equipment. A 2014 EPA study in Cincinnati found Legionella bacteria in 47% of the 268 samples taken from faucets. New York’s number of Legionnaires’ disease cases has more than doubled since introducing a requirement for a cooling tower registry and regular monitoring, while costing owners and tenants an estimated $130 million annually.
• Major knowledge gaps persist relating to the proliferation of Legionella bacteria in our public distribution systems. This area including aging infrastructure and related system events like water main breaks as well as flooding has never been adequately studied as a driver for outbreaks and sporadic cases of Legionnaires’ disease.
• Previous research also suggests that aspiration as a mode of disease transmission requires additional study. These areas represent clear gaps in knowledge – but are critical to better understanding the vast majority of Legionnaires’ disease cases.
• A reminder of the very personal and tragic stories of Legionnaires’ deadly wake: Muriel Bloch’s parents brought her to one of the world’s greater cancer treatment centers in New York City and got the 4-year-old a nearby apartment to recover in hopes of reducing her exposure to others while her immune system was fragile. Instead, the building water system was infected with and exposed her to bacteria. She contracted Legionnaires’, had several surgeries and ultimately died.

We can and must do better. In Illinois, state officials spent years carefully examining how to modernize the state’s water regulations for the first time since the 1980s. Rather than bow to temptation for more narrow solutions in the wake of tragic deaths of veterans in a highly publicized Legionnaires’ outbreak in western Illinois, they embraced a holistic view and systemwide reforms that should serve as a model for the nation: reducing stagnant water, better controlling water age through smarter system design, reducing nutrients that cause bacterial growth, and ensuring fully disinfected water is delivered to homes and buildings.

We were also encouraged by the recommendations in May from the National Summit on Waterborne Disease that embraced clear realities: we will only effectively prevent Legionnaires’ when we effectively educate public officials and the general public about water quality and its challenges, and when we take a comprehensive source-to-tap approach that directly connects the quality of our water sources and entire distribution systems with the spread of dangerous waterborne pathogens.

The National Summit report (http://waterbornedisease.org/wp-content/uploads/2019/06/Summit-Key-Findings_FINAL.pdf) is yet further evidence that the real work to prevent Legionnaires’ Disease around the country is still ahead of us. The more we objectively study the threats and causes of Legionella development and fully consider solutions to address it at every step along its path to our homes and businesses, the better our results. APLD’s sole mission is to save lives and prevent infection through safer, cleaner drinking water. We must learn from this report and turn theoretical recommendations into real, life-saving results.”