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Developing a legionnaires’ disease laboratory response plan : a practical guide for state and local public health laboratories

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  • English
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    • Corporate Authors:
      National Center for Immunization and Respiratory Diseases (U.S.). Division of Bacterial Diseases.
    • Description:
      Legionnaires’ disease is a serious type of pneumonia caused by the bacterium Legionella. This bacterium can also cause a milder, self-limited, influenza-like illness called Pontiac fever. The term legionellosis refers to either Legionnaires’ disease or Pontiac fever. Legionella is the leading cause of waterborne pneumonia outbreaks in the United States. The rate of reported cases of legionellosis in the United States increased nearly four and a half times from 2000-2015. Those at increased risk for Legionnaires’ disease include adults 50 years or older, people with a history of smoking or chronic lung disease, and people who are immunocompromised. Legionella lives naturally in soil and freshwater environments, such as lakes and streams, but is spread primarily via inhalation of contaminated aerosols from human-made water systems that are not adequately managed.

      Comparing Legionella isolates from both clinical respiratory specimens and environmental samples using molecular techniques can be vital for determining the source of a Legionnaires’ disease case, cluster, or outbreak. Obtaining isolates can be complicated by many factors, including:

      • Limited availability of respiratory specimens for culture since the urinary antigen test (UAT) is the most common clinical diagnostic assay

      • Legionella’s fastidious growth requirements

      • Limited commercial availability of specialized media (Buffered Charcoal Yeast Extract [BCYE] agar)

      • Challenges related to proper collection, transportation, and processing of environmental samples

      Laboratories can increase their preparedness by developing a Legionnaires’ disease Laboratory Response Plan (LDLRP). A completed LDLRP contains important information related to the Response Team, considerations regarding testing that will be performed in-house, and a plan for any tests that will be referred to outside laboratories. Having an LDLRP in place helps laboratories strengthen their Legionnaires’ disease response capabilities and prepare for potential cluster or outbreak investigations with confidence.

      Every state and local public health laboratory (PHL) can benefit from developing an LDLRP. During a Legionnaires’ disease cluster or outbreak response, laboratories may suddenly be faced with processing hundreds of samples. Preparing an LDLRP can help PHLs develop a strategy before a cluster or outbreak occurs, regardless of current Legionella testing capacity.

      labtoolkit.pdf

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