Building Capacity for Legionnaires' Disease Outbreak Response at the State and Local Levels: Assessing Needs and Brainstorming Solutions

Brief Summary
Legionella is the most common cause of drinking water outbreaks nationwide, and the incidence of Legionnaires’ disease (LD) has tripled over the past ten years.  Outbreak response is an essential public health function; however, many states lack the resources to effectively respond to LD outbreaks. In 2010, the Centers for Disease Control and Prevention (CDC) presented a three-part webinar series focused on LD outbreak response training for state and local health departments.  The webinars were developed with input from states, were well-attended, and highly rated.  However, many states continued to request assistance with the environmental and laboratory issues unique to LD investigations. To address this, in December 2012 and January 2013 we conducted 27 in-depth interviews with LD outbreak responders, including state and local epidemiologists and environmental health staff as well as state laboratory directors.  Our goals were to a.) assess the current ability of health departments to respond to LD outbreaks, b.) explore resources, tools, and trainings needed, and c.) assess whether health departments are interested in building their capacity for LD outbreak response, determine the best way to approach this, and identify possible barriers.  Interviews were conducted by a trained facilitator over the phone and lasted about one hour.  They were audio-recorded, transcribed, and analyzed to identify key themes and findings. State officials reported that the lack of a national standard makes it challenging to feel comfortable with decision-making during outbreaks.  In addition, LD outbreaks are infrequent, costly, high profile, and they require expertise and resources not needed to investigate other outbreaks.  Most state officials requested just-in-time archived training webinars and videos on specific topics like environmental sampling, but stated that even if these resources were available, they would not likely have time to use them and would still rely heavily on CDC. Based on this information, CDC plans to develop comprehensive secondary prevention (outbreak) guidelines, and potentially primary prevention guidelines as well.  The goal of this session is to solicit feedback regarding the approach, brainstorm ideas for guideline content, and form a working group for state input on future guideline development.