BACKGROUND: The incidence of Legionnaires’ disease in the U.S. has increased 286% since 2000. State and local health departments are facing an increasing burden to investigate outbreaks and prevent disease, often without dedicated resources. In 2015, CDC solicited feedback to determine priority areas for the Legionnaires’ disease program, with the goal of stabilizing and ultimately reducing the burden of disease.
METHODS: CDC’s internal review included participants from five different Centers at CDC, including key collaborators with expertise in waterborne diseases, healthcare-associated infections, and environmental health. During this half-day meeting in September 2015, program staff presented key challenges in primary disease prevention and outbreak response and suggestions for overcoming them. The Legionnaires’ disease program then sought feedback from the Boards of Scientific Counselors (BSCs) for the Office of Infectious Diseases and the National Center for Environmental Health; these are federal advisory committees comprised of leaders in public health, healthcare, and academia. CDC program staff presented the results of the internal review to the BSCs in December 2015 and received input regarding future projects and program directions.
RESULTS: We identified five key challenges: 1.) Balancing primary prevention and outbreak response, 2.) Reducing the time to identification of outbreak sources, 3.) Need for dedicated environmental expertise, 4.) Role of environmental testing for Legionella, and 5.) Evaluation of specific disinfection strategies. The BSCs agreed that CDC should support health departments in increasing implementation of the new industry Standard 188-2015 from the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE). New laboratory techniques should also be a priority, with the goal of reducing the amount of time needed to determine whether clinical and environmental strains match during outbreak investigations. The BSCs agreed that environmental capacity is essential at the federal, state, and local levels and supported CDC’s plan to communicate common environmental deficiencies that can lead to exposure to Legionella with public health audiences. The BSCs recommended partnering with industry, state and local health departments, and other federal agencies to reduce the incidence of Legionnaires’ disease and to address the need for additional expertise in environmental health, engineering, and disinfectant technologies.
CONCLUSIONS: In the near future, CDC’s Legionnaires’ disease program is planning greater emphasis on primary prevention through environmental control while maintaining its traditional role in supporting state and local health departments in outbreak response. CDC is committed to working with public health partners in implementing new prevention strategies.