Legionellosis in an infection caused by Legionella bacteria.
There are two different types of legionellosis:
- Pontiac fever
- Legionnaires' disease
Pontiac fever is a mild respiratory illness and Legionnaires' disease is more severe and is a type of pneumonia.
Legionnaires' disease is not normally spread from person to person.
The Department of Natural Resource’s Drinking Water and Groundwater Program and the Department of Health Services are advising all facilities, including schools, to consider the safety of their water supply. Many schools, gyms, libraries, and other educational facilities across the state have been temporarily shut down or experienced reduced usage in response to the COVID-19 pandemic. Before opening back up to the public or re-starting general use, it’s important to flush any stagnant water out of the plumbing system.
When water systems are dormant, there is a greater chance that bacteria can grow throughout the plumbing system. Of particular concern is the bacteria Legionella, which can cause a deadly respiratory infection with severe pneumonia-like symptoms, especially in people over 50 years old or those with compromised immune systems. When water is stagnant, hot water temperatures can decrease to the Legionella growth range (77–108°F, 25–42°C). Stagnant water can also lead to low or undetectable levels of disinfectant, such as chlorine. Ensure that your water system is safe to use after a prolonged shutdown to minimize the risk of Legionnaires’ disease and other diseases associated with water. In August, several schools in Ohio and Pennsylvania reported the detection of Legionella after sampling water systems that had been stagnate.
The Centers for Disease Control and Prevention recently published Guidance for Reopening Buildings After Prolonged Shutdown or Reduced Operation. Included in the guidance are 8 steps to follow to minimize Legionella risk before reopening a building.
Flushing stagnate water is just one of the several helpful recommendations. Additional steps building managers or owners can take include checking water heaters to make sure they are maintained, and inspecting and cleaning all faucets, showers, and toilets.
Causes and Transmission
Legionella bacteria are found naturally in freshwater and moist environments (e.g., lakes, rivers, groundwater) worldwide. Legionella can become a public health problem in manmade water systems, where it can grow and spread, causing disease. Most healthy people who are exposed to Legionella do not become sick. However, people aged 50 years or older, smokers, and those with underlying medical conditions such as chronic lung disease, or those with a weakened immune system, are at higher risk of becoming sick from Legionella or with legionellosis.
Outbreaks of Legionnaires’ disease are most commonly associated with large or complex water systems (e.g., hospitals, long-term care facilities, hotels, cruise ships).
People can become sick when they breathe in mist from a water source that has Legionella (water used for showering, cooling towers, decorative fountains, and hot tubs). This CDC infographic helps illustrate how Legionella is spread.
Signs and Symptoms
Common signs and symptoms of legionellosis are:
- Muscle aches
- Loss of appetite
- Diarrhea (occasionally)
Contact your doctor if you develop symptoms, such as fever, cough, chills, or muscle aches. Be sure to mention if you spent any nights away from home in the last 10 days.
Treatment depends on whether or not the person has Pontiac fever or Legionnaires' disease. Pontiac fever requires supportive care only and will go away on its own. Legionnaires' disease is treated with antibiotics. Most people who get sick need care in a hospital but make a full recovery. However, about 1 out of 10 people who get Legionnaires’ disease die from the infection.
There are no vaccines against Legionella bacteria. To prevent Legionella bacteria from growing, it is important to make sure that water systems in buildings are being properly cared for and maintained.
CDC web resources on Legionella prevention:
How Common is Legionellosis?
Legionnaires’ disease is on the rise in Wisconsin and nationally. The rising trend may be related to a combination of factors, such as increased awareness and testing, more people at risk (e.g., aging population, use of immune-suppressing medication), and increased Legionella in the environment.
Because Legionnaires’ disease is likely underdiagnosed, the number of cases may be underestimated. More illness is usually found in the summer and early fall, but it can happen any time of year.
- Legionellosis Fact Sheet, P-42066 (Multiple Languages): Educational fact sheet for the general public on legionellosis covering signs and symptoms, treatment, and prevention
- About Legionellosis: CDC webpage including information on symptoms, diagnosis, possible causes of legionellosis, treatment, and prevention
- Legionellosis resources: CDC webpage containing resources for patients and their families
- How Legionella affects building water systems and people: CDC infographic illustrating how Legionella is spread
Reporting and Surveillance Guidance
This is a Wisconsin disease surveillance category II disease:
- Report to the patient's local public health department electronically, through the Wisconsin Electronic Disease Surveillance System (WEDSS), by mail or fax using an Acute and Communicable Disease case report, F-44151 (Word) or by other means within 72 hours upon recognition of a case.
- Information on communicable disease reporting
Wisconsin case reporting and public health follow-up guidelines:
- Update on Legionnaires' Disease in Wisconsin Webinar – Bureau of Communicable Diseases Monthly Webinar Series Presentation, Given February 2019 (Adobe Connect)
- Diagnosing Legionnaires' Disease: Best Practices, P-02433 (PDF) 06/2019
- Division of Public Health Memo BCD-2021-05: Increased Reports of Laboratory-Confirmed Cases of Legionellosis (Legionnaires’ Disease)
- Legionella Information for Clinicians (CDC)
- Laboratory Guidelines (CDC)
- Environmental Investigation Resources for Health Departments (CDC)
Water Management Program Resources
In June 2017, the Centers for Medicare & Medicaid Services (CMS) released a survey and certification memo stating that healthcare facilities (hospitals and skilled nursing facilities) should develop and adhere to ASHRAE-compliant water management programs to reduce the risk for Legionella and other pathogens in their water systems.
The following resources may be useful when trying to understand what the requirement covers and for developing a comprehensive water management program.
Toolkits, Trainings, and Templates:
- Legionella Control Toolkit (CDC)
- Preventing Legionnaires’ Disease: A Training on Legionella Water Management Programs (PreventLD Training) (CDC)
- CDC Toolkit: Prevention of Legionnaires’ disease with Water Management Programs (CDC)
- Water Management Programs for Healthcare Facilities (CDC)
- CMS Surveyor Training Webinar: Legionella and Other Water Pathogens (CMS)
- Water Management Program Template (CSTE)
Fact Sheets and FAQ's:
- Fact sheet: Growth and spread of Legionella (CDC)
- Fact sheet: Legionella water management programs (CDC)
- FAQ's: Healthcare Water Management Programs (CDC)
- FAQ's: ASHRAE Standard 188 (CDC)
- Special Considerations for Healthcare Facilities (CDC)
- Considerations When Working with Legionella Consultants (CDC)
- Fact sheet: Hot Water Temperatures in Adult Family (DHS), P-01942 (PDF)
- Forms and Checklists: Construction and Remodeling for Health Care Facilities (DHS)
- Plumbing Plan Review in Health Care Facilities in Wisconsin (PDF) (Wisconsin Department of Safety and Professional Services)