Management of Legionella in Water Systems (2019)
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THE NATIONAL ACADEMIES PRESS This PDF is available at http://nap.edu/25474 SHARE Management of Legionella in Water Systems (2019) DETAILS 304 pages | 7 x 10 | HARDBACK ISBN 978-0-309-49947-7 | DOI 10.17226/25474 CONTRIBUTORS GET THIS BOOK Committee on Management of Legionella in Water Systems; Water Science and Technology Board; Board on Life Sciences; Board on Population Health and Public Health Practice; Division on Earth and Life Studies; Health and Medicine FIND RELATED TITLES Division; National Academies of Sciences, Engineering, and Medicine SUGGESTED CITATION National Academies of Sciences, Engineering, and Medicine 2019. Management of Legionella in Water Systems. Washington, DC: The National Academies Press. https://doi.org/10.17226/25474. 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Management of Legionella in Water Systems Management of Legionella in Water Systems Committee on Management of Legionella in Water Systems Water Science and Technology Board Board on Life Sciences Board on Population Health and Public Practice Division on Earth and Life Studies Health and Medicine Division A Consensus Study Report of Prepublication Version - Subject to further editorial revision Copyright National Academy of Sciences. All rights reserved. Management of Legionella in Water Systems THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by the Alfred P. Sloan Foundation under Grant No. G-2016- 7288; Centers for Disease Control and Prevention under Contract No. 200-2011-38807, TO# 59; Department of Veterans Affairs under Contract No. VA250-16-C-0012; and En- vironmental Protection Agency under Contract No. EP-C-14-005, TO# 22 and EP-C-14- 005/68HE0C18F0876. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organi- zations or agencies that provided support for the project. International Standard Book Number-13: International Standard Book Number-10: Digital Object Identifier: http://doi.org/10.17226/25474 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2019 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Cover credit: Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Manan- agement of Legionella in Water Systems. Washington, DC: The National Academies Press. doi: http://doi.org/10.17226/25474 Prepublication Version - Subject to further editorial revision Copyright National Academy of Sciences. All rights reserved. Management of Legionella in Water Systems The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the char-ter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engi- neering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was estab- lished in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distin- guished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy deci- sions. The National Academies also encourage education and research, recognize out- standing contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. Prepublication Version - Subject to further editorial revision Copyright National Academy of Sciences. All rights reserved. Management of Legionella in Water Systems Consensus Study Reports published by the National Academies of Sciences, Engineer- ing, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Acad- emies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Med- icine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opin-ions contained in proceedings are those of the participants and are not endorsed by other partici- pants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. Prepublication Version - Subject to further editorial revision Copyright National Academy of Sciences. All rights reserved. Management of Legionella in Water Systems COMMITTEE ON MANAGEMENT OF LEGIONELLA IN WATER SYSTEMS JOAN B. ROSE, NAE, Chair, Michigan State University, East Lansing NICHOLAS J. ASHBOLT, University of Alberta, Edmonton, Canada RUTH L. BERKELMAN, NAM, Emory University, Atlanta, Georgia BRUCE J. GUTELIUS, New York City Department of Health and Mental Hygiene CHARLES N. HAAS, Drexel University, Philadelphia, Pennsylvania MARK W. LECHEVALLIER, Dr. Water Consulting, LLC, Morrison, Colorado JOHN T. LETSON, Memorial Sloan-Kettering Cancer Center, New York City, New York STEVEN A. PERGAM, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle MICHÈLE PRÉVOST, Polytechnique Montréal, Canada AMY PRUDEN, Virginia Polytechnic and State University, Blacksburg MICHELE S. SWANSON, University of Michigan, Ann Arbor PAUL W. J. J. van der WIELEN, KWR Water Research Institute, Nieuwegein, The Netherlands LAN CHI NGUYEN WEEKES, La Cité, Ottawa, Canada National Academies Staff LAURA J. EHLERS, Study Director, Water Science and Technology Board ANDREA HODGSON, Program Officer, Board on Life Sciences KATHLEEN STRATTON, Scholar, Board on Population Health and Public Practice ERIC EDKIN, Program Coordinator, Board on Earth Sciences and Resources RAYMOND M. CHAPPETTA, Senior Program Assistant, Board on Earth Sciences and Resources v Prepublication Version - Subject to further editorial revision Copyright National Academy of Sciences. All rights reserved. Management of Legionella in Water Systems WATER SCIENCE AND TECHNOLOGY BOARD CATHERINE L. KLING, Cornell University, Ithaca, New York NEWSHA AJAMI, Stanford University, Stanford, California JONATHAN D. ARTHUR, Florida Geological Survey, Tallahassee DAVID A. DZOMBAK, NAE, Carnegie Mellon University, Pittsburgh, Pennsylvania FRANCINA DOMINGUEZ, University of Illinois, Urbana-Champaign WENDY D. GRAHAM, University of Florida, Gainesville MARK W. LECHEVALLIER, Dr. Water Consulting, LLC, Morrison, Colorado MARGARET A. PALMER, SESYNC – University of Maryland, Annapolis DAVID L. SEDLAK, University of California, Berkeley DAVID L. WEGNER, Jacobs Engineering, Tucson, Arizona P. KAY WHITLOCK, Christopher B. Burke Engineering, Ltd., Rosemont, Illinois National Academies Staff ELIZABETH EIDE, Director LAURA J. EHLERS, Senior Staff Officer STEPHANIE E. JOHNSON, Senior Staff Officer M. JEANNE AQUILINO, Financial Business Partner/Administrative Associate ERIC J. EDKIN, Program Coordinator BRENDAN R. MCGOVERN, Research Assistant/Senior Program Assistant vi Prepublication Version - Subject to further editorial revision Copyright National Academy of Sciences. All rights reserved. Management of Legionella in Water Systems Preface Legionnaires’ disease arrived on the scene in dramatic fashion during the 1976 Philadelphia out- break that included 182 cases of pneumonia and 29 deaths. Almost 40 years later, major outbreaks at a community level (Flint, Michigan), in healthcare facilities (such as the Quincy, Illinois veterans home), and due to cooling towers (New York City) have again catapulted Legionella into national headlines. Le- gionella is now the number one cause of reported waterborne disease in the United States, transmitted through contaminated water that is aerosolized and exposing those nearby via inhalation into the respi- ratory tract. The bacteria in the genusLegionella occur naturally