Missouri adds Legionellosis to List of Infectious Diseases that Require Reporting within 24 Hours

The Missouri Department of Health and Senior Services (DHSS) has investigated over 100 cases of Legionnaires’ disease, a serious lung infection, across Missouri so far this year; five of those who have contracted the disease are reported to have died. Although most people exposed do not develop illness, approximately 10-25 percent of Legionnaires’ disease cases are fatal. Reports of Legionnaires’ disease are increasing in Missouri and nationally. In response, DHSS has strengthened Legionnaires’ disease detection and prevention efforts.

Recently, DHSS filed emergency rules to reduce the timeframe for reporting legionellosis from three days to one day and introduced new testing methods at the Missouri State Public Health Laboratory (MSPHL).

“The timely diagnosis of legionellosis, and the identification of the water sources from which it arises, is crucial for preventing morbidity and mortality in the larger community,” said Dr. Randall Williams, director of DHSS. “We are committed to raising awareness and continuing to work with local health departments and the CDC during outbreaks, and we are excited about the innovative testing that MSPHL has instituted to aid in timely detection of Legionella in water sources.”

The MSPHL’s Environmental Bacteriology Unit can test water samples for the presence of Legionella pneumophila using the Idexx Legiolert system. The Legiolert test method provides highly sensitive results in just seven days that can also be used for further comparison to patient samples to link individual cases with environmental sources. 89 samples have been tested at the MSPHL for Legionella pneumophila since June 19.

“The MSPHL now provides high-quality testing services to detect Legionella pneumophila in a timely manner,” said Bill Whitmar, director, MSPHL. “This service not only protects our communities but also those who visit our communities.”

DHSS and local public health partners have completed over 50 environmental assessments this year at lodging and health care facilities in Missouri. DHSS has also been working to educate management of these types of facilities on the disease and what proactive measures can be taken to prevent anyone from contracting the disease from their water systems.

Legionella can be found naturally in the environment, but generally is not present in sufficient numbers to cause disease. In human-made water systems, like the interior plumbing of large buildings, cooling towers, decorative fountains, or hot tubs, Legionella can grow and be transmitted to susceptible people by breathing in small water droplets containing the bacteria. People at higher risk for getting sick include those over age 50, former or current smokers or those with chronic lung diseases, cancer, or other underlying illnesses. It is not spread from person to person.

While public health efforts are focused on investigating cases associated with lodging and health care facilities, you can take steps to protect yourself at home. Improper CPAP machine use (commonly used to treat sleep-related breathing disorders) is a frequently reported risk factor. You can reduce your risk of exposure by proper maintenance of CPAP machines, humidifiers and other household equipment where bacteria may grow that may create water vapor.

Outbreaks of Legionnaires’ disease often occur in hotels, health care facilities and pools. Although over 800 cases have been reported in the state since 2014, this disease is not a concern isolated only to Missouri. Earlier this month, a hotel in downtown Atlanta voluntarily closed after at least nine guests contracted the disease.