Lab Matters Spring 2019 - Page 26

INFECTIOUS DISEASES Looking For Legionella By Jill Sakai, writer Kara Levinson had only been in New Hampshire for a few weeks when a phone call last August set the course for her new position. Two recent visitors to the beachside tourist town of Hampton, New Hampshire, had just been diagnosed with Legionnaire’s disease. Within a week, two more reports had been linked to the same town. As a US Centers for Disease Control and Prevention (CDC) Laboratory Leadership Service Fellow newly based at the New Hampshire Public Health Laboratories, Levinson suddenly found herself at the heart of New Hampshire’s first Legionella outbreak investigation in decades. The New Hampshire lab rushed to pull together a team of health officials, environmental scientists and epidemiologists and reached out for federal assistance. As the laboratory lead, Levinson became immersed in planning and testing while simultaneously navigating a multifaceted response involving numerous labs and public officials on the ground in Hampton. With no recent outbreak experience to guide the investigation, the team managed issues as they arose and successfully pinpointed a town hotel as the source of the outbreak. “It was an outbreak that taught us a lot. We’re a relatively small state and we have a relatively small population, and Legionellosis is not something we deal with routinely,” Levinson said. With reported cases on the rise around the country, other states may find themselves in a similar position. Reported Legionellosis cases to the CDC increased nearly five and a half times from 2000 to 2017. Whether the bacterium is becoming more prevalent in the environment is not clear, but growing awareness, increased testing and advances in test sensitivity may be increasing detection of the pathogen. Together, these changes are bringing questions about Legionella 24 LAB MATTERS Spring 2019 Legionella pneumophila growing on specialized microbiological media (BYCE). Photo: CDC A huge component of Legionella investigations is the environmental sampling, and a lot of states, including us, are considering expanding our testing capabilities to include both clinical and environmental testing.” Kara Levinson surveillance, testing and response to the forefront for public health labs across the country. career launched her expertise in the organism. But testing is often not the right first step, she said. Put to the Test The organism is ubiquitous in the environment, so “more likely than not, the labs will find it,” she noted. “But just because you find it doesn’t mean it’s going to cause illness.” A better place to start, she said, is education. Since the 2017 directive from the Centers for Medicare and Medicaid Services (CMS) that requires healthcare facilities to reduce the risk of Legionella transmission through building water systems, Nancy Hall has seen greater awareness and more testing demand. Hall is the environmental microbiology manager at the State Hygienic Laboratory in Iowa, where a Legionella outbreak early in her 40-year Essentially all Legionella outbreaks are preventable through proper maintenance of water systems. Hall directs people to the CDC toolkit, which provides information and resources PublicHealthLabs @APHL APHL.org