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
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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
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