142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

298961
“A local public health agency investigation into an increase in community-acquired legionellosis June-September 2013 in Milwaukee, Wisconsin: Lessons from the frontlines”

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 10:30 AM - 10:50 AM

Paul A. Biedrzycki, MPH, MBA , City of Milwaukee Health Department, Milwaukee, WI
Marisa Stanley, MPH , City of Milwaukee Health Department, Milwaukee, WI
Kyle McFatridge, BS , City of Milwaukee Health Department, Milwaukee, WI
Terri Linder, BS, RS , City of Milwaukee Health Department, Milwaukee, WI
Lindor Schmidt, BS, RS , City of Milwaukee Health Department, Milwaukee, WI
Sarah Deroo, BS , City of Milwaukee Health Department, Milwaukee, WI
Jose Rivera Rodriquez, BA , City of Milwaukee Health Department, Milwaukee, WI
From June to September 2013, the City of Milwaukee Health Department (MHD) noted an increase in Legionellosis reporting in City residents. Fifty-four (54) confirmed cases of Legionnaires disease (Ld) representing a five-fold increase as compared to previous five years during a similar time frame were reported to the MHD resulting in an immediate epidemiological and environmental investigation by department staff.   All but one of the 54 adult cases (29-77) were hospitalized with Legionella pneumophila Serogroup I infection, with no reported deaths.  73% of cases were African-American, 65% had one or more risk factors associated with Ld.  89% had a history of smoking.  No common reservoir of exposure including institutional, commercial or residential was identified through epidemiological analysis.  MHD conducted an environmental field survey and sampling of several potential sources of L. pneumophila.  Several cooling towers tested positive for L. pneumophila with distinct strains identified. Yet, none of the strains matched any clinical specimens obtained from confirmed cases. Risk communication to the public via media occurred throughout the investigation.  Further, MHD consulted with local water treatment experts to enhance understanding of seasonal cooling tower operation in the metropolitan area given cooler seasonal temperature and high number of precipitation events.    Lessons from this investigation suggest that LPHAs need to improve awareness of environmental conditions conducive to Legionella bacterium colonization and dissemination, better understand potential sources of exposure related to community-acquired case reports, develop communication strategies that appropriately characterize risk to the public, and support partnerships with building owners and engineers and water treatment professionals that mitigate Legionellosis occurrence within a community. 

Learning Areas:

Communication and informatics
Environmental health sciences
Epidemiology
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health biology

Learning Objectives:
Describe the components including capacity and resources associated with the MHD epidemiologic and environmental investigation into the increase of reported Legionellosis in the City of Milwaukee during June-September 2013. Discuss challenges to developing an effective public risk communication strategy as well as interaction with television and print media throughout the MHD investigation. Explain how partnership with private sector entities such as building owners and engineers and water treatment professionals can inform epidemiologic and environmental Ld outbreak or cluster investigations by LPHAs. Define the outreach process and partnerships used to develop a community-wide symposium coordinated by the MHD and related to protecting building water systems from Legionella bacterium.

Keyword(s): Environmental Health, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have five years of epidemiology experience at the State and Local Health Department levels. I am currently the Infectious Disease Epidemiologist for the City of Milwaukee Health Department where I coordinates disease surveillance and outbreak investigations within the City of Milwaukee.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.