Large Community Outbreak of Legionnaires Disease Potentially Associated with a Cooling Tower - Napa County, California, 2022

• Published in: MMWR. Morbidity and mortality weekly report Vol. 72; no. 49; pp. 1315 - 1320
• Main Authors: Grossmann, Nárjara V, Milne, Crystal, Martinez, Melinda R, Relucio, Karen, Sadeghi, Banafsheh, Wiley, Erica N, Holland, Samuel N, Rutschmann, Sarah, Vugia, Duc J, Kimura, Akiko, Crain, Chad, Akter, Farhima, Mukhopadhyay, Rituparna, Crandall, John, Shorrock, Meghann, Smith, Jessica C, Prasad, Namrata, Kahn, Rebecca, Barskey, Albert E, Lee, Sooji, Willby, Melisa J, Kozak-Muiznieks, Natalia A, Lucas, Claressa E, Henderson, Kelley C, Hamlin, Jennafer A P, Yang, Eungi, Clemmons, Nakia S, Ritter, Troy, Henn, Jennifer
• Format: Journal Article Newsletter
• Language: English
• Published: United States U.S. Government Printing Office 08.12.2023; U.S. Center for Disease Control; Centers for Disease Control and Prevention
• Subjects: Antigens; California - epidemiology; Comparative analysis; Cooling; Cooling towers; COVID-19; Disease Outbreaks; Disease spread; Disease transmission; DNA sequencing; Environmental monitoring; Epidemics; Genomes; Genomics; Health aspects; Hospitalization; Humans; Legionella; Legionella pneumophila; Legionellosis; Legionnaires disease; Legionnaires' Disease - diagnosis; Legionnaires' Disease - epidemiology; Medical laboratories; Nucleotide sequence; Nucleotide sequencing; Nucleotides; Outbreak Report; Outbreaks; Patients; Pneumonia; Polymorphism; Public health; Remediation; Sampling; Typing; Water; Water Microbiology; California; United States > US; Napa County California
• ISSN: 0149-2195; 1545-861X
• DOI: 10.15585/MMWR.MM7249A1

Legionnaires disease is a serious infection acquired by inhalation of water droplets from human-made building water systems that contain Legionella bacteria. On July 11 and 12, 2022, Napa County Public Health (NCPH) in California received reports of three positive urinary antigen tests for Legionella pneumophila serogroup 1 in the town of Napa. By July 21, six Legionnaires disease cases had been confirmed among Napa County residents, compared with a baseline of one or two cases per year. NCPH requested assistance from the California Department of Public Health (CDPH) and CDC to aid in the investigations. Close temporal and geospatial clustering permitted a focused environmental sampling strategy of high-risk facilities which, coupled with whole genome sequencing results from samples and investigation of water system maintenance, facilitated potential linking of the outbreak with an environmental source. NCPH, with technical support from CDC and CDPH, instructed and monitored remediation practices for all environmental locations that tested positive for Legionella. The investigation response to this community outbreak illustrates the importance of interdisciplinary collaboration by public health agencies, laboratory support, timely communication with the public, and cooperation of managers of potentially implicated water systems. Timely identification of possible sources, sampling, and remediation of any facility testing positive for Legionella is crucial to interrupting further transmission.