Legionnaires' Disease (Legionellosis)

Albany County Department of Health Maribeth Miller, Interim Commissioner 175 Green Street Albany, NY 12202 Phone (518) 447-4580 Fax (518) 447-4698 Mon – Fri, 8:30 AM - 4:30 PM

Legionnaires’ disease is NOT spread from person to person

Legionella is the bacteria responsible for Legionnaires’ disease, which is a severe form of pneumonia. It can also cause Pontiac fever, a mild respiratory disease
Legionella bacteria naturally occurs in places where water is stored at warmer temperatures, such as:
- Cooling towers
- Hot tubs
- Hot water tanks and heaters
- Large plumbing systems
- Decorative fountains

How it is spread:

Infection results from breathing in water droplets that are contaminated with the bacteria.

Clinical features:

Symptoms of Legionella pneumonia, include fever, dry or productive cough, shortness of breath, as well as serious signs of illness, such as fast heart rate, low blood pressure, confusion, or changes in mental status.
Symptoms of Pontiac fever include tiredness, fever, cough, joint pain, headache, chest pain, and shortness of breath.
For most individuals, exposure to Legionella bacteria does not result in serious disease

Who is at risk:

People aged 50 and older, those with any history of smoking, and people with weakened immune systems are particularly susceptible to Legionnaires’ disease,

Medical Treatment

Legionella infection can be treated with appropriate antibiotics

Water Prevention

August 2024 Outbreak

As of August 2024, The Albany County Department of Health, alongside the NYS Department of Health (NYS DOH) is investigating an outbreak of Legionella at the Peregrine Senior Living at Shaker.

For additional information regarding this outbreak please contact the Epidemiology Office at (518) 447-4640 or Peregrine Senior Living at (518) 465-4444.

All media should contact the Director of Communications: Mary Rozak at (518) 447-7040

For more information

If you were exposed

Clinical features:

Symptoms of illness usually begin 2 to 14 days after being exposed and may include high fever, chills, cough and fatigue. For more information about legionellosis and related symptoms, please see the attached legionellosis fact sheet.

Notice of Exposure:

If you have been informed that you have been exposed to water contaminated with Legionella at a hotel, assisted living facility, nursing home, hospital, or large apartment complex, you should:

Monitor your symptoms daily, and if you develop symptoms, you are strongly encouraged to seek medical attention for further evaluation and treatment.
Consider Requesting Legionella testing, this includes a Urine Antigen Testing (UAT) for Legionella antigen and Sputum Culture if you develop symptoms
If you reside or visit a facility that is under investigation for legionella, adhere to water restrictions

Water Restrictions Instructions may include:

Stop use of tap water for drinking, oral care, or showering
Use bottled water for drinking and oral care, consider shower wipes for body cleansing
Consider purchasing a point-of-use (POU) microbial filters for showers and faucets with an effective pore size of 0.2-microns or less that comply with the requirements of ASTM F838
Allow the facility Building Maintenance to enter your unit for a water flushing program or testing

Reporting facilities

Reporting to ACDOH

Hospitals, nursing homes and other regulated health care facilities in New York State (including New York City) are required by law to report all suspected and confirmed cases of Legionnaires’ disease to the local health department where the patient resides.

Legionella outbreak should be suspected and reported if a cluster (more than 2 cases) of pneumonia occur within a 24 hour period.

The facilities must report any confirmed cases of Legionella to ACDOH

Facility staff should fill out the Communicable Disease Reporting Form (ny.gov) for each case
The form can be Faxed to ACDOH at 518-447-4515

Reporting providers

Indications for Legionnaires' disease testing

For patients with pneumonia, the following indications warrant testing for Legionnaires' disease:

Outpatient antibiotic failure for community-acquired pneumonia
Severe pneumonia, in particular illness requiring intensive care
Presence of an immunocompromising condition
Overnight travel away from the home during incubation period
Risk factors and hospitalization with healthcare-associated pneumonia
Overnight stay in a healthcare facility during incubation period
Epidemiologic link to a setting with known Legionella concerns, ie, a setting that is currently undergoing an environmental and/or outbreak investigation for legionella.

Testing for Legionella

The Infectious Disease Society of America and the American Thoracic Society (IDSA, ATS) recommend Urine Antigen testing (UAT) for Legionella pneumophila serogroup 1, for persons with

severe pneumonia that fails to respond to empiric treatment or
those who have been epidemiologically linked to an outbreak.

However, there are several other tests available and sputum culture remain a goal standard. Medical Facilities should confer with ACDOH to ensure that all Legionella isolates from any clinical specimen are submitted to NYS DOH Wadsworth Center Laboratories

Test Type	Specimen Type	Advantages	Challenges
Culture (gold standard)	Lower Respiratory (Sputum) Tissue	Provides confirmatory lab evidence of Legionnaires Disease Detection of all species and serogroups WGS can be conducted Comparison of clinical and environmental isolates to identify potential source.	Clinicians must specifically request specimen be cultured for Legionella (not general respiratory bacterial culture) as specialized media (buffered charcoal yeast extract {BCYE}agar) is required.
Polymerase Chain Reaction (PCR)	Lower Respiratory (Sputum) Tissue	Provides confirmatory lab evidence of Legionnaires Disease. Detection of L. pneumophila serogroup 1 as well as other species and serogroups.	Must be reflexed to culture to perform WGS for comparison to environmental isolates to identify potential source of infection in outbreaks.
Urine Antigen	Urine	Provides confirmatory lab evidence of Legionnaires Disease. Only reliably detects L. pneumophila serogroup 1.	Cannot identify or rule out infection of other Legionella species and serogroups. Cannot be used for WGS. Cannot be used to identify potential environmental source of infection in outbreaks.
Serology	Blood	Can diagnose acute Legionnaires Disease infection retrospectively.	A single antibody titer is NOT diagnostic for legionellosis. Requires collection of second specimen, 3-4 weeks apart, to detect a fourfold rise in antibody titer to a level of >1:128. Cannot be used to identify a potential environmental source of infection in outbreaks.

Reporting Legionella

Providers should report cases to LHD using the DOH-389 Communicable Disease Reporting form found here: health.ny.gov/professionals/diseases/reporting/communicable/. Laboratory specimens should be sent to NYS Wadsworth Center Bacteriology Laboratory

If you are unable to reach ACDOH, contact the NYSDOH BCDC at (518) 473-4439 or by email at epiLegionella@health.ny.gov during business hours or (866) 881-2809 evenings, weekends, and holidays.

Treatment for legionella

Current IDS guidelines for the recommended treatment of Legionella include Fluoroquinolone (levofloxacin or moxifloxacin) or a macrolide (azithromycin preferred) See IDS Guidelines [.pdf]

Azithromycin 500mg IV/PO q24h
Levofloxacin 750mg IV/PO q24h
Moxifloxacin 400mg IV/PO q24h

Albany County, NY

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