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DOH Issues Legionellosis Health Advisory

In a Health Advisory issued on July 16th to Healthcare Facilities, Providers, Clinical Laboratories, and Local Health Departments (LHDs), the Department of Health (DOH) alerts providers to be aware of the possibility of Legionella infection in hospitalized or at-risk patients with suspected pneumonia, especially if the individual tests negative for COVID-19. The Advisory notes that Legionnaires’ disease (LD) cannot be distinguished from other causes of pneumonia on clinical or radiologic grounds, including the virus that causes COVID-19. LD and COVID-19 both cause fever, fatigue, and respiratory illness (including pneumonia). Individuals at risk for Legionnaires' disease include individuals aged 50 years or older; current or former smokers; persons with chronic lung disease, immunocompromising conditions, systemic malignancy, or comorbid conditions like diabetes or renal/hepatic failure; and persons with a history of travel, care at a health care facility, or exposure to hot tubs.

DOH stresses that medical provider recognition of the possibility of Legionnaires’ disease (in persons with pneumonia), Pontiac fever (in persons without pneumonia), or Extrapulmonary Legionellosis (in persons with Legionella in sites outside of the lungs) coupled with appropriate diagnostic testing is critical to the identification and investigation of community clusters. Culture of the organism from respiratory secretions or tissues is the gold standard for diagnosis. When ordering culture, providers should specify that the intent is to identify Legionella, as laboratory procedures for identifying this organism are different from standard respiratory specimen cultures. All Legionellosis cases should be reported to the LHD where the individual resides.

Between 2018 and 2019, New York reported 2,479 cases of Legionellosis. Cases reported in 2018 were the highest number of any state and accounted for 14 percent of the cases reported nationally. The statewide incidence rate of 7.2 cases per 100,000 population was more than double the national incidence rate of 3.04 cases per 100,000. While infections occur year-round, the incidence of illness increases during the summer and early fall. The Advisory is available here.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841