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Study: Legionnaire's disease cases tripled in last decade

Researchers fault underdiagnosis and ineffective guidelines to prevent the disease as being at fault for the increase in cases.

By Stephen Feller

WASHINGTON, Aug. 7 (UPI) -- Officials in New York City say the Legionnaires' disease outbreak the city has dealt with for the last month -- at least 10 deaths and more than 100 confirmed cases -- appears to be winding down, but national health statistics in the U.S. show cases of the disease have tripled during the last decade.

The Legionella bacteria lives in warm, damp spaces such as air conditioning cooling towers and spas, and is spread most often by water drops in the air. The disease is characterized by pneumonia or similar symptoms and is most deadly for the elderly and people with compromised immune systems.

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"Legionnaires' disease continues to increase in importance as a public health issue in the United States, and legionellosis has one of the most rapidly increasing rates among nationally notifiable diseases. Surveillance artifacts should be considered as a possible reason for the increase," researchers wrote in a study published in the Journal of Public Health Management and Practice. "There is no evidence that there have been significant improvements in reporting, physician education, or diagnosis for this disease in the past decade. The disease is markedly underdiagnosed, even among hospitalized patients with community-acquired pneumonia."

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The number of cases of Legionnaires' disease rose from 1,127 in 2000 to 3,688 in 2012, and 4,548 cases in 2013, according to the Centers for Disease Control.

The CDC reports that between 8,000 and 18,000 people in the United States are hospitalized each year with Legionnaires' disease, a stark difference from the number of confirmed annual cases.

In addition to analyzing the increasing number of cases of the disease, researchers at Emory University reviewed national care standards, preparedness for handling and outbreaks, and guidance for preventing them, finding them significantly lacking in many ways.

"Cases associated with an outbreak comprise only 4 percent of the total number of individuals reported to public health authorities, and more attention is needed to address prevention of cases not known to be associated with an outbreak," the researchers wrote.

Noting that at least 4 agencies are responsible for preventing legionella's appearance in the various wet structures of cities, as well as handling outbreaks and monitoring clean-up when they occur, the researchers suggest a comprehensive review of national public health guidelines to improve what they call a growing problem.

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