What You Need To Know
Key Points or Updates:
- The New Jersey Department of Health (NJDOH) is observing an increase in reported cases of Legionnaires' disease in the Northeast and Central East regions of the state.
- Healthcare providers should maintain a high index of suspicion for Legionella when evaluating patients with community-acquired or healthcare-associated pneumonia, especially if SARS-CoV-2 testing is negative.
- NJDOH requests that lower respiratory specimens be collected and retained for patients who test positive for Legionella via a urinary antigen test and who reside in, work in, or have recently visited Ocean County, Union County, or Middlesex County.
- All suspected or confirmed cases of legionellosis (Legionnaires’ disease and Pontiac fever) should be promptly reported to the local health department where the patient resides. If the patient’s residence is unknown, report to your own local health department. Contact information is available at: localhealth.nj.gov.
- Local health departments should promptly investigate legionellosis cases within their jurisdiction using the Legionellosis Cluster Hypothesis Generating Questionnaire and inquire about any time spent in Ocean County, Union County, or Middlesex County, including addresses of locations visited and respective dates.
INFORMATION FOR HEALTHCARE PROVIDERS, FACILITIES, AND CLINICAL LABORATORIES
Healthcare providers should consider the diagnosis of Legionnaires’ disease in patients presenting with clinical features of pneumonia, fever, and cough. NJDOH requests that lower respiratory specimens (sputum, bronchoalveolar lavage, tracheal aspirate, or lung tissue) are collected and held for patients who tested positive for Legionella by a urinary antigen test and who reside in, work in, or otherwise visited Ocean County, Union County, or Middlesex County.
- These respiratory specimens should ideally be obtained prior to antibiotic administration, but antibiotic treatment should not be delayed to facilitate this process (and culture can be attempted even after antibiotic therapy has been initiated).
- Respiratory specimens should be frozen immediately after collection at =-20°C.
- Please inform your laboratory to not reject respiratory specimens based on specimen quality (e.g., due to lack of white blood cells in the sample, contamination with other bacteria).
Inform NJDOH’s Water Systems and Environmental Infection Control Unit (ICHEE.Water@doh.nj.gov) if any respiratory specimens are collected. After further public health investigation, NJDOH may request that these specimens are sent to a public health laboratory for Legionella culture and molecular sequencing free-of-charge.
Diagnostic Testing
The urinary antigen test is the most widely available rapid method of diagnosis and detects Legionella pneumophila serogroup 1. A negative urinary antigen test, however, does not rule out infection from other Legionella species and serotypes.
Culture of Legionella from a respiratory specimen (e.g., sputum, tracheal aspirate, or bronchoalveolar lavage fluid) is the gold standard diagnostic test and should be used in conjunction with rapid non-culture diagnostics like the Legionella urinary antigen test. Culture has the added benefits of identifying non-pneumophila Legionella that may cause infection and of generating isolates that can be further analyzed using molecular techniques. Molecular techniques can be used to compare clinical isolates to environmental isolates and confirm an outbreak source. The urinary antigen test alone does not allow for molecular comparison to environmental isolates.
Reporting
Health care providers and administrators are required to report cases of legionellosis (Legionnaires’ disease and Pontiac fever) to the local health department where the patient resides within 24 hours of diagnosis (N.J.A.C. 8:57 – 1.4). If the patient residence is unknown, report to your own local health department. Contact information is available at: localhealth.nj.gov. Timely identification and reporting of cases of legionellosis is important, as this allows public health officials to quickly identify and stop potential clusters and outbreaks by linking new cases to previously reported ones.
Contact Information:
Water Systems and Environmental Infection Control Unit, Communicable Disease Service, ICHEE.Water@doh.nj.gov.