New Jersey health officials reported last week on two cases of Legionnaires’ disease reported in August 2022 from the section of Hamilton Township, Mercer County, served by Trenton Water Works (TWW).
Two additional cases were reported, respectively in April 2022 and December 2021. Of the four, one individual has died.
Legionnaires’ disease is a type of pneumonia that people can get after breathing in aerosolized water (small droplets of water in the air) containing Legionella bacteria. You cannot get Legionnaires’ disease by drinking water that has Legionella. Less commonly, people can get sick when water containing Legionella is aspirated into the lungs while drinking (“goes down the wrong pipe”).
The New Jersey Department of Health (NJDOH) receives approximately 250–350 reports of Legionnaires’ disease each year throughout New Jersey. Public health departments routinely conduct disease surveillance to identify suspected clusters or outbreaks. When an outbreak is identified, impacted individuals are notified so they are aware of steps they can take to reduce their risk of Legionnaires’ disease.
The Hamilton Township Division of Health continues to work closely with NJDOH to investigate these cases. This is part of a larger ongoing investigation to determine potential sources of Legionella contributing to the higher burden of Legionnaires’ disease in Hamilton Township. Health officials continue to conduct surveillance for Legionnaires’ disease in other municipalities served by TWW.
As part of these ongoing efforts, the Hamilton Township Division of Health and NJDOH recruited 20 homeowners from Hamilton Township to voluntarily have their homes tested for Legionella. Water samples collected from more than half of the homes served by TWW identified the presence of Legionella, including in samples of the cold water entering homes. It is possible for Legionella to enter buildings and homes when receiving treated drinking water. However, health officials are concerned about the number of homes with Legionella in areas serviced by TWW. There is concern that Legionella may be present in other buildings and homes in the area, particularly in the areas of Hamilton Township served by TWW.
Hamilton Township and NJDOH are partnering with the New Jersey Department of Environmental Protection (NJDEP) and TWW to investigate factors that may be promoting the growth of Legionella bacteria and to evaluate actions that can be taken to reduce Legionella in the system. Investigators are also assessing if the other municipalities served by TWW are impacted.
“I want to thank Hamilton’s Division of Health, NJDOH, and NJDEP for their joint and thorough investigation into the causes of Legionnaire’s disease here in Hamilton,” said Mayor Jeff Martin. “This has been an issue for many years and their tireless work will hopefully reveal a cause for the high number of cases here in the Township – specifically those in the TWW service area.”
NJDOH recommends that all homeowners and building owners follow best practices to maintain their household and building water systems. However, health officials are especially urging residents and business owners in Hamilton Township served by TWW to take actions to reduce the risk of Legionella growth in their household and building plumbing. Recommendations for homeowners and building owners are available below.
It is not known whether individuals with Legionella detected in their home are more likely to develop Legionnaires’ disease, but there is no safe amount of Legionella, and individuals at increased risk for Legionnaires’ disease are especially urged to follow best practices for home plumbing system maintenance and safe uses of water.
It is rare for a healthy person exposed to Legionella to become sick with Legionnaires’ disease. However, people who are 50 years or older, especially those who smoke, or those with certain medical conditions, including weakened immune systems, chronic lung disease or other chronic health conditions, are at increased risk for Legionnaires’ disease.
Symptoms of Legionnaires’ disease include cough, shortness of breath, fever, muscle aches, and headaches, which are similar to symptoms caused by other respiratory infections, including COVID-19. Legionnaires’ disease can be fatal but is treatable with antibiotics. It is important that anyone who thinks they have symptoms of Legionnaires’ disease contact their health care provider and seek medical evaluation.
The Hamilton Township Division of Health and NJDOH want to remind healthcare providers to maintain a high index of suspicion for Legionnaires’ disease when evaluating patients for community-acquired and healthcare-associated pneumonia, especially among residents of Hamilton Township. This is important to ensure patients receive appropriate and timely treatment. Appropriate testing for Legionnaires’ disease includes use of the urinary antigen test and collection of a lower respiratory specimen.
“There are simple precautions that residents can take to help protect themselves – such as regularly flushing water at their taps, cleaning their showerheads, and maintaining their water heaters,” said State Epidemiologist Dr. Tina Tan. “Additionally, home and car air-conditioning units do not use water to cool the air, so they are not a risk for Legionella growth.”
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