Controlling Legionnaires’ disease will require a universal, preventive-based approach by a bevy of stakeholders ranging from building owners to hospital administrators, from public health officials to policymakers, and from scientists to water system engineers.

In other words, it’s going to take a village to get a handle on the deadliest waterborne disease in the United States, participants heard recently at the Legionella Conference 2018 in Baltimore, co-sponsored by NSF International and the National Science Foundation.

Incidence of Legionnaires’ disease – a severe lung inflammation caused by Legionella bacteria inhaled from water distribution and premise plumbing systems – has jumped more than 300 percent since 2000. Yet preventative efforts, conference speakers said, are being hampered by a lack of awareness and inconsistent planning, testing and management of building water systems. There are more than 5 million commercial buildings in the United States.

“If we want to reduce the incidence of Legionella outbreaks, and improve our response to them, we need to create a water safety culture,” said Christopher Boyd, General Manager of the Building Water Health Program in North America for NSF International. “That’s the key: integrating all these different stakeholders into a culture of prevention.”


A packed house of 450 attendees listened to presentations from more than 40 experts May 9-11 at Legionella Conference 2018 in Baltimore, co-sponsored by NSF International and the National Science Foundation.

A packed house of 450 attendees listened to presentations from Boyd and more than 40 other experts in this national public health conference focused on Legionella control. Speakers noted that Legionella can contaminate plumbing systems in buildings as well as settings that include water coolers and water tanks, and the bacteria can be affected by a host of factors such as variations in water flow and water temperature and residuals from water disinfectant.

While the Centers for Disease Control and Prevention (CDC) reports about 6,000 cases of Legionnaires’ disease a year, several speakers suggested this is simply the “tip of the iceberg” because the illness is dramatically underdiagnosed. Further, although people in the water industry may understand the severity of the problem, many other stakeholders may need more education.


Andrea Hodgson, an Associate Program Officer at the National Academies of Sciences, Engineering, and Medicine, is working with an Academies committee that is reviewing the state of the science with respect to Legionella and evaluating strategies for controlling these bacteria in water systems.

Local, state and federal regulations were also discussed. Boyd, whose efforts to combat Legionnaires’ disease outbreaks as a former New York City health official led to new regulations there, called on public health departments to develop a standard approach to monitoring and managing Legionella risk.

Legionella outbreaks are generally approached from an emergency management response,” Boyd said. “We need to move public health professionals to adopt best practices to incorporate prevention strategies along with consistent emergency management approaches. This will increase efficiencies and optimize resources, and fundamentally that is going to save lives.”

Learn more about the conference and speakers by following the news coverage below:

Photos by Karen Jackson