LEGIONELLA - World Health Organization

hot water (e.g. health-care facilities, hotels, saunas and swimming pools). The Dutch College
of General Practitioners has also been asked to improve the education of GPs on rare,
preventable, infectious diseases. In addition, regulations were drafted and guidance was issued
to ensure the safety of water in buildings (see Table 10.1).
Several guidelines for the management of adult community-acquired pneumonia have been
published. These include:
• American Thoracic Society guidelines, which were published in 1993 and updated in
2001 (Niederman et al., 1993; ATS, 2001)
• Guidelines of the Infectious Diseases Society of America, which were published in 1998 and
updated in 2004 (Mandell et al., 2004)
• Canadian guidelines for the initial management of community-acquired pneumonia (Mandell
et al., 2002)
• British Thoracic Society Guidelines (2001)
• European Respiratory Society Guidelines (ESOCAP, 1998).
Although these guidelines differ in several treatment recommendations, they uniformly recommend
regular antibiotic coverage of Legionella spp. in severe pneumonia requiring admission to
intensive care units.
Likely benefits of the adoption of the described measures to control and reduce the risks posed
by legionellae in cooling tower systems and warm water systems have been discussed in the
regulatory impact statement for the Victorian Health (Legionella) Regulations (Anon, 2001).
The direct benefits are from expected reductions in the incidence of the disease, which would
reduce mortality and lead to hospital cost savings. Indirect benefits include savings of medical
costs from treating patients, due to an associated reduction in non-fatal incidence of the disease,
and a reduction in loss of economic output caused by inability to work. Benefit calculations
range from US$8 million (“worst case”, with 25% effectiveness) to US$15 million (“best case”,
with 50% effectiveness). These calculations do not include any valuation of the estimated
10–20 lives that could be saved over a 10-year period. Given the US$20–27.5 million range
of net present value for the proposed package of controls, including the health regulations for
Legionella, the implicit costs per life saved range between US$1 million and US$3 million
(Anon, 2001).
LEGIONELLA AND THE PREVENTION OF LEGIONELLOSIS