A recent article by Henry Miller in Forbes magazine suggested that CDC policy on Legionella control was flawed. Miller, a well published biomedical scientist, a senior FDA policy maker and founding director of the FDA's Office of Biotechnology, sets out to debunk bad science and poor policy.
In the Forbes article he draws attention to the disease control oriented policy of the USA CDC (CDC is responsible for the control of Legionnaires disease (LD) cases in the USA). The CDC policy appears to be based on doing nothing, and especially not monitoring, until an LD case is detected at which point monitoring of the spread of the disease and the source water system is recommended. According to Miller this bizarre policy has its roots in the control of person to person transmitted diseases, like small pox, where it has been successful. LD is an environmentally transmitted disease and therefore cannot be controlled by monitoring diseased people. For diseases of environmental origin proactive environmental surveillance, rather than reactive disease surveillance, is the appropriate prevention strategy.
The article refers to culture techniques for monitoring the Legionella bacterium environment. In fact this reliance on lab culture testing may be part of the problem for the poor policy. As lab culture tests take 10-14 days to return a result the window for effective management control is reduced to virtually zero. Having established that environmental monitoring is the correct policy, the next important plank in a sound policy would be to determine which form of environmental monitoring is most useful in supporting timely control actions. Legionella antigen is directly linked to, and an unequivocal indicator of, the presence of Legionella bacteria in a water system, providing a convenient, reliable, and immediate call to action. Antigen testing can provide a result on-site in 25 minutes
The Hydrosense Legionella test detects the antigen of Legionella pneumophila serogroup 1. The strain of the Lp bacterium which causes upwards of 90% of all cases of LD and has been responsible for all outbreaks of the disease.
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