重要提示：2000-2014 年北美的军团病暴发事件中发现了环境控制方面的缺陷。
Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires' Disease - North America, 2000-2014.
出版信息
MMWR Morb Mortal Wkly Rep. 2016 Jun 10;65(22):576-84. doi: 10.15585/mmwr.mm6522e1.
BACKGROUND
The number of reported cases of Legionnaires' disease, a severe pneumonia caused by the bacterium Legionella, is increasing in the United States. During 2000-2014, the rate of reported legionellosis cases increased from 0.42 to 1.62 per 100,000 persons; 4% of reported cases were outbreak-associated. Legionella is transmitted through aerosolization of contaminated water. A new industry standard for prevention of Legionella growth and transmission in water systems in buildings was published in 2015. CDC investigated outbreaks of Legionnaires' disease to identify gaps in building water system maintenance and guide prevention efforts.
METHODS
Information from summaries of CDC Legionnaires' disease outbreak investigations during 2000-2014 was systematically abstracted, and water system maintenance deficiencies from land-based investigations were categorized as process failures, human errors, equipment failures, or unmanaged external changes.
RESULTS
During 2000-2014, CDC participated in 38 field investigations of Legionnaires' disease. Among 27 land-based outbreaks, the median number of cases was 10 (range = 3-82) and median outbreak case fatality rate was 7% (range = 0%-80%). Sufficient information to evaluate maintenance deficiencies was available for 23 (85%) investigations. Of these, all had at least one deficiency; 11 (48%) had deficiencies in ≥2 categories. Fifteen cases (65%) were linked to process failures, 12 (52%) to human errors, eight (35%) to equipment failures, and eight (35%) to unmanaged external changes.
CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE
Multiple common preventable maintenance deficiencies were identified in association with disease outbreaks, highlighting the importance of comprehensive water management programs for water systems in buildings. Properly implemented programs, as described in the new industry standard, could reduce Legionella growth and transmission, preventing Legionnaires' disease outbreaks and reducing disease.
背景
在美国，报告的军团病病例数量不断增加，军团病是一种由军团菌引起的严重肺炎。2000 年至 2014 年间，报告的军团病病例率从每 10 万人中 0.42 例增加到 1.62 例；4%的报告病例与暴发有关。军团菌通过受污染水的雾化传播。2015 年发布了一项新的建筑用水系统预防军团菌生长和传播的行业标准。疾病预防控制中心调查军团病暴发，以确定建筑水系统维护方面的差距，并指导预防工作。
方法
系统地提取了 2000 年至 2014 年疾病预防控制中心军团病暴发调查摘要中的信息，并将陆基调查中发现的水系统维护缺陷分为过程故障、人为错误、设备故障或未管理的外部变化。
结果
2000 年至 2014 年期间，疾病预防控制中心参与了 38 次军团病现场调查。在 27 次陆基暴发中，病例中位数为 10 例（范围=3-82），暴发病例病死率中位数为 7%（范围=0%-80%）。有足够的信息评估维护缺陷的调查有 23 项（85%）。其中，所有调查都至少有一个缺陷；11 项（48%）有≥2 个类别的缺陷。15 例（65%）与过程故障有关，12 例（52%）与人为错误有关，8 例（35%）与设备故障有关，8 例（35%）与未管理的外部变化有关。
结论和对公共卫生实践的意义
与疾病暴发相关的多个常见可预防的维护缺陷已被确定，这突出了建筑用水系统全面水管理计划的重要性。正如新的行业标准所述，适当实施的计划可以减少军团菌的生长和传播，预防军团病暴发和减少疾病。
Zotero 插件