Epidemic of Legionnaires’ disease prompts Florida Senate Bill 1190 | Guestview

The quiet epidemic of Legionnaires’ disease, impacting almost every state in the country including Florida, is now facing pushback from State Senator Joe Gruters (R), chair of the Florida Senate Commerce and Tourism Committee. Recognizing the adverse impact Legionnaires’ disease outbreaks have on the public health of Floridians and tourism, Senator Gruters introduced SB1190 for the 2020 Legislative Session.

The bill intends to protect the public from Legionnaires’ disease contracted from cooling towers by requiring owners to regularly clean, maintain, treat, sample, and report results to public health officials. If testing reveals that a cooling tower is harboring Legionella growth, it must be reported to the health department and may require public notification.

Legionnaires’ disease is a severe infection of the respiratory system, causing fever, cough, shortness of breath, and a severe form of pneumonia. The bacteria Legionella pneumophila, the most common cause of Legionnaires’ disease, can also cause gastrointestinal symptoms, altered mental status, and neurologic abnormalities. Legionnaires’ disease claims the lives of 10% of those who contract it from community sources, such as cooling towers, and it is fatal to one in four people who develop the disease from hospital and other healthcare sources.

Cooling towers have long been recognized as a major source of Legionnaires’ disease, causing almost half of the recorded outbreaks, and a majority of outbreak-associated cases of disease. Florida, with its year-round warm weather, robust agricultural produce and citrus industries, and constant need for air conditioning and refrigeration, has many cooling towers. Currently, there is no registry of where they are located or requirements for them to be maintained, periodically disinfected, or continuously treated with biocides to avoid the conditions that encourage Legionella growth.

SB1190 is based largely on the New York State legislation enacted after the 2015 New York City outbreak of Legionnaires’ disease. A contaminated cooling tower was found to cause the New York City outbreak infecting at least 128 people and killing 12. Between 2002 and 2018 the number of cases reported nationally increased by 650%, from 1,321 to 9,933 confirmed cases per year.

A 2019 report from the National Academies of Sciences estimated the actual number of Legionnaires’ disease cases in the United States ranges from 52,000 to 70,000 cases annually. In 2018, Florida accounted for 5% of cases reported nationally. If trends hold, this could mean that the actual number of cases occurring in Florida may be closer to 2,600 - 3,500 per year.

As written, SB1190 establishes a number of requirements, but does not clearly lay out the qualifications and competencies for “qualified persons” who will be key to its success. Knowledgeable and trained professionals capable of implementing the bill’s required actions are scarce in Florida. The American Industrial Hygiene Association (AIHA), in cooperation with the National Environmental Health Association (NEHA) is establishing the core competencies and critical training for Industrial Hygienists and Public Health Professionals who investigate outbreaks and perform routine monitoring for Legionella sources. By ensuring there are trained and qualified professionals ready to prepare plans, inspect compliance, and certify cooling towers are safe for operation, the bill is more likely to protect public health.

The cost to building owners, including municipal, county, and state buildings will be substantial to implement requirements of this bill. However, the benefits will outweigh the costs if the final law ensures that professionals performing the inspections, testing, and government oversight are adequately trained and knowledgeable. With robust implementation and effective oversight by state agencies tasked with enforcement, the bill could significantly improve public health for Floridians and tourists.

Florida native J. David Krause, PhD, MSPH, CIH is a Legionnaires’ disease expert with a doctorate from the University of South Florida College of Public Health who served as our state toxicologist from 2008-2011.