title: Introduction of monochloramine into a municipal water system: impact on colonization of buildings by Legionella spp.
abstract: Legionnaires' disease (LD) outbreaks are often traced to colonized potable water systems. We collected water samples from potable water systems of 96 buildings in Pinellas County, Florida, between January and April 2002, during a time when chlorine was the primary residual disinfectant, and from the same buildings between June and September 2002, immediately after monochloramine was introduced into the municipal water system. Samples were cultured for legionellae and amoebae using standard methods. We determined predictors of Legionella colonization of individual buildings and of individual sampling sites. During the chlorine phase, 19 (19.8%) buildings were colonized with legionellae in at least one sampling site. During the monochloramine phase, six (6.2%) buildings were colonized. In the chlorine phase, predictors of Legionella colonization included water source (source B compared to all others, adjusted odds ratio [aOR], 6.7; 95% confidence interval [CI], 2.0 to 23) and the presence of a system with continuously circulating hot water (aOR, 9.8; 95% CI, 1.9 to 51). In the monochloramine phase, there were no predictors of individual building colonization, although we observed a trend toward greater effectiveness of monochloramine in hotels and single-family homes than in county government buildings. The presence of amoebae predicted Legionella colonization at individual sampling sites in both phases (OR ranged from 15 to 46, depending on the phase and sampling site). The routine introduction of monochloramine into a municipal drinking water system appears to have reduced colonization by Legionella spp. in buildings served by the system. Monochloramine may hold promise as community-wide intervention for the prevention of LD.
authors.affiliation: Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-23, Atlanta, GA 30333, USA. matt.moore@cdc.hhs.gov
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Moore
authors.forename: Marsha
authors.initials: M
authors.lastname: Pryor
authors.forename: Barry
authors.initials: B
authors.lastname: Fields
authors.forename: Claressa
authors.initials: C
authors.lastname: Lucas
authors.forename: Maureen
authors.initials: M
authors.lastname: Phelan
authors.forename: Richard E
authors.initials: RE
authors.lastname: Besser
mesh_terms: D000656:Amoeba / Q000302:isolation & purification; D000818:Animals; D002700:Chloramines / Q000494:pharmacology*; D002947:Cities; D003252:Construction Materials / Q000382:microbiology*; D004202:Disinfectants / Q000494:pharmacology*; D004203:Disinfection / Q000379:methods; D005431:Florida; D005618:Fresh Water / Q000382:microbiology* / Q000469:parasitology; D006798:Housing; D007875:Legionella / Q000187:drug effects* / Q000254:growth & development*; D011633:Public Facilities; D014881:Water Supply / Q000592:standards*
chemical_list: D002700:Chloramines; D004202:Disinfectants; C030816:chloramine