What are rates of Legionnaires disease among VA patients?

Bottom Line: Rates of Legionnaires disease (LD) among U.S. Department of Veterans Affairs (VA) patients with overnight stays at a VA facility decreased from 2014 to 2016, even though overall rates of LD among VA patients increased in the same period; 91 percent of the 491 LD cases in the VA surveillance system had no VA exposure or only outpatient VA exposure.

Why The Research Is Interesting: Cases of LD have been increasing in the United States for decades. Health care facilities can transmit Legionella bacteria from building water systems to occupants. The VA has implemented prevention strategies at its medical facilities and has a national reporting system for LD cases, offering the first opportunity to look at LD rates in a U.S. healthcare system on a national level.

What and When: 491 LD cases in the VA surveillance system among patients from 2014 to 2016

What (Study Measures and Outcomes): Annual LD rates with cases categorized as VA or non-VA exposure

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control for all the natural differences that could explain the study results.

Authors: Shantini D. Gamage, Ph.D., M.P.H., of the VA National Infectious Diseases Service, Washington, D.C., and the University of Cincinnati College of Medicine, Cincinnati, Ohio, and coauthors.

Results: Total rates of LD increased from 1.5 to 2.0 per 100,000 VA enrollees from 2014 to 2016; 91 percent of the 491 LD cases had no VA exposure or outpatient-VA exposure; 44 cases of LD occurred in patients who had stayed at the VA overnight. The LD rate for the subset of VA patients who had an overnight stay significantly decreased between 2014 and 2016.

Study Limitations: Some cases of LD may have been missed, including cases in VA enrollees not diagnosed or treated at VA facilities; routine medical record reviews weren't done

Related Material: The invited commentary, "Prevention of Health Care-Associated Legionnaires Disease," by Shawn J. Skerrett, M.D., of the University of Washington School of Medicine, Seattle, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.0230)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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