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Chapter 127 : Control of in Large Buildings through Community-Wide Introduction of Monochloramine

Authors: Matthew R. Moore1, Brendan Flannery2, Lisa B. Gelling3, Michael Conroy4, Duc Vugia5, James Salerno6, June Weintraub7, Valerie Stevens8, S. Fields Barry9, Richard Besser10
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Affiliations: 1: Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333; 2: Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333; 3: Epidemiology-Communicable Disease Control, Kaua’i District Health Office, 3040 Umi St., Lihue, HI 96766; 4: San Francisco Public Utilities Commission, 1212 Market St., San Francisco, CA 94102; 5: California Department of Health Services, 850 Marina Bay Parkway, Bldg. P, Richmond, CA 94804; 6: San Francisco Public Utilities Commission, 1212 Market St., San Francisco, CA 94102; 7: City and County of San Francisco, Department of Public Health, 1390 Market St., Suite 910, San Francisco, CA 94102; 8: Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333; 9: Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333; 10: Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333
Content Type: Monograph
Publication Year: 2006

Category: Bacterial Pathogenesis

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Abstract:

Monochloramine can be more effective than chlorine at reducing colonization of potable water systems in large buildings, which are key sources of community-and hospital-acquired Legionnaire's disease. Because monochloramine use is associated with lower concentrations of trihalomethanes, many utilities are converting their residual disinfectant from chlorine to monochloramine. In this chapter, the author observed that monochloramine conversion was associated with decreased colonization of buildings served by the municipal water system. To determine whether this decreased risk was sustainable over a longer period of time and at a larger number of distal sites, a larger colonization survey was performed in San Francisco before and after conversion to monochloramine. were isolated from water samples and biofilm swabs, speciated, and serogrouped using standard methods. In the chlorine phase, 29% (45 of 157) of samples collected from water heaters yielded ; fewer than 1% (1 of 159) of water heaters sampled during the monochloramine phase were positive (P<0.001). After controlling for water heater temperature, building height, and disruptions in service, monochloramine use was associated with a 96% reduction in the prevalence of water heater colonization (P<0.001).

Citation: Moore M, Flannery B, B. Gelling L, Conroy M, Vugia D, Salerno J, Weintraub J, Stevens V, Barry S, Besser R. 2006. Control of in Large Buildings through Community-Wide Introduction of Monochloramine, p 526-528. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch127
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Control of Legionella in Large Buildings through Community-Wide Introduction of Monochloramine
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Citation: Moore M, Flannery B, B. Gelling L, Conroy M, Vugia D, Salerno J, Weintraub J, Stevens V, Barry S, Besser R. 2006. Control of in Large Buildings through Community-Wide Introduction of Monochloramine, p 526-528. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch127
/content/10.1128/9781555815660.ch127.ch127fig01
FIGURE 1
colonization of water heaters and distal sites sampled in San Francisco buildings (in rows), by residual disinfectant and sampling interval. species are represented by different patterns. Each row represents a single building and each cell, the results of culture for a site within the building. WH, water heater; D, distal site.
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10.1128/9781555815660/f0527-01.gif
Image of FIGURE 1
FIGURE 1

colonization of water heaters and distal sites sampled in San Francisco buildings (in rows), by residual disinfectant and sampling interval. species are represented by different patterns. Each row represents a single building and each cell, the results of culture for a site within the building. WH, water heater; D, distal site.

Citation: Moore M, Flannery B, B. Gelling L, Conroy M, Vugia D, Salerno J, Weintraub J, Stevens V, Barry S, Besser R. 2006. Control of in Large Buildings through Community-Wide Introduction of Monochloramine, p 526-528. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch127
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References

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1. Cunliffe, D. A. 1990. Inactivation of Legionella pneumophila by monochloramine. J. Appl. Bacte-riol. 68: 453– 459.
2. Fields, B. S.,, R. F. Benson, and, R. E. Besser. 2002. Legionella and Legionnaires’ disease: 25 years of investigation. Clin. Microbiol. Rev. 15: 506– 526.
3. Flannery, B.,, L. B. Gelling,, D. J. Vugia,, J. M. Weintraub,, J. J. Salerno,, M. J. Conroy,, V. A. Stevens,, C. E. Rose,, M. R. Moore,, B. S. Fields, and, R. E. Besser. 2006. Reduction of Legionella colonization after conversion to monochloramine for residual disinfection of municipal drinking water. Emerg. Infect. Dis. In press.
4. Heffelfinger, J. D.,, J. L. Kool,, S. Fridkin,, V. J. Fraser,, J. Hageman,, J. Carpenter, and, C. G. Whitney. 2003. Risk of hospital-acquired Legionnaires’ disease in cities using monochlo-ramine versus other water disinfectants. Infect. Control Hosp. Epidemiol. 24: 569– 574.
5. Kool, J. L.,, J. C. Carpenter, and, B. S. Fields. 1999. Effect of monochloramine disinfection of municipal drinking water on risk of nosocomial Legionnaires’ disease. Lancet 353: 272– 277.
6. Moore, M. R.,, M. Pryor,, B. Fields,, C. Lucas,, M. Phelan, and, R. E. Besser. 2006. Introduction of monochloramine into a municipal water system: impact on colonization of buildings by Legionella spp. Appl. Environ. Microbiol. 72: 378– 383.

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