Communications Resources

During a Legionnaires’ disease outbreak public health officials may need to quickly communicate through multiple channels to different stakeholders. Below are communication resources to help you during a Legionnaires’ disease outbreak.

Communication Toolkit

Protocols and guidance for communicating Legionnaires’ disease risks and mitigation information can vary across and within jurisdictions. The below toolkit offers comprehensive communications guidance for health departments, including setting- and scenario-specific modules.

• The Council for State and Territorial Epidemiologists Legionnaires’ Disease Risk Communication Toolkit

Notification Letter Templates

In notification letters, you want to convey what you know about the situation, who is at risk, and what you are doing to protect against further illness. Consider addressing the following elements when drafting notification letters:

• Who is the intended audience (i.e., hotel/travel accommodation guests, healthcare facility staff, patients and their families, community members)?
• What do you know about the case exposures (i.e., does the available epidemiologic information point to a given setting or device as the source of exposure)?
  • How many cases have common exposures?
  • What type of exposures are potentially implicated?
  • How tightly clustered in time were the cases?
• What do you know about the environment (i.e., the level of certainty that the implicated setting was the source of exposure)?
  • Have you already performed environmental sampling? Were any samples positive for Legionella?
  • Have you already obtained and characterized clinical and environmental isolates to confirm the exposure source?
• What measures have been taken so far or will be taken to prevent further cases (e.g., shutting down/draining hot tubs, remediating the hot water system, water restrictions, installation of point-of-use filters)?
• How can those at risk protect themselves (i.e., who is at increased risk, how is it spread and treated, where can more information be found [include contact information for the appropriate public health jurisdiction])?
• What are the symptoms that people should monitor for and over what time frame (e.g., monitor for respiratory symptoms for 14 days after most recent potential exposure. If symptoms develop, seek care and speak with a clinician about Legionella).

For travel outbreaks, consider

• Whether past guests who may have unrecognized or incubating infections should be notified about possible exposures that may have already occurred
• Whether future guests should be notified of the potential for exposure prior to or upon arrival so that they have an opportunity to find another accommodation if they are at increased risk

Below are customizable letter templates for use during Legionnaires’ disease outbreaks. Public health officials can adapt these templates according to individual circumstances, preferences, and available resources.

Healthcare Facilities

• Notification letter template to healthcare facility staff regarding a single possible healthcare-associated Legionnaires’ disease case
  Word [1 page] | PDF [1 page]
• Notification letter template to healthcare facility staff regarding a single presumptive healthcare-associated Legionnaires’ disease case, when a full investigation is warranted
  Word [1 page] | PDF [1 page]

Hotels

• Notification letter template to hotel/travel accommodation guests regarding a Legionnaires’ disease outbreak investigation
  Word [1 page] | PDF [1 page]
• Notification letter template to hotel management regarding a single Legionnaires’ disease case possibly associated with a travel accommodation
  Word [1 page] | PDF [1 page]

Sample Letters

Below are sample notification letters that have been used in various Legionnaires’ disease outbreaks.

• Letter to Tenants — 2017 [1 page]
• Letter to Tourist Accommodation — 2017 [2 pages]
• Guest Notification Letter — 2016 [1 page]

Fact Sheets

You may choose to attach or include these fact sheets with notification letters to general public audiences or healthcare facility staff.

• Legionnaires’ Disease [1 page]
  This fact sheet describes what Legionnaires’ disease is, its symptoms, how it’s spread and treated, and who is at increased risk.

• What Clinicians Need to Know about Legionnaires’ Disease [2 pages]
  This 2-page fact sheet describes diagnosis, testing, treatment, reporting, etiology, transmission, risk factors, common sources of infection, and prevention of Legionnaires’ disease.

Sample Press Releases

During an outbreak investigation, it is important to prepare how, when, and what you are going to communicate to the press. Below are sample Legionnaires’ disease outbreak investigation press releases created by health department officials around the country.

• New Jersey Department of Health Investigating Cluster of Legionnaires’ Cases in Union County — New Jersey Department of Health, 2021
• Health Department Investigating a Community Cluster of Legionnaires’ Disease in the Highbridge Neighborhood in the Bronx — New York City Department of Health and Mental Hygiene, 2022
• Southern Nevada Health District Investigating Two Cases of Legionnaires’ Disease — Southern Nevada Health District, 2018

Sample Health Advisories

During an outbreak investigation, it may be necessary to alert area clinicians about the outbreak and provide information about appropriate diagnostic testing and treatment. Below are sample health advisories created by health department officials around the country.

• Health Alert: Increase in Legionnaires’ Disease in Northeast Philadelphia [1 page] — Philadelphia Department of Public Health, 2017
• 2022 Alert #8: Test for Legionella in Adults for Pneumonia [3 pages] — New York City Department of Health and Mental Hygiene, 2022

Communications Considerations

• Be prepared — consider establishing a communications plan for outbreaks. It should include a strategy for when and how you will provide updates to the general public and media.
• Gauge level of public concern (large numbers of cases often result in extensive media attention).
• Consider participating in community events, like town halls, to communicate information about the outbreak to the public and answer their questions.
• Identify communications points of contact at the lead public health agency and facility, if applicable.
• For outbreaks in healthcare settings, discuss with the facility staff how to notify employees, visitors, and patients in a proactive manner.
• For outbreaks in travel accommodation settings, discuss with building owners/managers how to notify guests and staff in a proactive manner.
• Develop key messages and coordinate early and often at all levels (facility, local, state, and federal) to ensure clear and consistent messaging.
• Provide information only and do not speculate. Explain what you know and do not know. Do not jump to conclusions regarding the outbreak source.
• Consider providing estimates of case counts rather than an exact number (e.g., “more than 10 cases”).
• Describe how outbreaks typically have low attack rates and characterize disease transmission.
• Encourage anyone who has symptoms of Legionnaires’ disease to see a healthcare provider who can evaluate their symptoms and provide testing and treatment, if indicated.
• Use letter templates and other resources to notify healthcare facility staff, owners of travel accommodations, and travel accommodation guests.
• Consider terminology. Clusters and outbreaks have the same definition for Legionella and you can use either term. Both terms describe two or more people with Legionnaires’ disease exposed to Legionella at the same place at about the same time (as defined by the investigators). However, your target audience (e.g., the general public, the media, building owners/managers, healthcare facility staff) may perceive the terms differently. It is up to you to decide how to use these terms, but, whatever you choose, use the terms consistently.