Identify and Report Travel-Associated Legionnaires' Disease

Travel-Associated Legionnaires' Disease Should be a Priority

More than 20% of Legionnaires' disease cases reported to CDC are travel-associated.

Legionnaires' disease is important to diagnose and report because its identification implies the presence of an environmental source to which other susceptible individuals are likely to be exposed. Clusters of Legionnaires' disease associated with travel to hotels or aboard cruise ships are rarely detected by individual clinicians or health departments; travelers typically disperse from the source of infection before developing symptoms. Therefore, a travel history should be actively sought from patients with community-acquired pneumonia and Legionella testing should be performed for those who have traveled in the 2 weeks before onset of symptoms.

Because of the multi-state nature of travel in the U.S., national-level surveillance is necessary to detect outbreaks of travel-associated Legionnaires' disease. CDC relies upon state and local health departments to conduct this surveillance. Surveillance through the National Notifiable Diseases Surveillance System (NNDSS) is still important for monitoring national trends; all cases should be reported through NNDSS.

CSTE adopted a position statement relevant to travel-associated Legionnaires' disease in 2005. See this CSTE position statement.

Reporting a Travel-Associated Case of Legionnaires' Disease

Because of the public health importance of timely reporting, inform CDC of travel-associated cases by emailing travellegionella@cdc.gov. CDC will notify the state health departments where the patient traveled.

Health departments may choose to notify the hotel (See sample letter [66 KB, 2 pages]).

CDC Can Assist Health Departments in Investigating a Potential Cluster of Legionnaires' Disease

1. Epidemiologic assistance

   CDC staff, including Epidemiologic Intelligence Service officers (EIS), are available to assist with investigations including facilitating communication among state health department officials in a travel-associated case or outbreak. We can also assist with case definitions and disease reporting.

   Inform CDC about travel-associated cases by emailing travellegionella@cdc.gov. We are trying to improve the efficiency of travel-associated surveillance at CDC and need your help. Please continue official reporting mechanisms through NNDSS and through submission of case report forms[439 KB, 2 pages].

   Public inquiries: Please contact CDC INFO at 1-800-CDC-INFO, (800-232-4636), TTY: (888) 232-6348, cdcinfo@cdc.gov.

2. Sample outbreak questionnaires and other tools

   Samples of questionnaires used in institutional outbreaks, tracking travel-associated cases, or other situations are available upon request to use as tools or 'starter points' as you begin your investigation.

3. Laboratory testing

   CDC does not accept laboratory specimens of any type without clearance through the Respiratory Diseases Branch prior to submission. This includes urine antigen testing, specimens for culture, or other submissions for either initial or confirmatory testing.

   CDC laboratory testing is only done under special circumstances, e.g., an outbreak investigation that CDC is involved with, or if CDC has granted prior permission for submission of specimens. Routine laboratory submissions are not accepted by the CDC's laboratories.

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