Primary prevention
There is no vaccine for Legionnaires’ disease and antibiotic prophylaxis is not effective.[10]
The key to preventing Legionnaires’ disease is to reduce the risk of Legionella growth and spread. Water management programmes, including regular checks of building water systems and devices at risk for Legionella growth and transmission (e.g., showerheads and faucets, cooling towers, hot tubs, decorative fountains, and hot water tanks and heaters), can reduce the likelihood of outbreaks.[10] Most hospitals sample water regularly for Legionella, but routine testing is not required. When there is an outbreak, sampling should be dictated by the circumstances present in the facility.[34] Disinfection methods have been moderately successful and involve super-heating the water to 75°C (167°F) and distal site flushing, installing copper-silver ionisation units, and hyper-chlorinating the water.[35]
Travellers at increased risk for infection, such as older people or people with immunocompromise, should ideally avoid recognised high-risk exposures such as hot tubs.[10]
Secondary prevention
Secondary prevention involves prompt response to identification of a case. New patterns in testing show that diagnosis by culture, direct fluorescent antibody assay, and serological tests have decreased, and diagnosis by urine antigen test has dramatically increased. This limits detection of non-Legionella pneumophila serogroup 1 disease and impairs detection and control of outbreaks.[60] The relevant authority should be alerted so that an investigation may be performed if warranted.[84]
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