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Legionnaires' disease, a pneumonia caused by the Legionella bacterium, is the leading cause of reported waterborne disease outbreaks in the United States. Legionella occur naturally in water from many different environmental sources, but grow rapidly in the warm, stagnant conditions that can be found in engineered water systems such as cooling towers, building plumbing, and hot tubs. Humans are primarily exposed to Legionella through inhalation of contaminated aerosols into the respiratory system. Legionnaires' disease can be fatal, with between 3 and 33 percent of Legionella infections leading to death, and studies show the incidence of Legionnaires' disease in the United States increased five-fold from 2000 to 2017. Management of Legionella in Water Systems reviews the state of science on Legionella contamination of water systems, specifically the ecology and diagnosis. This report explores the process of transmission via water systems, quantification, prevention and control, and policy and training issues that affect the incidence of Legionnaires' disease. It also analyzes existing knowledge gaps and recommends research priorities moving forward.
Small communities violate federal requirements for safe drinking water as much as three times more often than cities. Yet these communities often cannot afford to improve their water service. Safe Water From Every Tap reviews the risks of violating drinking water standards and discusses options for improving water service in small communities. Included are detailed reviews of a wide range of technologies appropriate for treating drinking water in small communities. The book also presents a variety of institutional options for improving the management efficiency and financial stability of water systems.
Pursuant to a congressional request, GAO reviewed small community water systems' compliance with drinking water regulations, focusing on: (1) cost-effective and alternative management approaches for improving small water systems' regulation compliance; (2) the barriers that prevent the effective use of these alternative approaches; and (3) the Environmental Protection Agency's (EPA) efforts to remove any barriers and promote alternative approaches at the national level. GAO found that: (1) state efforts to improve small community water systems' compliance with safe drinking water standards include developing technology- and management-based alternative strategies, determining whether alternatives are cost-effective, testing ways to provide technical and financial assistance to small systems, and exploring small system restructuring options; (2) barriers that prevent states from using alternative strategies include the high cost and complexity of some treatment technologies and the lack of cost and performance data necessary to assess alternative technologies and identify nonviable water systems to ensure they comply with drinking water standards; (3) although EPA supports states' consolidation of nonviable water systems, its drinking water grant formula provides a disincentive for consolidating water systems; (4) EPA efforts to address the barriers include field testing alternative treatment technologies, improving state technical and managerial capabilities, revising state grant allocation methods, and recommending that states develop viability programs; and (5) EPA needs to revise its drinking water program priorities to emphasize the development and implementation of viability programs, work with Congress to ensure that its proposed requirement is accompanied by a realistic funding strategy, and eliminate disincentives for consolidating water systems.