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During a Legionnaires' disease outbreak at a Missouri hotel in 2015, the Centers for Disease Control and Prevention assisted state and local health departments to identify possible sources and transmission factors and to recommend improvements to water management. We performed an environmental assessment to understand the hotel's water systems and identify areas of risk for Legionella amplification and transmission. We obtained samples from the pool, spa, and potable water systems for Legionella culture. In the potable water system, we noted temperatures ideal for Legionella amplification and areas of water stagnation. Additionally, we found inadequate documentation of pool and spa disinfection and maintenance. Of 40 water samples, Legionella pneumophila serogroup 1 that matched the sequence type of one available clinical isolate was recovered from five sink and shower fixtures. A comprehensive environmental assessment proved crucial to identifying maintenance issues in the hotel's water systems and underscored the need for a water management program to reduce Legionnaires' disease risk., Introduction Legionnaires' disease (LD) is a severe pneumonia caused by the bacterium Legionella. Approximately 9% of cases are fatal (Dooling et al., 2015). The rate of reported LD cases in [...]

Editor's Note: NEHA strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, we feature this column on environmental health services from the Centers for Disease Control and Prevention (CDC) in every issue of the Journal. In these columns, authors from CDC's Water, Food, and Environmental Health Services Branch, as well as guest authors, will share insights and information about environmental health programs, trends, issues, and resources. The conclusions in these columns are those of the author(s) and do not necessarily represent the official position of CDC., The Need for Water Management Program Training The number of reported Legionnaires' disease (LD) cases increased by more than 250% over the past decade, with at least 8,400 cases reported [...]

Editor' S Note: NERA strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, we feature this column [...]

Editor's Note: As part of our continuing effort to highlight innovative approaches to improving the health and environment of communities, the Journal is pleased to publish a bimonthly column from [...]

Scientific studies of microplastics have expanded since 2015, propelling the topic to the forefront of scientific inquiry. Microplastics are ubiquitous in the environment and pose a potential risk to human health. The purpose of this review is to organize microplastics literature into areas of scientific research, summarize the state of the literature and identify the current data gaps in knowledge to promote a better understanding of human exposure to microplastics and their potential health effects. We searched for published literature from eight databases. Our search focused on three categories: (1) microplastics in the environment, (2) adsorption and absorption of chemicals to microplastics, and (3) human exposure to microplastics in the environment. We screened all abstracts to select articles that focused on microplastics. We then screened the remaining articles using criteria outlined in a questionnaire to identify and assign articles to the three scoping review categories. After screening abstracts, we selected 1186 articles (19%) to thoroughly assess their appropriateness for inclusion in the final review. Of the 1186 articles, 903 (76.1%) belonged to the environmental category, 268 (22.6%) to the adsorption and absorption category, and 16 (1.3%) to the human exposure category. Water was the most frequently studied environmental medium (440 articles). Our assessment resulted in 572 articles selected for the final review. Of the 572 publications, 268 (48.2%) included a geographic component and 110 (19.2%) were the product of literature reviews. We also show that relatively few publications have investigated human health effects associated with exposures to microplastics. [ABSTRACT FROM AUTHOR]

Objectives: Racial and socioeconomic disparities in the incidence of Legionnaires' disease have been documented for the past 2 decades; however, the social determinants of health (SDH) that contribute to these disparities are not well studied. The objective of this narrative review was to characterize SDH to inform efforts to reduce disparities in the incidence of Legionnaires' disease. Methods: We conducted a narrative review of articles published from January 1979 through October 2019 that focused on disparities in the incidence of Legionnaires' disease and pneumonia (inclusive of bacterial pneumonia and/or community-acquired pneumonia) among adults and children (excluding articles that were limited to people aged <18 years). We identified 220 articles, of which 19 met our criteria: original research, published in English, and examined Legionnaires' disease or pneumonia, health disparities, and SDH. We organized findings using the Healthy People 2030 SDH domains: economic stability, education access and quality, social and community context, health care access and quality, and neighborhood and built environment. Results: Of the 19 articles reviewed, multiple articles examined disparities in incidence of Legionnaires' disease and pneumonia related to economic stability/income (n = 13) and comorbidities (n = 10), and fewer articles incorporated SDH variables related to education (n = 3), social support (none), health care access (n = 1), and neighborhood and built environment (n = 6) in their analyses. Conclusions: Neighborhood and built-environment factors such as housing, drinking water infrastructure, and pollutant exposures represent critical partnership and research opportunities. More research that incorporates SDH and multilevel, cross-sector interventions is needed to address disparities in Legionnaires' disease incidence. [ABSTRACT FROM AUTHOR]

Although best management practices have been recommended by government agencies and non-profit organisations to reduce community gardeners' potential exposure to soil contaminants such as lead, some gardeners do not perform these practices. Understanding gardeners' beliefs and motivations is critical for effective promotion of safer gardening practices. This study, grounded in the Theory of Planned Behavior (TPB), employed five focus groups to investigate Atlanta community garden leaders' perspectives concerning three gardening practices: composting, hygiene behaviours, and mulching. These general practices are also considered safe gardening practices in that they can reduce exposure to toxicants in urban gardens. Qualitative analysis identified advantages and disadvantages; supporters and non-supporters; and barriers and facilitators that might influence gardeners' opinions regarding these behaviours. Gardeners expressed that more funding, volunteers, and training are needed to promote these behaviours. Gardeners noted that mulch and compost provided advantages such as improving soil quality, but a primary barrier was concern about contamination of source materials. Focus group participants did not directly associate composting and mulching with reduction of exposure to soil contaminants. Behavioural challenges related to hygiene included concerns about decreased exposure to salubrious bacteria, inadequate access to potable water, and limited availability of gloves and wipes. These study findings characterise factors that community garden stakeholders should consider when promoting safe gardening practices and interventions. [ABSTRACT FROM AUTHOR]

Plastic debris have been shown to degenerate to particle sizes that can be transported in air, water, and food. Small particles are documented to enter and exit our bodies and translocate to and from some internal organs. Health effects on respiratory, hepatic, immune, and gastrointestinal systems have been reported in humans and other mammals in response to elevated particle or fiber exposures. These health effects differed by plastic type and size, and there was evidence of dose response for a few health endpoints. We conducted a systematic word search and reviewed published literature to identify microplastic and nanoplastic studies that quantified exposure via the ingestion, inhalation, and subcutaneous absorption (not dermal) exposure pathways; identified translocation, internal dose, and associations with health effects and markers related to exposures to specific sizes and types of plastics. We identified the data gaps in relating exposure data to health effects and biomarkers, most notably the lack of characterization of plastic particles and fibers smaller than 10 μm in most media. Unlabelled Image • Humans are exposed to microplastics via ingestion, inhalation, and absorption. • There is little exposure information on nanoplastics and most foods. • There is evidence of uptake, absorption, translocation, and effect. • Impacts reported on the immune, respiratory, gastro-intestinal, and hepatic systems. • Effects and target organs are dependent on plastic type, size, and amount. [ABSTRACT FROM AUTHOR]