ACKNOWLEDGMENTS
This document was prepared for the U. S. Environmental Protection Agency, Office of Ground Water
and Drinking Water (OGWDW) by the Office of Science and Technology (OST) under contract with ISSI
Consulting Group (Contract No. 68-C-98-195). Overall planning and management for the preparation of this
document was provided by Latisha S. Parker, MS of OST.
EPA acknowledges the valuable contributions of those who reviewed this document. They include Lisa
Almodovar MPH, Robin Oshiro, MS and Stephen Schaub, Ph.D. of the U.S. EPA. EPA also thanks the
following external peer reviewers for their excellent review and valuable comments on the draft document:
Joseph Plouffe, Ph.D., James Barbaree Ph.D., Richard Besser Ph.D. and Andrea Benin Ph.D. Table of Contents
1. Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2. Occurrence of Disease/Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
3. Health Effects in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4. Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
5. Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
7. Research Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
8. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111. Executive Summary
Executive Order 13045, “Protection of Children from Environmental Health Risks and Safety Risks,”
requires all federal agencies to ensure that their standards take into account special risks to infants and children.
Children’s bodies are still developing, and therefore, their immune and metabolic systems may not be able to
protect them from the effects of certain environmental health threats. Children also may have greater exposure
to toxic agents than adults because, pound for pound, they breathe more air, drink more water, and eat more
food than adults. In addition, children’s behavior may increase their exposure to these agents (e.g., play
activities, hand-to-mouth patterns).
This document is an addendum to the 1998 Legionella Human Health Criteria document, which covers
all aspects of Legionella, except risk that may be posed to children. In response to that lack of information this
document will evaluate the risk that may be posed to children. The sections of this document address: the
occurrence of disease and infection caused by the bacteria (Section 2), the specific health effects exhibited by
children infected with the bacteria (Section 3), the immune response in infected children and the effects of
breast feeding (Section 4), risk factors for infection (Section 5), conclusions regarding the risk to children posed
by the bacteria (Section 6), and recommendations for further research on children’s risk from Legionella
(Section 7). The references are listed in Section 8. There are considerable data gaps with regard to all aspects
of pediatric Legionella infections.
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