New case of Legionnaires’ disease reported

North Carolina

RALEIGH, N.C. (WNCT) Public health officials are reporting a case of Legionnaires’ disease in a person who did not attend the Mountain State Fair but was present at the Western North Carolina Agricultural Center (WNC Ag Center) after the fair ended.

The person attended the Quilt Show held at the WNC Ag Center on September 27–29. 

To date, it is the only case of Legionnaires’ disease in an individual who did not attend the NC Mountain State Fair but was at the WNC Ag Center after the fair ended on September 15.

To protect the individual’s privacy, specific information such as county of residence or age will not be released. 

“We don’t know how or where this person might have been exposed to the Legionella bacteria,” said Dr. Zack Moore, State Epidemiologist. “It is possible that they were exposed at the WNC Ag Center, but Legionella bacteria are very common in the environment so we can’t rule out exposure in another location.” 

Public health officials are continuing to monitor for new cases of Legionnaires’ disease and have not identified any other reports in people who were at the WNC Ag Center after the Mountain State Fair ended. 

Health officials visited the WNC Ag Center on September 25 and 27 and did not identify any significant sources of aerosolized water.

The North Carolina Department of Agriculture and Consumer Services (NCDACS) suspended the rental of the Davis Event Center at the WNC Ag Center for mitigation activities after Legionella bacteria were found in one of six samples.

Out of an abundance of caution, NCDACS recommended and supervised an extensive industrial cleaning of the WNC Ag Center water system.

Legionella was not found in follow-up testing of samples collected on October 4 and 7. 

More information about Legionnaires’ disease can be found on the CDC website at www.cdc.gov/legionella/index.html and on the DPH website at epi.dph.ncdhhs.gov/cd/diseases/legionellosis.html.

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RALEIGH, N.C. (AP) — North Carolina health officials say a third person has died from an outbreak of Legionnaires’ disease linked to a hot tub display at a fair.

The Department of Health and Human Services confirmed the third death to news outlets Monday.

The department says 140 cases of Legionnaires’ have been confirmed in 19 North Carolina counties and “multiple states.” It says in addition to the three deaths, 94 people have been hospitalized.

The agency says the cases are connected to people who attended the Mountain State Fair last month in Fletcher. It says testing found Legionalla bacteria in one water sample at the fair and those who were diagnosed with the disease may have walked by the hot tub displays.

The department says they won’t release any information on the victims.

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RALEIGH, N.C. (WNCT)— Officials with the North Carolina Department of Health and Human Services’ Division of Public Health today released an interim report and FAQ related to the investigation into the Legionnaires’ disease outbreak associated with the NC Mountain State Fair.

As of Wednesday, the Division of Public Health has confirmed 134 cases of Legionnaires’ disease or Pontiac Fever in residents of multiple states and North Carolina counties who attended the 2019 NC Mountain State Fair, which took place September 6–15 at the Western North Carolina Agricultural Center in Fletcher.

88 people have been hospitalized and two deaths have been reported.

To protect the privacy of the families, the decedents’ personal information including location of residence, ages and genders will not be released.

“We send our sincerest condolences to the families of the two people who have died and to all those who have been affected by this outbreak,” said Dr. Zack Moore, State Epidemiologist. Legionnaires’ disease is a serious illness that can lead to complications and death, especially in older individuals or those with underlying conditions.”

The interim report outlines the timeline and process that the Division of Public Health, the North Carolina Department of Agriculture and Consumer Services, the Buncombe County Department of Health and Human Services, other local health departments and the Centers for Disease Control and Prevention (CDC) used throughout the investigation.   

The preliminary epidemiologic and environmental findings suggest that exposure to Legionella bacteria occurred in the Davis Event Center of the WNC Ag Center, particularly near the hot tubs and during the last five days of the fair.

Hot tubs are a well-established source of aerosolized water exposure and have been associated with previous Legionnaires’ disease outbreaks nationally and internationally.

These results highlight the importance of caring for and maintaining equipment that can aerosolize water.

There were no other significant sources of aerosolized water at the WNC Ag Center and no other ongoing potential sources of exposure identified. 

The report provides preliminary information from the investigation to date.

Additional information will be provided when the environmental and epidemiologic investigations are complete.   

Legionella bacteria are found naturally in the environment.

These bacteria can become a health concern when they grow and spread in human-made building water systems like hot water tanks, cooling towers of air conditioning systems, decorative fountains and hot tubs or spas that aren’t properly maintained.

Approximately 200 cases are reported annually in North Carolina.

If you experience symptoms consistent with pneumonia, please contact your health care provider.

Updated case counts and information about the outbreak are available online at https://epi.dph.ncdhhs.gov/cd/legionellosis/outbreak.html.

The FAQ can be found at https://epi.dph.ncdhhs.gov/cd/legionellosis/PublicFAQ

The Interim Summary Report at https://epi.dph.ncdhhs.gov/cd/legionellosis/InterimReportLegionnairesDiseaseOutbreak.

More information about Legionella bacteria and Legionnaires’ disease can also be found on the CDC website at https://www.cdc.gov/legionella/index.html and on the DPH website at https://epi.dph.ncdhhs.gov/cd/diseases/legionellosis.html

For additional information or to report possible cases, please call your local health department or the NCDHHS Division of Public Health at (919) 733-3419.

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RALEIGH, N.C. (WNCT) — The North Carolina Department of Health and Human Services is sharing early findings from an ongoing investigation to determine how people were exposed to Legionella bacteria at the NC Mountain State Fair.

The fair took place on September 6–15, 2019 at the Western North Carolina Agricultural Center in Fletcher.

As of Wednesday, 124 cases of Legionnaires’ disease and Pontiac fever (a milder form of infection) had been reported in people who attended or worked at the fair. 

Preliminary findings indicate that people who were diagnosed with Legionnaires’ disease were much more likely to have visited the Davis Event Center while at the fair and much more likely to report having walked by the hot tub displays compared to people who did not get sick.

The Davis Event Center is a large building that housed many vendor displays during the fair, including hot tubs.

People who were diagnosed with Legionnaires’ disease were also much more likely to have visited during the latter half of the fair compared to people who did not get sick.

These early findings are from an ongoing study comparing information gathered through surveys of people who were diagnosed with Legionnaires’ disease with similar information gathered from people who attended the fair but did not get sick.  

Health officials are also reporting early results from laboratory testing of environmental samples.

To date, testing has identified Legionella bacteria in one water sample taken from the Davis Event Center; results are still pending from other samples taken as part of this investigation.

“Finding Legionella in one water sample is an important piece of the puzzle, but it does not tell us how so many people were exposed at this event,” said Dr. Zack Moore, State Epidemiologist. To get Legionnaires’ disease or Pontiac fever, you have to breathe in Legionella in aerosolized water, meaning small droplets like mists or vapors.” 

Taken together, these early findings suggest that low levels of Legionella present were able to grow in hot tubs or possibly some other source in the Davis Event Center leading to exposure through breathing in aerosolized water that contained the bacteria; however, this is an ongoing investigation.

Health officials visited the Western North Carolina Agricultural Center on September 25 and September 27 — after the fair had ended — and did not identify any significant sources of aerosolized water on the site.

Very little aerosolized water is created from hand washing sinks, toilets and other currently operating water sources at the Agricultural Center, meaning the risk of exposure to Legionella is low. 

The North Carolina Department of Agriculture and Consumer Services shared the following information:

“The decision has been made to suspend the rental of the Davis Event Center at this time while we review and implement mitigation plans for the facility. This is being done out of an abundance of caution and to reassure event attendees, fairgoers and Ag Center employees that the center is safe for occupancy. Additionally, in collaboration with public health, we have taken steps to minimize water aerosolization opportunities on the grounds, as this is considered the means by which the Legionella bacteria is contracted. While we all feel confident that the facility is safe, we want to take these proactive mitigation measures to reassure the public and our employees.”

Although Legionnaires’ disease is a rare infection, this is a reminder that the bacteria that cause it are common in nature and can be found in man-made water systems,” said Dr. Moore. “This means it’s very important for owners and managers of water systems that can create aerosols to take steps to prevent Legionella from growing and spreading in water systems.”

Water systems that have been linked to past Legionnaires’ disease outbreaks include:

  • Hot tubs
  • Hot water tanks and heaters
  • Large plumbing systems
  • Cooling towers (structures that contain water and a fan as part of centralized air cooling systems for building or industrial processes)
  • Decorative fountains

Public health officials are actively monitoring for new cases of Legionnaires’ disease.

As of Thursday, there is no indication of an ongoing exposure since the end of the NC Mountain State Fair. 

Updated case counts and information about the outbreak are available at https://epi.dph.ncdhhs.gov/cd/legionellosis/outbreak.html.

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BUNCOMBE CO., NC (WSPA) – Health officials in North Carolina say they have now confirmed 79 total cases of Legionnaires’ disease, most of them in western North Carolina.

Many of the cases appear to be involving people who reported attending the NC Mountain State Fair in Fletcher, NC.

The fair was held from September 6 through September 15.

Anyone who attended the fair and is experiencing cough, fever, or shortness of breath is asked to call their healthcare provider as soon as possible and talk to them about Legionnaires’ disease.

There are also four confirmed cases of Pontiac Fever, which is caused by the same bacteria as Legionnaires’ disease.

One person has died in Buncombe County from the disease.

Of the cases, the North Carolina Division of Public Health says 60% of cases are men and 55 required hospitalization.

Health officials want to identify the source of the Legionella bacteria in order to prevent another outbreak in the future.

They are encouraging people to report possible cases to the Division of Public Health by calling 919-733-3419.

Total cases of Legionnaires’ disease in North Carolina by county:

CountyConfirmed Cases
Buncombe34
Haywood5
Henderson21
Jackson1
Madison5
McDowell2
Mitchell1
Rutherford1
Transylvania3
Yancey1
Other counties in NC4
South Carolina5
TOTAL84

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