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Investigation of an Outbreak of Legionellosis in Western North Carolina
Investigation of an Outbreak of Legionellosis in Western North Carolina Current Outbreak
On September 23, 2019, the NC Division of Public Health was notified about an increase in the number of Legionnaire’s disease cases in Buncombe and Henderson counties.
The source of the outbreak is under investigation.
Many of the cases reported attending the NC Mountain State Fair, held September 6-15, 2019 in Fletcher, NC.
As a precaution, anyone who attended the NC Mountain State Fair and is experiencing cough, fever or shortness of breath, is advised to call their healthcare provider right away and talk to them about Legionnaire’s disease. See the provider memo.
Case finding is ongoing, and additional cases have been reported
Investigation of an Outbreak of Legionellosis in Western North Carolina Current Outbreak
On September 23, 2019, the NC Division of Public Health was notified about an increase in the number of Legionnaire’s disease cases in Buncombe and Henderson counties.
The source of the outbreak is under investigation.
Many of the cases reported attending the NC Mountain State Fair, held September 6-15, 2019 in Fletcher, NC.
As a precaution, anyone who attended the NC Mountain State Fair and is experiencing cough, fever or shortness of breath, is advised to call their healthcare provider right away and talk to them about Legionnaire’s disease. See the provider memo.
Case finding is ongoing, and additional cases have been reported
Investigation of an Outbreak of Legionellosis in Western North Carolina Current Outbreak
On September 23, 2019, the NC Division of Public Health was notified about an increase in the number of Legionnaire’s disease cases in Buncombe and Henderson counties.
The source of the outbreak is under investigation.
Many of the cases reported attending the NC Mountain State Fair, held September 6-15, 2019 in Fletcher, NC.
As a precaution, anyone who attended the NC Mountain State Fair and is experiencing cough, fever or shortness of breath, is advised to call their healthcare provider right away and talk to them about Legionnaire’s disease. See the provider memo.
Case finding is ongoing, and additional cases have been reported
Case count as of October 2, 2019:
Buncombe County
47
Burke County
2
Gaston County
1
Granville County
1
Haywood County
10
Henderson County
32
Jackson County
1
Madison County
6
McDowell County
3
Mecklenburg County
3
Mitchell County
2
Polk County
1
Rutherford County
2
Transylvania County
3*
Union County
1
Watauga County
1
Yancey County
1
Out of state (SC)
7
TOTAL
124
Male
72 (58%)**
Female
50 (40%)**
Median age in years (range)
61 (24-91)*
Hospitalizations
80 (65%)
Deaths
1
Legionnaires' Disease
116 (94%)
Pontiac Fever
8 (6%)
*Previously included suspect cases
**Some cases reported with unknown gender
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, which took place Sept. 6–15, 2019 at the Western North Carolina Agricultural Center in Fletcher, NC. As of Oct. 2, 2019, 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 Sept. 25 and Sept. 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)
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 Legionnaire’s disease outbreak associated with the NC Mountain State Fair.
As of Oct. 9, 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 Sept. 6–15, 2019 at the Western North Carolina Agricultural Center in Fletcher, NC. Eighty-eight 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 which 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.
This 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/legion.../outbreak.html. The FAQ can be found at https://epi.dph.ncdhhs.gov/cd/legionellosis/PublicFAQ and 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/diseas...onellosis.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. In Buncombe County, call BCHHS Communicable Disease at (828) 250-5109. In Henderson County, please call (828) 694-6019.
North Carolina health officials confirm another death caused by Legionnaires' disease
Latest victim is from Burke County, NCDHHS says
WYFF 4 Updated: 4:24 PM EDT Oct 14, 2019
BURKE COUNTY, N.C. —
Another person has died as a result of an outbreak of Legionnaires' disease in North Carolina, according to health officials.
The North Carolina Department of Health and Human Services said Monday the latest death was confirmed in Burke County.
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As of Monday, 140 cases of Legionnaires’ disease or Pontiac fever had been reported in residents of North Carolina and multiple states, NCDHHS said...
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. This person attended the Quilt Show held at the WNC Ag Center Sept. 27–29.
To date, this 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 Sept. 15. To protect the individual’s privacy, specific information such as county of residence or age will not be released.
Legionnaires’ disease is a form of pneumonia caused by infection with the Legionella bacteria. People can get Legionnaires’ disease when they breathe in aerosolized water (small droplets of water in the air) that contain the bacteria. Symptoms usually begin two to 10 days after being exposed to the bacteria.
“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.” Preliminary findings from the public health outbreak investigation suggest that exposure to Legionella during the Mountain State Fair occurred in the Davis Event Center, particularly during the last five days of the fair. Additional analysis of information collected during the investigation is ongoing.
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.
Symptoms of Legionnaires’ disease include fever, cough and shortness of breath. These symptoms can be very similar to the flu or other respiratory infections that are common at this time of year. It is important to talk to your doctor if you have these symptoms to determine whether testing or treatment for any of these infections might be needed.
Health officials visited the WNC Ag Center on Sept. 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 Oct. 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.
RALEIGH, N.C. (WNCN) – Four people are now dead in connection with an outbreak of Legionnaire’s disease from a fair in western North Carolina in September.
The North Carolina Department of Health and Human Services confirmed the fourth death on Friday.
A total of 141 cases of the disease have been reported in the state...
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