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The case count in the North Carolina Legionnaires’ disease outbreak is changing daily as the North Carolina Department of Health and Human Services (NCDHHS) confirmed an updated count of 32 cases – including one death – in the western part of the state, all associated with the Mountain State Fair.
The NCDHHS first announced the outbreak Tuesday, at which point there were nine cases and one fatality. The department increased the total to 25 on Wednesday, and then it confirmed seven more on Thursday.
Initially, the outbreak infected individuals from three counties, but a fourth county was added Wednesday, as two cases were identified in Transylvania County. It’s not unrealistic to think that residents of other counties or even other states will join the roll in the coming days.
The Mountain State Fair was held from Sept. 6-15 at the WNC Agricultural Center in Fletcher, which is about 12 miles south of Asheville. Fair officials said more than 170,000 people attended the 10-day event.
The number of confirmed cases per county is:
- Buncombe – 15
- Henderson – 13
- Haywood – 2
- Transylvania – 2
WNC outbreak: About the disease
Legionnaires’ disease – which is also known as legionellosis or Legionella pneumonia – is a respiratory illness that is contracted when people inhale microscopic aerosolized water droplets (vapor or mist), such as those formed by misting stations or large air conditioners.
Legionellosis is the collective term for diseases caused by Legionella bacteria, including Legionnaires’ disease (most serious) and Pontiac fever. Because many symptoms of legionellosis are similar to those of the common flu or pneumonia (see below), the illness it causes is often overlooked or undiagnosed, leading to the disease being underreported, according to the Centers for Disease Control and Prevention (CDC).
For the disease to be classified correctly, specific testing and diagnosis must be done from a Legionnaires’ disease standpoint, and those tests are often not ordered. It’s not required for physicians to order Legionella-specific testing when a patient presents with pneumonia.
That’s why health officials urge anyone who attended the Mountain State Fair and has since become ill to see their health-care provider. Let them know that you attended the fair and when symptoms started.
WNC outbreak: Multiple symptoms
Legionnaires’ disease is a potentially deadly type of pneumonia. Symptoms usually develop two to 10 days after exposure to Legionella and generally begin with:
- muscle aches
- chills and fever, which can be 104 degrees Fahrenheit or higher.
After the second or third day, symptoms usually worsen to include:
- coughing, which can produce mucus or blood
- shortness of breath (called dyspnea)
- chest pains (called pleurisy, pleuritis, or pleuritic chest pains)
- gastrointestinal problems, such as nausea, vomiting, and diarrhea
- confusion and other mental changes.
Legionnaires’ disease cannot be passed from person to person. It is treatable with antibiotics if diagnosed early. If that does not occur, however, it can lead to severe complications.
WNC outbreak: High-risk demographics
People 50 years old and older – especially those who smoke or have a chronic lung condition, such as COPD (chronic obstructive pulmonary disorder, most commonly emphysema or bronchitis) – are at a much higher risk of contracting Legionnaires’ disease.
Other groups more susceptible include:
- people with a compromised immune system
- organ-transplant recipients
- people on a specific drug protocol, such as corticosteroids
After Legionnaires’ disease has been diagnosed, hospitalization is almost always required. In the most severe cases, complications can include respiratory failure, kidney failure, septic shock, or death (about 10 percent of those infected will die).
WNC outbreak: 22 victims hospitalized
The NCDHHS has examined 25 of the 32 patients confirmed with Legionnaires in this outbreak. Their ages range from 37 to 90, with a median age of 67. Twenty-two victims have been hospitalized, and 60 percent are male.
To be considered part of the outbreak, a patient must have displayed:
- Legionnaires symptoms within 2-14 days of attending or working at the Mountain State Fair, or Pontiac Fever symptoms within three days of attending or working at the fair.
- The diagnosis must be confirmed through laboratory testing, including – but not limited to – cultures (i.e., respiratory secretions, lung tissue, pleural fluid, or other normally sterile sites) and urine analysis.
WNC outbreak: Ag Center visitors at risk?
State and local health officials, along with WNC Agricultural Center and Mountain State Fair representatives, continue to work together to locate the source of the Legionella bacteria causing the infections.
The Ag Center is host to the Asheville Quilt Show, which begins today (Sept. 27) and runs through Sunday. Matt Buchanan, general manager of the Ag Center and the Mountain State Fair, said he believes attendees will be safe.
“Two of our engineers from solar and water here locally inspected all the buildings, all the grounds, and they found nothing that would be a risk,” Buchanan told the Asheville Citizen Times. “We had two environmentalists out of the Raleigh office come in, inspecting the buildings and everything, and they did not find anything.”
NCDHHS confirmed to the Citizen Times that scientists “did not identify any significant sources of aerosolized water currently at the WNC Agricultural Center.”
According to WHKP Radio, state officials are looking into three possible sources:
- A water-spraying fan the Skyland Fire Department had at the fair to cool visitors.
- Hot tubs that were emitting water into the air.
- The cooling system of three buildings.
WNC outbreak: Information hotlines
For more information or to report possible cases of Legionnaires’ disease, the public is being asked to call the Division of Public Health at (919) 733-3419 or contact your local health department:
- In Buncombe County, call (828) 250-5109.
- In Haywood County, call (828) 452-6675.
- In Henderson County, call (828) 694-6019.
- In Transylvania County, call (828) 884-3135.