North Carolina outbreak: Legionnaires lawyer Elliot Olsen has vast experience when it comes to filing a Legionnaires lawsuit. If you or a family member were sickened in this outbreak, you might have reason to do just that. Please call Elliot at (612) 337-6126 for a free consultation.

The North Carolina outbreak of legionellosis is up to 116 cases, making it the largest such outbreak in state history, the NC Department of Health and Human Services (NCDHHS) confirmed. One victim has died, 75 have been hospitalized, and 109 have developed Legionnaires’ disease.

(Note: There are two types of legionellosis: Legionnaires’ disease, the most severe form of the illness, and Pontiac fever.)

The NCDHHS first announced the outbreak on Sept. 23, detailing nine Legionnaires cases and one fatality. Updates have been almost daily since then, and the NCDHHS website says that the “case finding is ongoing, and additional cases have been reported.”

The source of the Legionella bacteria that caused the illnesses is still unknown, and officials are concerned that additional cases will be identified.

The focus of their investigation remains on the Mountain State Fair, which was Sept. 6-15 at the WNC Agricultural Center in Fletcher, about 12 miles south of Asheville in the western part of the state. Fair officials said the 10-day event was attended by more than 170,000 people.

North Carolina outbreak:
Public asked for help

The North Carolina Division of Public Health (DPH) has requested that all attendees of the Mountain State Fair, even if they did not become ill, complete an online survey. Officials said participation will help investigators understand the outbreak, and it could help prevent future outbreaks.

Answers will be confidential, the DPH said, and the information will be used only for public health purposes. The survey takes about five minutes; if multiple people in a household attended the fair, the DPH asks that each person complete a survey.

If someone is not able to answer the questions, another person can answer on their behalf. Start a new survey for each person at

To report possible cases, or to ask questions about the survey or the investigation, call the DPH hotline at (828) 694-4040, or contact the NCDHHS at (919) 733-3419.

North Carolina outbreak:
Criteria considered

To be considered as part of the North Carolina outbreak, a patient must have displayed:

  • Legionnaires’ disease symptoms: pneumonia (clinical or radiologically confirmed; see symptoms below) in anyone who attended or worked at the Mountain State Fair, with symptom onset 2-14 days after attending the fair.
  • Pontiac fever: fever, myalgia (muscle pain), headaches, chills, nausea, vomiting or diarrhea within three days of attending or working at the fair.
  • A diagnosis confirmed through laboratory testing, including cultures (respiratory secretions, lung tissue, pleural fluid, or other normally sterile sites) and urine analysis.

For the disease to be classified correctly, specific testing and diagnosis must be done from a Legionnaires’ disease standpoint, and those tests often go unordered. (Doctors are not required to order Legionella-specific testing when a patient presents with pneumonia.) That’s why officials are urging anyone who attended the Mountain State Fair and has since become ill to see their health-care provider; tell them that you attended the fair; and provide the date for the onset of symptoms.

North Carolina outbreak:
75 have been hospitalized

The case characteristics compiled by the NCDHHS are as follows:

  • Seven victims have contracted Pontiac fever, a milder form of Legionnaires’ disease that does not affect the lungs.
  • Sixty-eight victims (59 percent) are male, and 47 are female.
  • The victims’ ages are between 24 and 90, with a median age of 61. (Note: People over the age of 50 are particularly susceptible to Legionella.)
  • Seventy-five people (65 percent) have been hospitalized.
  • One victim has died.
  • Residents of 17 North Carolina counties have been infected.
  • There are six out-of-state cases, all in South Carolina.

North Carolina outbreak:
Symptoms are numerous

Symptoms usually develop two to 10 days after exposure to Legionella, and they usually begin with:

  • headaches
  • muscle aches
  • fever, which can be 104 degrees Fahrenheit or higher, and chills.

After the second or third day, symptoms often worsen to include:

  • coughing, which can produce mucus or blood
  • shortness of breath (dyspnea)
  • chest pains (also: pleurisy, pleuritis, or pleuritic chest pains)
  • gastrointestinal problems (nausea, vomiting, diarrhea)
  • confusion and other mental changes.

Legionnaires’ disease cannot be contracted from someone else. If it is diagnosed early enough, it is treatable with antibiotics. If that does not occur, however, it can lead to severe complications, such as respiratory failure, kidney failure, and septic shock.

North Carolina outbreak:
More on the disease

The disease is contracted by inhaling microscopic, aerosolized water droplets (vapor or mist), such as those formed by misting stations or large air conditioners.

Other groups of people more likely to develop Legionnaires’ disease include:

  • smokers, current or former
  • those with chronic lung conditions, such as chronic obstructive pulmonary disorder (COPD, most commonly bronchitis or emphysema)
  • anyone with a compromised immune system
  • organ-transplant recipients
  • anyone on a specific drug protocol, such as corticosteroids
  • alcoholics.