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An eighth case of Legionnaires’ disease has been linked to the East Texas State Fair, the Northeast Texas Health District (NET Health) announced. One person has died in the outbreak.

NET Health announced that all eight people confirmed with the disease visited the fair.

The new case was one of five possible cases of the illness that were being monitored from the East Texas State Fair, which was held Sept. 20-29 in Tyler; the other four cases have been cleared. No information was released about the most recent victim.

East Texas outbreak: focus on convention center

There is renewed interest in the Harvey Convention Center as the possible source for the Legionella bacteria, which causes Legionnaires’ disease. The convention center initially was ruled out after testing was negative for Legionella.

However, after it was learned that the victim who died had volunteered at the Smith County Democratic Party’s information booth in the convention center, the investigation’s spotlight returned to the building.

NET Health retested the facility and sent environmental samples to the Centers for Disease Control and Prevention (CDC) in Atlanta for testing. Those results are pending.

East Texas outbreak: source sought

Legionella are naturally found in water, especially warm water. All possible sources inside the Harvey Convention Center are being reinvestigated, including the ventilation system, potable water sources, humidifiers, and vendors stationed inside the building.

One vendor being scrutinized is a hot tub vendor who was located near the information booth.

East Texas outbreak: hot tubs

At September’s Mountain State Fair in Fletcher, North Carolina, a hot tub display was the source of a legionellosis outbreak in which four people died and 139 were sickened – 134 with Legionnaires’ disease and five with Pontiac fever, the weaker of the two legionellosis diseases.

Hot tubs (or spas) that are not cleaned and disinfected often enough can become contaminated with Legionella, and a person can become infected when they breathe in steam or mist from a contaminated hot tub.

Because high water temperatures make it hard to maintain the disinfectant levels needed to kill germs like Legionella, making sure the hot tub has the right disinfectant and pH levels is essential, according to the CDC.

East Texas outbreak: numerous possibilities

Other human-made environments in which Legionella can be found include:

  • air-conditioning system cooling towers
  • large plumbing systems
  • water systems of large buildings (hospitals, nursing homes, hotels, etc.)
  • hot-water heaters and tanks
  • bathroom showers and faucets
  • swimming pools
  • physical-therapy equipment
  • mist machines and hand-held sprayers
  • decorative fountains.
East Texas outbreak: new case risk low

NET Health said there is no risk to attendees of future events at Harvey Convention Center or the surrounding area.

“NET Health has identified no evidence of any public health risk that would interrupt current or future events from occurring at Harvey Hall and its neighboring properties,” according to a NET Health statement. “Attendance at previous, upcoming or future events at Harvey Hall do not mean that a person has contracted or will contract the Legionella bacteria.”

The statement also reiterated that the department is continuing to communicate with vendors who were in Harvey Convention Center, as well as attendees who were close to the eight people diagnosed with the disease.

Terrence Ates, public information officer for NET Health, said the department is committed to “definitively identifying the exact source of our local Legionella cases, yet we ask everyone to exercise patience with the scientific process of testing and confirming the exact source of contamination.”

Testing for the potability and safety of public water supplies and distribution systems is required by the Texas Commission on Environmental Quality and performed by the local health department.

If you have questions concerning Legionnaires’ disease, call the Disease Surveillance Division at NET Health at (903) 595-1350.

East Texas outbreak: seek advice if ill

If you attended or worked at the East Texas State Fair and exhibited Legionnaires’ disease symptoms (see below), NET Health urges you to contact your health-care provider.

The disease is not contagious – that is, it cannot be passed from person to person – and it is treatable with antibiotics if diagnosed early enough. If that does not occur, however, it can lead to severe complications.

East Texas outbreak: disease symptoms

Legionnaires’ disease is a severe type of pneumonia or lung infection that – according to the CDC – is contracted by an estimated 25,000 Americans yearly. However, because of its nonspecific symptoms, only 5,000 cases are reported.

Symptoms – which usually develop two to 10 days after exposure to Legionella – mimic those of pneumonia and even common flu. Along with cough, fever, and shortness of breath (dyspnea), other symptoms to be concerned about include:

  • headaches
  • muscle pains
  • chills
  • chest pains (called pleurisy or pleuritis)
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea
  • confusion and other mental changes.