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Health officials are investigating the East Texas State Fair as the source of a Legionnaires’ disease outbreak, a situation that mirrors a recent outbreak in North Carolina.

The Northeast Texas Public Health District (NET Health) announced that seven confirmed and five possible cases of the pneumonia-like illness had been identified, all of which are likely tied to the East Texas State Fair, which ran from Sept. 20 to Sept. 29 in Tyler.

Fair officials said more than 257,000 people attended the 10-day event.

Investigators determined that all the patients attended the fair, NET Health CEO George Roberts said.

East Texas State Fair:
Small start for NC outbreak

On Sept. 24, the North Carolina Department of Health and Human Services reported an outbreak infecting nine people, one of whom died, all connected to the Mountain State Fair in Fletcher.

A month later, the legionellosis case count in that outbreak hit 142, including 134 with Legionnaires’ disease and four deaths. (Legionellosis is the collective term for the two diseases caused by Legionella bacteria: Legionnaires’ disease, which is also called Legionella pneumonia, and Pontiac fever, a less-severe illness.)

Health officials said the probable source of the North Carolina outbreak was a hot tub display at the fair.

East Texas State Fair:
Searching for more

NET Health’s Disease Surveillance Division is working with the Texas Department of State Health Services (DSHS), the Centers for Disease Control and Prevention (CDC), event organizers, and local health departments to investigate the East Texas outbreak and pinpoint a source for the Legionella.

NET Health has released an advisory to area health-care professionals to be on the lookout for additional cases.

“Clinicians should consider legionellosis in patients who attended the East Texas State Fair and present with symptoms consistent with Legionnaires’ disease,” the advisory reads.

Roberts told the Tyler Morning Telegraph, “We want (doctors) to specifically ask any patient with the symptoms whether they were at the fair.”

East Texas State Fair:
About Legionnaires

If you attended or worked at the East Texas State Fair and are exhibiting any Legionnaires’ disease symptoms (see below), NET Health urges you to seek care from your health-care provider immediately.

Legionnaires’ disease is not contagious – that is, it cannot be passed from person to person. The condition is treatable with antibiotics, but it must be diagnosed early. That is the key. If that does not occur, it can lead to severe complications.

Symptoms – which usually develop two to 10 days after exposure to Legionella – mimic those of pneumonia and even the 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.

Legionnaires’ disease often is overlooked or undiagnosed because of its vague symptoms, the CDC says.

East Texas State Fair:
Individuals most at risk

Legionnaires’ disease is contracted by inhaling microscopic aerosolized water droplets (vapor or mist). People 50 years old and older – especially smokers or those with a chronic lung condition, such as COPD (chronic obstructive pulmonary disorder, most commonly bronchitis and emphysema) – are more susceptible to developing the illness.

Other high-risk people include:

  • anyone with a compromised immune system
  • organ-transplant recipients
  • anyone on a specific drug protocol (for example, corticosteroids)
  • alcoholics.
East Texas State Fair:
Convention Center cleared

The Harvey Convention Center has been ruled out as a possible source. The center was used for numerous events during the fair, including the marketplace and photography shows, both of which occur throughout the entire run of the 10-day event.

“NET Health and state officials conducted an investigation of the facility to test the water sources at Harvey Hall as the disease is spread through water particles,” NET Health’s statement read. “Public health officials confirmed the facility came back negative for any conditions that would allow for Legionnaires’ disease to be present.”

East Texas State Fair CEO John Sykes said he was made aware of reported cases by NET Health, and he is working with the organization to determine the source. “We’ve got to find the source,” Sykes told the Tyler Morning Telegraph. “This is a real surprise to us.”

Health officials are looking at all water sources throughout the fairgrounds, including hot tubs, humidifiers, food vendors, and all buildings in use during the fair.