Mountain State Fair Legionnaires outbreak: 9 illnesses, 1 death

Health officials in North Carolina confirmed the existence of a Legionnaires’ disease outbreak in the western part of the state after nine people contracted the serious respiratory illness – and one of them died.

Officials said the Mountain State Fair is the probable source of the outbreak, which has sickened residents of three counties: Buncombe, Haywood, and Henderson. The one commonality is that all nine victims attended the fair, which is held at the WNC Ag Center in Fletcher; no other information was released on those infected.

The outbreak is being investigated by the North Carolina Department of Health and Human Services (NCDHHS), as well as the Buncombe Health and Human Services and Henderson County Health departments.

Mountain State Fair Legionnaires outbreak:
170,000-plus attendees

The 10-day Mountain State Fair, which was held Sept. 6-15, was attended by more than 170,000 people. Given the size and duration of the fair, health officials are concerned additional cases will be reported.

“We don’t yet know whether people might have been exposed to Legionella bacteria at the NC Mountain State Fair,” said Dr. Zack Moore, state epidemiologist. “As a precaution, we are recommending that anyone who went to the fair and has symptoms of pneumonia, like cough, fever or shortness of breath, see a doctor right away and talk with them about Legionnaires’ disease.”

A Mountain State Fair Legionnaires outbreak of nine illnesses and one death has sparked an investigation by multiple health departments in North Carolina.

Mountain State Fair Legionnaires outbreak:
Symptoms are numerous

Legionnaires’ disease symptoms, which usually develop two to 10 days after exposure to Legionella, include:

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

If you attended the Mountain State Fair and have any of those symptoms, see your health-care provider immediately.

Legionnaires’ 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.

Mountain State Fair Legionnaires outbreak:
Call for more info

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 North Carolina, there were 83 cases of legionellosis reported through July of this year. In 2018, 175 cases were recorded, and between 2014 and 2018, there was an average of 198 cases per year, according to the NCDHHS communicable disease reports.

Mountain State Fair Legionnaires outbreak:
Focus on water features

Legionnaires’ disease is a severe form of pneumonia (lung disease) that is also known as legionellosis or Legionella pneumonia. It is contracted by breathing in small droplets of water (mist or vapor) containing Legionella. For that reason, the investigation is focusing on any rides or exhibits with water features.

“Features, exhibits, and rides that incorporated some type of water exposure that created droplets which came in contact with visitors will be our focus,” Steven Smith, Henderson County’s director of health, wrote in an email to the Henderson County Board of Health. “Limiting any future exposures for individuals is an important objective right now.”

A water-coiled cooling fan provided by the Skyland Fire Department to help cool fairgoers also is being considered. Fire chief Ryan Cole, however, said he expects the fan to be ruled out as a source. “We had many of our staff near the station during the time it ran, and none of them have been sick or shown any symptoms,” Cole told WLOS-TV news. “The health department said they’re looking for an environmental specialist to test the fan and that they would be back in touch.”

Mountain State Fair Legionnaires outbreak:
High-risk groups

It’s likely that the fire department staff didn’t exhibit symptoms because staff members don’t meet the criteria for infection. People 50 years old and older – especially those who smoke or have a chronic lung condition, such as COPD – are at a much higher risk.

Others more susceptible to infection include:

• organ-transplant recipients
• people on a specific drug protocols, such as corticosteroids
• people with a compromised immune system
• alcoholics.

After Legionnaires’ disease has been diagnosed, hospitalization is almost always necessary. In the most severe cases, complications can include respiratory failure, kidney failure, septic shock, or even death – and about 10 percent of those infected will die from the infection.