NC Legionnaires outbreak up to 92 confirmed cases: health department

The case count in the NC Legionnaires’ disease outbreak is up to 92, the North Carolina Department of Health and Human Services (NCDHHS) confirmed.

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

The focus of the investigation is the Mountain State Fair, which was held Sept. 6-15 at the WNC Agricultural Center in Fletcher, which is 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.

NC Legionnaires outbreak:
63 have been hospitalized

The case characteristics compiled by the NCDHHS are as follows:

• Five victims have contracted Pontiac fever, a milder form of Legionnaires’ disease that does not affect the lungs, putting the total number of legionellosis cases at 97.
• Fifty-eight victims (60 percent) are male, and 38 are female. (Note: There is no explanation for the discrepancy between the total of 97 legionellosis cases vs. 96 total of male/female cases).
• The median age of those infected is 61 (people over the age of 50 are particularly susceptible to Legionella, the bacteria that causes Legionnaires’ disease).
• Sixty-three people (65 percent) have been hospitalized.
• One victim has died.
• Residents of 16 North Carolina counties have been infected.
• There are six out-of-state cases, all in South Carolina.

NC Legionnaires outbreak:
Outbreak criteria

To be considered as part of this NC Legionnaires outbreak, a patient must have displayed:

• Legionnaires’ disease symptoms: pneumonia (clinical or radiologically confirmed; see symptoms below) in an individual who attended or worked at the 2019  Mountain State Fair, with symptom onset two to 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 Mountain State Fair.
• The diagnosis must be 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. (It’s not required for physicians 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.

The case count in the NC Legionnaires’ disease outbreak is up to 92, the North Carolina Department of Health and Human Services (NCDHHS) has confirmed. The focus of the investigation is the Mountain State Fair (above), held Sept. 6-15 in Fletcher.

NC Legionnaires outbreak:
Multiple symptoms

Legionnaires’ disease symptoms usually develop two to 10 days after exposure to Legionella bacteria and usually begin with:

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

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 (diarrhea, nausea, vomiting)
• confusion and other mental changes.

Legionnaires’ disease cannot be passed from person to person. It is treatable with antibiotics if diagnosed early, but if that does not occur, the disease can lead to severe complications, including respiratory failure, kidney failure, and septic shock.

NC Legionnaires outbreak:
More on the disease

In addition to legionellosis, Legionnaires’ disease is also called Legionella pneumonia. It 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, either 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.

NC Legionnaires outbreak:
Survey being conducted

The North Carolina Division of Public Health is conducting a survey of people who attended the Mountain State Fair, even if they did not become ill. Officials said that participation will help investigators understand the outbreak and could help prevent future outbreaks.

The NCDHHS said answers will be confidential, and the information will be used only for public health purposes. The survey should take less than five minutes; if multiple people in a household attended the fair, each person should complete a survey.

If someone cannot answer the questions, then someone else can answer on their behalf. Start a new survey for each person at  https://www.surveymonkey.com/r/dhhs_survey.

For questions about the survey, the investigation, or to report possible cases, call the Public Health Hotline at (828) 694-4040 or contact the NCDHHS at (919) 733-3419.