North Carolina Legionnaires outbreak explodes to 32 cases

The case count in the North Carolina Legionnaires’ disease outbreak is changing daily. The state’s Department of Health and Human Services (NCDHHS) confirmed an updated count of 32 cases – including one death – in the western part of the state, all associated with the Mountain State Fair.

The NCDHHS first announced the outbreak Tuesday, detailing nine cases and one death. On Wednesday, the department increased the total to 25 and then added seven more the next day.

The Mountain State Fair concluded Sept. 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.

North Carolina Legionnaires outbreak: 22 in hospital

The NCDHHS has examined 25 of the 32 victims, whose ages range from 37 to 90 (median: 67). Twenty-two of them have been hospitalized, and 60 percent are male.

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

• Legionnaires’ disease symptoms within two weeks of attending or working at the Mountain State Fair, or Pontiac Fever symptoms within three days.
• The diagnosis must be confirmed through laboratory testing, including cultures (i.e., respiratory secretions, lung tissue, pleural fluid, or other normally sterile sites) and urine analysis.

North Carolina Legionnaires outbreak: Fourth county

The outbreak initially infected only residents of three counties, but a fourth county was added Wednesday, as two cases were identified in Transylvania County. The number of confirmed cases per county is:

• Buncombe – 15
• Henderson – 13
• Haywood – 2
• Transylvania – 2

The North Carolina Legionnaires outbreak has jumped to 32 Legionnaires’ disease cases, state health officials confirmed. One victim has died, and 22 have been hospitalized.

North Carolina Legionnaires outbreak: Disease info

Legionnaires’ disease – which is also known as legionellosis or Legionella pneumonia – is contracted when people inhale microscopic aerosolized water droplets (vapor or mist), such as those formed by misting stations or large air conditioners.

Legionellosis is the collective term for diseases caused by Legionella bacteria, including Legionnaires’ disease (most serious) and Pontiac fever. Because many legionellosis symptoms are similar to those of flu or pneumonia (see below), the illness often is overlooked or undiagnosed, leading to it being underreported, the Centers for Disease Control and Prevention (CDC) reports.

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 health officials urge 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 that symptoms started.

North Carolina Legionnaires outbreak: Symptoms

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

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

After Day 2 or 3, symptoms often worsen to include:

• cough, which can produce mucus or blood
• shortness of breath (or 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.

North Carolina Legionnaires outbreak: High risk

People 50 years old and older – especially smokers or those with a chronic lung condition, such as COPD (chronic obstructive pulmonary disorder, such as emphysema or bronchitis) – are at a much higher risk of contracting Legionnaires’ disease. Other susceptible groups include:

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

North Carolina Legionnaires outbreak: Search continues

Health officials, along with representatives of the Mountain State Fair and the WNC Agricultural Center, continue trying to locate the source of the Legionella bacteria causing the infections, especially since the Ag Center is the site of the Asheville Quilt Show, which begins today (Sept. 27) and ends Sunday.

Matt Buchanan, general manager of the Ag Center and the Mountain State Fair, said he believes Quilt Show attendees will be safe.

“Two of our engineers from solar and water here locally inspected all the buildings, all the grounds, and they found nothing that would be a risk,” Buchanan told the Asheville Citizen Times. “We had two environmentalists out of the Raleigh office come in, inspecting the buildings and everything, and they did not find anything.”

NCDHHS officials confirmed to the Citizen Times that scientists “did not identify any significant sources of aerosolized water currently at the WNC Agricultural Center.”

According to WHKP Radio, officials are looking into three possible sources:

• A water-spraying fan the Skyland Fire Department had at the fair to cool visitors.
• Hot tubs that were emitting water into the air.
• The cooling system of three buildings.

North Carolina 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 Transylvania County, call (828) 884-3135.