WNC Mountain State Fair Legionnaires outbreak: 2nd death confirmed

North Carolina health officials confirmed a second death in the WNC Mountain State Fair Legionnaires’ disease outbreak, which is up to 126 victims, 88 who have been hospitalized.

The North Carolina Department of Health and Human Services (NCDHHS) reports a total of 134 cases of legionellosis, which is the umbrella term for diseases caused by Legionella bacteria: Legionnaires’ disease and its milder sibling, Pontiac fever. NCDHHS officials did not provide information on the two people who died, citing privacy laws.

“We send our sincerest condolences to the families of the two people who have died and to all those who have been affected by this outbreak,” said Dr. Zack Moore, the state epidemiologist. “Legionnaires’ disease is a serious illness which can lead to complications and death, especially in older individuals or those with underlying conditions.”

The 10-day NC Mountain State Fair took place Sept. 6-15 at the WNC Agricultural Center in Fletcher.

WNC Mountain State Fair outbreak: hot tubs likely

The NCDHHS released an interim report on the legionellosis outbreak, which suggested that exposure to Legionella occurred in the Davis Event Center at the WNC Ag Center, more specifically near the hot tubs and during the fair’s final five days.

According to the Centers for Disease Control and Prevention (CDC), Legionella bacteria are naturally found in water, especially warm water. Hot tubs and spas that are not cleaned and disinfected often enough can become contaminated with Legionella, and infection occurs when a person breathes in steam or mist from a contaminated hot tub.

“Hot tubs are a well-established source of aerosolized water exposure, and have been associated with previous Legionnaires’ disease outbreaks nationally and internationally,” the interim report said. “No other significant sources of aerosolized water at the WNC Ag Center or other ongoing potential sources of exposure identified and continuing surveillance for Legionnaires’ disease cases indicates that the outbreak has ended.”

NC officials confirmed a second death in the WNC Mountain State Fair Legionnaires’ disease outbreak, which has 126 victims, 88 who have been hospitalized.

WNC Mountain State Fair outbreak: death in SC

An obituary for Lorene Hall Williams, 83 of Campobello, SC, stated that she died from Legionnaires’ disease, and family members said she attended the NC Mountain State Fair. Spartanburg County coroner Rusty Clevenger, however, told WSPA 7 News he could not confirm Williams’ cause of death, so it’s believed her death is not one of the two connected to the outbreak.

To be considered part of the WNC Mountain State Fair outbreak, a patient must have displayed:

• Legionnaires’ disease symptoms: pneumonia (clinical or radiologically confirmed; see symptoms below) in anyone who attended or worked at the WNC Mountain State Fair, with symptom onset 2-14 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 fair.
• Diagnosis confirmed through laboratory testing, including cultures (respiratory secretions, lung tissue, pleural fluid, or other normally sterile sites) and urine analysis.

WNC Mountain State Fair outbreak: symptoms

Legionnaires’ disease is a severe type of pneumonia or lung infection that, according to the CDC, occurs in about 25,000 Americans yearly. Because of the disease’s nonspecific symptoms, however, only 5,000 cases are reported.

Beginning symptoms generally include:

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

By the second or third day, symptoms often worsen to include:

• coughing, which can produce blood and mucus
• dyspnea (shortness of breath)
• pleuritic chest pains, which are characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling (also: pleurisy or pleuritis)
• gastrointestinal symptoms, such as diarrhea, vomiting, and nausea
• confusion and other mental changes.

Although Legionnaires’ disease primarily affects the lungs, it occasionally can cause infections in wounds and other parts of the body, including the heart.

WNC Mountain State Fair outbreak: reactions

In response to the outbreak, officials for the Dixie Classic Fair in Winston-Salem decided to implement several safety measures during the fair’s 10-day run, which concludes Sunday:

• Vendors and fairgoers alike are banned from using misting fans.
• The fair’s only water ride is being disinfected daily.
• Drinking fountains will be available inside a building adjacent to the fairgrounds.

The Raleigh Home Show (Fall), which took place Oct. 4-6, also implemented extra precautions. Hot tub and whirlpool vendors were taking extra steps, such as adding more chlorine and conducting water tests.

“We’ve been actually testing this hot tub about once an hour, every hour,” said Rod Adams with Spa & Pool Outlet, in a news report by Raleigh’s CBS 17 News. “We do have a lot of people coming in and out of the booth. We’ve never had an incident at this show, like they had in the mountains. We don’t anticipate having something like that.”

Chiara Renella-Brooks, manager of the Raleigh Home Show, said the event always has taken precautions, such as requiring hot tub companies to test water a few times daily. Renella-Brooks also said state health officials provided helpful guidelines.

“We do have guidance we have created, especially in light of the outbreak at the Mountain State Fair, that’s specifically for vendors of hot tubs and other whirlpools,” Dr. Moore said.