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FLETCHER — At least one Watauga County resident has been diagnosed with Legionellosis as part of an outbreak that state health officials are tracing to the N.C. Mountain State Fair, which was held in Fletcher on Sept. 6-15.

“On Sept. 23, the N.C. Division of Public Health was notified about an increase in the number of Legionnaire’s disease cases in Buncombe and Henderson counties,” an Oct. 3 statement from the N.C. Department of Health and Human Services said. “The source of the outbreak is under investigation.”

“As a precaution, anyone who attended the N.C. Mountain State Fair and is experiencing cough, fever or shortness of breath, is advised to call their health care provider right away and talk to them about Legionnaire’s disease,” the Oct. 3 statement continued.

An Oct. 7 updated list of confirmed cases lists one Watauga County resident as part of the 131 confirmed cases of either Legionnaire’s disease or Pontiac fever. The cases range in people aged 24 to 91, the N.C. DHHS noted.

Nearly 80 percent of patients identified so far have required hospitalization and one has died, the N.C. DHHS stated. AppHealthCare Public Health Director Jen Greene said the health department investigated two cases in Watauga County and had the one confirmed case of someone who attended the fair. Greene declined to give an update on the patient, but did say the person was not the one fatality reported statewide.

“Legionnaires’ disease is pneumonia caused by Legionella bacteria and is very similar to other types of pneumonia, with symptoms that include cough, shortness of breath, fever, muscle aches or headaches,” explained N.C. Epidemiologist Zach Moore in a Sept. 25 provider’s memorandum. “Patients at highest risk include those aged (more than) 50 years, current or former smokers and those with chronic lung disease (such as emphysema or COPD) or a weakened immune system.”

Pontiac fever, according to Moore, is a milder, self-resolving infection caused by the same bacteria, with primary symptoms including fever and muscle aches.

According to early fundings made by the N.C. DHHS, released on Oct. 3, people who later were confirmed cases were “much more likely” to have visited the Davis Event Center while at the fair and having visited the hot tub displays during the later half of the fair.

“To date, testing has identified Legionella bacteria in one water sample taken from the Davis Event Center; results are still pending from other samples taken as part of this investigation,” the Oct. 7 statement added.

“Although Legionnaires’ disease is a rare infection, this is a reminder that the bacteria that cause it are common in nature and can be found in man-made water systems,” Moore said on Oct. 7. “This means it’s very important for owners and managers of water systems that can create aerosols to take steps to prevent Legionella from growing and spreading in water systems.”

Water systems that have been linked to past Legionnaires’ disease outbreaks include:

  • Hot tubs
  • Hot water tanks and heaters
  • Large plumbing systems
  • Cooling towers (structures that contain water and a fan as part of centralized air cooling systems for building or industrial processes)
  • Decorative fountains

As of Oct. 3, there is no indication of an ongoing exposure since the end of the NC Mountain State Fair.

Updated case counts and information about the outbreak are available at epi.dph.ncdhhs.gov/cd/legionellosis/outbreak.html. More information about Legionella bacteria and Legionnaires’ disease can also be found on the CDC website at www.cdc.gov/legionella/index.html and on the DPH website at epi.dph.ncdhhs.gov/cd/diseases/legionellosis.html.

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