Legionnaires' outbreak in North Carolina linked to state fair — what you need to know about the disease

Spending a day at the fair isn’t usually equated with contracting a deadly bacteria, but that’s just what happened early last month when more than 100 attendees at the North Carolina Mountain State Fair contracted Legionnaires’ disease. It’s got organizers of the upcoming Dixie Classic Fair (in Winston-Salem, two hours away from the initial outbreak) anxious and taking extra precautions. Fair organizers have nixed the use of decorative water fountains and banned attendees from bringing in handheld fans. But will that be enough to protect fairgoers? And what should attendees and others know about Legionnaires’ disease in order to protect themselves?

According to the Mayo Clinic, Legionnaires’ disease is a severe form of pneumonia caused by the bacterium legionella. This type of pneumonia was first observed after an outbreak following the American Legion Convention in Philadelphia in 1976. Over 130 attendees contracted the illness, most of which were hospitalized. Of those infected, 25 died from the disease.

Today, around 10,000 to 18,000 people contract the disease annually in the United States. Unfortunately, many infected people still end up in the intensive care unit, with some experiencing long-term issues, including persistent fatigue, neurologic symptoms, and neuromuscular symptoms.

Inhaling microscopic infected water droplets is the main way in which people contract Legionnaires’ disease. Outbreaks are generally linked to swimming pools, decorative fountains, hot tubs and whirlpools, birthing pools, drinking water and cooling towers in air conditioning systems.

Less commonly, people can become infected from shower and faucet sprays, as well as through aspirating infected water, or coming into contact with contaminated soil. It’s believed that the culprit behind the most recent outbreak was likely a hot tub display at the Davis Event Center located on the Western North Carolina Agricultural Center where the fair took place.

Legionnaires’ disease can be treated if caught in time, so it’s important to know the signs. The illness begins with a high fever (104 F/40 C or above), headaches, and muscle aches. Shortly after, infected individuals might experience chest pain, shortness of breath, coughing (sometimes with mucus or blood), plus gastrointestinal symptoms like nausea, vomiting and diarrhea. Some people also experience confusion or other changes in mental state.

It can take roughly two to 10 days for symptoms to begin, so it’s important to stay vigilant if potentially exposed. While anyone can catch it, smokers, individuals who are 50 and over and immunocompromised people are at greatest risk for contracting it.

Additionally, those with chronic lung disease, people taking corticosteroids, as well as anyone who has received an organ transplant are also at highest risk of catching Legionnaires’ disease. It’s also possible to contract a less severe disease when exposed to legionella bacteria called Pontiac fever, which is akin to the flu, but this infrequently requires treatment.

Treatment generally involves use of antibiotics. Macrolides and quinolones are the most effective antibiotics for treating Legionnaires’ disease, though tetracycline, doxycycline, minocycline and trimethoprim/sulfamethoxazole have also proven to be effective.

Left untreated or treated too late, Legionnaires’ disease can cause respiratory failure, acute kidney failure, septic shock and even death. The recent outbreak in Fletcher has already claimed one life. Another person recently died from Legionnaires’ disease in Flushing, Mich., after contracting it back in August.

While many individuals can become infected from the same source, the good news is that Legionnaires’ disease is not contagious. No precautions need to be taken when dealing with infected individuals.

Overall, Legionnaires’ disease is not extremely common, but those who are at highest risk should take extra precautions to avoid contamination. And if you’re really worried, maybe skip over the water rides or hot tub displays next time the fair comes to town.

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