Death toll rises in North Carolina disease outbreak tied to state fair

North Carolina health officials say four people have died following an outbreak of Legionnaires' disease, a type of pneumonia, which has been associated with hot tubs on display at a state fair.

As of Oct.17, the North Carolina Division of Public Health confirmed 141 cases of Legionnaires’ involving residents from multiple states and North Carolina counties who attended the 2019 North Carolina Mountain State Fair which spanned just over a week ending on Sept. 15.

Eight of those confirmed cases were Pontiac fever, which is a milder form of the disease. In addition to the deaths, 94 people were hospitalized, according to officials.


After establishing, through interviews, that the fair appeared to be the only common factor linking these cases, the department notified the public regarding the exposure on Sept. 24, roughly a week after the fair came to a close.

The North Carolina Division of Public Health worked with the local public health staff and with the North Carolina Department of Agriculture and Consumer Services to identify and address any possible sources of ongoing exposure. Officials say the sources included hot tubs and diffusers that had been on display at an event center.

According to preliminary findings, those who were diagnosed were more likely to have walked by hot tubs at an event center during the latter half of the fair compared to those who did not get sick.

Legionnaires’ disease is a type of pneumonia caused by Legionella bacteria. People can become infected by breathing in mist or accidentally swallowing water that contains the bacteria, according to the Centers for Disease Control.

The bacteria live in freshwater environments and can become a health concern — as in this case — when it grows and spreads in human-made building water systems.

The number of cases reported to the CDC has been on the rise since 2000 with almost 7,500 cases being reported in 2017, according to government data.


In North Carolina, more than 150 cases of Legionnaires’ are reported each year, according to health officials.

Symptoms typically begin as soon as two days after exposure and can include coughing, shortness of breath, fever, muscle aches and headaches.

Legionnaires’ can be treated effectively with antibiotics, while Pontiac fever resolves without treatment, health officials said.