By Dave Russell
The Jackson County Department of Public Health is reporting five cases of Legionnaires’ disease, connected with about 100 contracted through the Mountain State Fair in Fletcher.
Three of the cases involve Jackson County residents and two are from out of the county, but tested as positive in Jackson.
Local health officials don’t know whether to anticipate additional cases of Legionnaires’ disease, Deputy Health Director Melissa McKnight said. The fair ran from Sept. 6-15 and symptoms of Legionnaires’ disease appear anywhere from two to 14 days after exposure.
Legionnaires’ disease is pneumonia caused by Legionella bacteria and is very similar to other types of pneumonia. Symptoms include cough, shortness of breath, fever, muscle aches or headaches. It is typically contracted when a victim breathes water droplets containing the bacteria, according to the U.S. Centers for Disease Control and Prevention.
The county health department started getting calls about Legionnaires’ disease Monday afternoon after a post to The Sylva Herald’s Facebook page was shared by 443 people.
“I assume we will get more as word gets out,” McKnight said. “We can handle them.”
The health department does not administer tests for diagnosing Legionnaires’ disease, she said.
“Anyone who is experiencing symptoms who called or came here, we would recommend they go to their primary care physician or to urgent care to receive that test,” she said. “I don’t have a number as to how many people have sought treatment or a diagnosis for Legionnaires’ if they were experiencing symptoms.”
The N.C. Division of Public Health is recommending health care providers test patients using a culture of lower respiratory secretions and administering the Legionella antigen urinary test, she said.
Most primary care providers and urgent care centers offer that test, according to McKnight.
“The last time we had Legionnaires’ in Jackson County that’s what we recommended,” she said.
Last November, the health department and the N.C. Division of Public Health worked with the Eastern Band of Cherokee Indians to investigate three cases in people who visited Harrah’s Cherokee Casino and Resort.
“That was a little bit of an unusual case in that those three individuals were not Jackson County residents,” she said. “They were traveling from out of state, but we have had experience with the bacteria and have investigated it quite thoroughly.”
The health department is still monitoring Harrah’s HVAC system, she said.
“We’re working with them as they continue to develop their water management plan,” she said.
The state Division of Public Health is performing field testing at the WNC Ag Center, the site of the fair, but had not confirmed a source as of Monday afternoon, she said.
The county health department is the reporting agency for the cases.
“With any reportable disease, and Legionnaires’ is one, any positive test that comes from a primary care doctor or hospital or wherever, those positive results are referred to the health department,” she said.
From there, information goes to the N.C. Division of Public Health and CDC, she said.
In spite of the cases reported in Jackson, there’s no need to worry about an epidemic, she said.
“When we share information about Legionella, we share that it is not shared from person to person,” McKnight said. “It comes from breathing in tiny droplets of water that contain the bacteria.”
Heather Gordon, 4-H agent with the N.C. Cooperative Extension office in Sylva, attended the fair on Sept. 6.
“I was there all day,” she said. “I went everywhere and saw everything. I was in livestock barns, the exhibit halls, the building where the business displays are. But I would also say that I am a pretty healthy individual, so I don’t think I would be at an increased risk.”
Gordon had not received information about a survey for attendees, but she plans to participate, she said.
“I hope they can get to the bottom of it and find out what happened,” she said.
She definitely plans to go back to the fair next year, she said.
According to the N.C. Division of Public Health, officials are continuing an “intensive investigation” into the outbreak.
Investigations are ongoing into possible sources of aerosolized water during the fair. Officials are using email to contact people who purchased tickets online and requested all attendees take a survey, which can be found at www.surveymonkey.com/r/dhhs_survey.
“Comparing information from people who got sick and people who did not is an important way for us to find out how people were exposed,” said Dr. Zack Moore, state epidemiologist. “This will also help us understand how to prevent similar outbreaks in the future.”