Lethal Legionella Outbreak in North Carolina Linked to Hot Tub Display

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A deadly outbreak of Legionnarie's disease in North Carolina has infected 141 people, hospitalized 94 and killed four people, making it the largest Legionnaire’s outbreak on state record. Investigations are still ongoing, but officials currently suspect the outbreak originated from a hot tub display at the NC Mountain State Fair in early September.

Legionella is most commonly contracted by aerosolized water droplets — like steam inhaled into the lungs, which is why the hot tub display was identified early on as a possible culprit. However, Legionella can also be linked to cooling towers, decorative pools and fountains and other plumbing systems.

So far, investigators from the North Carolina Department of Health and Human Services have learned most of the infected people walked by the hot tub display during the latter half of the 10-day event. Two hot tub vendors participated in the event (neither of which have been named by officials), and both have submitted water samples for testing. That said, the test results may be inconclusive if the hot tubs were drained and disinfected prior to sample collection.

As Circle of Blue, a news outlet focused on global water-related issues, reported yesterday, investigators also discovered a strain of Legionella present in the plumbing at the Davis Event Center, the venue for the hot tub display. However, the strain is genetically different than the strain that infected fairgoers.

According to the CDC, approximately one in 10 people who become ill with Legionnaires die. Victims who smoke, are immune compromised or suffering from other respiratory diseases are at the greatest risk. The CDC reports that each year anywhere between 8,000-18,000 people are hospitalized with the disease.

According to Legionnaires researcher Dr. Paul Epstein, there may be as many as 100,000 cases each year, the vast majority of which go unreported because symptoms are very similar to pneumonia.
Preventive measures recommended by the CDC include maintaining proper disinfectant and pH levels, removal of slime and biofilm by scrubbing and other cleaning methods, proper filter maintenance and replacement, and replacing hot tub water. 

To learn more about Legionellosis, read this story from the PHTA Recreational Water Quality Committee.

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