Legionnaires': The Investigation Behind The Outbreak

Oct 24, 2019

It's been a month since health officials announced the Legionnaires' outbreak linked to the Mountain State Fair.  

More than 140 people have contracted the respiratory illness.  Four people have died.  The outbreak has triggered speculation, lawsuits and a massive public health investigation as officials work to find the source.  BPR’s Helen Chickering talked with local health officials and brings us a behind the scenes look at the investigation  

One of the busiest departments in every local county health department is one that flies under the public radar.  

“This is something that is unseen by the public, but probably one of the most vital roles for public health departments across the state,” says Henderson County Health Director Steve Smith about the public health team on the front lines of communicable disease investigations..

“So that’s populated with all kinds of disciplines, from our medical director, to our communicable disease nurses to public information specialists, environmental health personnel, “says Smith.

A broad multidisciplinary team that is constantly receiving and assessing reports from local health care providers who are required by law to report cases of specific diseases.  Cases that could be a public health risk are investigated. Many turn out to be false alarms, but all are taken seriously,   including the calls that started coming in near the end of September to the Buncombe County Health Department.

“The first report about suspected Legionella came to us on September 20th, a Friday,” says Buncombe County Medical Director Dr. Jennifer Mullendore, “One case of Legionella infection is not that uncommon, we get anywhere from 5-7 cases a year, so that in of itself, clearly we’re going to investigate it, but it doesn’t ring alarm bells. And then on the 22nd we were alerted by a medical provider that we had 3 patients who were very sick and had lab results that said Legionella infection.”  

The alarm bells started ringing and an investigation began.  Communicable disease nurses interviewed patients and families.

“We put  all that information into the state system,” says Mullendore, “but we also  picked up the phone and said ‘Hey, we’re  seeing a cluster of pneumonia caused by legionella out here and just wanted to let you to know,’”  

Meantime, a similar scene was bubbling up in Henderson County says Health Director Steve Smith.

“My first indication was a report by our communicable disease nurse which confirmed an initial case of Legionella.  And then later that day I was contacted by the state epidemiologist that other cases had emerged in counties other than Henderson.”  

By Monday September 23rd health officials confirmed a Legionnaires’ outbreak. At this point the state took over the investigation and soon a common thread emerged, says Dr.  Mullendore.

“Later that morning they called us back and asked if any of those patients had gone to the fair. So it’s like they getting info from us and we’re getting info from them and we’re trying to figure out what’s going on and what we need to be worried about.”

Cases from other counties and nearby states started pouring in.  State health officials surveyed people who attended the Mountain State Fair, which was long over.  They also sent a team to inspect and take samples at the WNC Ag Center in Fletcher and from vendors with a focus on sources of aerosolized water.  People get legionnaires’ when they breathe in water droplets contaminated with the legionella bacteria

“There’s progress on the investigation I want to share with you.”

On October 3rd, State Epidemiologist Dr. Zack Moore announced early findings of their investigation.  People who got sick were more likely to attend the fair during the last few days and walk by hot tub displays in the Davis Event Center.  So far only one sample, from a sink in restroom has tested positive for Legionella. Dr. Mullendore says it’s important to note that while there are many solid clues, there may never be a smoking gun.

“Sometimes we have a good suspicion, like a high probability that something is the source.  But if you don’t have confirmatory information, you are not going to be able to say with 100 percent certainty.

The investigation is ongoing and there’s a new twist for health officials to figure out -  a single  case has been linked to a quilt show at the Ag Center. I’m Helen Chickering

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