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Legionnaires' Disease Outbreak Overview

The Legionnaires’ disease outbreak linked to the Mountain State Fair has impacted many people in our community and our thoughts are with all of those individuals and families who have been affected.

NC Division of Public Health (NC DPH) continues to update case counts related to this multi-county and multi-state outbreak. Please reference the NC DPH webpage for updated case counts. 

Legionnaires’ disease is a form of pneumonia (lung infection) caused by the Legionella bacteria. 

Most healthy people exposed to Legionella do not get Legionnaires’ disease. However, certain people are at higher risk of getting sick, including those 50 years of age and older, current or former smokers, and those with chronic lung disease or weak immune systems. Most people who get sick with Legionnaires’ disease recover with the use of antibiotics. However, the disease can be very serious and even cause death.

Legionnaires’ disease is spread through breathing in tiny water droplets containing the Legionella bacteria. According to the CDC, it is unlikely to be spread from person to person. Legionella bacteria can be found naturally in freshwater environments such as lakes and streams, and can become a health concern when it grows and spreads in manmade water systems such cooling towers, hot tubs, and decorative fountains. 

Work with Partners during Disease Outbreak Investigation:
Buncombe County Health and Human Services (BCHHS), like all local health departments in NC, investigates suspected cases of reportable communicable diseases in residents of our county. On September 23, 2019, BCHHS confirmed the first case of Legionnaires’ disease in a Buncombe County resident. Additional cases reported by medical providers and laboratories were confirmed throughout the day as Communicable Disease (CD) Nurses were interviewing ill patients and their families. The information gathered through those interviews was crucial to confirming the diagnosis and determining possible exposures. Due to the abrupt increase in cases of Legionnaires’ disease, CD Nurses immediately notified NC Division of Public Health (NCDPH). Experts at the NC Communicable Disease Branch reviewed reports from NC counties.  

BCHHS also alerts local medical providers when we are aware of increases in certain diseases or when we are aware of other public health threats to our community. On the morning of Tuesday, September 24, 2019, we alerted local medical providers of the increase in cases.

Legionnaires’ Outbreak Link to the Mountain State Fair:
On September 24, 2019, NCDPH notified the public of the possible link of Legionnaires’ disease at the Mountain State Fair and encouraged people who were sick and attended the fair to seek medical attention.

Legionnaires’ disease symptoms start within two weeks after inhaling the Legionella bacteria. Because more than 2 weeks have passed since the end of the Mountain State Fair, if you attended the fair and did not become sick, then you will not develop Legionnaire’s disease from going to the fair. 

As NCDPH mentioned in their Interim Report, to reduce the risk of Legionnaires’ disease, it is important for individuals and businesses to properly maintain equipment that produces tiny water droplets, such as decorative fountains, hot tubs, and cooling towers.

We have seen a significant decline in the number of reported cases related to the Mountain State Fair. However, our CD Nurses are always on call, 24/7, to respond to reports of suspected communicable disease in our county.

We want to thank our local medical providers, hospitals and laboratories and ask that they remain vigilant in reporting communicable diseases to their local health departments. Without the help of medical providers who suspected, tested for, and reported Legionnaires’ disease appropriately, it would have taken longer to identify and address this outbreak. We also want to thank our county leadership, public health colleagues in Henderson and surrounding counties, as well as our state and federal partners for their support and hard work during this investigation.

As we look forward to additional information from NCDPH, we will continue to provide factual information that supports our goal of protecting and promoting the public’s health. Buncombe County HHS continues to support the state investigation.

Please reference recent updates from NCDHHS for information on the investigation: 

Health Officials Investigate Legionnaires' Disease in Buncombe County

Buncombe County, N.C.- Numerous cases of Legionnaires’ disease have been reported to Buncombe County Health and Human Services by local medical providers over the past several days. The investigation of these cases is ongoing. The NC Communicable Disease Branch is working with Mountain State Fair organizers to investigate a possible connection of these cases with attendance at the fair earlier this month (Sept. 6-15th). 

Legionnaires’ disease is caused by Legionella bacteria. It is spread through water droplets in the air that people can breathe in. Legionnaires’ disease is not typically spread person to person. State Health Officials, event organizers, and Local Health Departments are investigating reports and working to identify a source.

Legionnaires’ disease causes a severe lung infection or pneumonia. Symptoms may include cough, high fever, weakness, muscle aches, headaches, and shortness of breath. Legionnaires’ disease is treated with antibiotics. Most people who get sick with it need to be hospitalized, but recover fully. However, according to the Centers for Disease Control and Prevention, about 1 out of 10 people with Legionnaires’ disease will die from the infection.  

Most healthy people exposed to Legionella do not become sick but certain people are at increased risk for getting Legionnaires’ Disease including:

  • Those age 50 or older
  • Current or former smokers
  • Those with chronic lung disease like emphysema or COPD
  • Those with weakened immune systems due to disease or medication

If you attended the Mountain State Fair and are sick with symptoms of Legionnaires’ disease, we recommend you see your health care provider and discuss Legionnaires' disease with them. If you live in Buncombe County and have questions about Legionnaires’ disease, please call Buncombe County Communicable Disease at (828) 250 – 5109.

NCDHHS issued a press release about the investigation. For more information on Legionnaires' disease, visit this link. You may also view the attached fact sheets from the CDC.


Table: News Item Documents
File NameSizeTypeDate & Time Added
DPH Interim Report 73 KB 10/11/2019 9:22 AM
Public FAQ 339 KB 10/11/2019 9:22 AM
Fact Sheet: English 540 KB 09/24/2019 5:54 PM
Fact Sheet: Spanish 536 KB 09/24/2019 5:54 PM
Medical Provider Memo from NCDHHS 135 KB 10/10/2019 8:57 AM

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Stoney Blevins
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P. (828) 250-5588

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