A fourth person has died after contracting Legionnaires' disease believed to be linked to hot tubs that were on display at a North Carolina fair, state health officials said Friday.
Identifying information about the fourth victim was not released due to privacy restrictions, a North Carolina Department of Health and Human Services spokesperson told BuzzFeed News.
More than 130 cases of Legionnaires’ disease have been reported in people who attended the NC Mountain State Fair, a 10-day agricultural fair held in September at the Western North Carolina Agricultural Center in Fletcher. Health officials also reported eight cases of Pontiac fever among attendees.
The illnesses have been reported in multiple counties in North Carolina, as well as South Carolina. Fletcher is located about 30 minutes south of Asheville in western North Carolina.
Legionnaires' disease is a serious form of pneumonia that results from breathing in droplets of water containing Legionella bacteria. About 1 in 10 people who contract Legionnaires' disease die from it, according to the CDC. Pontiac fever is a milder infection resulting from exposure to Legionella.
The exact source of Legionella is still being determined in these cases, North Carolina health officials said. Possible sources tested for Legionella included hot tubs and diffusers that had been on display in the Davis Event Center, and a fan located outside the center during the fair, but the only water sample that tested positive for the bacteria was from the women's restroom at the venue.
However, the health department noted that these water samples were all collected between 12 and 22 days after the Mountain State Fair wrapped up, and that the Legionella found in the positive sample was genetically different from the clinical samples found in patients who were part of the outbreak.
A study conducted by the health department found that the people who contracted Legionnaires' or Pontiac fever were likely to have "walked by or spent time at the hot tubs" in the event center, and to have attended during the last five days of the fair.
Hot tubs are a source of aerosolized water exposure, and they've been previously associated with Legionnaires’ disease outbreaks nationally and internationally, the department report noted.
Two hot tub companies that displayed at the fair, All Pro Billiards & Spas and Soft Fun, are being sued by a man who said he was hospitalized with a 105-degree fever, diarrhea, and vomiting after spending an hour inside the Davis Center and talking to a hot tub salesperson on Sept. 10, according to the Charlotte Observer.
"If everyone did everything they were supposed to do, this would not have happened,” Fred Pritzker, a lawyer for the man, Jimmy Thomas, told the Observer. “This started with the water supply in the Davis Center.”
All Pros Billiards & Spas said in a statement that it "took all measures to make sure that the water in the hot tub was well maintained during the duration of the fair dates." The company said water samples collected by the CDC from its spa filter used at the fair tested negative for Legionella.
Calls and emails to Soft Fun, which operates as SCM Relaxation Spas in South Carolina, were not immediately returned Saturday.
On Thursday, health officials announced a case of Legionnaires’ disease in a person who did not attend the Mountain State Fair, but did visit the Western North Carolina Agricultural Center for a quilt show held Sept. 27–29.
It's the only case of Legionnaires’ disease reported to date in a person who didn't attend the NC Mountain State Fair, but did visit the agricultural center after the fair.
The Davis Event Center had been declared safe by Department of Agriculture employees prior to the quilt show. However, at least one event scheduled to be held at the event center has since been canceled out of "an abundance of caution."
The center's hot water system was treated with a thermal eradication disinfecting process earlier this month as a "precautionary measure," the Western North Carolina Agricultural Center said in a statement.