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NC Department of Health and Human Services
NC Division of Public Health
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Investigation of an Outbreak of Legionellosis in Western North Carolina

Current Outbreak

  • On September 23, 2019, the NC Division of Public Health was notified about an increase in the number of Legionnaire’s disease cases in Buncombe and Henderson counties.
  • 136 cases of Legionnaires’ disease or Pontiac Fever were identified in residents of multiple states and North Carolina counties who attended the NC Mountain State Fair, held September 6-15, 2019 at the Western North Carolina Agricultural Center in Fletcher, NC.
  • The Division of Public health has released an Interim Summary Report (PDF) with preliminary findings from the investigation. This interim report was updated on October 18, 2019. Additional information will be posted when the investigation is complete.
  • If you have questions about Legionnaires’ disease or the outbreak, you can find more information in our FAQ (PDF).
  • Final case count:
County of Residence Confirmed Cases*
Buncombe County 49
Burke County 1
Caswell County 1
Cherokee County 1
Gaston County 1
Granville County 1
Haywood County 11
Henderson County 33
Jackson County 3
Madison County 6
McDowell County 5
Mecklenburg County 5
Mitchell County 2
Polk County 1
Rutherford County 1
Transylvania County 3
Watauga County 1
Yancey County 1
Out of State 11

*No new cases linked to the outbreak have been identified since the end of October. Some previously reported cases did not meet the case definition for this outbreak once a full clinical and risk history were assessed.

Case Characteristics  
Male 77 (57%)*
Female 58 (43%)*
Median age in years (range) 61 (24-91)
Hospitalizations 96 (71%)*
Deaths 4
Legionnaires' Disease 135 (99%)
Pontiac Fever 1 (1%)

*some cases were reported with unknown gender or hospitalization status


Outbreak Case Definition

Clinical Criteria

  • A. Legionnaire’s Disease
    Pneumonia (clinical or radiologically confirmed) in an individual who attended or worked at the 2019 NC Mountain State Fair, with symptom onset within 2 – 14 days after fair attendance


  • B. Pontiac Fever
    Fever, myalgia, headache, chills, nausea, vomiting or diarrhea within 3 days of attending or working at the 2019 NC Mountain State Fair.

Laboratory Criteria

Laboratory confirmed Legionella

  • By culture: isolation of any Legionella organism from respiratory secretions, lung tissue, pleural fluid, or other normally sterile site
  • By detection of Legionella pneumophila serogroup 1 antigen in urine using validated reagents
  • By seroconversion: fourfold or greater rise in specific serum antibody titer to L. pneumophila serogroup 1 using validated reagents on specimens collected 3–6 weeks apart

Confirmed Case: Patient meets clinical criteria A or B AND laboratory criteria

Sources and for more information: