Hot tub water that sprayed into the air likely caused an outbreak of Legionnaires' disease that killed four people in North Carolina last year, state health officials said Thursday.
The state Department of Health and Human released its final report on the outbreak, which infected people who attended a state fair in western North Carolina. The final report tallied 136 cases of Legionnaires' disease and one case of Pontiac fever in residents of multiple states, officials said.
Ninety-six people were hospitalized.
People attending the North Carolina Mountain State Fair, held in September in Fletcher, were likely exposed to the bacteria in aerosolized water from hot tubs on display at the fair, the report said. Hot tubs have been linked to outbreaks of Legionnaires' disease nationally and internationally, state health officials said in a news release.
“People who entered the building where the hot tubs were on display and people who actually walked by the hot tubs were far more likely to become sick than people who did not,” said State Epidemiologist Zack Moore.
Legionnaires’ disease is a severe type of lung infection caused by Legionella bacteria, which is usually spread through water droplets in the air and can grow and spread in places like showerheads and hot tubs.
“This outbreak was a reminder of the importance of appropriate care and maintenance of hot tubs -- particularly in this type of setting where potentially large numbers of people could be exposed,” Moore added.
Hot tubs have been linked to other Legionnaires’ disease outbreaks across the U.S., including one at a state fair in Texas.
In response to the investigation, the Centers for Disease Control and Prevention and North Carolina’s Division of Public Health have developed and published hot tub display recommendations.
The final report confirms the cause that was included in an interim report released in October.