JCDPH & EBCI Investigating Three Cases of Legionnaires' Disease

LEGIONNAIRES’ DISEASE

What is Legionnaires’ disease?

Legionnaires’ disease is a form of pneumonia caused by the Legionella bacteria.  Read more about the disease here.

How severe is the illness?

Legionnaires’ disease can be very serious and even cause death.  Most cases can be successfully treated with antibiotics and healthy people usually recover from the infection.

How do people get Legionnaires’ disease?

The disease is spread through breathing in tiny water droplets containing the Legionella bacteria.  According to the Centers for Disease Control and Prevention (CDC), Legionnaires’ disease is not spread from person to person. 

Legionella bacteria is most commonly found in warm water, especially stagnant or standing water.  Legionella bacteria can be found naturally in freshwater environments such as lakes and streams; it has also been isolated in manmade water systems such hot tubs, cooling towers, large plumbing systems, and decorative fountains. 

Outbreaks occur following the exposure of individuals to a common source of the bacteria in the environment.

Who is most susceptible?

Most people who are exposed to Legionella do not get sick but some people are more at risk than others.  There are factors that can put people at an increased risk of getting sick: being age 50 years or older, being a current or former smoker, having a chronic lung disease (like chronic obstructive pulmonary disease or emphysema), having a weakened immune system or taking drugs that weaken the immune system (like after a transplant operation or chemotherapy), having cancer, or having underlying illnesses such as diabetes, kidney failure, or liver failure.

What are the symptoms?

Symptoms include: a high fever, chills, cough, and fatigue or weakness.  Some people also suffer from muscle aches or headaches.

How soon do the symptoms occur?

Symptoms usually begin 2 to 14 days after exposure to the bacteria.

What is the treatment?

Certain antibiotics are effective in treating the disease.  Early diagnosis and treatment are important for recovery.

Where can I get more information?

OUTBREAK ASSOCIATED WITH HARRAH’S CHEROKEE CASINO RESORT

What property is associated with the cases of Legionnaires’ disease?

Harrah’s Cherokee Casino Resort

777 Casino Drive

Cherokee, NC 28719

How many cases have been found?

There were three cases reported in persons who visited the property in May—November 2018.  The Centers for Disease Control and Prevention (CDC) considers a Legionnaires’ disease outbreak as occurring when there are two or more cases associated with the same property in a 12-month period.

Who is involved in the investigation?

The Jackson County Department of Public Health (JCDPH) is working with the Eastern Band of Cherokee Indians Public Health and Human Services (EBCI PHHS), North Carolina Division of Public Health (NC DPH), and Harrah’s Cherokee Casino Resort on this investigation.

How did you learn about the cases?

Public Health officials across the country track cases of Legionnaires’ disease and their travel history in the 10 days preceding onset of illness.  Reported cases have increased significantly since 2000.  Still, it is possible that not all cases are reported to Public Health.  Local, State, and Federal public health agencies share information about the travel history of cases in an effort to identify specific places of exposure and prevent further transmission of this disease.  In this particular outbreak, the CDC notified NC DPH about the cases, since all were residents of other states who had traveled to North Carolina.

What is Public Health doing about this?

Once JCDPH received notification of the first confirmed case of Legionnaires’ disease in an individual who stayed at the property, JCDPH notified Harrah’s Cherokee Casino Resort.  While one case of Legionnaires’ disease in a guest does not constitute an outbreak per CDC definition, it is noteworthy and gives the property the opportunity to review their water management systems and processes.

Upon notification of the second confirmed case, JCDPH, EBCI PHHS, and NC DPH conducted a detailed site visit, an environmental assessment of the property was performed, and multiple environmental samples were collected for Legionella testing.  The presence of Legionella bacteria was identified at this time at low levels in a single source.  Currently, Harrah’s Cherokee Casino Resort is working with an experienced consultant to conduct remediation and continued follow up sampling to ensure remediation efforts are effective. 

I (or my family member) visited Harrah’s Cherokee Casino Resort and became ill afterwards.  What should I do? 

If you visited the property from October 16, 2018 to present day and experienced respiratory illness or pneumonia up to 14 days after your stay, contact your primary care provider so that you may be tested for Legionnaires’ disease.

What is Harrah’s Cherokee Casino Resort doing about this situation?

The investigation has focused on environmental assessment, environmental sampling to determine whether the Legionella bacteria are present, and identifying people with Legionnaires’ disease.   The presence of Legionella bacteria was identified at this time in very small amounts in a single non-public industrial source.  This source was immediately treated.  Currently, Harrah’s Cherokee Casino resort is working with an experienced consultant to conduct remediation and follow up sampling to ensure remediation efforts are effective. 

The property is continuing to work with JCDPH, EBCI PHHS, and NC DPH to ensure Legionella bacteria have been removed.  If needed, the property will continue to remedy the situation.  After Legionella are no longer found, the property will continue to do follow-up testing on a schedule to ensure the measures worked.  Additionally, Harrah’s Cherokee Resort Casino is implementing a water management program to monitor for conditions that are conducive for Legionella growth and transmission. 

The property is assisting in the investigation and notifying current and appropriate past guests who stayed at the property dating back to October 16, 2018.

I have a room/suite booked or I intend to visit Harrah’s Cherokee Casino Resort.  Am I at risk?

Please note that it cannot be confirmed whether any of the cases were exposed to Legionella bacteria while visiting Harrah’s Cherokee Casino Resort.  Legionella bacteria is naturally occurring in the environment and has up to a 14-day incubation period, making it difficult to pinpoint exact location of exposure.   Regardless, Harrah’s Cherokee Casino Resort has taken immediate steps to ensure the safety and health of their guests. 

Most people who are exposed to Legionella do not get sick, but some people are more at risk than others.  There are factors that can put people at an increased risk of getting sick—being age 50 years and older, being a current or former smoker, having a chronic lung disease (like COPD or emphysema), having a weakened immune system or taking drugs that weaken the immune system (like after a transplant operation or chemotherapy), having cancer, or having underlying illnesses such as diabetes, kidney failure, or liver failure.

We understand that many may be concerned about the safety of the property and we continue to work with the property to monitor the situation regarding Legionella bacteria.  You should review the risk factors to Legionnaires’ disease and assess if you have one or more of them.  If you have questions, it is recommended that you speak to your primary care provider.