Harrah’s Cherokee Casino Legionnaires Outbreak

Posted in Legionella,Legionnaire's disease,Our Blog,Outbreaks & Recalls on December 10, 2018

A few gamblers at Harrah’s Cherokee Casino Resort in North Carolina brought home dubious winnings this year. There have been three confirmed cases of Legionnaires’ disease in visitors to the casino from May through November 2018. It’s possible there are more which were not reported. Here’s the scoop on the Harrah’s Cherokee Casino Legionnaires outbreak.

On November 21, the Jackson County Department of Public Health issued a notice about their investigation, reminding folk who visited the casino to contact their primary care doctor if they had a respiratory illness or pneumonia around 14 days from visiting. It can be difficult to pinpoint the start of an outbreak like Legionnaires’ Disease because the bacteria have a 14 day incubation period. The CDC and health departments around the country monitor reported cases and the travel itineraries of the patients so they can track down possible sources as soon as possible. In this instance, the cases were reported out of state and the CDC connected them to Harrah’s Cherokee Casino and Resort, notifying the North Carolina Department of Public Health, who in turn notified the Jackson County Department of Public Health.

In the course of the investigation of the Casino they found legionella pneumophila in a nonpublic source and immediately disinfected the source. The Resort is now working with a consultant to test and clean their facilities thoroughly. They are also implementing a water management plan to monitor conditions and prevent any subsequent issues with contamination and working with the Jackson County Department of Public Health to notify current and past guests who stayed at the property as far back as Oct 16, 2018.

These preventative measures are very sensible, as casinos and resorts of this nature tend to attract some of the at-risk groups for Legionnaires’ disease (namely, folk over 50 years of age and folk who smoke).

What is Legionnaires’ Disease?

Legionnaires’ disease is a respiratory disease contracted by inhaling water droplets or mist containing the bacteria known as Legionella pneumophila. Its less severe manifestation is called Pontiac Fever, and collectively they are called legionellosis. The symptoms are similar to pneumonia and may start to manifest 2 to 10 days after exposure.

According to the Mayo Clinic, symptoms start with headaches and muscle pain which may be accompanied by chills and a fever of 104 or more. By the second or third day the symptoms may progress to include symptoms such as a cough, shortness of breath and chest pain. There may be gastrointestinal symptoms like nausea, vomiting or diarrhea. As with pneumonia, symptoms may also include confusion or mental changes.

Pontiac Fever, the milder form of legionellosis, doesn’t progress to a lung infection but contents itself with fever, chills, headache and muscle pain.

Legionnaire’s disease, if left untreated, can lead to lethal complications like respiratory failure, septic shock and acute kidney failure. It must be diagnosed by a doctor and then treated as soon as possible to prevent these possible consequences.

The Culprit

Legionella pneumophila occurs naturally in lakes and streams but becomes a problem when it grows in man-made water systems. Being a bacterium, it loves warm standing water, which means it has all sorts of potential to grow in modern plumbing systems. The more complex the system, the higher the risk. Though bacteria are everywhere, legionellosis usually only infects people who breathe in–or aspirate—contaminated mist, vapor, or water. (Aspiration is when you choke in such a way that spittle or water goes into your comparatively defenseless lungs instead of down to your stomach where the good bacteria in your gut and your stomach acid deal with unwanted intruders). It is also technically possible to get Legionnaires’ from working in contaminated soil, and it occasionally occurs as a wound infection.

Legionella pneumophila have the potential to spread through any system which produces mist or vapor and hasn’t been properly cleaned or disinfected; such as air conditioning systems, sprinkler systems, produce sprinklers, humidifiers, or hot tubs. You could also contract legionellosis by choking in the shower.

The Risk

Legionnaires’ disease is relatively uncommon, but very serious. It is estimated that 10,000 to 18,000 of people in the United States become infected by the Legionella pneumophilabacteria each year, and according the CDC, approximately 1 in 10 of those people who contract Legionnaires’ disease will die. There is no vaccine.

The people most at risk are those with fragile health or a compromised immune system to start with, people over age 50, and people who smoke. The reason smokers are more vulnerable is that their aspiration prevention mechanism is dysfunctional, which means they are far more likely to inhale water droplets than a nonsmoker. Folks who have lung disease such as COPD or emphysema have the same vulnerability.

Even in the rare event that an otherwise healthy person contracts Legionnaires’ disease, hospitalization is still likely. Admission to intensive care is also common. Legionnaires’ is treated with antibiotics, and in most cases (9 out of 10) treatment is successful. It can, however, take a long time for all the symptoms to fade. Survivors may show persistent fatigue, neurological or muscular issues in the months following, but most will recover entirely within a year.

Staying Safe

The single biggest thing you can do to prevent Legionellosis is to quit smoking or help your loved one quit smoking. If you or a loved one have lung disease, cancer, or a recent organ transplant, be very careful when traveling. Look for accommodations that look clean and well maintained. Maybe skip the public pool or hot tub, at least until your health is fully restored.

If you or a loved one inhale water or mist, then fall ill within a couple days, pay very close attention to the symptoms and the progression. If the symptoms escalate or persist, go see a doctor for testing. Better safe than sorry. If you or a loved one contracted Legionellosis, you may be able to recover compensation with the help of a Legionnaires’ disease lawyer.

For further prevention, if you or a loved one need a nursing home or long-term care, make sure to look for reputable long-term care homes and nursing homes which are well maintained and follow meticulous cleaning and disinfection procedures for their pools and spas. Make sure that you stay in touch with your loved one and know how illness affects their body so you can be alert to any signs of more serious infection.

By: Abigail Cosette Ryan, Contributing Writer (Non-Lawyer)