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(CNN)A deadly outbreak of Legionnaires' disease at a North Carolina state fair is now responsible for killing two people, state health officials announced Thursday. Authorities are not publicly identifying the deceased.

Health officials have confirmed 134 cases of Legionnaires' disease, an airborne lung infection, or Pontiac Fever, a milder form of the disease, in residents of multiple states who attended last month's NC Mountain State Fair in Fletcher, North Carolina. Eighty-eight people have been hospitalized.

Health officials' interim report suggested that exposure to the Legionella bacteria occurred in one event center at the state fair, "particularly near the hot tubs and during the last five days of the fair," which went from September 6-15.
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"Hot tubs are a well-established source of aerosolized water exposure and have been associated with previous Legionnaires' disease outbreaks nationally and internationally," according to the North Carolina Department of Health and Human Services.

Legionella bacteria are found naturally in the environment but can become a health concern when they "spread in human-made water systems like hot water tanks, cooling towers of air conditioning systems, decorative fountains and hot tubs or spas that are not properly maintained," North Carolina health officials have said.

Legionnaires' disease can be treated with antibiotics, but about 1 in 10 people who get sick from the disease die, according to the US Centers for Disease Control and Prevention.

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A fourth person has died in a Legionnaires' outbreak that's been linked to a hot tub display at a North Carolina state fair last month.

Nearly 150 people who attended the N.C. Mountain State Fair were sickened in addition to the four fatalities, according to an update Friday from the North Carolina Department of Health and Human Services. At least 133 people were diagnosed with Legionnaires' while another eight were confirmed to have a milder form of the disease called Pontiac fever.

At least 94 people were hospitalized in the North Carolina outbreak
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Samples taken from the hot tubs on display tested negative for Legionella pneumophila, the bacteria associated with the disease, according to to Friday's report. The state's health department noted that environmental samples were not collected until two to three weeks after the fair's end, and might not be able to judge conditions while the festival was going on.

One sample from the women's restroom at the Davis Event Center did test positive for Legionella pneumophila, but scientists determined the strain was genetically different than the strain collected from patients.

 
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