Health agencies have not identified the source of contaminated water that caused an outbreak of Legionnaires’ disease in East Texas that has left one dead.

Six others diagnosed with the disease and five with symptoms consistent with the disease all visited the East Texas State Fair from Sept. 20 to 29 in Tyler.

Health officials are checking water sources on the fairgrounds as the most likely source for the Legionella bacteria, Terrence Ates, the spokesman for NET Health, said Saturday.

People contract Legionnaires’ disease by breathing droplets of water contaminated with Legionella bacteria.

“An example is breathing in steam from a contaminated hot tub,” according to information posted by the Texas Department of Health Services.

Contaminated water can be generated by air conditioning systems or anything that creates a fine mist.

“We are testing every potential exposure site,” Ates said Saturday. This includes buildings on the fairgrounds and sources generated by food and display vendors.

Local health department employees have finished collecting water samples, which have been sent to the state health department to test for bacteria.

Ates said that NET Health has not received results of all the samples. Health professionals are still going through the testing process.

Ates was not sure when the investigation would be completed.

Earlier NET Health released a statement to the city saying that based on a test, the ventilation system in Harvey Convention Center had been ruled out as the source. However, on Saturday, Ates said that nothing had been ruled out.

The ventilation system in Harvey has been tested again and the results of the second test to the system have not been returned, he said.

“We don’t want to leave anything out (as a source to be tested) and are doing our due diligence,” Ates said.

On Friday 69-year-old Ruben Gutierrez of Flint died. As a volunteer for the Smith County Democratic Party, he manned the party’s information booth in Harvey Convention Center each day of the fair.

George Roberts, CEO of NET Health, confirmed that Gutierrez was one of the people diagnosed as having the disease.

Gutierrez’s wife, Susan Gutierrez, said Friday that her husband was treated for the disease in a Tyler hospital in October. After his initial treatment, he contracted sepsis and other complications, which caused him to go into kidney failure, but he bounced back, his wife said.

Earlier this month he was readmitted to a hospital and died late Friday.

Susan Gutierrez said Friday that she was told the source of her husband’s contamination had not been identified.

“They said it was something in the fair, but he was there every day,” she said Friday. “It could have been the A/C, it could have been the hot tubs or (something else).”

The Democratic Party’s information booth in Harvey Convention Center was near a hot tub display and under an air conditioning vent.

According to the Centers for Disease Control and Prevention, Legionella is naturally found in water, especially warm water, and that hot tubs or spas that are not cleaned and disinfected well enough can become contaminated with Legionella.

Because high water temperatures make it hard to maintain the disinfectant levels needed to kill germs like Legionella, making sure the hot tub has the right disinfectant and pH levels is essential, according to the CDC.

Legionella can also be found in cooling towers, plumbing systems, and decorative pools and fountains.

Legionnaires’ disease mimics pneumonia. Most people who get it are older than 50 and have respiratory problems or other health problems which have weakened their immune system, according to information from NET Health.

Those in the target group who have pneumonia-like symptoms and have been to the fair should see a doctor, Ates said.

The health department earlier advised doctors who have patients in the target group who show these signs to specifically ask if they were at the fair, and if they were, to test them for Legionnaires’ disease. Health care providers are required to report cases of Legionnaires’ disease.

The disease can be dormant in a person for weeks before someone becomes sick, Ates said.

Ates said Saturday that no more diagnosed or suspected cases have surfaced since NET Health released information to the public about the outbreak earlier this month.

Those who have Legionnaires’ disease are treated with antibiotics. Most recover after treatment.