One of these cases is associated with the outbreak in the Bronx and the other two are sporadic cases with no links to New York City or each other, according to the Rockland County Health Department.
The case related to New York City involves an individual who works in the Bronx, but lives in Rockland County.
Last week an employee of Chromalloy Gas Turbine Corporation in Orangeburg was diagnosed with the disease. The company said it reopened Monday morning after disinfecting cooling towers.
The Rockland County Health Department says its "closely monitoring the situation" and is contact with state health officials.
In a statement, the department said, "As part of the Health Department's efforts to outreach to the community, letters have been sent to local providers and businesses. Correspondence to physicians include information on symptoms, testing and treatment. Letters to the business owners include information on inspection and maintenance of hot and cold water systems, which include cooling towers."
Meanwhile, Mayor Bill de Blasio on Monday announced new legislation on inspecting and maintaining cooling towers in the wake of the deadly outbreak of Legionnaires' disease, the worst in New York City history, that has killed at least 12 people and sickened more than 100 in the South Bronx.
It will require all cooling towers to be registered with the city and subject to quarterly inspections, with dangerous levels of microbes required to be reported to health department. Building owners who do not comply will be penalized.
"We need stringent new regulations to ensure this can never happen again," de Blasio said.
The bill will go to the City Council Tuesday, and in order to expedite the process, a voluntary online database has been created.
"We are confident the Legionnaires' outbreak in the South Bronx has been contained, and are working with our partners in the City Council to protect the entire city in the long-term through stringent new regulations for building owners," de Blasio said. "New York is the first major city in the nation to propose new registration, inspection, and enforcement standards for the cooling towers which harbor Legionnaires' bacteria. This action reflects our chief priority: to safeguard the health of New Yorkers."
De Blasio said the total number of cases has reached 113, but the last diagnosis came on August 3, a sign that the outbreak is contained. Additionally, two more cooling towers had shown signs of the bacteria.
"So as we go through every passing day with no new sicknesses, it's a very promising sign," he said. "But what is very important to note is we have no evidence over the last few days of any new cases of Legionnaires'."
Out of 39 cooling towers inspected, 12 of them were found to have Legonella bacteria.
"Our data, which must be our guiding light in all of this, continues to show that we are bringing this outbreak under control," New YOrk City health department commissioner Dr. Mary Bassett said.
While the mayor was briefing reporters, Governor Andrew Cuomo was doing much the same on state efforts in the Bronx. Reporters point to the dueling press conferences as yet another example of Cuomo and de Blasio not getting along.
But de Blasio dismissed all that and said state and city health officials are working together just fine.
"They have been working together from the very beginning of this outbreak," he said. "So the politicians here are not the issue here. The issue is do the people who know the facts, are they working together constantly, and the answer is yes."
Cuomo said more than 500 building sites have been canvassed in the Bronx over the past two days to identify cooling towers that could be potential sources of Legionella bacteria, which was found in five buildings within a few blocks of one another.
The governor said that as of Monday, a total of 11 sites have tested positive for legionella within the impact zone. Additionally, 4 sites have previously tested positive for legionella outside of the impact zone that are not related to the outbreak in the South Bronx.
The victims were adults with underlying medical conditions. The disease is a form of pneumonia caused by breathing in contaminated mist.
The governor's office says teams led by the State Department of Health will be focusing on high impact areas and providing information on Legionnaires' disease to members of the public as well as surveying additional buildings for cooling towers. Teams led by the New York State Office of Emergency Management and the Office of Fire Prevention and Control will be taking samples from cooling tower sites.
"We are taking every precaution to prevent the spread of Legionnaires' Disease," Cuomo said. "This outbreak has been a source of great concern for people throughout the Bronx and the rest of New York City, but residents should know that we are doing everything necessary to protect the public health. The state is working closely with our federal and local partners, and together we will keep New Yorkers safe."
De Blasio had said last week that one or more of the five sites announced where Legionnaires' had been detected likely caused the start of the outbreak:
-- Lincoln Hospital, remediation completed
-- Concourse Plaza, remediation completed
-- Opera House Hotel, remediation completed
-- Verizon remediation, completed Streamline Plastic Co., remediation completed
He also identified seven new sites that were cleaned and disinfected after the bacteria was found:
-- 1106 Hoe Ave. (Verizon commercial facility)
-- 118 Grand Concourse (New York City housing court)
-- 245 E. 161 St. (Bronx Hall of Justice)
-- 554 Grand Concourse (Post office building about to be decommissioned turning into a commercial building this month )
-- 455 Southern Blvd.(Samuel Gompers High School)
-- 151 East 151st Street (Prevention Assistance and Temporary Housing intake facility for the Department of Homeless Services)
-- 160 Teller Ave (Daughters of Jacob Nursing Home)
The city also released two graphs that are very helpful in understanding the outbreak. They show the number of cases by date of onset and by date of diagnosis, and both curves show that the number of cases has fallen dramatically. Although the case number has gone up, these new cases must represent cases with earlier onset dates and delays in reporting.
Under Cuomo's direction, state health commissioner Dr. Howard Zucker arrived at Montefiore Robert Moses facility to test for the bacteria. Test results will take at least a week.
"We're going to get a sample and find out what we have," Zucker said.
Hospital staff said they followed strict guidelines on keep the cooling towers.
"All owners of coin towers got a notice from the New York City commissioner to sanitize their towers, so we're doing that but we have a great maintenance program where we clean the towers twice a year," said Edward Pfleging, Montefiore senior vice president of facilities.
Teams led by the State Department of Health will be surveying additional buildings for cooling towers and providing information on Legionnaires' Disease to the public throughout the Bronx. Teams will be at 4 Train stops, including the Grand Concourse and 161st Street and River Avenue (Yankee Stadium) Stations and at 5 Train stops, including the 3rd Avenue and 149th Street and Gun Hill Road (Co-op City) Stations.
The state is working with the Centers for Disease Control and Prevention and New York City's Department of Health and Mental Hygiene.
On Thursday, the governor announced that the state is offering free Legionella testing to building owners, operators, managers and landlords of buildings with cooling towers or evaporative condenser units that can be sources of the bacteria. This testing is being offered free of charge, and two hotlines have been set up to further support the collection of testing samples. Those numbers are 888-769-7243 and 518-485-1159, and are staffed by trained operators Monday through Friday from 8:30am to 4:30pm.
Building owners, operators, managers, and landlords who wish to have DOH test for Legionella can also send the name and address to which the kit should be mailed, and a working phone number to: Legionella@health.ny.gov. DOH will send an appropriate sampling kit with simple instructions for sample collection.
The State DOH will provide results of the tests, and when the test shows dangerous levels of Legionella or other bacteria. When tests show dangerous levels of bacteria, the State will work with property owners and managers to facilitate prompt disinfection.
The Associated Press contributed to this report.