MI: Blastomycosis outbreak in a paper mill in Escanaba 2022-2023

[Shiloh]

Source: https://www.cnn.com/2023/04/10/health/fungal-infection-paper-mill/index.html

Almost 100 confirmed or probable cases of rare fungal infection linked to Michigan paper mill, health officials say
By Katherine Dillinger, CNN
Published 7:51 PM EDT, Mon April 10, 2023

CNN —

Ninety-three confirmed or probable cases of blastomycosis have been identified in Michigan’s Delta and Menominee counties, according to the local health department, and they are believed to be associated with a paper mill in the town of Escanaba.

Blastomycosis is caused by a fungus, Blastomyces, that lives in the environment, especially in moist soil and decomposing matter like wood or leaves, according to the US Centers for Disease Control and Prevention. It is predominantly found in the Midwest and the South, particularly around the Ohio and Mississippi rivers and the Great Lakes.

There are only one or two cases per 100,000 people each year in states where blastomycosis is a reportable condition, according to the CDC. One analysis found 1,216 deaths related to the illness from 1990 to 2010...

 

[Shiloh]

Source: https://www.usatoday.com/story/news...eak-escanaba-michigan-paper-mill/11680237002/

Employee dies, nearly 100 workers infected in fungal outbreak at Michigan paper mill
Keith Matheny
Detroit Free Press

DETROIT – A contracted employee to a paper mill in Michigan has died from blastomycosis, the fungal infection whose rare outbreak has affected nearly 100 employees at the mill, local health officials said.

The contracted employee to the Billerud mill in Escanaba, whose name was not released, died “recently,” Public Health Delta and Menominee County officials said in a release.

"Everyone at Billerud is deeply saddened by this news," Brian Peterson, operations vice president for the Billerud Escanaba Paper Mill, said in a release. "Anyone who works at our facility is a part of our team, and we are keeping this individual, their family, coworkers and friends in our thoughts and close to our hearts."

Billerud officials on Friday announced the mill with nearly 900 employees would temporarily close for up to three weeks. Authorities will perform a deep cleaning of the vast facility and its ventilation systems, an inspection of incoming materials for the blastomyces fungal spores that cause the disease, and a health hazard evaluation of employees...

 

[Emily]

Update - still no source, still investigating.

https://flutrackers.com/forum/forum...rce-of-largest-fungal-outbreak-in-u-s-history

 

[Pathfinder]

Blastomycosis Investigation

Download PDF​

​https://phdm.org/

​

 

[Shiloh]

Source: https://www.wilx.com/2023/04/15/upd...ycosis-infection-after-working-escanaba-mill/

UPDATE: NIOSH continues to analyze samples from Escanaba Billerud mill in blastomycosis investigation
By TV6 News Team
|Updated: Jun. 22, 2023 at 4:40 PM EDT

ESCANABA, Mich. (WLUC) - Public Health Delta & Menominee Counties said the investigation continues into the blastomycosis outbreak among Escanaba Billerud mill workers, which started in March.

PHDM said in total, the health department has seen 120 cases. That number, according to PHDM Health Officer Mike Snyder, is two more than last reported on May 19. They were reported in late May.

Snyder said the last onset of illness among employees and visitors to the mill was May 3...​

 

[Shiloh]

Source: https://www.cdc.gov/mmwr/volumes/73/wr/mm735152a2.htm

Outbreak of Blastomycosis Among Paper Mill Workers — Michigan, November 2022–May 2023
Weekly / January 2, 2025 / 73(5152);1157–1162


R. Reid Harvey, DVM1,*; Allyson W. O’Connor, PhD1,*; Marcia L. Stanton1; Ju-Hyeong Park, ScD1; Dallas Shi, MD, PhD2,3; Perri C. Callaway, PhD1,4; Xiaoming Liang, MS1; Ryan LeBouf, PhD1; Rachel Bailey, DO1; Ethan Fechter-Leggett, DVM1; Ian Hennessee, PhD3,5; Mitsuru Toda, PhD5; Rebecca Reik, MPH6; Mary Grace Stobierski, DVM6; Jevon McFadden, MD6,7; Sara Palmer, MPH6,8; Melissa Millerick-May, PhD6; Robert Yin, MD9; Michael Snyder, MPA9; Jennifer Meece, PhD10; Jeremy Olstadt10; Alana K. Sterkel, PhD11,12; Suzanne Dargle11; Olivia Bree11; David Weissman, MD1; Marie A. de Perio, MD13; Stella Hines, MD1; Jean Cox-Ganser, PhD1 (View author affiliations)
View suggested citation
Summary

What is already known about this topic?

Blastomycosis is a rare fungal disease often initially misdiagnosed, which can contribute to severe pulmonary illness. Community outbreaks have been reported after soil disruption and outdoor recreational activities in blastomycosis-endemic areas.

What is added by this report?

The largest documented outbreak of blastomycosis in the United States occurred among workers at a paper mill in Michigan during 2022–2023. Although environmental sampling did not identify the source of Blastomyces exposure in the mill, this was the first recognized blastomycosis outbreak in an industrial, largely indoor setting.

What are the implications for public health practice?

Collaboration by local, state, and federal public health authorities with managers and workers can facilitate rapid case detection and implementation of prevention measures to protect workers.

​Abstract

Blastomycosis is a fungal disease caused by inhalation of Blastomyces spores from the environment that can result in severe pulmonary illness and high hospitalization rates. In early March 2023, Public Health Delta and Menominee Counties (Michigan) reported a cluster of blastomycosis cases among paper mill workers to the Michigan Department of Health and Human Services (MDHHS). MDHHS subsequently notified CDC. On March 17, paper mill management requested a health hazard evaluation (HHE) from CDC’s National Institute for Occupational Safety and Health (NIOSH) to investigate potential workplace exposures to Blastomyces and recommend prevention and control measures at the mill. The workplace epidemiologic investigation combined a NIOSH HHE medical survey consisting of a questionnaire on work and health with Blastomyces urine antigen testing of specimens obtained from workers to assist in case finding, with additional case information from MDHHS blastomycosis surveillance data. Assessment of 645 mill workers identified 162 cases of blastomycosis with illness onset during November 1, 2022–May 15, 2023, with the weekly case count peaking at 21 cases in early March 2023. HHE environmental sampling in and around the mill did not identify the source of workers’ Blastomyces exposure in the mill. This outbreak was the largest documented blastomycosis outbreak in the United States, and the first associated with a paper mill or an industrial setting. A coordinated public health response facilitated swift prevention measures with recommendations focused on reducing workers’ exposure to Blastomyces, including hazard communication, respiratory protection, mill cleaning, and ventilation system improvements...