The Billerud Paper Mill in Escanaba, Michigan, has closed for cleaning following an outbreak of blastomycosis fungal infections, Billerud North America announced.
The outbreak included a fatality, according to local public health officials.
“As a precautionary measure, we will temporarily idle the Escanaba Mill for up to three weeks to facilitate additional proper cleaning based on recommendations from NIOSH and other organizations, which requires larger portions of the mill to be vacant while this work is performed,” Christoph Michalski, Billerud president and CEO, said in a company statement.
According to Public Health Delta & Menominee Counties (PHDM), a contractor at the paper mill suffered a fatal blastomycosis infection, and there have been 21 confirmed cases and 76 people at the mill classified as probable cases. A probable case is a person with symptoms of blastomycosis and who has a positive antigen or antibody test. Twelve out of the 97 total cases have been hospitalized, PHDM says.
All 97 cases are either employees, contractors, or visitors of the Billerud Paper Mill.
Blastomycosis, like coccidioidomycosis (Valley Fever) and histoplasmosis, is a fungal disease that can infect anyone regardless of immune status, according to the Centers for Disease Control and Prevention (CDC). Fungal infections can progress to life-threatening pulmonary diseases and usually are acquired by inhaling fungal spores.
The CDC published its most recent surveillance report for blastomycosis, coccidioidomycosis, and histoplasmosis in August 2022, and it received 240 case reports of blastomycosis in 2019 from 5 states: Arkansas, Louisiana, Michigan, Minnesota, and Wisconsin. Minnesota and Wisconsin accounted for 75% of all cases (179).
In 2022, the CDC received reports of 20,061 cases of coccidioidomycosis and reports of 1,124 cases of histoplasmosis.
The CDC’s National Institute for Occupational Safety and Health performed a health hazard evaluation at the mill and recommended that the employer:
- Continue to provide employees with N95 filtering facepiece respirators for voluntary use to minimize exposure to Blastomyces.
- Encourage employees who experience signs and symptoms, such as cough, fever, chills or night sweats, shortness of breath, poor appetite or weight loss, muscle pain, joint or bone pain, fatigue, or skin lesions, to contact a health provider for diagnosis and treatment.
- Carefully consider any activities beyond regular mill operations with the potential to disturb dirt, soil, or organic material on the mill property that may be contaminated with Blastomyces.
The institute also recommended that Billerud inspect all heating, ventilation, and air-conditioning (HVAC) systems and contract with a licensed ventilation engineer or building scientist to inspect the ductwork for evidence of water incursion and microbial growth.
According to the CDC, Blastomyces live in the environment, particularly in moist soil and decomposing organic matter like leaves and wood. The fungus mainly lives in the midwestern, south-central, and southeastern United States, particularly in areas surrounding the Ohio and Mississippi River valleys, the Great Lakes, and the Saint Lawrence River. Blastomycosis does not spread through the air between people or between people and animals, according to the CDC, but in extremely rare cases, blastomycosis has been spread through needlestick injuries, bites, or sexual contact.