UPDATE: Health experts to conduct hazard study of Billerud Mill workers amid growing numbers of lung infections

DELTA COUNTY, Mich. (WLUC) - Public Health Delta & Menominee Counties (PHDM) said as of Friday, it has identified 39 probable cases of blastomycosis, a fungal lung infection, among Billerud mill workers. As a result, a team of health experts will perform a health hazard study of the Escanaba mill employees.

According to PHDM, there have been 14 confirmed cases of blastomycosis identified to date and 39 probable cases.

A confirmed case is a person with symptoms of blastomycosis and where the fungus has either been grown (culture) or seen by microscope in a specimen. A probable case is a person with symptoms of blastomycosis and who has a positive antigen or antibody test.

At the request of Billerud, the National Institute for Occupational Safety & Health (NIOSH), an OSHA research agency, will perform a health hazard evaluation focused on studying the health and safety of Escanaba mill employees. A team of experts from NIOSH, the Centers for Disease Control and Prevention (CDC), the Michigan Department of Health and Human Services (MDHHS) and PHDM will perform a site visit to tour the mill and meet with members of management, the mill’s occupational health and safety team and union representatives.

The evaluation is expected to continue after the onsite visit is complete, as the NIOSH team continues to analyze data and review case investigation information collected by PHDM.

Michael Snyder, Health Officer of PHDM said, “PHDM continues to interview cases identified by the healthcare providers. This information is being shared with MDHHS and NIOSH to aid in their health hazard evaluation.”

PHDM said these interviews assist in determining the approximate timeframe of when the exposure occurred, where the exposure occurred, and possibly how to prevent further exposures to additional individuals.

“The health and safety of our Escanaba employees remains our first priority,” said Brian Peterson, Operations Vice President, Billerud Escanaba Mill. “Though no causal link to our mill has been confirmed, we continue to take this matter very seriously. The addition of an independent review by NIOSH will deepen the investigation. We continue to work with OSHA, PHDM, and an industrial hygienist to determine common areas where affected employees have been. Across the facility, ventilation systems have been inspected, filters have been changed, and common areas have been deep cleaned.”

In addition to the onsite visits from NIOSH and the CDC, Billerud is providing OSHA-recommended N95 masks to all employees, contractors and visitors, along with information on how to properly wear the mask.

PHDM, Billerud and MDHHS continue to communicate daily regarding this investigation. “We will continue to closely communicate with local union leadership, state and local public health officials and our communities,” said Peterson.

A specific source of the Blastomyces fungus causing this outbreak has not been identified. Because the fungus is common in the environment in the UP, identifying a specific source of exposure can be difficult. Health officials are making every effort to identify any exposures common among the ill individuals.

PHDM and Billerud will continue to provide updates about cases at the Escanaba Mill and the community at large. Please contact PHDM with any questions by calling: (906) 786-4111.

Blastomycosis is a disease associated with a fungus that grows in moist soil and decomposing matter such as wood and leaves. People can get blastomycosis infection by breathing in fungal spores from the air. Blastomycosis does not spread from person to person or between animals and people. For preventative measures, see previous stories below.

Last published: Mar 17, 2023 4:03:54 PM

Public Health Delta & Menominee Counties said as of Friday, there are 35 cases of blastomycosis identified (confirmed or probable) in total among Billerud Mill workers in Escanaba. That is 20 more confirmed or probable cases than a week ago.

In addition to the 35 confirmed or probable cases, PHDM said there are nine more cases awaiting test results.

A causal link has not yet been established between the infection among mill workers and the site of the Billerud Mill itself. Because the fungus is common in the environment in the UP, PHDM said identifying a specific source or exposure can be difficult.

However, Operations Vice President for Billerud’s Escanaba Mill Brian Peterson said as a precaution during the investigation, the company has encouraged its Escanaba employees to wear provided N95 masks to prevent illness. In addition, the company said its team has “quickly begun deep cleaning in high traffic areas throughout the mill,” such as the walking bridge and other common areas. The company is also inspecting ventilation systems and filters and testing various raw materials coming into the mill based off feedback from health experts.

Peterson said Billerud is regularly communicating new information with union leadership and employees. The company said is has also retained an industrial hygienist and is consulting with their team and MIOSHA about their investigation.

Blastomycosis is a disease associated with a fungus that grows in moist soil and decomposing matter, such as wood and leaves. People can get blastomycosis infection by breathing in fungal spores from the air. Blastomycosis does not spread from person to person or between animals and people.

Michael Snyder, Health Officer of PHDM said, ”While the Upper Peninsula (UP) of Michigan is a known risk area for blastomycosis infection, it should be noted that these infections are exceedingly rare. Most people who breathe in blastomycosis will not get sick.”

PHDM, Billerud, and the Michigan Department of Health and Human Services are communicating daily regarding the investigation. PHDM said it has interviewed the individuals identified by healthcare providers as having blastomycosis. These interviews assist in determining the approximate timeframe of when the exposure occurred, where the exposure occurred, and possibly how to prevent further exposures to additional individuals.

Those who do get sick can develop symptoms such as cough (sometimes with blood), fever, chest pain, difficulty breathing, night sweats, fatigue, weight loss, muscle aches, and joint pain. Persons experiencing these symptoms should contact their healthcare provider.

While there currently is not a vaccine available to prevent the illness, PHDM said blastomycosis can be treated with antifungal medications prescribed by a medical provider. Treatment is most effective when started as soon as possible after diagnosis by a healthcare provider.

Last published: Mar 9, 2023 5:47:12 PM

Public Health Delta and Menominee Counties has now identified 15 total cases of atypical pneumonia infections among Billerud Mill workers in Escanaba, 4 more cases than previously identified two days ago.

In an updated release Thursday, PHDM said it was first notified on Feb. 28 of several atypical pneumonia infections in individuals employed at Billerud Mill. Tuesday, the health department confirmed the number had risen from eight to 11 cases in a day’s time. Thursday, the department confirmed that to date, the total number of cases is 15.

According to PHDM, the symptoms for these patients began in January and February. Early testing has indicated that these infections may be caused by a fungal infection called blastomycosis. PHDM said additional testing to confirm these results may take a couple of weeks and is underway.

Billerud Mill responded with a statement to TV6 Wednesday, saying it is taking the cases “very seriously.”

“At Billerud, the health and safety of our employees is always our first priority,” the company said. “We are very alarmed and concerned with the illnesses our employees are experiencing.”

Billerud’s communications team said the company is in “constant communication” with PDHM and is collaborating with the health department and medical professionals to better understand the symptoms and diagnoses associated with the cases.

In addition, Billerud said it has proactively reached out to an industrial hygienist, contacted Michigan OSHA to assist with its investigation, and has consulted with them on the company’s actions and plans to date.

Blastomycosis is a fungal disease associated with a fungus that grows in moist soil and decomposing matter such as wood and leaves. People can get blastomycosis infection by breathing in fungal spores from the air. Blastomycosis does not spread from person to person or between animals and people.

People who spend time near moist soil (by lakes and rivers); who participate in activities such as forestry work, hunting, and camping in wooded areas; and individuals exposed to disturbed soil may be at higher risk for getting blastomycosis.

These infections are exceedingly rare, said PHDM. On average over the past five years, only 26 cases have been reported for the entire State of Michigan annually. However, the health department said Upper Michigan is a known risk area for blastomycosis infection.

Most people who breathe in blastomycosis spores will not get sick. Those who do get sick can develop symptoms such as cough (sometimes with blood), fever, chest pain, difficulty breathing, night sweats, fatigue, weight loss, muscle aches, and joint pain. Symptoms usually appear between 3 weeks to 3 months after exposure.

Blastomycosis can be treated with antifungal medications prescribed by a medical provider. Treatment is especially effective when administration begins as soon after symptoms as possible.

Because the fungus that causes blastomycosis occurs in the environment, it is not possible to completely avoid being exposed. People with weakened immune systems may want to consider avoiding activities that involve disrupting soil in areas where blastomycosis is found. There is currently no vaccine available to prevent blastomycosis.

The following tips may reduce a person’s risk of exposure:

• Wear personal protective equipment (facemasks or respirators, eye protection, and gloves) when engaging in higher risk activities
• Only move leaf litter when it is dry.
• Avoid moving or digging soil on windy days.
• Cover soil and yard materials.
• Ensure water has adequate drainage and doesn’t pool near work areas.
• Install walkways over wet areas to prevent walking through and disturbing muddy soil.

Health officials from PHDM and Michigan Department of Health and Human Services along with Billerud Paper Mill occupational health staff are working together to investigate this cluster of illness. Because the blastomyces fungus is common in the environment in the UP, PHDM said identifying a specific source or exposure can be difficult.

Health officials said they are making every effort to identify any exposures common among the ill individuals. Information and guidance have also been distributed to local medical providers to assist in the recognition and appropriate diagnosis of blastomycosis.

Last Published Mar. 7, 2023 at 5:57 PM EST

Public Health Delta and Menominee Counties (PHDM) is investigating a cluster of lung infections among paper mill workers in Delta County.

In a letter from PHDM Medical Director Dr. Robert Yin to medical providers and emergency departments Monday, he said the department had identified a cluster of eight cases of atypical pneumonia in the last month. He also said to date, all of those cases have been observed in men who work in a paper mill.

Since Yin’s memo, however, PHDM Health Officer Mike Snyder confirmed Tuesday that three additional cases among paper mill workers were added, totaling 11.

All men are showing respiratory symptoms, chest films consistent with pneumonia, and “CT scans showing necrotizing pneumonia, sometimes with cavitary findings,” said Yin.

According to Yin, five of the 11 identified cases have shown evidence of blastomycosis infection — a fungal infection of the lungs — based on antigen testing. Test results are pending for the other six.

The department said it has not yet identified a source of the fungal infection.

Billerud Mill is a major employer in Delta County. TV6 emailed Billerud’s corporate communications office Tuesday to ask if Billerud is conducting a health investigation of its own or has changed any of its protocols.

The company responded Wednesday, saying while no causal link to the Billerud Mill has been established right now, it is taking the cases “very seriously.”

“At Billerud, the health and safety of our employees is always our first priority,” the company said. “We are very alarmed and concerned with the illnesses our employees are experiencing.”

Billerud’s communications team said the company is in “constant communication” with PDHM and is collaborating with the health department and medical professionals to better understand the symptoms and diagnoses associated with the cases.

In addition, Billerud said it has proactively reached out to an industrial hygienist, contacted Michigan OSHA to assist with its investigation, and has consulted with them on the company’s actions and plans to date.

For more on the investigation into Blastomycosis among Escanaba mill workers:

‘Everybody’s interest is the same’: USW Local 21 works with Billerud to find infection source

UPDATE: Health officials provide update on blastomycosis outbreak among Billerud Mill workers, cite additional probable cases

Delta County health officials explain process of finding source for blastomycosis among Billerud Mill workers

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