Assessment of Environmental Risk Factors for Blastomycosis During a Large Outbreak at a Michigan Paper Mill

Details

• Journal Article:
  PLoS One
• Personal Author:
  O'Connor, Allyson W. ; Park, Ju-Hyeong ; Stanton, Marcia L. ; Liang, Xiaoming ; Shi, Dallas S. ; Callaway, Perri C. ; Harvey, R. Reid ; LeBouf, Ryan F. ; Bailey, Rachel L. ; Hennessee, Ian ; Toda, Mitsuru ; Meece, Jennifer ; Sterkel, Alana K. ; Dargle, Suzanne ; Bree, Olivia ; Olstadt, Jeremy ; Reik, Rebecca ; Stobierski, Mary G. ; Snyder, Michael ; Yin, Robert ; de Perio, Marie A. ; Hines, Stella E. ; Cox-Ganser, Jean M.
• Description:
  Background: Blastomycosis is a rare, potentially fatal fungal infection caused by inhalation of Blastomyces spores, typically acquired outdoors in the midwestern and eastern United States. In 2023, the largest recorded U.S. blastomycosis outbreak occurred among workers at a paper mill in Michigan's Upper Peninsula. Few data exist on occupational risk factors or indoor exposure to Blastomyces, limiting prevention efforts. Objectives: We assessed workplace environments and conditions associated with blastomycosis risk through a cross-sectional medical survey and environmental sampling. Methods: During April 22-28, 2023, we conducted a voluntary medical survey, including a work and health questionnaire and urine antigen testing, for 603 workers out of approximately 1,000 at the mill. We compared worker characteristics, work locations, and environmental exposures by blastomycosis case status and modeled disease risk using Poisson regression. We tested 533 environmental samples of outdoor soil, indoor surface dust, and raw materials for Blastomyces using polymerase chain reaction and culture-based methods. Results: Twenty percent of workers were classified as blastomycosis cases based on positive urine antigen testing during the survey, self-reported provider diagnoses, or confirmed or probable case status reported by state or local health departments. Prevalence was highest among workers in paper machine line #1 (27%) and maintenance areas (25%). Adjusted analyses indicated a 40% [Prevalence Ratio (PR): 1.40; 95% confidence interval (CI): 1.00, 1.95] and 53% (PR: 1.53; 95% CI: 1.04, 2.25) higher risk for workers in these locations, respectively, compared to workers working elsewhere. Working in both locations doubled blastomycosis risk. Daily exposure to indoor pooling water was associated with a nearly two-fold higher prevalence of blastomycosis (PR: 1.79; 95% CI: 1.25, 2.57). All indoor and outdoor environmental samples were negative for Blastomyces. Discussion: Blastomycosis was associated with specific indoor work locations and environmental conditions, suggesting the potential for occupational exposure to Blastomyces in indoor industrial settings. These findings may guide future outbreak investigations and occupational prevention strategies.
• Subjects:
  Blastomycosis Fungi Mycoses Occupational Exposure Occupational Health Paper Safety Surveys And Questionnaires
• Keywords:
  Blastomycosis; Fungal infections; Infectious diseases; Paper mills; Occupational exposure; Risk factors; Cross sectional studies; Medical surveys; Environmental exposure; Epidemiology
• Source:
  PLoS One 2025 Sep; 20(9):e0332398
• ISSN:
  1932-6203
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  West Virginia ; Ohio ; Georgia ; Wisconsin ; Michigan ; Philadelphia Region [OSHA] ; Chicago Region [OSHA] ; Atlanta Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division ; DFSE - Division of Field Studies and Engineering ; OD - Office of the Director
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  16 pdf pages
• Volume:
  20
• Issue:
  9
• NIOSHTIC Number:
  nn:20071303
• Contact Point Address:
  Dallas Shi, Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, United States of America
• Email:
  rhq9@cdc.gov
• Federal Fiscal Year:
  2025
• Peer Reviewed:
  True
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:9e69f67bca4d382b9b877ad7a32f3f460950ea605c60171effa8a14b480c8148d64d6343aaea4a510866eb82a714ce4b39540255e1a4da2482e7d06121df97fa
• Download URL:
  https://stacks.cdc.gov/view/cdc/258779/cdc_258779_DS1.pdf
• File Type:
  [PDF - 1.01 MB ]