ESCANABA, Mich. (From news reports) -- Local health officials are continuing to investigate a cluster of pneumonia cases among Escanaba paper mill workers that is believed to be caused by a fungus.

Public Health Delta & Menominee Counties (PHDM) was first notified of several atypical pneumonia infections in individuals employed at the Escanaba Billerud Paper Mill on Feb. 28. As of Friday, there have been 35 cases of blastomycosis identified -- either as confirmed cases or probable cases -- among mill workers. An additional nine suspected cases are awaiting test results.

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

Blastomycosis infections are rare, and the number of cases being identified in Escanaba is unusually high. Over the past five years, only 26 cases have been reported annually for the entire state of Michigan on average.

According to a press release issued by PHDM Friday, PHDM, Billerud and the Michigan Department of Health and Human Services are communicating daily regarding the investigation into the Escanaba cases. PHDM has interviewed the individuals identified by healthcare providers as having blastomycosis. The interviews are being used to help determine the approximate timeframe when exposures occurred, where exposures occurred, and how to prevent others from being exposed.

"The health and safety of our Escanaba employees has been and continues to be our first priority," said Brian Peterson, operations vice president for the Billerud Escanaba Mill. "Though no causal link to our mill has been confirmed, we are taking this matter very seriously and have taken a number of proactive steps."

According to Peterson, the mill is

≤ Conducting extensive cleaning of common areas and inspecting ventilation systems and filters, as well as testing raw materials coming into the mill, based on guidance from the Michigan Occupational Safety and Health Administration (MIOSHA)

≤ Retaining an industrial hygienist to assist with the investigation

≤ Providing N95 masks to all employees, along with information on how to properly wear the mask

≤ Requesting the National Institute for Occupational Safety & Health (NIOSH) perform a health hazard evaluation focused on studying Escanaba mill employees' health and safety as well as the wider community

"We will continue to closely communicate with local union leadership, state and local public health officials and our communities," Peterson added.

The specific source of the blastomyuces fungus causing the outbreak has not been identified. Because the fungus is common in the environment of the Upper Peninsula, PHDM says identifying a specific source can be difficult, but health officials are working to identify commonalities among the ill individuals that could identify where exposure took place.

"While the Upper Peninsula 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," said Michael Snyder, health officer for PHDM.

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. Anyone experiencing these symptoms should contact their healthcare provider.

There is no vaccine available to prevent blastomycosis, however the disease 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 professional.

Spending time near moist soil, such as near lakes and rivers; participating in activities such as forestry work, hunting, and camping in wooded areas; and being exposed to disturbed soil increase the risk of infection. However, there are actions that can be taken to reduce the possibility of contracting the disease.

Tips to reduce the risk of exposure include:

≤ Wearing personal protective equipment -- such as face masks, respirators, eye protection and gloves -- when engaging in hier risk activities

≤ Only moving leaf litter when it is dry

≤ Avoiding moving or digging in soil on windy days

≤ Covering soil or yard materials

≤ Ensuring water has adequate drainage and doesn't pool near work areas

≤ Installing walkways over wet areas to prevent walking through and disturbing muddy soil.

PHDM and Billerud will continue to provide updates about cases at the Escanaba mill and the community at large.