A total of 104 cases of blastomycosis (both confirmed and probable) have been identified among employees, contractors, and visitors of the Billerud Paper Mill in Escanaba. Thirteen of these cases have resulted in hospitalization and there has been one previously reported death associated with the outbreak. These numbers are the latest update from Public Health Delta & Menominee Counties (PHDM), the Michigan Department of Health and Human Services, the National Institute for Occupational Safety and Health (NIOSH), and the Centers for Disease Control and Prevention.

Blastomycosis is caused by a fungus that grows in moist soil, decomposing matter, and can be contracted by breathing in fungal spores from the air. Symptoms include cough, fever, chest pain, difficulty breathing, night sweats, fatigue, weight loss, muscle aches, and joint pain. It is treatable with antifungal medication, but early diagnosis is crucial.

PHDM will no longer distinguish between confirmed and probable cases, as all reported cases have a blastomycosis diagnosis. Blastomycosis does not spread from person to person or between animals and people. For more information on this outbreak, visit the NIOSH website at https://www. cdc.gov/niosh/newsroom/ alerts/blastomycosishhe. html.

The Billerud mill is still temporarily closed while deep cleaning and other safety measures are installed.