Elizabethkingia…ARE YOU NEXT? The infection you don’t know about.
You may not have heard of the Elizabethkingia (ee-LIZ’-ah-beth-kin-GEE-ah)., or “E.K.”, outbreak that local, state and federal public health and hospital personnel in Wisconsin and Michigan are dealing with. The bloodstream infection is named after the CDC microbiologist, Elizabeth Osborne King, who discovered the bacteria about 55 years ago. Elizabeth died in 1960, at the young age of 53, and to this day continues to be a hailed as a pioneer and hero to public health practitioners working to combat infectious disease and outbreaks.
To date, 18 people have died with “EK”. There are now 62 positive cases of “EK” in Wisconsin and Michigan. It is important to note that most of those that have died are over the age of 65, and all who have died had existing medical conditions. The average age of those testing positive for Elizabethkingia bacteria was 77. EK infects the blood and symptoms include fever, chills and shortness of breath. Laboratory tests are required to confirm or rule-out that a person has the EK bacteria in their bloodstream. CDC Epidemiologists continue to work with the Wisconsin Department of Health Services (DHS) staff to identify the reason behind this rare blood infection. The case counts are increasing, but thankfully, at a slower rate.
So where does EK come from?
Elizabethkingia is common in the environment — in soil and in water — but it’s important to note that it rarely gets people sick. Cases pop up in ones and twos, usually in people with weak immune systems, says Michael Bell, deputy director of the Centers for Disease Control and Prevention’s healthcare quality division. “The fact that we’re seeing more than four dozen cases, that is a very large outbreak.”
So why Wisconsin and Michigan and what’s going on?
The fact is, it’s a mystery for both the CDC’s disease detectives, a corps of about 70 doctors and epidemiologists who specialize in tracing outbreaks. This includes foodborne illnesses to Ebola. It is the largest EK outbreak of its kind in reportable history.
When the outbreak began back in November, CDC suspected the tap water. Coincidentally, around that same time, CDC’s emerging diseases journal published a report about a nearly two-year long Elizabethkingia outbreak in a London critical care unit. This outbreak ended up originating with contaminated taps in hospital sinks. However, the tap water in Wisconsin was negative for the bacteria. Adding to the mystery in the Badger State, this outbreak doesn’t match the pattern of other infections which appeared in clusters in the same facility. So the short answer is, we don’t know (yet!)
At this point perhaps you’re thinking, am I or my elderly loved ones at risk where I live and what are they doing to investigate this thing?
Although the outbreak remains a mystery, and one that DHS and CDC seem to be getting closer to solving, probably not. Most of Wisconsin patients were elderly. Some lived in nursing homes and others had gone to the hospital. Victims lived across 12 different counties.
Disease detectives have fanned out across the state, knocking on doors of patients and are asking questions. Disease detectives are trying to fill in the blanks with samples of personal care products like lotions, health products, or wipes that might harbor the bacteria. Trying to find the common factor or factors here is much like the investigations of foodborne outbreaks.
The questions they ask are methodical and standardized. They are talking to groups of people who live in the same communities, but have not gotten sick. Then they start crossing off hypotheses. A 10 hour day on the road might end with several more hours of data entry back at DHS in the Emergency Operations Center (EOC).
At this point, CDC is still investigating water as a potential source of contamination. Water used on produce requires tracing it back to grocery stores or farms, and has become the focus. “The amount of potential exposure sources is very large,” Bell says.
So is everyone going to die who has tested positive?
The short answer is doubtful. Elizabethkingia is resistant to some, but not all antibiotics and the number of deaths has held steady as doctors have learned how to treat the once obscure bacteria. Wisconsin may be seeing a new bacterial threat, but at least the CDC is learning how to handle it. It is important to note that “EK” is not spread person to person and can be treated. This bacteria is very resilient and only a few antibiotics are effective which is why it is important to get to the cause.
The following video clip from CBS News provides more information on the Elizebethkingia outbreak in Wisconsin and Michigan. http://www.cbsnews.com/news/questions-remain-over-mystery-bacteria-killing-elderly-in-midwest/
Lastly, DHS and CDC staff are working tirelessly to find the cause of this outbreak. Families, friends and neighbors are seeking answers as to why they have lost their loved ones. A website has been established by DHS for both general information and specific data for Health Professionals. You can follow the work of DHS and CDC through their website below. The site provides weekly research updates, case counts, press releases, and other pertinent information associated to this outbreak. https://www.dhs.wisconsin.gov/disease/elizabethkingia.htm
