Elizabethkingia outbreak update: 7 questions with the Wisconsin Department of Health Services

When news of the Elizabethkingia outbreak first hit in March, it was described by media outlets as a mysterious bloodstream infection. Now many Wisconsinites and other Midwesterners are well-acquainted with the cumbersome moniker. Still, mystery surrounding the nature of the infection and the outbreak persist.

Even though WDHS has been investigating the outbreak since the winter of 2015, the original infection source remains unknown. Elizabethkingia occurs in the natural environment and has been detected in soil, river water and reservoirs. The bacterium rarely makes people ill. Morbidities most commonly associated with infections are neonatal meningitis or meningitis and infections of the blood and respiratory system in individuals with weakened immune symptoms.

As of Tuesday, there have been 63 confirmed cases of the infection in the state of Wisconsin. There are four additional cases in individuals who tested positive for Elizabethkingia, but those strains cannot be confirmed as being associated with the outbreak because specimens are no longer available for testing. In total, there have been 19 deaths associated with Elizabethkingia in Wisconsin.

The Wisconsin Department of Health Services recently took time to answer some questions via email for Becker's regarding the Elizabethkingia outbreak.

Note: Responses have been lightly edited for length and clarity.

Question: The outbreak of Elizabethkingia across the state has stabilized? When did this stabilization begin and how was it achieved?

Wisconsin Department of Health Services: In Wisconsin, there are currently no cases under investigation. These are the same results that were reported [during the week of June 19], which is good news, but this investigation is ongoing, and we'll wait to see if this trend continues. Awareness and quick action by our partners, especially healthcare providers, is helping to identify and treat Elizabethkingia anophelis.

Q: What has been the most challenging aspect of the investigation into the origin of the outbreak? Will it be possible to detect the source?

WDHS: Since Elizabethkingia anophelis was first reported, our team of disease detectives has been working diligently to find the source, and that has proved to be the greatest challenge. While it may be that a source is never determined, DHS and our partners will continue to be vigilant about testing and treating the infection caused by the bacteria. At this time this remains a full-scale investigation.

Q: How many more confirmed cases will Wisconsin likely see before the outbreak comes to an end?

WDHS: That's impossible to predict. As long as healthcare providers are aware of the possibility for Elizabethkingia anophelis, and test for it, there is always a chance that a case will be confirmed.

Q: What is the risk of additional cases being detected in other states as they previously were in Michigan and Illinois?

WDHS: That's impossible to predict. Elizabethkingia bacteria (Elizabethkingia anophelis and Elizabethkingia meningoseptica) are not unique to Wisconsin, and are commonly found in the environment worldwide. According to the CDC, there are typically five to 10 cases reported in each state in the U.S. each year. We have been sharing information with health officials in Michigan and Illinois to determine if there are any commonalities between our cases and those reported in those states, but again, we can't predict if there will be other cases in other states.

Q: Do you feel that the public is well-informed regarding this outbreak?

WDHS: We do. In addition to the press release announcing the outbreak, we update weekly case counts on the WDHS Elizabethkingia webpage every week. We also provide updates to the local and tribal health departments and other partners to keep them informed about the investigation and any new developments so that they can effectively communicate with their communities and clients.

Q: Has media coverage proved distracting or disruptive regarding the investigation in any way?

WDHS: We understand that an outbreak of any kind is news, and we appreciate the assistance of the media in helping us inform the public about it. Because of the media's continued interest in the Elizabethkingia anophelis infection outbreak, we made reporters aware that case counts are updated weekly on the DHS Elizabethkingia webpage and created an image library to provide them with pictures to use in their reports. Both have been mutually beneficial and allow us to provide current information in an efficient manner.

Q: What would you like people to know about Elizabethkingia and the current state of the outbreak and the investigation?

WDHS: It's important to remember that Elizabethkingia bacteria are rarely reported to cause illness in humans, and those who have been diagnosed with the infection in Wisconsin are, for the most part, over the age of 65 and have at least one underlying serious illness. There have been no children infected as part of this outbreak. DHS and our partners will continue to investigate this outbreak and search for the source of the bacteria that caused it. DHS will also continue to keep the public informed of weekly case counts and any new developments associated with this outbreak.

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