State, county feud over Flint outbreak response

Jonathan Oosting
Detroit News Lansing Bureau

Lansing — Michigan and Genesee County health departments are again feuding over the response to a bacterial outbreak in the Flint region of at least 84 cases of shigellosis, a highly contagious gastrointestinal illness.

An advisory the Genesee health department issued last month acknowledged the increase in Shigella. The bacteria can leave an infected person’s body in stool then is spread by contaminated hands, surfaces, food, or water, state health officials said.

Genesee County environmental health supervisor Jim Henry on Monday told CNN he initially struggled to work with the Michigan Department of Health and Human Services after alerting it to the shigellosis outbreak in August, a charge a state spokeswoman called “incorrect” and “entirely irresponsible.”

For weeks “the state MDHHS stopped communicating and assisting (the county) regarding all disease investigations, including shigellosis. This action directly compromised the safety and health of our communities,” said Henry, who did not respond to request for further comment from The Detroit News.

The state health department began working with Genesee County in May and on July 14 provided informational resources that could have been shared with schools and other groups, said spokeswoman Jennifer Eisner. The spread of shigellosis can usually be prevented by thorough hand washing.

The Michigan Public Health code does not specify strict time periods for investigations or public notices about disease outbreaks, said Eisner, who noted that each case can involve unique circumstances. Local health departments are responsible for investigating within their jurisdictions “and we provide guidance and support as indicated,” she said.

Eisner acknowledged communication was limited for a two-week period in August because of a protective order related to previous outbreaks of deadly Legionnaires’ disease in the region, but the two departments are now working together again.

The court order, issued as part of Attorney General Bill Schuette’s criminal probe of Flint’s water contamination crisis, prohibited the state department from working directly with the county on “any and all issues, testing, analysis required involving any lead and/or legionella issues, water testing, and any other assistance needed for the City of Flint water crisis.”

The order was amended Aug. 24 to specify that it does not prevent state and county collaboration on public health issues unrelated to lead or Legionella.

“Mr. Henry was fully aware that the protective order restricted MDHHS’s ability to communicate with GCHD,” Eisner told The News by email. “It is entirely irresponsible for Mr. Henry to attempt to portray MDHHS’s efforts regarding the Genesee County shigellosis situation as somehow lacking. MDHHS has been fully engaged in this effort.”

Gov asks court to lift order

Gov. Rick Snyder’s administration is asking a state appeals court to lift the protective orders against the health department, which Chief Medical Executive Eden Wells has said “represents a significant threat” to public health.

Schuette’s office maintains the order is appropriate because his team is investigating the state health department’s role in the Flint crisis. Special prosecutor Todd Flood has so far charged eight current or former state workers with crimes, including three health department employees.

Twelve people died after contracting Legionnaires’ disease in Genesee County during 2014 and 2015, outbreaks that included 91 diagnosed cases. Health officials faced criticism for failing to alert the public at the time, and previously released emails suggest the state and county departments at times struggled to work cooperatively.

Snyder said Tuesday the state health department is now working with the county on shigella. The department said it is printing literature and is currently helping develop a hand-washing campaign.

“We’ve been working hard on it, and I think we are trying to collaborate with the county health department,” the governor said. “We’ve been doing a lot of collaboration with the Saginaw health department, which also has this outbreak, and so we’re going to continue working the issues.”

Snyder continued: “The recommendation is people should just wash their hands with warm water and soap.”

Sagninaw Co. also affected

State statistics show Genesee County, which includes Flint, has Michigan’s highest level of shigellosis this year. Genesee had 84 cases through September, while neighboring Saginaw County had 47, the second-largest total in the the state.

The illness is caused by a bacteria and spread person-to-person, sparking an estimated 500,000 cases nationwide annually, according to the U.S. Centers for Disease Control and Prevention. In 2013, the average annual incidence of shigellosis was 4.82 cases per 100,000 people, the center reported.

Symptoms include diarrhea, sometimes bloody; fever; and abdominal pain, and typically start one to two days after exposure and can last up to a week, according to the CDC. Young children are the most likely to get shigellosis.

Eisner said state epidemiologists in mid-July provided both Genesee and Saginaw counties with information that could be shared with schools, day care centers and others to help mitigate the shigella outbreak.

“While the Saginaw County Health Department used this information to assist them in their public health response and successfully control the shigella outbreak, the same cannot be said for Genesee County,” she said.

An advisory the Genesee health department issued last month highlighted the increase in shigella. The bacteria can leave an infected person’s body in stool that is then spread by contaminated hands, surfaces, food or water.

The health department is also providing tips on home diapering, cleaning, sanitizing and disinfecting that can help minimize the spread.

Prevention includes avoiding swallowing water from ponds, lakes or untreated swimming pools; hand washing for at least 20 seconds with soap and warm water, including cleaning under the fingernails. Those infected are also advised to remain isolated for least 48 hours.

For more information, go to www.gchd.us or call the Genesee County Health Department at (810) 257-1017.

joosting@detroitnews.com

(517) 371-3660

Staff reporter Mark Hicks contributed.