In the last four months, nearly two-dozen Vinalhaven residents were sickened during the state’s first fishermen-centered outbreak of Methicillin-resistant Staphylococcus aureus (MRSA).
A coordinated effort by community members and health care officials and seems to have contained the outbreak.
Several Vinalhaven residents required intravenous-administered antibiotics and minor surgery to deal with the deep lesions that sometimes can occur with MRSA infection.
Although Staphylococcus (often refered to as “staph”) is common, MRSA has captured the attention of medical officials because the bacterial infection has evolved a resistance to some common antibiotics. While it was first found only in hospitals, a more virulent strain started to appear in U.S. communities in 1997. Health officials now believe the hospital and community-based strains have mingled to form something more virulent. The federal Centers for Disease Control (CDC) estimates that MRSA was responsible for some 17,000 deaths in the U.S. in 2005.
While state health officials have dealt with MRSA outbreaks in schools, prisons and sports teams, this was the first reported outbreak involving a fishing community, said Megan Kelley, a Maine CDC field epidemiologist who monitored the Vinalhaven outbreak.
“It was really kind of a learning process for all of us,” she said.
In July, medical personnel at the Islands Community Medical Center on Vinalhaven began to notice unusual skin rashes on a few fishermen from the same pier, said Dr. Rich Entel, the doctor who first reported the outbreak. “We started to see fishermen and dock workers who were developing abscesses,” he said.
Skin irritation is nothing new in fishing. Entel was used to seeing Erysipeloid, a skin irritation caused by handling fish. But these skin conditions were more severe, sometimes going so deep as to infect tendons below the skin. Entel sent away samples to test for MRSA, and the tests came back positive. He alerted state health officials.
Kelley responded and began to work with Entel and Megan Morton, community health care coordinator, to find out how the disease was spreading among fishermen. Vinalhaven residents had several theories, partly fueled by published reports that MRSA could be contracted by contact with infected ocean water.
“The fishermen themselves, and a lot of the community, thought it was coming from the bait,” Entel said. “There are folks that wondered if it could be spread from a bait shovel or contaminated water.”
Morton, Kelley and another state health official interviewed infected fishermen. Kelley also checked with colleagues who dealt with similar outbreaks. She said that while water-born MRSA was possible, her colleagues kept encouraging her to focus on person-to-person contact.
In the course of her interviews, Kelley found that the original MRSA cases were not just concentrated on one wharf, but connected to exposure with an individual who had battled MRSA infection in the past.
MRSA is estimated to be present on the skin in roughly 1 in 4 people, but it often causes no problems in most people. It’s still unclear why it causes infections in some and spares others. Once MRSA breaks out in lesions, however, it’s extremely infectious. While it is virtually impossible to prove a single vector for MRSA, Kelley believes the Vinalhaven outbreak was caused by working in close proximity with infected individuals and sharing outdoor gear.
Speculation that bait is responsible also might be partly right, according to Entel. Because new fishing regulations have caused a shortage in fresh herring, more fishermen are using frozen bait, which might have exasperated the outbreak.
“A lot of the fishermen are saying they are getting poked a lot,” said Entel. Those cuts, combined with the normal chafing that comes with fishing, leave the body primed for MRSA infection.
Kelley, Entel and Morton began to spread the word about MRSA and how to stop its spread. They published a notice in the island newspaper The Wind, distributed fliers and sent home information in fishermen’s paychecks. They stressed that it’s up to those infected to take proper precautions to stop the spread to family and co-workers. Generally, this means covering up lesions and not sharing equipment, but sometimes it also meant staying home if lesions couldn’t be covered.
They also worked with lobstermen to make sure disinfectant procedures already in place were effective against MRSA. For example, Kelley noticed some people spread disinfectant on surfaces and then wiped the surfaces off immediately.
“Most of the sprays need contact time of ten minutes or more,” she said.
Morton, Entel and Kelley all were impressed with the proactive response of the fishing community and other Vinalhaven residents. They said the community became an important partner in combating the outbreak.
“Everyone reacted responsibly,” said Morton. “Everybody’s been on board to make sure there’s not a widespread outbreak.”
The combined effort seems to have paid off. The number of new cases has tailed off in the fall, and Entel believes the outbreak seems to be contained.
Kelley has heard rumors of other possible outbreaks in fishing communities at Owl’s Head and Spruce Head on the mainland, but she hasn’t been able to confirm that information. She has grown busy with preparations for the H1N1 virus. Also, tracking MRSA on the mainland is harder than on the island because infected individuals on the mainland can go to multiple health care workers who may not communicate with each other.