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Warmer seas drive more bacterial infections, threatening fishermen, public health
By Will Atwater
Last month, three people died as a result of infections from a category of bacteria you’ve likely never heard of: Vibrio. It is commonly present in coastal and brackish water, especially during warmer months.
“There are almost 80 described species of Vibrio that live in the water,” said UNC Chapel Hill Institute of Marine Sciences researcher Rachel Noble. But Noble also noted that as the seas warm through to climate change, there’s more Vibrio in North Carolina’s waterways.
According to a news release from the N.C. Department of Health and Human Services, there have been 47 recorded cases and eight deaths from infection caused by Vibrio microorganisms since 2019.
One way that people get infected with the bacteria is through eating undercooked seafood. Another way is the bacteria getting into a cut or scrape in the skin when exposed to water containing Vibrio. In people with weakened immune systems, a Vibrio skin infection can all too quickly lead to a systemic infection that can lead to loss of limbs or, left untreated, death.
Noble is among the experts who predict that in the future, Vibrio cases will pop up in places that previously had no issues, and they indicate that there will be more infections in December and January, for instance, since coastal waters are not cooling as much as in the past. .
Noble said that when she began testing the Neuse River estuary for Vibrio two decades ago in the winter, she found anywhere from three to ten microorganisms per 100 milliliters (a tenth of a liter) of water.
“Twenty years later, those numbers are closer to 100 to 200 per 100 milliliters in January.”
“There has definitely been not only an extending of the summer infection season,” she said, “but there’s also been a trend that it’s no longer true that our estuaries go down to almost zero in concentration in the winter months. They don’t. The Vibrios [bacteria] are still very much there.”
Climate change and Vibrio
Vibrio bacteria thrive in warmer, brackish waters where blue crabs live, especially when they’re molting and losing their hard outer shell. And one of the prime ways people get infected is when the bacteria gets into small cuts and scrapes.
Those small nicks in the skin have the potential to be a big issue for people like commercial fisherman Keith Bruno.
Bruno migrated to North Carolina from Long Island, where he once fished for lobster. After an outbreak of West Nile virus in New York in the 1990s, the regions around Long Island Sound aggressively sprayed for mosquitoes that carry the virus. Bruno is among those who blame the spraying for the collapse of the lobster fishery there. But around the same time, the waters in Long Island Sound began to warm, likely delivering the lobsters a fatal blow.
Now, the waters off the North Carolina coast, where Bruno harvests blue crab, are warming. The Vibrio bacteria threaten commercial fishers and those who work and play in or near coastal estuaries and marshes. In the wake of Hurricane Florence in 2018, there were a number of Vibrio incidents.
And with that warming water comes more risk to Bruno and other fishers, who often get cuts and scrapes over the course of their work day.
Zachary and Benjamin Bruno are setting crab pots. Crabbers and other anglers can get nicks and cuts on the arms and hands from handling wire mesh pots, which, they say, is part of the job. Credit: Zachary Bruno
Because of a medical condition, Bruno leaves most of the handling of crab pots to his son these days. But, he said, the risk of infection is part of the job.
“We are constantly getting scratched and cut and bit and jammed and poked,” said Bruno, who recounted being scratched from handling crab pots and fishing gear and being poked by bones protruding from buckets of bait.
“If anybody gets a wound in the water, they need to get medical attention right away,” said Dr. Michael Somers, an emergency medical physician at Carolina East Medical in New Bern. “We can … treat the infections, but better than that we can give medication to prevent the infection.”
If people who may have been exposed to Vibrio seek immediate medical attention, they can be prescribed an antibiotic such as doxycycline to protect themselves against developing the infection, Somers said.
Bruno said to save time, he and other fishers rely on bleach to prevent infection while out on the water.
“The down and dirty is ‘throw some bleach on it and get back to work,’” he said. “We live to work and work to live … We’re not going up to the walk-in clinic for antibiotics every time we get scratched — we’d live there and never make any money.”
There’s something in the water
A research article published in March 2023 supports the idea that Vibrio is spreading northward along the Atlantic Coast. That study bolsters a growingbody of research showing that warming seas are driving more bacterial infections in more northern climes.
To better track the bacteria, the CDC partnered in 1989 with the Food and Drug Administration and four Gulf Coast states — Texas, Louisiana, Alabama and Florida — to develop the Cholera and Other Vibrio Illness Surveillance. The surveillance has now expanded and includes Vibrio data for the Atlantic Coast states.
Noble said that two forms of Vibrio are of particular interest to researchers and public health officials in the state: Vibrio vulnificus and Vibrio parahaemolyticus. V. vulnificus infections usually occur from exposure to brackish water, and V. parahaemolyticus is associated with eating undercooked shellfish.
The Centers for Disease Control reported in an email that in 2019, there were 158 Vibrio vulnificus infections. Twenty-one percent of the infections resulted in deaths — roughly one-half of V. vulnificus infections occurred in Gulf Coast states, and about one-third were in Atlantic Coast states.
When it comes to V. parahaemolyticus, the agency estimates about 52,000 people contract it annually from shellfish. While it will make a person miserable, with vomiting and stomach cramps, it has a very low death rate.
One of the three North Carolina deaths was someone who both ate seafood and waded in brackish water, so it’s unclear whether food or water exposure killed them.
Typically, healthy individuals infected with Vibrio have mild reactions. However, the CDC reports that individuals with underlying health conditions “are more likely to develop V. vulnificus or severe complications such as septicemia,” according to the email.
Protective measures
Sheila Davies, director of public health with the Dare County Department of Health & Human Services, understands the challenges faced by crabbers and fishers, but she strongly advises anyone to seek medical attention as soon as possible if they have scratches or cuts that have been exposed to brackish water.
“If you’re getting cut on a fishing hook, or crab pot or barnacles hanging … it increases your risk of infection,” she said. “So [I’m] strongly promoting how important it is to seek medical attention.”
Echoing Davies’ concern, NCDHHS included the following suggestions designed to help people avoid a Vibrio infection:
If you have a wound (including from a recent surgery, piercing or tattoo), stay out of saltwater or brackish water, if possible. This includes wading at the beach.
Cover your wound with a waterproof bandage if it could come into contact with saltwater, brackish water or raw or undercooked seafood.
If you sustain any type of wound while in salt or brackish water (e.g., cutting your hand on a boat propeller or crab pot) immediately get out of the water and wash with soap and water.
Wash wounds and cuts thoroughly with soap and water after contact with saltwater, brackish water or raw seafood.
Mental health agencies agree to consolidate amid delayed launch of specialized Medicaid plans
By Jaymie Baxley
Two organizations that manage behavioral health services for people with Medicaid and for some uninsured people in different areas of North Carolina have agreed to merge into a single entity that will serve more than 100,000 people across 21 counties.
Eastpointe, an organization that coordinates care for low-income residents in 10 eastern counties, on Thursday said it intends to consolidate with the Sandhills Center, which operates in 11 southwestern counties. The consolidated entity is expected to be the second-largest of its kind in the state “based on population,” according to a news release from Eastpointe.
Sandhills Center and Eastpointe are part of a network that currently consists of six state-supported managed care agencies, commonly called LME-MCOs, that serve people with mental health needs, substance use disorders and intellectual or developmental disabilities. These people tend to require more extensive care and support than the average Medicaid participant.
The LME-MCOs play a critical role in the N.C. Department of Health and Human Services’ vision for the future of Medicaid, which includes moving many of the residents served by the agencies onto specialized health care plans that are tailored to their complex needs. DHHS had originally hoped to launch the tailored plans in December 2022. After multiple delays, the department announced last month that the rollout would be postponed indefinitely to give the LME-MCOs more time to prepare for the transition.
In a statement to NC Health News on Friday, DHHS said the decision to delay the launch of tailored plans was “influenced in part by the need to ensure LME/MCOs readiness and focus on providing services to populations they are best positioned to manage successfully.”
“Ensuring that all North Carolinians have access to quality whole-person health care is central to the Department’s mission,” a DHHS spokeswoman said in an email. “This is especially true when it comes to management of the Medicaid Tailored Plans that will serve people with complex behavioral health conditions, Intellectual/Developmental Disabilities and traumatic brain injury.”
The spokeswoman added that DHHS will “evaluate the intent to consolidate” Sandhills Center with Eastpointe, and “work with the entities on a path forward that best serves improving outcomes for the people of our state.”
‘The best opportunity’
The department has saidabout 150,000 people, or 5 percent of the state’s Medicaid participants, will eventually be moved to tailored plans. The LME-MCOs will be responsible for coordinating care for tailored-plan enrollees by acting as intermediaries between patients and providers, who will work under contract with the agencies.
In the news release announcing the consolidation agreement, Sarah Stroud, CEO of Eastpointe, said combining with Sandhills Center will “give us an unmatched ability to deliver quality benefits and support our provider partners while also meeting the objectives of the state’s policymakers.” Stroud will also serve as CEO of the consolidated entity, which has not yet been named.
Anthony Ward, who earlier this year became CEO of Sandhills Center, added that consolidation “offers the best opportunity to preserve local management of services for individuals in our communities.” In an email to NC Health News, Ward said he will serve as executive vice president of the consolidated organization.
No layoffs are expected in connection with the consolidation. The new entity will employ nearly 900 people and oversee a budget of about $1.4 billion, according to the news release. It will be based out of Sandhills Center’s facility in the Moore County town of West End.
In addition to Moore, the Sandhills Center covers Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Randolph, Richmond and Rockingham counties. Eastpointe covers Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Warren, Wayne and Wilson counties.
The boards of Eastpointe and Sandhills Center, which are made up of 19 commissioners from the agencies’ respective counties, will be condensed into a single board. The consolidated organization will “draw about half of its board members from each LME-MCO,” according to the news release.
Harry Southerland, a Hoke County commissioner who chairs the Sandhills Center board, said the agreement “presents a tremendous opportunity to promote superior services to our members and meet the goals of the Department of Health and Human Services and our legislature.”
His comments were echoed by Jerry Jones, a Greene County commissioner who chairs the Eastpointe board. Consolidation, Jones said, “ensures our approach to service delivery reaches more members at exactly the right time as North Carolina looks to expand its Medicaid program.”
The proposed consolidation must still be approved by DHHS. In its statement to NC Health News, the department said it does not know how long that will take.
“Without having seen the specific proposal at this time, it is hard for NCDHHS to comment on the consolidation,” the department said.
If approved, the new consolidation will reduce the number of LME-MCOs in North Carolina to five. The other agencies are Alliance Health, Partners Health Management, Trillium Health Resources and Vaya Health.
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