American Journal of Epidemiology Vol. 136, No. 4: 475-487
Copyright © 1992 by The Johns Hopkins University School of Hygiene and Public Health
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A Multistate Outbreak of Sporotrichosis associated with Sphagnum Moss
1Division of Field Services, Epidemiology Program Office, Centers for Disease Control Atlanta, GA
2Meningitis and Special Pathogens Branch, Division of Bacterial Diseases, Center for Infectious Diseases, Centers for Disease Control Atlanta, GA
3Bureau of Communicable Disease Control, New York State Department of Health Albany, NY
4Bureau of Epidemiology, Pennsylvania Department of Health Harrisburg, PA
5Laboratories for Mycology, Wadsworth Center for Lab oratories and Research, New York State Department of Health Albany, NY
Reprint requests to Dr. F. Bruce Colas, Bureau of Communicable Disease Control, New York State Department of Health, Room 651, Coming Tower, Empire State Plaza, Albany, NY 12237
In the spring of 1988, the largest documented US outbreak of cutaneous sporotrichosis to date occurred, with 84 cases among persons from 15 states who were exposed to Wisconsin-grown sphagnum moss used in packing evergreen tree seedlings. In New York State, 13 cases occurred among 109 forestry workers. All 13 cases occurred among 76 workers who had handled evergreen seedlings and moss (attack rate = 17%). For those exposed to evergreens and moss, the risk of infection increased as worktime exposure to moss increased (attack rates: <10 hours, 8%; 10–19 hours, 12%; >19 hours, 33%). While environmental samples of moss from the Wisconsin supplier were negative, Sporothrix schenckii was cultured from multiple samples of the sphagnum moss obtained from one of six Pennsylvania tree nurseries, representing the nursery that was identified as the source for 79 (94%) of the moss-associated cases. Differences in tree-handling procedures at this nursery—including the use of 1- to 3- year-old moss to pack seedlings, use of a pond water source to wet the moss, use of an organic polymer gel on the seedling root system, and underground storage and longer storage of moss-packed seedlings before shipping—suggested possible explanations for the assodatlon. Efforts to prevent sporotrichosis among persons handling evergreen seedlings should include the use of alternate types of packing material (e.g., cedar wood chips or shredded paper) and protective clothing such as gloves and longsleeved shirts.
disease outbreaks; plants; sporotrichosis; trees
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