Buncombe County is facing an outbreak of bacteria-related illness in the wake of Helene triggered by one type of microorganism that is far outpacing others and likely brought on by hand hygiene and food handling issues. 

Since the storm, there have been 16 cases of gastrointestinal illness in Buncombe related to four common, powerful bacteria, according to North Carolina Health and Human Services data obtained by Asheville Watchdog. One in particular, campylobacter, caused 13 of the cases.

For the past five Octobers, the median number of campylobacter cases has been five. The 13 cases occurred between Oct. 1-19 alone, according to the data. Those include seven in the third week of the month.

“There has been an increase in campylobacter cases above baseline in Buncombe County in October,” the NCDHHS Division of Public Health’s Communicable Disease Branch told Buncombe health officials in an Oct. 24 email summarizing its findings. 

“Campylobacter typically is the most common reportable [gastrointestinal] illness in Buncombe County. Based on patient interviews that the [communicable disease] nurses have conducted, this increase does appear to be storm related with a variety of potential sources including deficiencies in appropriate hand hygiene, food handling, and/or cleaning of food preparation surfaces,” the NCDHHS notice said.

Buncombe had requested a report from NCDHHS following anecdotal evidence of an outbreak, according to the agency’s officials. 

Five days after the NCDHHS report was sent, Buncombe County Health and Human Services Medical Director Dr. Jennifer Mullendore addressed the outbreak in a public briefing, ensuing news release, and email to local health care providers.

“Following a major flooding event like we experienced with Hurricane Helene, there is an increased risk of gastroenteritis,” Mullendore said.

Research shows a hurricane and flood often bring with it several waves of sickness and injury, as The Watchdog reported Oct. 11.

Gastroenteritis is an illness that involves the stomach and/or the intestines. Symptoms can include vomiting, diarrhea, abdominal pain or cramping, headaches, muscle aches and fever. It can be caused by norovirus, hepatitis, cryptosporidium, E. coli, salmonella, shigella, giardia and campylobacter.

Why people are getting it is less clear, but there are a number of likely culprits.

“The risk of gastroenteritis increases for a variety of reasons, including contact with sewage or water that has been contaminated with human or animal waste, decreased ability for appropriate hand hygiene and safe food handling practices, lack of consistent refrigeration due to power outages; flooding can also wash organisms from livestock into areas where fruits and vegetables are grown, contaminating the produce,” Mullendore said. 

City of Asheville’s Water Resources lab staff is conducting daily testing throughout the damaged water distribution system for total coliform, E. coli and chlorine, the state noted in its report.

“E. coli and total coliform have not been detected in the distribution system,” according to the Oct. 24 email. 

By Oct. 30, those bacteria were still absent from test results. 

There were no E. coli cases in Buncombe County in October, according to the report.

Regardless of the source, health officials don’t know if the spike in cases is an anomaly or the beginning of a trend.

“It’s too early to know if this is the start of an increasing trend, a return to baseline, because these levels fluctuate routinely, or just a blip,” Mullendore said. “Epidemiologists at the state are continuing to monitor this data.”

‘Certainly unprecedented’

Systems to track diseases in North Carolina have existed for years, but Helene means experts are taking a more focused approach, keeping an eye on diseases that are more likely following a natural disaster.

“It’s definitely not business as usual,” state epidemiologist Dr. Zack Moore told The Watchdog. 

“We’re looking at the syndromes, the infections, that we know are likely following a disaster. And I don’t know when it’s going to end … In terms of lack of access to basic services, this is certainly unprecedented in North Carolina. So, you know, we’re still worried.” 

The state works closely with Buncombe County HHS to track disease outbreaks. According to Moore, the recent report was created because Buncombe told the state about reports of gastrointestinal cases. These cases are reported by local health care providers, including Mission Hospital, which has a dedicated epidemiologist. 

This is the first report the state has generated for Buncombe and potentially one of many to come, Moore said. Without access to potable water, basic sanitation or stable living situations, the risks of infections will linger.

“People don’t have access to these things now and in some cases, in some locations, they’re not going to for a while,” Moore said.

Focused tracking of these diseases will remain intact for as long as the need exists, Moore said, noting if Buncombe needs more data and guidance in the future, “we’ll create it.”

How to minimize your risk

Buncombe issued this guidance for avoiding sickness Oct. 28:

Use safe water:

• Use bottled or disinfected water for drinking, cooking, brushing teeth.
• If boiling: bring clear water to a rolling boil for 1 minute.
• If using bleach: add eight drops of bleach per gallon, wait 30 mins.
• Avoid well water until disinfected and tested.

Practice hand hygiene:

• Wash hands with soap and clean water, or use sanitizer (60% alcohol).
• Key times: before eating or preparing food, after bathroom use, after animal contact.

Sanitize food prep areas:

• Clean surfaces with soap and safe water.
• Use bleach solution (1 tbsp bleach per gallon of water) for sanitizing.

Follow food safety:

• Discard unrefrigerated meat/dairy.
• Cook food thoroughly and consume it hot.
•  Avoid raw foods unless you’ve peeled them yourself.

If sick with diarrhea:

• Stay hydrated with safe water.
• See a doctor if you experience severe symptoms (e.g., high fever, dehydration).

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email arjones@avlwatchdog.org. The Watchdog’s local reporting during this crisis is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.

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