If you go outside this Labor Day weekend, don't forget the bug spray.

The dangerous but rare Eastern equine encephalitis virus is flaring up in Michigan, state health officials say, and has been confirmed in two people in Berrien and Kalamazoo counties and is suspected in five more people.

The virus, carried by birds and transmitted to humans through the bite of infected mosquitoes, is deadly in 1 in 3 people who contract it, and can cause brain damage and permanent neurological disabilities in those who survive.

"The best way Michiganders can protect themselves is to follow these steps" to avoid mosquito bites, said Lynn Sutfin, a spokeswoman for the Michigan Department of Health and Human Services:

Apply insect repellents that contain the active ingredient DEET, or other U.S. Environmental Protection Agency-approved product to exposed skin or clothing, and always follow the manufacturer’s directions for use.

Wear long-sleeved shirts and long pants when outdoors. Apply insect repellent to clothing to help prevent bites.

Maintain window and door screening to help keep mosquitoes outside.

Empty water from mosquito breeding sites around the home, such as buckets, unused kiddie pools, old tires or similar sites where mosquitoes may lay eggs.

Use nets and/or fans over outdoor eating areas.

All seven Michigan people who are suspected of having EEE, are hospitalized, Sutfin said, and they range in age from 14-68.

Among them is 14-year-old Savanah Dehart, who was admitted Aug. 17 to Bronson Children's Hospital in Kalamazoo and remains in serious condition.

More:Michigan mom says daughter, 14, has rare Eastern equine encephalitis virus

"We tend to get a flare-up in cases of EEE every 10 years," Sutfin said. "There is no definitive cause determined, although weather is suspected to play a part in this."

In an average year, there are only seven cases of EEE nationally, according to the U.S. Centers for Disease Control and Prevention. But this year, Michigan alone has that many cases under investigation.

The virus is found mostly in the eastern United States and in the Great Lakes region. Infections tend to occur near freshwater hardwood swamps, according to the CDC.

Massachusetts tries to prevent EEE

Michigan isn't the only state reporting EEE infections this summer.

Four people have been confirmed to have the virus in Massachusetts, where one woman has died from EEE.

Massachusetts health officials have mapped high-risk areas, started mosquito-spraying programs and have recommended the cancellation of outdoor activities between dusk and dawn to reduce the risk of being bitten when mosquitoes are most active, according to the state's government website, mass.gov.

Here in Michigan, no such actions have been taken.

"Mosquito control and surveillance are decided upon and funded at the local level," said Sutfin of the MDHHS, which means individual counties or communities would have to opt to pay for a mosquito-spraying program or the use of larvicides for mosquito control.

Just four counties in Michigan — all in the Saginaw Bay area — have comprehensive mosquito surveillance and control programs, Sutfin said.

Berrien and Kalamazoo counties, where Michigan's EEE outbreak is concentrated, do not have such programs.

Gillian Conrad, communications manager for the Berrien County Health Department, said the county does some surveillance of mosquitoes. But it's only to study what types of mosquitoes are most prevalent.

"We're not testing each mosquito to see if it's a carrier for the virus," Conrad said. "We're looking for specific species, knowing that if particular species are circulating in our area, we can make some educated guesses about what illnesses those mosquitoes might be carrying."

There are no plans at this point to start spraying for mosquitoes or to use larvicides to stop them from breeding in Berrien County, Conrad said. And no outdoor events have been canceled between dusk and dawn, when mosquitoes are most active.

"It sounds like a pretty robust effort Massachusetts is undergoing," she said. "I am hopeful in the coming days and weeks here, we'll potentially be looking at all the options available to us in Michigan.

"Right now, it's about getting the public informed and educated about what EEE is. I'll tell you, nine ut of 10 people don't know about it. ... In our area, where agriculture is big, and there are lots of people that keep horses and spend time around horses, we want to make sure that people understand that you're not going to get it from a horse. It is spread by mosquitoes."

She said the health department has done media interviews and posted information about EEE on its website and on social media platforms.

"Here we are in the last real weekend of summer before school starts," Conrad said. "We don't want to make anyone feel they need to stay inside due to an extremely rare, rare illness that may be circulating in the mosquito population."

Instead, she said, the focus is on telling the public about the precautions it can take to prevent bites.

"I think that the local health departments will certainly be in further conversations with our state health department in the coming days and weeks if there continues to be a trend of cases that are popping up in humans and discuss all the options that are on the table to protect the public health," Conrad said.

"I am speaking from a local health department perspective, and as you can understand, our resources are always limited. If there were to be any conversations about mosquito-control efforts, those would include our state health department."

Kalamazoo County Health Officer Jim Rutherford didn't answer questions from the Free Press about whether it has done anything to control mosquitoes or whether the county is considering the cancellation of events that take place when mosquitoes are most active, from dusk-to-dawn, as Massachusetts has done.

Rather, he sent a statement by email Friday afternoon urging the same mosquito-bite-prevention tips that the MDHHS recommends.

EEE symptoms, what to look for

Symptoms off EEE typically appear from four to 10 days after the bite of an infected mosquito, according to the CDC. The infection can be either systemic or encephalitic, which involves the swelling of the brain. Some people who contract EEE do not have symptoms at all.

In those who develop a systemic infection, symptoms can appear suddenly and last up to two weeks. They include:

Chills

Fever

Malaise

Joint and muscle pain

In people who develop the encephalitic infection, the following symptoms typically follow after a few days of systemic illness:

Fever

Headache

Irritability and restlessness

Drowsiness, disorientation

Anorexia

Vomiting

Diarrhea

Cyanosis, which is bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood

Convulsions

Coma

Animals can get EEE, too. So far, the state has confirmed seven cases in horses — two in Barry County, three in Kalamazoo County and two in St. Joseph County — and in two white-tailed deer in Barry and Cass counties. The virus is 90% fatal in horses, though there is a vaccine to protect horses that is not available for humans.

Other mosquito-borne illnesses

In addition to EEE, Sutfin said the MDHHS has confirmed one case of another mosquito-borne form of encephalitis — California encephalitis virus — in a Genesee County resident, and it's investigating a suspected case of West Nile virus in a person from Wayne County.

Like EEE, West Nile virus also is transmitted by the bite of infected mosquitoes.

So far this year, 20 mosquito pools have tested positive for West Nile virus in Michigan in the following counties: Oakland, Saginaw, Wayne (including the City of Detroit), Bay, and Midland, Sutfin said. In addition, eight birds infected with West Nile virus have been found in the following counties: Kalamazoo, Bay, Gladwin, Otsego, Saginaw, Midland, and Wayne.

Contact Kristen Jordan Shamus: 313-222-5997 or kshamus@freepress.com. Follow her on Twitter @kristenshamus.