State health officials have advised residents in eight counties to avoid being outdoors during evening hours after three people died of a mosquito-borne disease in Michigan amid what officials are calling the “worst outbreak” in more than a decade.

How that advice might affect events planned in those communities is less clear, with local school districts and other institutions still discussing whether they will take advice to cancel or postpone evening outdoor activities.

The Michigan Department of Health and Human Services, in a news release sent Tuesday, Sept. 17, warned the public to avoid outdoor activities at dusk and encouraged local leaders in eight counties to postpone any outdoor events because of the risk of Eastern equine encephalitis. The eight counties included in the advisory are: Barry, Berrien, Cass, Genesee, Kalamazoo, Lapeer, St. Joseph and Van Buren.

“We are taking this really seriously as a public health threat,” Bob Wheaton, public information officer with MDHHS, said in an interview with MLive Wednesday, Sept. 18.

The number of human cases of Eastern equine encephalitis confirmed so far this year is “relatively uncommon,” Wheaton said. The last time the state had a “significant number” of cases was in 2002 when six human cases of EEE were reported, he said.

Wheaton said he does not know the last time the state issued a similar advisory for residents to avoid evening activities and for community leaders to consider canceling or postponing events.

“It’s very uncommon,” Wheaton said. “It indicates the seriousness of the situation.”

The region is experiencing the “worst (EEE) outbreak” in more than a decade, state officials said in Tuesday’s release.

A total of seven human cases of the disease have been confirmed in Barry, Cass, Van Buren, Berrien and Kalamazoo counties. Three fatalities due to the disease were confirmed in Kalamazoo, Cass and Van Buren counties.

The state’s advisory also included Genesee, Lapeer and St. Joseph counties because the virus was confirmed in deer or horses in those areas.

Kalamazoo County Health Officer Jim Rutherford said in an interview with MLive Wednesday that the county has notified school superintendents in the area to postpone evening activities or, if not possible, to advise attendees to dress in long clothing and wear insect repellent.

Susan Coney, director of communications at Kalamazoo Public Schools, said the school district is currently looking into the state’s advisory and “having conversations about planned outdoor events.” Coney said the district would be releasing more information later Wednesday evening.

Rutherford acknowledged people may not want to stay indoors as fall is the “prettiest time in Michigan."

The disease has a “significantly high” fatality rate, he said, but there are protections people can take to avoid the virus.

“It’s certainly concerning when people are getting sick from mosquitoes,” Rutherford said. “The good news is that it’s preventable.

“Repellent. Repellent. Repellent,” he said.

Rutherford stressed other protections that people can take to avoid exposure, including draining standing water from items like playground equipment, which can attract mosquitoes.

“Take action to minimize exposure to mosquitoes to minimize your chance of contracting a mosquito-borne illness,” Rutherford said.

State health officials advise people to use insect repellent with DEET, wear long sleeves and pants, be sure windows and screens are secure and empty any standing water from places like flower pots, buckets, barrels and tires.

Van Buren/Cass District Health Department posted the state’s warning on its own website, encouraging the postponement or cancellation of any evening events, especially those involving children.

The Berrien County Health Department, in a news release issued Wednesday, “is not recommending that community groups cancel outdoor evening events, such as sporting events.” Instead, local health officials suggested events be relocated to indoor spaces, if practical, and that individuals take steps like using insect repellent and wearing long clothing when outdoors.

The Barry-Eaton District Health Department also issued a news release Wednesday reminding residents that though human cases are “rare,” at an average of seven per year in the U.S., the presence of the virus in the region is “of concern,” and residents should take precautions to avoid mosquitoes.

According to the Centers for Disease Control and Prevention, between 2009 and 2019, the United States averaged seven cases of EEE. Nationwide, the number of cases ranged from three in 2009 to 15 in 2012. The states with the highest number of cases were Florida and Massachusetts, according to CDC data.

The Barry-Eaton health officials also advised local jurisdictions and schools to postpone evening events or encourage bystanders to protect themselves with clothing and bug repellent.

Kalamazoo Deputy City Manager Jeff Chamberlain said the city government has no plans to cancel any events, but are suggesting residents follow the advice of state officials and to wear insect repellent. Most events held in Kalamazoo are hosted by private organizations, he said.

Only 4-5% of people will be become sick when infected with the virus, according to information provided by MDHHS. Those infected usually do not show symptoms; however, those who do will develop chills, fever, weakness, muscle and joint pain.

Less than 1% of people who are infected will develop a serious neurological illness that causes inflammation of the brain or surrounding tissues, according to MDHHS. About 30% of people who develop neurological infection due to Eastern equine encephalitis will die, according to MDHHS.

In addition to the human cases, as of Sept. 16, nine fatal cases of EEE in horses had been confirmed in Barry, Kalamazoo, Lapeer, and St. Joseph counties. Also, five deer in Barry, Cass, Genesee, Kalamazoo, and Van Buren counties have been confirmed with EEE infection and were euthanized due to the severity of their disease symptoms.

People who engage in outdoor work and recreational activities in areas where the virus is found are at increased risk of infection. Those over 50 and under 15 appear to be at the greatest risk for developing severe disease, according to the CDC.

Most cases of EEE are reported from Florida, Massachusetts, New York, and North Carolina. Transmission of the virus is most common in and around freshwater hardwood swamps in the Atlantic and Gulf Coast states and the Great Lakes region, the CDC said.