[Show abstract][Hide abstract] ABSTRACT: Coccidioidomycosis is associated with soil-disruptive work in Coccidioides-endemic areas of the southwestern United States. Among 3,572 workers constructing 2 solar power–generating facilities in San Luis Obispo County, California, USA., we identified 44 patients with symptom onset during October 2011–April 2014 (attack rate 1.2 cases/100 workers). Of these 44 patients, 20 resided in California outside San Luis Obispo County and 10 resided in another state; 9 were hospitalized (median 3 days), 34 missed work (median 22 days), and 2 had disseminated disease. Of the 25 patients who frequently performed soil-disruptive work, 6 reported frequent use of respiratory protection. As solar farm construction in Coccidioides-endemic areas increases, additional workers will probably be exposed and infected unless awareness is emphasized and effective exposure reduction measures implemented, including limiting dust generation and providing respiratory protection. Medical providers, including those in non–Coccidioides-endemic areas, should suspect coccidioidomycosis in workers with compatible illness and report cases to their local health department.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Coccidioidomycosis, endemic in California, is associated with soil disturbances. Physician occupational illness reports identified coccidioidomycosis among employees constructing 2 solar power-generating facilities in San Luis Obispo County (SLO). We investigated confirmed cases to recommend preventive measures.
METHODS: A case was defined as clinical- and laboratory-confirmed coccidioidomycosis in an employee of either solar farm after August 2011 and before symptom onset. Patients were interviewed for demographics, missed work days, daily work activities, and protective practices. Hazard ratios for time from employment to symptom onset, adjusted for smoking (aHR), were calculated by Cox proportional hazards regression. Incidence rate (IR)/100,000 population/year was calculated for 1 employer and compared with the SLO IR.
RESULTS: Of 43 patients, 40 were male and 10 Hispanic; ages ranged from 21 to 63 (median: 47) years. Nine (21%) were hospitalized. Of 42 interviewed, 34 (81%) had missed work (1–547 days; median: 22). The most common occupations were electrician (13), heavy equipment operator (10), and laborer (6). Twenty-one performed soil-disruptive work daily; of these, 6 always used respiratory protection. Fourteen never performed soil-disruptive work. Thirty reported dusty conditions all or the majority of days. Shorter time to symptom onset was associated with performing soil-disruptive work daily (aHR: 4.15; 95% confidence interval [CI]: 1.61–10.67). For 1 employer with 29 patients, IR was 5,342/100,000/year, 139 (95% CI: 86–226) times the SLO IR of 38/100,000/year.
CONCLUSIONS: Risk for coccidioidomycosis was not limited to employees performing soil-disruptive work at the solar farms; however, daily soil-disruptive work was associated with earlier illness onset. We recommended further limiting dust generation and ensuring access to respiratory protection for all employees, practices the solar farm has reported implementing.
2014 Council of State and Territorial Epidemiologists Annual Conference; 06/2014
[Show abstract][Hide abstract] ABSTRACT: In March 2013, the California Department of Public Health (CDPH) identified two Doctor's First Reports of Occupational Injury or Illness (DFRs) regarding Los Angeles County residents who had worked at the same jobsite in January 2012 and had been evaluated for possible work-associated coccidioidomycosis (valley fever). Occupational exposure to Coccidioides, the causative fungi, typically is associated with soil-disrupting activities. The physicians noted that both workers were cast or crew members filming a television series episode, and the site of possible exposure was an outdoor set in Ventura County, California. On the basis of their job titles, neither would have been expected to have been engaged in soil-disrupting activities. Los Angeles County Department of Public Health (LACDPH) conducted an outbreak investigation by using CDPH-provided occupational surveillance records, traditional infectious disease surveillance, and social media searches. This report describes the results of that investigation, which identified a total of five laboratory-confirmed and five probable cases linked to this filming event. The employer and site manager were interviewed. The site manager stated that they would no longer allow soil-disruptive work at the site and would incorporate information about the potential risk for Coccidioides exposure onsite into work contracts. Public health professionals, clinicians, and the television and film industry should be aware that employees working outdoors in areas where Coccidioides is endemic (e.g., central and southern California), even those not engaged in soil-disruptive work, might be at risk for coccidioidomycosis.
MMWR. Morbidity and mortality weekly report 04/2014; 63(15):321-4.
[Show abstract][Hide abstract] ABSTRACT: Emergence of the novel 2009 influenza A H1N1 virus in California led to an evaluation of hospital respiratory protection programs (RPPs) and practices by the California Department of Public Health during the 2009-2010 influenza season.
Onsite evaluation of 16 hospitals consisted of interviews with managers and health care workers about RPPs and practices, review of written RPPs, and limited observations of personnel using respirators. Data were analyzed using descriptive statistics.
All hospitals had implemented policies requiring the minimum use of N95 filtering facepiece respirators when working with patients with H1N1 virus infection; 95.5% of health care workers (n = 199) reported they would wear at least this level of protection when in close contact with a patient with confirmed or suspected H1N1 virus infection. However, evaluation of written RPPs indicated deficiencies in required areas, most commonly in recordkeeping, designation of a program administrator, program evaluation, employee training, and fit testing procedures.
Health care workers were aware of respiratory protection required when providing care for patients with confirmed or suspected H1N1 virus infection. Hospitals should improve written RPPs, fully implement written procedures, and conduct periodic program evaluation to ensure effectiveness of respirator use for health care worker protection. Increased accessibility of resources tailored for hospital respirator program administrators may be helpful.
American journal of infection control 08/2013; 41(11). DOI:10.1016/j.ajic.2013.05.006 · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Coccidioidomycosis, a fungal infection endemic in the southwestern United States, can lead to severe and potentially fatal disseminated disease. Workplace-acquired coccidioidomycosis can result from soil-disturbing activities or windborne dust. In December 2012, San Luis Obispo County (SLO) Public Health alerted the California Department of Public Health (CDPH) to three coccidioidomycosis cases among construction workers at Solar Power Farm A. CDPH investigated to determine the extent of the outbreak and risk factors.
METHODS: Because use of coccidioidomycosis prevention measures within this growing industry is unknown, CDPH reviewed routinely collected occupational injury/illness and confidential morbidity reports, and associated medical records. Cases were defined as both clinical- and laboratory-diagnosed coccidioidomycosis, symptom onset since January 1, 2012, and working on solar farm construction in SLO.
RESULTS: By March 7, 2013, a total of 12 cases were identified from two solar farms in SLO, five from Farm A and seven from Farm B. Five patients resided outside SLO and two outside California. All patients were male, aged 21–63 years, and had symptom onset January 13, 2012–January 1, 2013. Six patient records noted dusty workplace conditions, four working in or near heavy equipment, five digging or working in soil, and four lack of respiratory protection. Two patients were hospitalized; four visited emergency departments; and five were unable to work for 2 weeks–12 months.
CONCLUSIONS: Data from routine public health and occupational illness reporting revealed ongoing occurrence of coccidioidomycosis among construction workers at two solar power farms in SLO. An Epi-X call for cases was posted March 5, 2013, and worksite investigations are under way to assess practices, identify additional cases, and educate construction employers in endemic areas.
2013 Council of State and Territorial Epidemiologists Annual Conference; 06/2013
[Show abstract][Hide abstract] ABSTRACT: The California Department of Public Health received serial spirometry data for flavoring manufacturing workers at 20 companies at risk of bronchiolitis obliterans.
We graded spirometry quality; identified individual workers with excessive decline in forced expiratory volume in 1 s (FEV(1)) using relative longitudinal limits of decline based on 4% average within-person variability; and analyzed declines by occupational risk factors.
The quality of 1,696 spirometry tests from 724 workers varied by 17 providers, with poorer quality from commercial providers. Of 416 workers with at least two tests, 40 (9.6%) had abnormal FEV(1) decline. Of 289 workers with high quality spirometry, 21 (7.3%) had abnormal decline. Only one of the 21 had airways obstruction. Abnormal FEV(1) decline rates (per person-month) were greater among workers at companies using ≥800 lbs/year diacetyl than at companies using lesser amounts. Abnormal FEV(1) decline rates were greater at companies previously having four-person clusters of spirometric obstruction than at companies with no or only one worker with obstruction.
Spirometric surveillance of flavoring workers can identify individual workers with an abnormal FEV(1) decline for preventive intervention, even when the FEV(1) itself remains within the normal range. Good quality spirometry and classification of abnormal with relative longitudinal limit of decline minimize misclassification of possible work-related health effects.
American Journal of Industrial Medicine 08/2012; 55(8):657-68. DOI:10.1002/ajim.21013 · 1.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the investigation of a 2007 occupational coccidioidomycosis outbreak in California, recommend prevention measures, and assess statewide disease burden.
We evaluated the worksite, observed work practices, interviewed the workers and employer, reviewed medical records, provided prevention recommendations including risk-based respirator selection, and analyzed statewide workers' compensation claims.
Ten of 12 workers developed acute pulmonary coccidioidomycosis; none used respiratory protection. We recommended engineering, work practice, and administrative controls, powered air-purifying respirator use, and medical care. Occupational coccidioidomycosis incidence nearly quadrupled in California from 2000 to 2006, with the highest rates in construction and agricultural workers.
Construction workers are at risk for occupational coccidioidomycosis. The high attack rate in this outbreak was due to lack of awareness, rainfall patterns, soil disruption, and failure to use appropriate controls. Multiple risk-based measures are needed to control occupational coccidioidomycosis in endemic areas.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 04/2012; 54(5):564-71. DOI:10.1097/JOM.0b013e3182480556 · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This essay examines the role state public health agencies could play in the surveillance of emerging workplace hazards including nanotechnology.
This essay describes existing state occupational health surveillance programs in order to demonstrate their potential applicability, and limitations, in regards to nanomaterial worker surveillance.
State public health agencies have access to information and an ability to put surveillance information to use in ways that complement those of industry, academia, regulatory agencies, and federal partners.
Some state public health agencies have significant experience with occupational health surveillance and are therefore valuable partners in the development and implementation of nanotechnology worker surveillance programs. Including states in emerging hazard surveillance enhances surveillance activities and builds state capacity to help workers.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 06/2011; 53(6 Suppl):S38-41. DOI:10.1097/JOM.0b013e31821ad8bd · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The California Department of Public Health, Occupational Health Branch, in collaboration with the National Institute for Occupational Safety and Health (NIOSH), is performing an evaluation of respiratory protection programs in a sample of California hospitals during the H1N1 pandemic of 2009-2010. The objectives of this evaluation are to assess the implementation of respiratory protection programs in acute care hospitals in California in the context of H1N1, and to identify common barriers and successes in effective program implementation. Sixteen hospitals were randomly selected for participation, and approximately 21 interviews of hospital managers, unit managers, and healthcare workers were conducted in each hospital using a standardized survey instrument. Interviews included questions about the facility's respiratory protection program and implementation of this program, knowledge and beliefs regarding respirators, and safety climate of the facility. Clinical practices regarding respirator use were observed in each hospital. An anonymous online survey about respirator practices, knowledge, and beliefs was distributed via union email lists to healthcare workers throughout California. Descriptive statistics will be used to identify best practices and limitations of hospital respiratory protection programs. Results are expected to be available by the second quarter of 2010. Preliminary results suggest that there are common shortcomings in hospital respiratory protection program implementation and adherence. The results of this evaluation will be used to identify barriers to implementing and sustaining successful respiratory protection programs for pandemic influenza. This knowledge will aid CDPH and NIOSH in providing useful and timely guidance to healthcare facilities regarding respiratory protection for healthcare workers.
138st APHA Annual Meeting and Exposition 2010; 11/2010
[Show abstract][Hide abstract] ABSTRACT: Two cases of bronchiolitis obliterans in flavor manufacturing workers prompted California health and labor agencies to initiate industry-wide surveillance.
Companies' physicians submitted cross-sectional questionnaire and spirometry data for 467 workers in 16 workplaces. We compared prevalence ratios of respiratory symptoms, diagnoses, and abnormal spirometry to a general population sample. We calculated odds ratios for risk factors for spirometric obstructive abnormality.
Flavoring workers were 2.7 times more likely than the general population to have severe airways obstruction. Risk factors identified for 18 cases with obstruction from six companies included younger age, Hispanic ethnicity, liquid and powder production work, greater company diacetyl usage, and having a coworker with obstruction. Severity of obstruction was related to tenure. At least 12 workers had probable occupational fixed airways obstruction.
The flavoring industry risk of severe lung disease justifies lowering flavoring exposures and medical screening for secondary prevention until worker safety is demonstrated.
American Journal of Industrial Medicine 06/2010; 53(9):857-65. DOI:10.1002/ajim.20858 · 1.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The California Department of Health Services' Occupational Health Branch and others have identified the construction industry as being at high risk for injuries, illnesses, and fatalities. Effective tailgate trainings (brief job site safety meetings) can be a powerful tool to promote hazard awareness and safe work practices. The authors found that many contractors and supervisors conducted ineffective tailgate trainings. They developed the BuildSafe California Project to assist contractors to have more effective programs by holding 25 training-of-trainers sessions reaching 1,525 participants. The needs assessment, intervention, and evaluation results from the first 18 trainings are presented. Eighty-six percent of the participants found the program "very helpful." Participants used the materials and made improvements in the quality and frequency of trainings. Supervisors must be skilled at conducting tailgate trainings as part of their responsibilities. There is a serious need to provide more culturally appropriate safety training in a workforce increasingly made up of Latino workers.
Health Promotion Practice 04/2008; 10(3):359-69. DOI:10.1177/1524839907307885 · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Exposure to glutaraldehyde is a recognized cause of work-related asthma. An investigation was undertaken to describe exposure to glutaraldehyde among workers making bioprosthetic heart valves and to make recommendations for prevention. At the two largest heart valve manufacturing facilities in California, the work process was observed; employer representatives and glutaraldehyde-exposed workers were interviewed; and employer written records, including company-generated industrial hygiene data, were analyzed. Approximately 600 female workers had continuous airborne exposure to glutaraldehyde over the course of every work shift and the routine potential for skin and eye contact with glutaraldehyde while making heart valves. Employee short-term (15-min) glutaraldehyde exposures were all well below the current regulatory ceiling level (0.20 ppm). Overall, approximately 40% of the glutaraldehyde-related job tasks involved exposures above the American Conference of Industrial Hygienists threshold limit value ceiling of 0.05 ppm; the majority (71.4% and 83.3%, depending on the company) involved exposures greater than 0.015 ppm. At one company, two cases of physician-diagnosed asthma were recorded by the employer in the previous 5-year period; these reports met the surveillance case definition for new-onset, work-related asthma associated with a known asthma inducer. Factors that contributed to worker exposure included large exposed surface areas of glutaraldehyde under agitation; working with glutaraldehyde-treated tissue in proximity to workers' breathing zones; manual pouring and disposal of glutaraldehyde solutions without local exhaust ventilation, eye protection, and waste neutralization; and prolonged use of latex gloves. Workers making bioprosthetic heart valves are at risk for occupationally acquired asthma. Employers should implement additional engineering controls to minimize workers' exposures to at least below a level of 0.015 ppm, an appropriate glove to prevent workers' skin exposure to glutaraldehyde, consistent and universal use of eye protection, and a medical surveillance program for glutaraldehyde-exposed workers.
Journal of Occupational and Environmental Hygiene 06/2007; 4(5):311-20. DOI:10.1080/15459620701267964 · 1.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research conducted in recent years has increased public health concern about the toxicity of lead at low dose and has supported a reappraisal of the levels of lead exposure that may be safely tolerated in the workplace. In this article, which appears as part of a mini-monograph on adult lead exposure, we summarize a body of published literature that establishes the potential for hypertension, effects on renal function, cognitive dysfunction, and adverse female reproductive outcome in adults with whole-blood lead concentrations < 40 microg/dL. Based on this literature, and our collective experience in evaluating lead-exposed adults, we recommend that individuals be removed from occupational lead exposure if a single blood lead concentration exceeds 30 microg/dL or if two successive blood lead concentrations measured over a 4-week interval are > or = 20 microg/dL. Removal of individuals from lead exposure should be considered to avoid long-term risk to health if exposure control measures over an extended period do not decrease blood lead concentrations to < 10 microg/dL or if selected medical conditions exist that would increase the risk of continued exposure. Recommended medical surveillance for all lead-exposed workers should include quarterly blood lead measurements for individuals with blood lead concentrations between 10 and 19 microg/dL, and semiannual blood lead measurements when sustained blood lead concentrations are < 10 microg/dL. It is advisable for pregnant women to avoid occupational or avocational lead exposure that would result in blood lead concentrations > 5 microg/dL. Chelation may have an adjunctive role in the medical management of highly exposed adults with symptomatic lead intoxication but is not recommended for asymptomatic individuals with low blood lead concentrations.
Environmental Health Perspectives 03/2007; 115(3):463-71. DOI:10.1289/ehp.9784 · 7.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Associations between magnitude and timing of maternal pregnancy blood lead (Pb) levels (BLLs), birth weight, and total days of gestation were examined, as well as associations with related clinical diagnoses of low birth weight (LBW), preterm, and small-for-gestational-age (SGA) birth.
Among a sample of 262 mother-infant pairs studied retrospectively, one-way analysis of variance and regression statistics were used to measure the relationship between level of maternal pregnancy BLLs and birth outcomes while controlling for key maternal and newborn factors.
Women with maximum pregnancy BLLs (max-PBLLs) > or =10 microg/dl tended to give birth earlier and their babies were at substantially increased risk for preterm and SGA birth. By holding other explanatory factors constant, each unit increase in max-PBLL above 10 mug/dl was found to be associated with a decrease of -0.3 in total days of gestation. Compared to women with lower levels, women with max-PBLLs > or =10 microg/dl were at a threefold increased risk for preterm birth (adjusted OR=3.2, 95% CI 1.2-7.4) and more than a fourfold increased risk for having an SGA infant (adjusted OR=4.2, 1.3-13.9). Second trimester maximum BLLs > or =10 microg/dl were associated with a steep decrease in total days of gestation (a decrease of -1.0 days per each unit increase above 10 microg/dl).
These data provide evidence of the adverse effects of maternal pregnancy BLLs, particularly when levels are > or =10 microg/dl. Prenatal Pb exposure at these levels was associated with significant decreases in total days of gestation and an increased risk of preterm and SGA birth.
Journal of Perinatology 04/2006; 26(3):154-62. DOI:10.1038/sj.jp.7211453 · 2.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is a real need to educate small painting and remodeling contractors about lead-safe work practices to protect the health of occupants (especially small children) and employees. From 1996 to 2000, 34 half-day lead awareness trainings were held throughout California to increase contractors' use of lead-safe practices. Educational methods included focusing on best practices, utilizing a peer educator, and working with stakeholders to do outreach to this hard-to-reach audience. We report on the evaluation of 18 of these seminars where we found that 30% to 49% of the interviewed contractors began doing many of the lead-safe work practices after attendance. We conclude that this program can have a modest impact in areas that contractors are more familiar with; new areas not part of their experience do not fare as well. However, without a more integrated public health educational and enforcement strategy, educational efforts such as ours can have only a limited impact.
Health Promotion Practice 08/2004; 5(3):297-305. DOI:10.1177/1524839903257764 · 0.55 Impact Factor