National Estimates of Noncanine Bite and Sting Injuries Treated in US Hospital Emergency Departments, 2011-2015.

OBJECTIVES: Injuries resulting from contact with animals are a significant public health concern. This study quantifies and updates nonfatal bite and sting injuries by noncanine sources using the most recent data available (2011-2015) from the National Electronic Injury Surveillance System-All Injury Program with the purpose of using these updates to better understand public health consequences and prevention techniques. Increased rates of bites and stings can be expected in this study's time frame, possibly caused by the increasing human population expanding into animal territories, as well as changes in animal geographic distribution and pet ownership. METHODS: The National Electronic Injury Surveillance System-All Injury Program is an ongoing nationally representative surveillance system used to monitor all types and causes of injuries treated in US hospital emergency departments (EDs). Cases were coded by trained hospital coders using information from medical records on animal sources of bite and sting injuries being treated. Data from 2011-2015 were weighted to produce national annualized estimates, percentages, and rates based on the US population. RESULTS: An estimated 1.17 million people visited EDs for noncanine bite and sting injuries annually. This translates to a rate of 371.3/100,000 people. Insects accounted for 71.0% of noncanine bite and sting injuries, followed by arachnids (19.2%) and mammals (7.8%). The estimated annual total lifetime medical and work cost of unintentional noncanine injuries was $5,755,581,000. CONCLUSIONS: Various sources of bite and sting injuries had an outsized effect on injury rates and identify potential areas of focus for education and prevention programs to reduce the burden of these injuries on health and healthcare costs. The study describes the diversity of animal exposures based on a national sample of EDs. Noncanine bite and sting injuries significantly affect public health and healthcare resources. Priorities can be focused on animal sources with the most impact on bite and sting injury rates, healthcare costs, and disease burden.

Fatal and Nonfatal Snakebite Injuries Reported in the United States.

OBJECTIVES: Venomous and nonvenomous snakes are found throughout the United States. Two families of venomous snakes are indigenous to this country: the Viperidae, or pit vipers (rattlesnakes, cottonmouths, and copperheads), and the Elapidae (three species of coral snakes and a sea snake). Bites from captive nonindigenous venomous snakes such as cobras also may present at medical facilities, given the interest in exotic pet ownership in the United States. Even "dry," nonenvenomating snakebites and those from nonvenomous snakes can result in puncture wounds that require medical evaluation. This article presents updated national estimates of snakebite injuries treated in US emergency departments (EDs). METHODS: Data on nonfatal snakebite injuries were abstracted from the National Electronic Injury Surveillance System-All Injury Program (2001-2015). Variables included age, sex, body part affected, cause, disposition, and treatment month. The snake species were coded based on narrative comments. Estimates were weighted and analyzed with SAS 9.4. Data on fatal snakebites were obtained from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiological Research (1999-2017). RESULTS: From 2001-2015, an estimated 137,800 snakebite injuries were treated in US EDs (crude rate: 3.0 individuals per 100,000 population). The majority of patients were male (70.7%; crude rate 4.4/100,000 population). Arms/hands (46.8%) and legs/feet (46.1%) were the primary body parts injured. The majority of patients were treated and released (67.1%); however, nearly 30% were hospitalized or transferred to another hospital. Two-thirds of the cases involved a nonvenomous or unknown snake (67.7%). Among venomous encounters, 70.3% involved a rattlesnake. For fatal snakebites, an average of 6 deaths per year was reported (range 2-12). CONCLUSIONS: Although rare, nonfatal snakebites in this study resulted in an estimated average of 9192 annual visits to EDs (roughly 1 visit per hour) and an average of 6 fatal snakebites per year. Epidemiologic data on snakebite injuries provide healthcare providers, public health officials, and veterinarians with information on populations at risk for snakebites, species of snakes likely to be encountered, and guidance for prevention efforts.

Photokeratitis among restaurant workers: A case series.

This case report highlights the challenges associated with the diagnosis and workplace evaluation of occupationally acquired ultraviolet (UV) radiation-induced photokeratitis and associated skin burns in a group of restaurant workers. UV-C spectrum bulbs were inadvertently shipped and installed in insect light traps. Ocular and dermal symptoms were reported in 18 of 85 restaurant employees to varying degrees of severity over a 2-day period. One patient was formally diagnosed with a chemical burn/irritation of the cornea. More severe symptoms were reported by individuals working in close proximity to the lights. This clinical picture can resemble mass chemical or irritant exposure when multiple individuals are affected, and a multidisciplinary approach was required for rapid identification of the source to limit morbidity. Prevention strategies for similar events should be considered which can include limiting hardware compatibility and improving warning labels.

Fatal and non-fatal animal-related injuries and illnesses to workers, United States, 2011-2014.

BACKGROUND: Study provides update of national estimates for work-related fatal injuries and non-fatal injuries and illnesses by animals in US. METHODS: Between 2011 and 2014, injuries and illnesses were retrieved from US Department of Labor and were translated to economic losses using National Safety Council estimates. RESULTS: Total of 222 fatalities (36% by cattle and other bovines) and 71 460 non-fatal injuries and illnesses (38% by insects, arachnids, mites) were identified from animal sources. For non-fatal injuries and illnesses from primary animal sources, annual incidence rates were 1.5-1.6/10 000 full-time workers and annual median days lost from work were 3-4 days. Work-related costs were $222M for fatalities and $2.8B for non-fatal injuries and illnesses that resulted in at least 1 day lost from work. CONCLUSIONS: Study provides evidence of specific animals contributing to more severe injuries and potential for more severe injuries when there is more than one source of injury.

Notes from the field: elemental mercury spill in school bus and residence - North Carolina, 2013.

On September 16, 2013, the North Carolina Division of Public Health was notified of an elemental (metallic and liquid) mercury spill on a school bus. An elementary student boarded the bus with approximately 1 pound (454 g) of elemental mercury contained in a film canister, which the student had taken from an adult relative who had found it in a neighbor's shed. The canister was handled by several students before the contents spilled on the bus floor. Ten passengers aboard the bus were exposed, including eight students and two staff members. Although elemental mercury is not readily absorbed from skin contact or ingestion, it does vaporize at room temperatures and inhalation of the vapor can be harmful. The bus driver promptly notified school officials. Firefighters and a local hazardous materials team directed decontamination procedures (i.e., changing clothes and washing hands and shoes) for the 10 exposed passengers. The bus was immediately taken out of service and sent for disposal because of its age and the cost of decontamination.

National estimates of noncanine bite and sting injuries treated in US Hospital Emergency Departments, 2001-2010.

OBJECTIVE: Injuries resulting from contact with animals and insects are a significant public health concern. This study quantifies nonfatal bite and sting injuries by noncanine sources using data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). METHODS: The NEISS-AIP is an ongoing nationally representative surveillance system used to monitor all types and causes of injuries treated in US hospital emergency departments (EDs). Cases were coded by trained hospital coders using information from medical records on animal and insect sources of bite and sting injuries being treated. Data were weighted to produce national annualized estimates, percentages, and rates based on the US population. RESULTS: From 2001 to 2010 an estimated 10.1 million people visited EDs for noncanine bite and sting injuries, based on an unweighted case count of 169,010. This translates to a rate of 340.1 per 100,000 people (95% CI, 232.9-447.3). Insects accounted for 67.5% (95% CI, 45.8-89.2) of bite and sting injuries, followed by arachnids 20.8% (95% CI, 13.8-27.9). The estimated number of ED visits for bedbug bite injuries increased more than 7-fold-from 2156 visits in 2007 to 15,945 visits in 2010. CONCLUSIONS: This study provides an update of national estimates of noncanine bite and sting injuries and describes the diversity of animal exposures based on a national sample of EDs. Treatment of nonfatal bite and sting injuries are costly to society. Direct medical and work time lost translates to an estimated $7.5 billion annually.

Retrospective Risk Assessment of Injuries and Fatalities in the Forestry and Logging Workforce in the United States, 2003-2019.

OBJECTIVES: The objectives of this study on the forestry and logging workforce are to: 1) Analyze causes of injuries/fatalities to inform future intervention studies focused on risk mitigation, 2) determine whether there are any trends or associations between work-related risk factors and workplace injuries/fatalities over a 16-year period (2003-2019), and 3) identify knowledge gaps related to injuries and fatalities for future studies to address. METHODS: Data on fatalities, injuries, and illnesses of the forestry and logging workforce from the United States Bureau of Labor Statistics were analyzed. Correlation analysis (p < .05) was conducted to assess the relationship between causes of forestry and logging workforce fatalities by cause of fatality in the United States. Injury and fatality rates were calculated for each year (fatalities: 2003-2018; injuries: 2005-2019) and time span-specific incidence rates were calculated by cause. RESULTS: Contact with objects and equipment was the primary cause of injuries and fatalities in the forestry and logging workforce during the study period. Transportation-related incidents ranked second as the cause of fatalities, while the category of falls, slips, and trips was the second leading cause of injuries. CONCLUSION: Gaps in occupational health and safety identified by this study should be collaboratively addressed by researchers and the forestry industry.

Occupational health outcomes for workers in the agriculture, forestry and fishing sector: implications for immigrant workers in the southeastern US.

BACKGROUND: Workers in the Agriculture, Forestry, and Fisheries (AgFF) sector experience exposures directly related to the work itself, as well as the physical environment in which the work occurs. Health outcomes vary from immediate to delayed, and from acute to chronic. METHODS: We reviewed existing literature on the health outcomes of work in the AgFF sector and identified areas where further research is needed to understand the impact of these exposures on immigrant Latino workers in the southeastern US. RESULTS: Outcomes related to specific body systems (e.g., musculoskeletal, respiratory) as well as particular exposure sources (e.g., pesticides, noise) were reviewed. The most extensive evidence exists for agriculture, with a particular focus on chemical exposures. Little research in the southeastern US has examined health outcomes of exposures of immigrant workers in forestry or fisheries. CONCLUSION: As the AgFF labor force includes a growing number of Latino immigrants, more research is needed to characterize a broad range of exposures and health outcomes experienced by this population, particularly in forestry and fisheries.

Descriptive review of asbestosis and silicosis hospitalization trends in North Carolina, 2002-2011.

BACKGROUND: Asbestosis and silicosis are debilitating pulmonary conditions resulting from inhalation of asbestos fibers or silica dust. PURPOSE: We provide a descriptive analysis of asbestosis and silicosis hospitalizations in North Carolina to assess trends over a 10-year period. METHODS: Events were defined as inpatient hospital discharges during the period 2002-2011 with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 501 or 502. Using statewide discharge data for 2002-2011, we calculated asbestosis and silicosis hospitalization rates in North Carolina (by demographics, hospital length of stay, cost, and payment type) and compared them with national rates. RESULTS: In North Carolina, average annual age-standardized hospitalization rates for asbestosis and silicosis were 71.2 hospitalizations per 1 million residents and 6.2 hospitalizations per 1 million residents, respectively. Rates for asbestosis and silicosis decreased significantly (less than .01 for both conditions) between 2002 and 2011, by 46% and 67%, respectively. Men had significantly higher rates than women (less than .01), more than half of hospitalizations were among persons aged 65-84 years, and Medicare was the predominant payment source. The highest silicosis rates by county were clustered in Western North Carolina; no geographic patterns were observed for asbestosis. The estimated average annual cost statewide for these hospitalizations was $10,170,417 for asbestosis and $886,143 for silicosis. LIMITATIONS: ICD-9-CM misclassification and duplicate hospitalization records may have biased the observed rates of asbestosis and silicosis. CONCLUSIONS: Decreases in hospitalization rates in North Carolina may be due to misdiagnosis, underreporting, or the declining use of asbestos in industries. Obtaining complete exposure histories at diagnosis is useful for continued public health surveillance.

RABIES IN RODENTS AND LAGOMORPHS IN THE USA, 2011-20.

Rabies is an acute progressive encephalitis caused by infection with rabies viruses, with reservoirs among bats and mesocarnivores, but all mammals are susceptible. Despite its distribution and abundance, cases of rabies are much less common in rodents and lagomorphs. Familiarity with current rabies prevalence data is important for informed decisions on human postexposure prophylaxis after rodent and lagomorph bites. This study is an update of rabies cases reported in rodents and lagomorphs in the US from 2011 to 2020. Rabies reports were collected passively from laboratory testing agencies in the US and Puerto Rico from 2011 to 2020. Descriptive analysis was conducted to determine the percent positivity of rabies cases by species. A total of 401 cases of rabies in rodents and lagomorphs were reported from 2011 to 2020. Most reported cases were in groundhogs (Marmota monax), representing >90% of cases, and the trend closely aligned with rabies in raccoons (Procyon lotor). In any given year, the percent positivity of rabies in rodents and lagomorphs was <2.5%, and the trend of percent positivity from 2011 to 2020 was stable. Groundhog and North American beaver (Castor canadensis) percent positivity was significantly higher than the rest of the rodents and lagomorphs. Most rabies cases occurred during the months of May-September. Documented cases of rabies in rodents and lagomorphs are generally rare, but with variation between species. Groundhogs and North American beavers had rabies percent positivity similar to high-risk species, such as bats and raccoons, and constituted 97% of all rodent and lagomorph positive cases. Since 1993, the trend in rabies cases in groundhogs has significantly declined. These results can be used to help inform public health officials on rodent and lagomorph prevention and control efforts, as well as rabies postexposure prophylaxis.

Consequences of respiratory exposures in the farm environment.

Depending on the type of farming practice, respiratory symptoms are common among agricultural workers. Farmers are at risk for pulmonary illnesses, including chronic bronchitis, organic dust toxic syndrome, farmer's lung diseases, allergic and nonallergic asthma, nasal irritation and polyps, and chemical pneumonitis.

Snakebite during pregnancy: a literature review.

OBJECTIVE: To review reported bites by venomous snakes in pregnant women. METHODS: This is a review of Medline/PubMed articles on venomous snakebites occurring during pregnancy reported in the English literature from 1966 to May 2009. RESULTS: Two hundred thirteen venomous snakebites were reported in pregnant women. The overall case-fatality rate in the pregnant females was approximately 4%, and the fetal loss rate was approximately 20%. CONCLUSIONS: Although rare, venomous bites and stings during pregnancy may have a significant adverse effect on the fetus as well as the mother.

Adverse encounters with alligators in the United States: an update.

OBJECTIVE: Severe injuries and fatalities can occur from an alligator attack. Encounters with alligators appear to be increasing in the United States. This review provides information from alligator attacks reported in the United States as well as infections that may occur after an alligator bite. METHODS: Telephone interviews were conducted with state wildlife offices in all Southern states in order to collect information on the number of alligator bites, nuisance calls, and the estimated alligator population of each state. Detailed information from alligator attacks in Florida is presented, including basic demographic information on the victims and description of the types of injuries and the activity of the victim at the time of injury. Additional information regarding the size and behavior of the alligator involved in the attack is also provided in many cases. RESULTS: There have been 567 reports of adverse encounters with alligators with 24 deaths reported in the United States from 1928 to January 1, 2009. In addition, thousands of nuisance calls are made yearly and the number of nuisance calls as well as the alligator population is increasing in many states. CONCLUSIONS: Injuries from encounters with alligators may range from minor scratches and punctures to amputations and death. The larger the alligator, the more likely that serious injury will occur. As the human population encroaches on the habitat of the alligator, attacks and nuisance complaints will continue to occur. A uniform reporting system among states should be developed to obtain more complete information on alligator encounters. Guidelines have been developed by many state wildlife officials to reduce adverse encounters with alligators.

Animal-Encounter Fatalities, United States, 1999-2016: Cause of Death and Misreporting.

OBJECTIVES: Errors and misreporting on death certificates are common, along with potential inaccuracies in cause-of-death coding. We characterized and compared fatalities by animal-encounter mentions reported as underlying cause of death (UCD) with animal-encounter mentions reported as multiple cause of death (MCD) to determine factors associated with misreporting UCD. METHODS: We analyzed fatality data from 1999-2016 from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research by UCD and MCD animal-encounter mentions (International Classification of Diseases, 10th Revision codes W53-59, X20-27 and X29, T63.0-63.6, T63.8-63.9, and T78.2-78.4). We examined differences in reporting by age, sex, race, autopsy (yes, no, unknown), allergic reactions, and toxicities. RESULTS: The number of animal-encounter mentions by UCD was 3638 (202 average per year) and by MCD was 4280 (238 average per year), a difference of 18% (n = 642; 36 average per year) by MCD analysis. The number of nonvenomous animal-encounter mentions increased 20% (from 2138 UCD to 2567 MCD), and the number of venomous animal-encounter mentions increased 14% (from 1500 UCD to 1713 MCD). Decedents aged ≥65 had the highest additional number of animal-encounter mentions among all age groups, primarily encounters with other reptiles (n = 113), other mammals (n = 71), and dogs (n = 42). Of 642 MCD additional animal-encounter mentions, heart disease (n = 211, 33%) and infections (n = 146, 23%) represented more than half of the UCD. Of 553 dog-encounter fatalities, 165 (30%) were among children aged ≤4. CONCLUSIONS: Animal-encounter fatalities, analyzed by UCD alone, may be underreported. An initiating animal injury, complicated by comorbidities and fatality, may obscure the causal chain, resulting in misreporting UCD. Ongoing training for medical certifiers is recommended, highlighting accurate identification of UCD and contributing causes in the causal chain of death.

Occupational Hazards and Health and Safety Risks for Latino Tree Trimmers in the Pine Forest Industry.

A pilot project was conducted to evaluate the working conditions and work-related body pain among Latino immigrant tree trimmers (n = 57) in the commercial pine forest service industry. Participants were interviewed about personal and work characteristics, job-related occupational hazards, and body pain. A structured questionnaire and a body pain diagram were used as measures for evaluating associations between personal and work characteristics and body pain. The most common health complaints were physical exhaustion (80.7 percent) and headache (33.9 percent). The reported percent of work-related body pain was 54.4 percent. Statistically significant associations were identified between experiencing body pain in knees, working more than two years, and working more than six hours per day (p < .05) as a tree trimmer. Thorough clinical evaluations are needed to confirm these findings. Future research including a larger sample size and more in-depth evaluations are needed to better evaluate worker tasks, musculoskeletal risk factors, and safety climate issues among this highly vulnerable occupational group.

Prolonged respiratory illness after single overnight continuous positive airway pressure humidification: endotoxin as the suspect.

A patient developed a prolonged respiratory illness after a single overnight use of tap water to humidify air supplied by a constant positive airway pressure (CPAP) device, which she had previously used for six years without difficulty. During those years, she used only distilled water for this purpose, as instructed by her sleep specialist. Analysis of the well water supplying her home showed no microorganisms, metals or other analytes likely to have caused her illness, but endotoxin was found at concentrations well above that recommended by the U.S. Pharmacopeia, as a maximum in water which may be inhaled as an aerosol.

Risk Assessment and Recommendations for Forester Exposure to Hymenoptera.

OBJECTIVE: Ants, bees, hornets, wasps, and yellow jackets (insects in Order Hymenoptera) are potentially a serious concern to outdoor workers, as the venom from their stings can cause life-threatening allergic reactions. This study assessed the impacts of Hymenoptera stings and related worker training regimes of forestry workers across the United States (US). METHODS: A survey was distributed to nearly 2,000 outdoor workers in the forestry industry from four US regions (South, West, Northeast, and Midwest). RESULTS: Ants are a primary concern in the South, with >75% of participants reporting ant stings within the last 5 years. Bees, hornets, wasps, and yellow jackets are a concern for surveyed foresters in all US regions, with 60-70% and 75-93% of participants, respectively, having been stung by bees or hornets/wasps/yellow jackets within the last 5 years. Despite such a large number of participants experiencing stings, nearly 75% of participants were not concerned about being stung or their reaction to stings. Approximately, 70% of participants reported not having received any safety training related to Hymenoptera from their employers. CONCLUSION: No significant difference was shown in the number of foresters stung at work between safety trained and non-safety trained participants. However, it was significantly more likely for participants to carry a first aid kit if they had received Hymenoptera safety training. Consequently, more comprehensive and frequent training should be considered to help reduce risk of exposure to Hymenoptera.

North Carolina Toxic Substance Incidents Program 2010-2015: Identifying Areas for Injury Prevention Efforts.

The National Toxic Substance Incidents Program (NTSIP) is a surveillance system designed to capture acute toxic substance releases, factors contributing to the release, and any associated injuries. North Carolina has participated since 2010, when NTSIP was established. This article will present a descriptive statistical summary from 2010 to 2015 focused on releases that resulted in injuries in order to identify areas for public health prevention efforts. Of the 1690 toxic releases in North Carolina, 155 incidents resulted in injuries and 500 people were injured. Carbon monoxide injured the greatest number of people. Of the incidents that resulted in injuries, 68 occurred at private vehicles or residences (44%), injuring 124 people (25%). Over half of events where at least one responder was injured occurred at private vehicles or residences. Events occurring at private residences did not have a significant relationship between evacuations and injuries, while for industry-related events, the odds of an evacuation being ordered were 8.18 times greater (OR = 8.18, 95% CI = 5.19, 12.89) when there were injuries associated with an event. Intervention efforts should focus on preventing responder injuries while responding to private residence releases and educating the general public on how to prevent injuries by self-evacuating areas where hazardous chemicals have been released.

North Carolina State Agencies Working to Prevent Agricultural Injuries and Illnesses.

Over the past 25 years, the North Carolina Departments of Labor, Agriculture and Consumer Services, and Health and Human Services have worked with farmers, farmworkers, commodity and trade associations, universities, and cooperative extension agents to develop programs to decrease the occurrence of injuries and illnesses among agricultural workers and their families. The Bureau of Agricultural Safety and Health in the North Carolina Department of Labor helped craft the Migrant Housing Act, created the Gold Star program, and developed numerous projects promoting rural highway safety and farm safety. The Structural Pest Control & Pesticides Division in the North Carolina Department of Agriculture & Consumer Services administers programs funded by the Pesticide Environmental Trust Fund (PETF), including the Pesticide Container Recycling Program, Pesticide Disposal Assistance Program (PDAP), and Soil Fumigation Training. The Occupational and Environmental Epidemiology Branch (OEEB) in the North Carolina Department of Health and Human Services developed public health surveillance programs for pesticide incidents and carbon monoxide poisoning. These projects, programs, and policies demonstrate the work that North Carolina state agencies are doing to improve the health of agricultural workers and their families.