Acute Occupational Pesticide-Related Illness and Injury -United States, 2007-2011.

CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on acute pesticide-related illness and injury reported by 12 states (California, Florida, Iowa, Louisiana, Michigan, Nebraska, North Carolina, New Mexico, New York, Oregon, Texas, and Washington). This report summarizes the data on illnesses and injuries arising from occupational exposure to conventional pesticides from 2007 through 2011. This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016 (1). The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases (2). In a separate report, data on illnesses and injuries from nonoccupational exposure to pesticides during 2007-2011 are summarized (3).

Notes from the field: Exposures to discarded sulfur mustard munitions - Mid-Atlantic and New England States 2004-2012.

Before the 1970s, the United States sometimes disposed of at sea excess, obsolete, or unserviceable munitions, including chemical munitions. Chemical munitions known to have been disposed of at sea included munitions filled with sulfur mustard, a vesicant (i.e., an agent that causes chemical burns or blisters of the skin and mucous membranes). Signs and symptoms of exposure to a mustard agent can include redness and blistering of the skin, eye irritation, rhinorrhea, hoarseness, shortness of breath, and (rarely) diarrhea and abdominal discomfort. Since 2004, CDC has received notification of three separate incidents of exposure to sulfur mustard munitions. In one incident, a munition was found with ocean-dredged marine shells used to pave a driveway. The other two incidents involved commercial clam fishing operations. This report highlights the importance of considering exposure to sulfur mustard in the differential diagnosis of signs and symptoms compatible with exposure to a vesicant agent, especially among persons involved with clam fishing or sea dredging operations.

Chemical and traumatic occupational eye exposures in aviation personnel.

INTRODUCTION: The eye is vulnerable to chemical exposure and foreign body infiltration in the occupational setting. Individuals working in the aviation field are prone to these types of exposures. METHODS: We conducted a 28-mo retrospective chart review to document the number of airline workers complaining of chemical or foreign body exposure to the eye at an onsite airport medical clinic. The International Classification of Diseases, Ninth Revision (ICD-9), code for chemical conjunctivitis (372.5), was used to identify patients' charts. We documented the type of treatment that was initiated and whether there was eye damage. We further investigated the chemical composition of the products and whether there was any associated toxicity. RESULTS: Few instances of chemical exposure and foreign body infiltration were found. Patients were exposed to the following products: lubricants (e.g., naphthenic oils), hydraulic fluid (e.g., petroleum or phosphate ester based), jet fuel (e.g., kerosene), and de-icing agents (e.g., propylene glycol). There was no documentation regarding the use of personal protection equipment in the patients' charts. All patients received eye irrigation with normal saline. No sequelae were documented. CONCLUSION: Airline personnel are exposed to a variety of chemical agents in the workplace. None of the agents that workers were exposed to in this small study exhibited toxic effects to the eye. Proper use of personal protection equipment in aviation personnel may limit the number of chemical and foreign body eye exposures.

National Toxic Substances Incidents Program - Nine States, 2010-2014.

PROBLEM/CONDITION: Every year in the United States, thousands of toxic substance incidents harm workers, first responders, and the public with the potential for catastrophic consequences. Surveillance data enable public health and safety professionals to understand the patterns and causes of these incidents, which can improve prevention efforts and preparation for future incidents. PERIOD COVERED: 2010-2014. DESCRIPTION OF SYSTEM: In 2010, the Agency for Toxic Substances and Disease Registry (ATSDR) initiated the National Toxic Substance Incidents Program (NTSIP), and it was retired in 2014. Nine state health departments participated in NTSIP surveillance: California, Louisiana, North Carolina, New York, Missouri, Oregon, Tennessee, Utah, and Wisconsin. The states conducted surveillance on acute toxic substance incidents, defined as an uncontrolled or illegal acute (lasting <72 hours) release of any toxic substance including chemical, biologic, radiologic, and medical materials. Surveillance focused on associated morbidity and mortality and public health actions. This report presents an overview of NTSIP and summarizes incidents and injuries from the nine participating states during 2010-2014. RESULTS: During 2010-2014, participating state health departments reported 22,342 incidents, of which 13,529 (60.6%) met the case definition for acute toxic substance incidents, and included 6,635 injuries among 5,134 injured persons, of whom 190 died. A trend analysis of the three states participating the entire time showed a decrease in the number of incidents with injuries. NTSIP incidents were 1.8 times more likely and injured persons were 10 times more likely to be associated with fixed facilities than transportation. Natural gas, carbon monoxide, ammonia, and chemicals used in illegal methamphetamine production were the most frequent substances in fixed-facility incidents. Sodium and potassium hydroxide, hydrochloric acid, natural gas, and sulfuric acid were the most frequent substances in transportation-related incidents. Carbon monoxide was the most frequent substance in incidents with a large number of injured persons, and chemicals used in illegal methamphetamine production were the most frequent substance in incidents involving decontamination. Incidents most frequently occurred during normal business days (Monday through Friday) and hours (6:00 a.m.-5:59 p.m.) and warmer months (March-August). The transportation and warehousing industry sector had the largest number of incidents (4,476); however, most injured persons were injured in their private residences (1,141) or in the industry sectors of manufacturing (668), educational services (606), and real estate rental and leasing (425). The most frequently injured persons were members of the public (43.6%), including students. Injured first responders, particularly police, frequently were not wearing any chemically protective equipment. Respiratory system problems (23.9%) were the most frequently reported symptoms among injured persons and, in a related finding, volatilization was the most frequent type of release in incidents with injured persons. INTERPRETATION: Industrial and transportation incidents occur frequently and have the potential for catastrophic outcomes. However, exposures to toxic substances occur frequently in other settings. Carbon monoxide, natural gas, and chemicals used in illegal methamphetamine production are commonly found in places where persons live, work, attend school, and recreate and are large contributors to incidents affecting the public. Having active NTSIP state surveillance programs did appear to improve the incidents with morbidity and/or mortality, but these programs have ended. PUBLIC HEALTH ACTION: Archived NTSIP public use data are available to download from the website for analysis. There are also many publications and reports on the website to help understand chemical risks. In addition, jurisdictions might choose to collect surveillance data themselves in a similar manner to what NTSIP states did. Chemical incident surveillance data can be used by public health and safety practitioners, worker representatives, emergency planners, preparedness coordinators, industries, and emergency responders to prepare for and prevent chemical incidents and injuries. As noted by the U.S. Chemical Safety Board, more action needs to be taken to prevent large industrial incidents. Although preventing such incidents might not be in the realm of public health, describing the public health implications and preparing for them is. Another important finding of NTSIP is that industrial incidents are only part of the problem. For example, a large number of persons were injured in a private residence or vehicle (22.2%) and an educational facility (11.8%). Public health professionals must resourcefully target prevention and preparedness to protect vulnerable populations in locations where they might spend time (e.g., schools, daycares, nursing homes, recreational areas, jails, prisons, and hospitals). Reducing the threat of chemical incidents and injuries in the United States will require a concerted effort with a variety of stakeholders including industry and labor, responder groups, policymakers, academia, and citizen advocacy groups.

Shoulder Injury Related to Vaccine Administration (SIRVA): An Occupational Case Report.

Transient shoulder pain is a common complaint following intramuscular vaccine administration into the deltoid. More severe vaccination-associated shoulder complications comprising of weakness and decreased range of motion are categorized under the construct "shoulder injury related to vaccine administration" (SIRVA) that subsumes both subjective and objective findings consistent with injury. We describe the presentation and management of a case of SIRVA in a health care worker following seasonal influenza vaccine administration as part of a hospital-based employee health program and review the relevant biomedical literature. We present a case from a single medical center. All data were collected by professionals in occupational health by interviewing, performing physical examinations, and reviewing medical records associated with the injured worker. Severe pain and limited range of shoulder motion developed following an influenza vaccination that was administered using a poorly positioned, larger than recommended needle. Magnetic resonance imaging (MRI) demonstrated moderate glenohumeral joint effusion and synovitis, with fluid accumulating in the subscapularis recess within 1 week of injury. At 8 months after initial injury, MRI showed persistent mild tenosynovitis of the long head of the biceps tendon, interval accumulation of a large glenohumeral joint effusion, and infraspinatus tendinitis with subjacent reactive bone marrow edema. The affected worker experienced work restrictions but had no complete lost workdays to date due to the injury. Occupationally related SIRVA is a preventable adverse event that should be considered in workplace vaccine administration programs, and appropriate education and training provided to vaccine administrators to address this.

Noise and neurotoxic chemical exposure relationship to workplace traumatic injuries: A review.

INTRODUCTION: More than 5,000 fatalities and eight million injuries occurred in the workplace in 2007 at a cost of $6 billion and $186 billion, respectively. Neurotoxic chemicals are known to affect central nervous system functions among workers, which include balance and hearing disorders. However, it is not known if there is an association between exposure to noise and solvents and acute injuries. METHOD: A thorough review was conducted of the literature on the relationship between noise or solvent exposures and hearing loss with various health outcomes. RESULTS: The search resulted in 41 studies. Health outcomes included: hearing loss, workplace injuries, absence from work due to sickness, fatalities, hospital admissions due to workplace accidents, traffic accidents, hypertension, balance, slip, trips, or falls, cognitive measures, or disability retirement. Important covariates in these studies were age of employee, type of industry or occupation, or length of employment. DISCUSSION: Most authors that evaluated noise exposure concluded that higher exposure to noise resulted in more of the chosen health effect but the relationship is not well understood. Studies that evaluated hearing loss found that hearing loss was related to occupational injury, disability retirement, or traffic accidents. Studies that assessed both noise exposure and hearing loss as risk factors for occupational injuries reported that hearing loss was related to occupational injuries as much or more than noise exposure. Evidence suggests that solvent exposure is likely to be related to accidents or other health consequences such balance disorders. CONCLUSIONS: Many authors reported that noise exposures and hearing loss, respectively, are likely to be related to occupational accidents. Practical applications: The potential significance of the study is that findings could be used by managers to reduce injuries and the costs associated with those injures.

Top five industries resulting in injuries from acute chemical incidents­Hazardous Substance Emergency Events Surveillance, nine states, 1999-2008.

PROBLEM/CONDITION: Because industries using and/or producing chemicals are located in close proximity to populated areas, U.S. residents are at risk for unintentional chemical exposures. REPORTING PERIOD: 1999-2008. DESCRIPTION OF SYSTEM: The Hazardous Substances Emergency Events Surveillance (HSEES) system was operated by the Agency for Toxic Substances and Disease Registry during January 1991-September 2009 to collect data that would enable researchers to describe the public health consequences of chemical releases and to develop activities aimed at reducing the harm from such releases. This report summarizes data for the top five industries resulting in injuries from an acute chemical incident (lasting <72 hours) occurring in the nine states (Colorado, Iowa, Minnesota, New York, North Carolina, Oregon, Texas, Washington, and Wisconsin) that participated in HSEES during its last 10 full years of data collection (1999-2008). RESULTS: Five industries (truck transportation, educational services, chemical manufacturing, utilities, and food manufacturing) accounted for approximately one third of all incidents in which persons were injured as a result of unintentional release of chemicals; the same five industries were responsible for approximately one third of all persons injured as a result of such releases. INTERPRETATION: Acute chemical incidents in these five industries resulted in serious public health implications including the need for evacuations, morbidity, and mortality. PUBLIC HEALTH IMPLICATIONS: Targeting chemical incident prevention and preparedness activities towards these five industries provides an efficient use of resources for reducing chemical exposures. A variety of methods can be used to minimize chemical releases in industries. One example is the Occupational Safety and Health Administration's hierarchy of controls model, which focuses on controlling exposures to occupational hazards. The hierarchy includes elimination, substitution, engineering controls, administrative controls, and use of personal protective equipment.

Clinical arterial infusion of calcium gluconate: the preferred method for treating hydrofluoric acid burns of distal human limbs.

OBJECTIVE: This study was designed to evaluate the efficiency and safety of arterial infusions of calcium gluconate to treat hydrofluoric (HF) acid burns of the distal human limbs. MATERIALS AND METHODS: Eligible patients with HF burn limbs, collected from January 2008 to October 2011, were given the arterial infusion of calcium gluconate into the injured limbs. The measures of pain were conducted before the infusion, immediately after the infusion, 4 h after the infusion, and 2 days after the infusion by the visual analogy score (VAS). If the VAS score was higher than 4.0 at the time point 4 h after the first infusion, the infusion was repeated. The time of wound healing, and the number and ratio of the cases receiving the surgical operation were also evaluated. RESULTS: A total of 118 patients, male (107 cases) and female (11 cases), were collected, including 64 cases of outpatients and 54 cases of inpatients. The age of the subjects ranged from 16 to 60 years, with the mean age of 37.6. The burn sites were located in the lateral limbs (28 cases) and in the unilateral limbs (90 cases). For 107 cases, the pain scores decreased quickly after the first infusion. The other 11 cases, with the VAS score higher than 4.0 at the time point 4 h after the first infusion, received the second infusion. The average time of wound healing and the ratio of the cases receiving the surgical operation were closely related to the interval from the injury to the reception of infusion. CONCLUSIONS: Arterial infusion of calcium gluconate, effectively relieving the pain, blocking wound progressive deepening, and causing no adverse effects, could be the preferential method to treat hydrofluoric acid burns of the distal human limbs.