Prevalence of spirometry-defined airflow obstruction in never-smoking working US coal miners by pneumoconiosis status.

INTRODUCTION: This study estimated the prevalence of spirometry-defined airflow obstruction and coal workers' pneumoconiosis (CWP) among never-smoking coal miners participating in the National Institute for Occupational Safety and Health (NIOSH) Coal Workers' Health Surveillance Program (CWHSP). METHODS: Data were from working miners screened by a CWHSP mobile unit who had valid spirometry and chest radiography results. Spirometry-defined airflow obstruction was determined when the ratio of forced expiratory volume in the first second to forced vital capacity is less than the lower limit of normal. Chest radiographs were classified according to the International Labour Office system to identify pneumoconiosis, including the most severe form of pneumoconiosis, progressive massive fibrosis (PMF). RESULTS: Prevalence of airflow obstruction among never-smoking coal miners in this sample was 7.7% overall, 16.4% among miners with CWP and 32.3% among miners with PMF. Airflow obstruction was significantly associated with CWP and PMF. CONCLUSIONS: There was a higher prevalence of airflow obstruction among never-smoking coal miners with pneumoconiosis compared with those without pneumoconiosis. These findings support prior research on airflow obstruction and smoking and show pneumoconiosis might present with an obstructive pattern regardless of smoking status.

Linking Compensation and Health Surveillance Data Sets to Improve Knowledge of US Coal Miners' Health.

OBJECTIVE: Increase knowledge of US coal miners' respiratory health by linking data from the black lung benefits program (BLBP) and the coal workers' health surveillance program (CWHSP). METHODS: BLBP claims data from 2000 through 2013 was linked to CWHSP data from 1970 through 2016. RESULTS: Overall, 273,644 miners participated in CWHSP, 37,548 in BLBP, and 22,903 in both programs. Median age of miners at their time of first/only participation in CWHSP was 28 and 32 years, respectively. BLBP claimants were older (median age 59). Thirty-nine percent of BLBP claimants had not participated in CWHSP. The relative contributions of states to participation differed between CWHSP and BLBP. For example, Kentucky miners accounted for 18% of CWHSP participants, but 36% of BLPB participants. CONCLUSIONS: Many BLBP claimants never appeared in CWHSP, indicating missed opportunities for secondary prevention.

Ebola virus disease contact tracing activities, lessons learned and best practices during the Duport Road outbreak in Monrovia, Liberia, November 2015.

BACKGROUND: Contact tracing is one of the key response activities necessary for halting Ebola Virus Disease (EVD) transmission. Key elements of contact tracing include identification of persons who have been in contact with confirmed EVD cases and careful monitoring for EVD symptoms, but the details of implementation likely influence their effectiveness. In November 2015, several months after a major Ebola outbreak was controlled in Liberia, three members of a family were confirmed positive for EVD in the Duport Road area of Monrovia. The cluster provided an opportunity to implement and evaluate modified approaches to contact tracing. METHODS: The approaches employed for improved contact tracing included classification and risk-based management of identified contacts (including facility based isolation of some high risk contacts, provision of support to persons being monitored, and school-based surveillance for some persons with potential exposure but not listed as contacts), use of phone records to help locate missing contacts, and modifications to data management tools. We recorded details about the implementation of these approaches, report the overall outcomes of the contact tracing efforts and the challenges encountered, and provide recommendations for management of future outbreaks. RESULTS: 165 contacts were identified (with over 150 identified within 48 hours of confirmation of the EVD cases) and all initially missing contacts were located. Contacts were closely monitored and promptly tested if symptomatic; no contacts developed disease. Encountered challenges related to knowledge gaps among contact tracing staff, data management, and coordination of contact tracing activities with efforts to offer Ebola vaccine. CONCLUSIONS: The Duport Road EVD cluster was promptly controlled. Missing contacts were effectively identified, and identified contacts were effectively monitored and rapidly tested. There is a persistent risk of EVD reemergence in Liberia; the experience controlling each cluster can help inform future Ebola control efforts in Liberia and elsewhere.

Respiratory morbidity among U.S. coal miners in states outside of central Appalachia.

BACKGROUND: Recent NIOSH publications have focused on the respiratory health of coal miners in central Appalachia, yet 57% of U.S. coal miners work in other regions. We characterized respiratory morbidity in coal miners from these regions. METHODS: Active coal miners working outside of central Appalachia who received chest radiographs and/or spirometry during 2005-2015 were included. Chest radiographs were classified according to International Labour Office standards and spirometry was interpreted using the American Thoracic Society guidelines. Prevalence of coal workers' pneumoconiosis (CWP) and abnormal spirometry were compared by region. RESULTS: A total of 103 (2.1%) miners had CWP. The eastern region had the highest prevalence (3.4%), followed by the western (1.7%), and interior (0.8%) regions. A total of 524 (9.3%) miners had abnormal spirometry. CONCLUSIONS: CWP occurs in all U.S. coal mining regions. Prevalence of CWP was higher in the eastern region, but lower than levels reported in central Appalachia.

Agreement between fixed-ratio and lower limit of normal spirometry interpretation protocols decreases with age: is there a need for a new GOLD standard?

OBJECTIVES: To assess concordance between the fixed 70% ratio cutoff point with the fixed percent predicted values (Fixed-ratio) and the lower limit of normal (LLN) algorithms in interpreting spirometry results in an older population. METHODS: Spirometries were interpreted using Third National Health and Nutrition Examination Survey reference equations for 2319 workers. RESULTS: The Fixed-ratio algorithm characterized 34.5% (n = 801) results as abnormal, compared with 29.7% (n = 689) by the LLN. There were almost twice as many obstructive and mixed airways spirometries identified under the Fixed-ratio compared to LLN. Rates of restrictive pattern physiology were virtually the same under each algorithm. Overall agreement between the algorithms decreased with age from "almost perfect" for those younger than 60 years to "substantial" for those older than 80 years. CONCLUSIONS: This study found age-related discordance between two algorithms possibly related to the lack of reference equations and standards for individuals older than 80 years.