Demystifying and Demonstrating the Value of a One Health Approach to Parasitological Challenges.

The One Health approach recognizes the interconnectedness of human, animal, and ecosystem health and encourages collaboration between diverse disciplines to address complex health problems. In this paper, 3 academics, with diverse training, experience and backgrounds who each work on different pathogenic parasites, will share their stories of tackling parasitic challenges by applying a One Health approach. The pathogenic parasites to be discussed include the helminth Taenia solium and protozoans Giardia, Theileria, Babesia, Neospora and Toxoplasma species. The 3 narratives focus on research and clinical case-based challenges and illustrate where collaboration between human, animal, and environmental health scientists either has or could lead to improved control of human and animal health as well as important research discoveries. The need for better evaluation of interventions and scientific evidence to support changes in clinical practice and encourage enhanced collaboration between human and veterinary clinicians, as well as new governmental policies to improve public and wildlife health, are described. The need for a range of evidence-based metrics to monitor the success and impact of the One Health approach to veterinary parasitology is also discussed.

Occupational Injuries of Aquaculture Workers: Washington State.

OBJECTIVE: To characterize occupational injuries of aquaculture workers in Washington State. METHODS: We reviewed accepted Washington State workers' compensation claims from January 1, 2006 to December 31, 2014. Trends in employment, worker demographics (including age, sex, and body mass index), claim rate, and injury characteristics were summarized for accepted claims in the Washington State risk classes that include aquaculture workers. RESULTS: During the nine-year study period, there were 1,180 accepted claims, 836 (65.1%) were medical-aid only and 344 (26.8%) were compensable. Most commonly reported injury types included being struck by/against an object (n = 420) and work-related musculoskeletal disorders (n = 310). Over the study period, there was no statistically significant change in claim rates in aquaculture (p = 0.77), though they were elevated compared to claim rates for all WA industries combined. A significant upward trend (p = 0.003) in aquaculture employment was observed during our study period. CONCLUSIONS: Given the growth in aquaculture production, and that aquaculture workers in Washington are experiencing higher occupational injury rates compared to other workers in the state, our study suggests that the industry should devote greater attention to prevention of work-related injuries, especially those resulting in being struck by/against objects or work-related musculoskeletal disorders. Enhanced occupational safety and health programs for this industry could help reduce injuries, as well as the cost of workers' compensation claims.

Assessing Hearing Conservation Program Effectiveness: Results of a Multisite Assessment.

OBJECTIVES: Noise-induced hearing loss (NIHL) remains one of the most prevalent occupational diseases. Occupational hearing conservation programs (HCPs) can reduce the risk of NIHL, but there remains no consensus on assessing HCP effectiveness. We conducted a multisite, mixed-method assessment of HCP programs. METHODS: At 13 manufacturing plants, we performed assessments, including interviews with program staff and worker focus groups and surveys. We analyzed the association between these assessments and age-corrected NIHL rates. RESULTS: Only a few items from the HCP staff interviews correlated with NIHL rates. For the employee survey, management commitment to NIHL prevention and being counseled about NIHL were strongly associated with NIHL rates. CONCLUSION: Management commitment and counseling of workers about NIHL may be key factors in program effectiveness. A combination of qualitative and quantitative methods appears to be useful for assessing HCPs.

Costs and effectiveness of hearing conservation programs at 14 US metal manufacturing facilities.

OBJECTIVE: This study characterised overall and specific costs associated with hearing conservation programmes (HCPs) at US metal manufacturing sites, and examined the association between these costs and several noise-induced hearing loss (NIHL) outcomes. DESIGN: We interviewed personnel and reviewed records at participating facilities. We also measured noise for comparison to the ten-year average of measurements made by each facility. NIHL outcomes assessed included rates of standard threshold shifts (STS) and high-frequency hearing loss, as well as prevalence of hearing impairment, for each participating facility. We used linear regression to identify per-person HCP costs that best predicted the NIHL outcomes. STUDY SAMPLE: We evaluated 14 US metal manufacturing facilities operated by a single company. RESULTS: Annual HCP costs ranged from roughly $67,000 to $397,000 (average $308 ± 80 per worker). Our full-shift noise measurements (mean 83.1 dBA) showed good agreement with the facilities' measurements (mean 82.6 dBA). Hearing impairment prevalence was about 15% overall. Higher expenditures for training and hearing protector fit-testing were significantly associated with reduced STS prevalence. Higher training expenditures were also related to lower hearing impairment prevalence and high-frequency hearing loss rates. CONCLUSIONS: HCP costs were substantial and variable. Increased workplace spending on training and fit-testing may help minimise NIHL.

Modeling risk of occupational zoonotic influenza infection in swine workers.

Zoonotic transmission of influenza A virus (IAV) between swine and workers in swine production facilities may play a role in the emergence of novel influenza strains with pandemic potential. Guidelines to prevent transmission of influenza to swine workers have been developed but there is a need for evidence-based decision-making about protective measures such as respiratory protection. A mathematical model was applied to estimate the risk of occupational IAV exposure to swine workers by contact and airborne transmission, and to evaluate the use of respirators to reduce transmission. The Markov model was used to simulate the transport and exposure of workers to IAV in a swine facility. A dose-response function was used to estimate the risk of infection. This approach is similar to methods previously used to estimate the risk of infection in human health care settings. This study uses concentration of virus in air from field measurements collected during outbreaks of influenza in commercial swine facilities, and analyzed by polymerase chain reaction. It was found that spending 25 min working in a barn during an influenza outbreak in a swine herd could be sufficient to cause zoonotic infection in a worker. However, this risk estimate was sensitive to estimates of viral infectivity to humans. Wearing an excellent fitting N95 respirator reduced this risk, but with high aerosol levels the predicted risk of infection remained high under certain assumptions. The results of this analysis indicate that under the conditions studied, swine workers are at risk of zoonotic influenza infection. The use of an N95 respirator could reduce such risk. These findings have implications for risk assessment and preventive programs targeting swine workers. The exact level of risk remains uncertain, since our model may have overestimated the viability or infectivity of IAV. Additionally, the potential for partial immunity in swine workers associated with repeated low-dose exposures or from previous infection with other influenza strains was not considered. Further studies should explore these uncertainties.

Work-related injuries to animal care workers, Washington 2007-2011.

BACKGROUND: For workers engaged in animal care, workplace hazards are common and may outnumber those experienced by human healthcare workers. METHODS: We used accepted Washington State workers' compensation claims for the period from January 1, 2007 and December 31, 2011 to compare injury rates and types of injuries across animal care occupations. RESULTS: Work-related injuries frequently affect veterinary support staff and those working in pet stores, shelters, grooming facilities and kennels. Animal-related injuries were the most commonly reported injury type experienced by all groups, though the animal source of injury appears to differ by work setting. CONCLUSIONS: Workplace related injuries among animal care workers are common and most often caused by physical insults resulting from worker-animal interaction.

Phylogeography of influenza A H5N1 clade 2.2.1.1 in Egypt.

BACKGROUND: Influenza A H5N1 has killed millions of birds and raises serious public health concern because of its potential to spread to humans and cause a global pandemic. While the early focus was in Asia, recent evidence suggests that Egypt is a new epicenter for the disease. This includes characterization of a variant clade 2.2.1.1, which has been found almost exclusively in Egypt.We analyzed 226 HA and 92 NA sequences with an emphasis on the H5N1 2.2.1.1 strains in Egypt using a Bayesian discrete phylogeography approach. This allowed modeling of virus dispersion between Egyptian governorates including the most likely origin. RESULTS: Phylogeography models of hemagglutinin (HA) and neuraminidase (NA) suggest Ash Sharqiyah as the origin of virus spread, however the support is weak based on Kullback-Leibler values of 0.09 for HA and 0.01 for NA. Association Index (AI) values and Parsimony Scores (PS) were significant (p-value < 0.05), indicating that dispersion of H5N1 in Egypt was geographically structured. In addition, the Ash Sharqiyah to Al Gharbiyah and Al Fayyum to Al Qalyubiyah routes had the strongest statistical support. CONCLUSION: We found that the majority of routes with strong statistical support were in the heavily populated Delta region. In particular, the Al Qalyubiyah governorate appears to represent a popular location for virus transition as it represented a large portion of branches in both trees. However, there remains uncertainty about virus dispersion to and from this location and thus more research needs to be conducted in order to examine this.Phylogeography can highlight the drivers of H5N1 emergence and spread. This knowledge can be used to target public health efforts to reduce morbidity and mortality. For Egypt, future work should focus on using data about vaccination and live bird markets in phylogeography models to study their impact on H5N1 diffusion within the country.

Use of medical insurance claims data for occupational health research.

OBJECTIVE: The objective of this study was to demonstrate that health claims data, widely available due to the unique nature of the U.S. healthcare system, can be linked to other relevant databases such as personnel files and exposure data maintained by large employers. These data offer great potential for occupational health research. METHODS: In this article, we describe the process for linking claims data to industrial hygiene exposure data and personnel files of a single large employer to conduct epidemiologic research. RESULTS: Our results demonstrate the ability to replicate previously published findings using commonly maintained data sets and illustrate methodological issues that may arise as newer hypotheses are tested in this way. CONCLUSIONS: Health claims files offer potential for epidemiologic research in the United States, although the full extent and guidelines for successful application await further clarification through empiric research.