Excess risk of SARS-CoV-2 infection among in-person nonhealthcare workers in six states, September 2020-June 2021.

BACKGROUND: While the occupational risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for healthcare personnel in the United States has been relatively well characterized, less information is available on the occupational risk for workers employed in other settings. Even fewer studies have attempted to compare risks across occupations and industries. Using differential proportionate distribution as an approximation, we evaluated excess risk of SARS-CoV-2 infection by occupation and industry among non-healthcare workers in six states. METHODS: We analyzed data on occupation and industry of employment from a six-state callback survey of adult non-healthcare workers with confirmed SARS-CoV-2 infection and population-based reference data on employment patterns, adjusted for the effect of telework, from the U.S. Bureau of Labor Statistics. We estimated the differential proportionate distribution of SARS-CoV-2 infection by occupation and industry using the proportionate morbidity ratio (PMR). RESULTS: Among a sample of 1111 workers with confirmed SARS-CoV-2 infection, significantly higher-than-expected proportions of workers were employed in service occupations (PMR 1.3, 99% confidence interval [CI] 1.1-1.5) and in the transportation and utilities (PMR 1.4, 99% CI 1.1-1.8) and leisure and hospitality industries (PMR 1.5, 99% CI 1.2-1.9). CONCLUSIONS: We found evidence of significant differences in the proportionate distribution of SARS-CoV-2 infection by occupation and industry among respondents in a multistate, population-based survey, highlighting the excess risk of SARS-CoV-2 infection borne by some worker populations, particularly those whose jobs require frequent or prolonged close contact with other people.

COVID-19 Outbreaks Linked to Workplaces, 23 US Jurisdictions, August-October 2021.

OBJECTIVES: Early in the COVID-19 pandemic, several outbreaks were linked with facilities employing essential workers, such as long-term care facilities and meat and poultry processing facilities. However, timely national data on which workplace settings were experiencing COVID-19 outbreaks were unavailable through routine surveillance systems. We estimated the number of US workplace outbreaks of COVID-19 and identified the types of workplace settings in which they occurred during August-October 2021. METHODS: The Centers for Disease Control and Prevention collected data from health departments on workplace COVID-19 outbreaks from August through October 2021: the number of workplace outbreaks, by workplace setting, and the total number of cases among workers linked to these outbreaks. Health departments also reported the number of workplaces they assisted for outbreak response, COVID-19 testing, vaccine distribution, or consultation on mitigation strategies. RESULTS: Twenty-three health departments reported a total of 12 660 workplace COVID-19 outbreaks. Among the 12 470 workplace types that were documented, 35.9% (n = 4474) of outbreaks occurred in health care settings, 33.4% (n = 4170) in educational settings, and 30.7% (n = 3826) in other work settings, including non-food manufacturing, correctional facilities, social services, retail trade, and food and beverage stores. Eleven health departments that reported 3859 workplace outbreaks provided information about workplace assistance: 3090 (80.1%) instances of assistance involved consultation on COVID-19 mitigation strategies, 1912 (49.5%) involved outbreak response, 436 (11.3%) involved COVID-19 testing, and 185 (4.8%) involved COVID-19 vaccine distribution. CONCLUSIONS: These findings underscore the continued impact of COVID-19 among workers, the potential for work-related transmission, and the need to apply layered prevention strategies recommended by public health officials.

Characteristics Associated With a Previous COVID-19 Diagnosis, Vaccine Uptake, and Intention to Be Vaccinated Among Essential Workers in the US Household Pulse Survey.

Objectives. To explore previous COVID-19 diagnosis and COVID-19 vaccination status among US essential worker groups. Methods. We analyzed the US Census Household Pulse Survey (May 26-July 5, 2021), a nationally representative sample of adults aged 18 years and older. We compared currently employed essential workers working outside the home with those working at home using adjusted prevalence ratios. We calculated proportion vaccinated and intention to be vaccinated, stratifying by essential worker and demographic groups for those who worked or volunteered outside the home since January 1, 2021. Results. The proportion of workers with previous COVID-19 diagnosis was highest among first responders (24.9%) working outside the home compared with workers who did not (13.3%). Workers in agriculture, forestry, fishing, and hunting had the lowest vaccination rates (67.5%) compared with all workers (77.8%). Those without health insurance were much less likely to be vaccinated across all worker groups. Conclusions. This study underscores the importance of improving surveillance to monitor COVID-19 and other infectious diseases among workers and identify and implement tailored risk mitigation strategies, including vaccination campaigns, for workplaces. (Am J Public Health. 2022;112(11):1599-1610. https://doi.org/10.2105/AJPH.2022.307010).

Reported Exposures Among In-Person Workers With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in 6 States, September 2020-June 2021.

BACKGROUND: Surveillance systems lack detailed occupational exposure information from workers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The National Institute for Occupational Safety and Health partnered with 6 states to collect information from adults diagnosed with SARS-CoV-2 infection who worked in person (outside the home) in non-healthcare settings during the 2 weeks prior to illness onset. METHODS: The survey captured demographic, medical, and occupational characteristics and work- and non-work-related risk factors for SARS-CoV-2 infection. Reported close contact with a person known or suspected to have SARS-CoV-2 infection was categorized by setting as exposure at work, exposure outside of work only, or no known exposure/did not know. Frequencies and percentages of exposure types are compared by respondent characteristics and risk factors. RESULTS: Of 1111 respondents, 19.4% reported exposure at work, 23.4% reported exposure outside of work only, and 57.2% reported no known exposure/did not know. Workers in protective service occupations (48.8%) and public administration industries (35.6%) reported exposure at work most often. More than one third (33.7%) of respondents who experienced close contact with ≥10 coworkers per day and 28.8% of respondents who experienced close contact with ≥10 customers/clients per day reported exposures at work. CONCLUSIONS: Exposure to occupational SARS-CoV-2 was common among respondents. Examining differences in exposures among different worker groups can help identify populations with the greatest need for prevention interventions. The benefits of recording employment characteristics as standard demographic information will remain relevant as new and reemerging public health issues occur.

Reported exposure trends among healthcare personnel COVID-19 cases, USA, March 2020-March 2021.

BACKGROUND: Health care personnel (HCP) have experienced significant SARS-CoV-2 risk, but exposure settings among HCP COVID-19 cases are poorly characterized. METHODS: We assessed exposure settings among HCP COVID-19 cases in the United States from March 2020 to March 2021 with reported exposures (n = 83,775) using national COVID-19 surveillance data. Exposure setting and reported community incidence temporal trends were described using breakpoint estimation. Among cases identified before initiation of COVID-19 vaccination programs (n = 65,650), we used separate multivariable regression models to estimate adjusted prevalence ratios (aPR) for associations of community incidence with health care and household and/or community exposures. RESULTS: Health care exposures were the most reported (52.0%), followed by household (30.8%) and community exposures (25.6%). Health care exposures and community COVID-19 incidence showed similar temporal trends. In adjusted analyses, HCP cases were more likely to report health care exposures (aPR = 1.31; 95% CI:1.26-1.36) and less likely to report household and/or community exposures (aPR = 0.73; 95% CI:0.70-0.76) under the highest vs lowest community incidence levels. DISCUSSION: These findings highlight HCP exposure setting temporal trends and workplace exposure hazards under high community incidence. Findings also underscore the need for robust collection of work-related data in infectious disease surveillance. CONCLUSIONS: Many reported HCP cases experienced occupational COVID-19 exposures, particularly during periods of higher community COVID-19 incidence.

Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006-2015.

Workers in specific settings and activities are at increased risk for certain infectious diseases. When an infectious disease case occurs in a worker, investigators need to understand the mechanisms of disease propagation in the workplace. Few publications have explored these factors in the United States; a literature search yielded 66 investigations of infectious disease occurring in US workplaces during 2006-2015. Reported cases appear to be concentrated in specific industries and occupations, especially the healthcare industry, laboratory workers, animal workers, and public service workers. A hierarchy-of-controls approach can help determine how to implement effective preventive measures in workplaces. Consideration of occupational risk factors and control of occupational exposures will help prevent disease transmission in the workplace and protect workers' health.

Tdap Vaccination Among Healthcare Personnel-21 States, 2013.

INTRODUCTION: Outbreaks of pertussis can occur in healthcare settings. Vaccinating healthcare personnel may be helpful in protecting healthcare personnel from pertussis and potentially limiting spread to others in healthcare settings. METHODS: Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry/occupation module were analyzed in 2016. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination status was self-reported by healthcare personnel along with their occupation, healthcare setting/industry, demographics, and access to care factors. To compare groups, t-tests were used. The median state response rate was 44.0%. RESULTS: Among all healthcare personnel, 47.2% were vaccinated for Tdap. Physicians had higher Tdap coverage (66.8%) compared with all other healthcare personnel except nurse practitioners and registered nurses (59.5%), whose coverage did not statistically differ from that of physicians. Tdap vaccination coverage was higher among workers in hospitals (53.3%) than in long-term care facilities (33.3%) and other clinical settings, such as dentist, chiropractor, and optometrist offices (39.3%). Healthcare personnel who were younger, who had higher education, higher annual household income, a personal healthcare provider, and health insurance had higher Tdap vaccination coverage compared with reference groups. Tdap vaccination coverage among healthcare personnel in 21 states ranged from 30.6% in Mississippi to 65.9% in Washington. CONCLUSIONS: Improvement in Tdap vaccination among healthcare personnel is needed to potentially reduce opportunities for spread of pertussis in healthcare settings. On-site workplace vaccination, offering vaccines free of charge, and promoting vaccination may increase vaccination among healthcare personnel.

Influenza vaccination among workers-21 U.S. states, 2013.

BACKGROUND: Influenza illnesses can result in missed days at work and societal costs, but influenza vaccination can reduce the risk of disease. Knowledge of vaccination coverage by industry and occupation can help guide prevention efforts and be useful during influenza pandemic planning. METHODS: Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry-occupation module were analyzed. Influenza vaccination coverage was reported by select industry and occupation groups, including health care personnel (HCP) and other occupational groups who may have first priority to receive influenza vaccination during a pandemic (tier 1). The t tests were used to make comparisons between groups. RESULTS: Influenza vaccination coverage varied by industry and occupation, with high coverage among persons in health care industries and occupations. Approximately half of persons classified as tier 1 received influenza vaccination, and vaccination coverage among tier 1 and HCP groups varied widely by state. CONCLUSIONS: This report points to the particular industries and occupations where improvement in influenza vaccination coverage is needed. Prior to a pandemic event, more specificity on occupational codes to define exact industries and occupations in each tier group would be beneficial in implementing pandemic influenza vaccination programs and monitoring the success of these programs.

Prevalence of workers with shifts in hearing by industry: a comparison of OSHA and NIOSH Hearing Shift Criteria.

OBJECTIVE: The purpose of this study was to compare the prevalence of workers with National Institute for Occupational Safety and Health significant threshold shifts (NSTS), Occupational Safety and Health Administration standard threshold shifts (OSTS), and with OSTS with age correction (OSTS-A), by industry using North American Industry Classification System codes. METHODS: From 2001 to 2010, worker audiograms were examined. Prevalence and adjusted prevalence ratios for NSTS were estimated by industry. NSTS, OSTS, and OSTS-A prevalences were compared by industry. RESULTS: Twenty percent of workers had an NSTS, 14% had an OSTS, and 6% had an OSTS-A. For most industries, the OSTS and OSTS-A criteria identified 28% to 36% and 66% to 74% fewer workers than the NSTS criteria, respectively. CONCLUSIONS: Use of NSTS criteria allowing for earlier detection of shifts in hearing is recommended for improved prevention of occupational hearing loss.

Shift work and cancer screening: do females who work alternative shifts undergo recommended cancer screening?

BACKGROUND: Alternative shift work is classified as a probable human carcinogen. Certain cancer screening tests reduce cancer mortality. METHODS: The 2010 National Health Interview Survey was used to examine associations between adherence to breast, cervical, and colon cancer screening recommendations and alternative shift work among female workers. RESULTS: Workers on alternative shifts, compared to workers on daytime shifts, were more likely to be non-adherent to screening recommendations for breast (34% vs. 23%) and colorectal (55% vs. 48%) cancer (P < 0.05). Workers on alternative shifts in two industries ("Manufacturing" and "Accommodation/Food Services") and three occupations ("Food Preparation/Serving," "Personal Care Services," and "Production") were more likely to be non-adherent to screening recommendations for at least two cancers (P < 0.05). CONCLUSIONS: The Affordable Care Act eliminates out-of-pocket screening expenses for these three cancers. Greater efforts are needed to promote this benefit, particularly among workers with demonstrated non-adherence. Am. J. Ind. Med. 57:265-275, 2014. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Public health surveillance data: legal, policy, ethical, regulatory, and practical issues.

In the United States, data systems are created by the ongoing, systematic collection of health, demographic, and other information through federally funded national surveys, vital statistics, public and private administrative and claims data, regulatory data, and medical records data. Certain data systems are designed to support public health surveillance and have used well-defined protocols and standard analytic methods for assessing specific health outcomes, exposures, or other endpoints. However, other data systems have been designed for a different purpose but can be used by public health programs for surveillance. Several public health surveillance programs rely substantially on others' data systems. An example of data used for surveillance purposes but collected for another reason is vital statistics data. CDC's National Center for Health Statistics (NCHS) purchases, aggregates, and disseminates vital statistics (birth and death rates) that are collected at the state level. These data are used to understand disease burden, monitor trends, and guide public health action. Administrative data also can be used for surveillance purposes (e.g., Medicare and Social Security Disability data that have been linked to survey data to monitor changes in health and health-care use over time).

Influenza-associated hospitalizations by industry, 2009-10 influenza season, United States.

In response to pandemic (H1N1) 2009, data were collected on work status and industry of employment of 3,365 adults hospitalized with laboratory-confirmed influenza during the 2009-10 influenza season in the United States. The proportion of workers hospitalized for influenza was lower than their proportion in the general population, reflecting underlying protective characteristics of workers compared with nonworkers. The most commonly represented sectors were transportation and warehousing; administrative and support and waste management and remediation services; health care; and accommodation and food service.

Workplace assaults on nursing assistants in US nursing homes: a multilevel analysis.

OBJECTIVES: We examined risk factors for injuries to nursing assistants from assaults by nursing home residents at both the individual and the organizational level. METHODS: We analyzed data from the 2004 National Nursing Assistant Survey that were linked to facility information from the 2004 National Nursing Home Survey by use of multilevel modeling that accounted for the complex survey design effect. RESULTS: Thirty-four percent of nursing assistants surveyed reported experiencing physical injuries from residents' aggression in the previous year. Mandatory overtime (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.22, 2.24) and not having enough time to assist residents with their activities of daily living (OR = 1.49; 95% CI = 1.25, 1.78) were strongly associated with experiencing injuries from assaults. Nursing assistants employed in nursing homes with Alzheimer care units were more likely to experience such injuries, including being bitten by residents. CONCLUSIONS: Reducing mandatory overtime and having a less demanding workload may reduce the risk of workplace violence. In particular, prevention activities should be targeted at those nursing homes that care for cognitively impaired patients.

Pandemic influenza and farmworkers: the effects of employment, social, and economic factors.

Employment, social, and economic factors have the potential to affect the magnitude of an influenza pandemic among farmworkers. Prevention efforts targeted toward livestock farmworkers, including increased access to seasonal influenza vaccine, risk reduction training, various forms of personal protection, and workplace sanitation, are needed. Crop and livestock farmworkers are at increased risk of exposure to influenza A viruses because of limited resources, substandard housing, immigration status, communication and cultural barriers, and discrimination. Recommendations were gathered from migrant clinicians, farmworker advocates, state and federal government agencies, industry stakeholders, and researchers to overcome these barriers, including surveillance of livestock farmworkers, inclusion of farmworker service organizations in planning efforts, and separation of immigration enforcement from emergency assistance.

Enhancing occupational safety and health through use of the national skill standards.

In a voluntary national effort, U.S. industry, education, labor, and government have initiated the development of standards for job skills and competencies in jobs in 15 economic sectors. The aim of the skill standards is to maintain a globally competitive workforce. Efforts to include occupational safety and health knowledge and skills as core elements in these standards are described. The first skill standards to include occupational safety and health competencies were developed for the manufacturing sector, evaluated by 3,800 workers in 700 companies, and published. National skill standards can stimulate extensive training in occupational safety and health, with resultant application to a larger percentage of workers than ever before.