Coccidioidomycosis among Workers Constructing Solar Power Farms, California, USA, 2011-2014.

Coccidioidomycosis is associated with soil-disruptive work in Coccidioides-endemic areas of the southwestern United States. Among 3,572 workers constructing 2 solar power-generating facilities in San Luis Obispo County, California, USA, we identified 44 patients with symptom onset during October 2011-April 2014 (attack rate 1.2 cases/100 workers). Of these 44 patients, 20 resided in California outside San Luis Obispo County and 10 resided in another state; 9 were hospitalized (median 3 days), 34 missed work (median 22 days), and 2 had disseminated disease. Of the 25 patients who frequently performed soil-disruptive work, 6 reported frequent use of respiratory protection. As solar farm construction in Coccidioides-endemic areas increases, additional workers will probably be exposed and infected unless awareness is emphasized and effective exposure reduction measures implemented, including limiting dust generation and providing respiratory protection. Medical providers, including those in non-Coccidioides-endemic areas, should suspect coccidioidomycosis in workers with compatible illness and report cases to their local health department.

Fatal meningococcal disease in a laboratory worker--California, 2012.

Occupationally acquired meningococcal disease is rare. Adherence to recommendations for safe handling of Neisseria meningitidis in the laboratory greatly reduces the risk for transmission to laboratory workers. A California microbiologist developed fatal serogroup B meningococcal disease after working with N. meningitidis patient isolates in a research laboratory (laboratory A). The California Department of Public Health (CDPH), the local health department, the California Division of Occupational Safety and Health (CalOSHA), and the federal Occupational Safety and Health Administration (OSHA) collaborated on an investigation of laboratory A, which revealed several breaches in recommended laboratory practice for safe handling of N. meningitidis, including manipulating cultures on the bench top. Additionally, laboratory workers had not been offered meningococcal vaccine in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations and CalOSHA Aerosol Transmissible Diseases Standard requirements. In accordance with OSHA and CalOSHA regulations, laboratory staff members must receive laboratory biosafety training and use appropriate personal protective equipment, and those who routinely work with N. meningitidis isolates should receive meningococcal vaccine.

Longitudinal lung function declines among California flavoring manufacturing workers.

BACKGROUND: The California Department of Public Health received serial spirometry data for flavoring manufacturing workers at 20 companies at risk of bronchiolitis obliterans. METHODS: We graded spirometry quality; identified individual workers with excessive decline in forced expiratory volume in 1 s (FEV(1)) using relative longitudinal limits of decline based on 4% average within-person variability; and analyzed declines by occupational risk factors. RESULTS: The quality of 1,696 spirometry tests from 724 workers varied by 17 providers, with poorer quality from commercial providers. Of 416 workers with at least two tests, 40 (9.6%) had abnormal FEV(1) decline. Of 289 workers with high quality spirometry, 21 (7.3%) had abnormal decline. Only one of the 21 had airways obstruction. Abnormal FEV(1) decline rates (per person-month) were greater among workers at companies using ≥800 lbs/year diacetyl than at companies using lesser amounts. Abnormal FEV(1) decline rates were greater at companies previously having four-person clusters of spirometric obstruction than at companies with no or only one worker with obstruction. CONCLUSIONS: Spirometric surveillance of flavoring workers can identify individual workers with an abnormal FEV(1) decline for preventive intervention, even when the FEV(1) itself remains within the normal range. Good quality spirometry and classification of abnormal with relative longitudinal limit of decline minimize misclassification of possible work-related health effects.

Industry-wide medical surveillance of California flavor manufacturing workers: Cross-sectional results.

BACKGROUND: Two cases of bronchiolitis obliterans in flavor manufacturing workers prompted California health and labor agencies to initiate industry-wide surveillance. METHODS: Companies' physicians submitted cross-sectional questionnaire and spirometry data for 467 workers in 16 workplaces. We compared prevalence ratios of respiratory symptoms, diagnoses, and abnormal spirometry to a general population sample. We calculated odds ratios for risk factors for spirometric obstructive abnormality. RESULTS: Flavoring workers were 2.7 times more likely than the general population to have severe airways obstruction. Risk factors identified for 18 cases with obstruction from six companies included younger age, Hispanic ethnicity, liquid and powder production work, greater company diacetyl usage, and having a coworker with obstruction. Severity of obstruction was related to tenure. At least 12 workers had probable occupational fixed airways obstruction. CONCLUSIONS: The flavoring industry risk of severe lung disease justifies lowering flavoring exposures and medical screening for secondary prevention until worker safety is demonstrated.

Primary prevention of occupational asthma: identifying and controlling exposures to asthma-causing agents.

BACKGROUND: Primary prevention of occupational asthma requires timely identification and regulation of asthma-causing agents. METHODS: We examined 39 substances identified as causing allergic occupational asthma in the US to determine the basis for their identification and their regulatory status. We compared them with occupational asthmagens identified and regulated in the UK and Germany. RESULTS: US regulatory agencies have not established consistent, evidence-based methods to identify and control exposures to substances that cause occupational asthma. Occupational asthmagens are identified primarily by non-regulatory US organizations, and most are not regulated to prevent asthma. CONCLUSIONS: Implementing an evidence-based identification and regulatory process for occupational asthmagens will help to ensure primary prevention of occupational asthma in the US. This should include: establishing consistent identification criteria; publishing a list of occupational asthmagens; collecting use, exposure, and health effects information on asthma-causing substances; requiring medical surveillance and medical removal protection in addition to exposure limits; and stimulating development of safer alternatives.

Glutaraldehyde exposures among workers making bioprosthetic heart valves.

Exposure to glutaraldehyde is a recognized cause of work-related asthma. An investigation was undertaken to describe exposure to glutaraldehyde among workers making bioprosthetic heart valves and to make recommendations for prevention. At the two largest heart valve manufacturing facilities in California, the work process was observed; employer representatives and glutaraldehyde-exposed workers were interviewed; and employer written records, including company-generated industrial hygiene data, were analyzed. Approximately 600 female workers had continuous airborne exposure to glutaraldehyde over the course of every work shift and the routine potential for skin and eye contact with glutaraldehyde while making heart valves. Employee short-term (15-min) glutaraldehyde exposures were all well below the current regulatory ceiling level (0.20 ppm). Overall, approximately 40% of the glutaraldehyde-related job tasks involved exposures above the American Conference of Industrial Hygienists threshold limit value ceiling of 0.05 ppm; the majority (71.4% and 83.3%, depending on the company) involved exposures greater than 0.015 ppm. At one company, two cases of physician-diagnosed asthma were recorded by the employer in the previous 5-year period; these reports met the surveillance case definition for new-onset, work-related asthma associated with a known asthma inducer. Factors that contributed to worker exposure included large exposed surface areas of glutaraldehyde under agitation; working with glutaraldehyde-treated tissue in proximity to workers' breathing zones; manual pouring and disposal of glutaraldehyde solutions without local exhaust ventilation, eye protection, and waste neutralization; and prolonged use of latex gloves. Workers making bioprosthetic heart valves are at risk for occupationally acquired asthma. Employers should implement additional engineering controls to minimize workers' exposures to at least below a level of 0.015 ppm, an appropriate glove to prevent workers' skin exposure to glutaraldehyde, consistent and universal use of eye protection, and a medical surveillance program for glutaraldehyde-exposed workers.