Occupational Coccidioidomycosis in a heavy equipment operator.

This article describes a case of Coccidioidomycosis pneumonia in an individual who worked in the McKittrick Oil Field, Kern County, California, for 15 days during an approximate 1-month period in 2016. Coccidioidomycosis is caused by inhaling spores of Coccidioides immitis (C. immitis), a soil fungus endemic in regions of California, most notably the San Joaquin Valley. In California, Kern County has the highest incidence rate of Coccidioidomycosis, and the McKittrick Oil Field lies within the most highly endemic part of Kern County. The affected individual, who resided in a nonendemic state, traveled to Kern County to operate heavy equipment and also perform some laborer tasks. He experienced substantial exposure to soil dust without wearing adequate respiratory protection. Consideration of the relative amounts of soil dust exposure due to the individual's oil field work vs. ambient air permits a conclusion that his infection was work-related. In addition to respiratory protection, some measures needed to reduce soil dust exposure during construction work in areas endemic for C. immitis are discussed.

A point-source outbreak of Coccidioidomycosis among a highway construction crew.

Coccidioidomycosis is an infection caused by inhaling spores of the soil fungus Coccidioides immitis (hereafter termed Cocci). Cocci is endemic in certain areas of California. When soil containing the fungus is disturbed, as during earth-moving activities, respirable Cocci spores can become airborne and be inhaled by persons in the vicinity. This article describes a cluster of seven Cocciodioidomycosis cases among a highway construction crew that occurred in June/July 2008 in Kern County, CA, which is among the most highly endemic regions for Cocci in California. The exposures spanned no more than seven work days, and illness developed within two to three weeks of the exposures. Given the common source of exposure (soil dust generated at the work site) and the multiple cases occurring close in time, the cluster can also be termed a "point-source outbreak." The contractor was not informed of the infection risk and did not take adequate precautions against dust exposure. Appropriate engineering/administrative controls and respiratory protection are discussed.

The near field/far field model with constant application of chemical mass and exponentially decreasing emission of the mass applied.

The near field/far field (NF/FF) model is a contaminant dispersion construct that permits making airborne contaminant exposure estimates for an individual located close to an emission source. In the present analysis, chemical emission involves a constant mass rate of chemical application to surfaces, denoted I (mg/min), and an exponentially decreasing rate of emission of the chemical from the surfaces with rate constant α (min(-1)). The time-dependent emission rate function is: G(t), mg/min = I - I exp(- αt), where time t is in minutes. The exact time-dependent equations for the contaminant concentration in the NF and the FF are presented. These equations are used to revise a previous analysis of a study in which a penetrant liquid containing benzene was applied to parts on a work table in a test room. The previous analysis assumed that the benzene was applied as a bolus at the start of a 15-min use period, whereas the present analysis assumes the same total benzene mass was applied at a uniform rate over the 15-min use period, but with the same evaporation rate constant α. The new G(t) function leads to a lower 15-min time weighted average NF benzene concentration that better matches the experimental data. It is also shown that the exact equation for the NF concentration is well approximated by combining two well-mixed single-zone equations. The approximation method is mathematically simpler and obviates the need to derive the exact NF equation.

Benchmarking of a Markov multizone model of contaminant transport.

A Markov chain model previously applied to the simulation of advection and diffusion process of gaseous contaminants is extended to three-dimensional transport of particulates in indoor environments. The model framework and assumptions are described. The performance of the Markov model is benchmarked against simple conventional models of contaminant transport. The Markov model is able to replicate elutriation predictions of particle deposition with distance from a point source, and the stirred settling of respirable particles. Comparisons with turbulent eddy diffusion models indicate that the Markov model exhibits numerical diffusion in the first seconds after release, but over time accurately predicts mean lateral dispersion. The Markov model exhibits some instability with grid length aspect when turbulence is incorporated by way of the turbulent diffusion coefficient, and advection is present. However, the magnitude of prediction error may be tolerable for some applications and can be avoided by incorporating turbulence by way of fluctuating velocity (e.g. turbulence intensity).

Experimental evaluation of a Markov multizone model of particulate contaminant transport.

The performance of a Markov chain model of the three-dimensional transport of particulates in indoor environments is evaluated against experimentally measured supermicrometer particle deposition. Previously, the model was found to replicate the predictions of relatively simple particle transport and fate models; and this work represents the next step in model evaluation. The experiments modeled were (i) the release of polydispersed particles inside a building lobby, and (ii) the release of monodispersed fluorescein-tagged particles inside an experimental chamber under natural and forced mixing. The Markov model was able to reproduce the spatial patterns of particle deposition in both experiments, though the model predictions were sensitive to the parameterization of the particle release mechanism in the second experiment. Overall, the results indicate that the Markov model is a plausible tool for modeling the fate and transport of supermicrometer particles.

A decoupling method to compute near field and far field exposure concentrations.

In the near field/far field (NF/FF) dispersion construct, the analytical solutions for the NF and FF concentration equations, respectively denoted CNF(t) and CFF(t) in mg/m3, are coupled in their mathematical derivation. Depending on the form of the contaminant emission rate function G(t) (mg/min), deriving CNF(t) and CFF(t) can range from being relatively easy to impossible. A method is presented to more easily approximate these concentration functions. The method decouples the NF and FF equations by treating the NF as an isolated well-mixed space with volume VNF (m3) and supply/exhaust airflow rate ß(m3) and treating the FF as an isolated well mixed-space with volume V (m3) and supply/exhaust airflow rate Q (m3). Assuming that each space contains a source with the same contaminant emission rate function G(t), a contaminant concentration function is derived for the FF zone, denoted CWMR1(t), and an independent contaminant concentration function is derived for the NF zone, denoted CWMR2(t). Deriving a concentration function for a single zone is far easier than deriving coupled concentration functions. It is shown that the sum CWMR1(t) + CWMR2(t) provides an excellent approximation of CNF(t) and that CWMR1(t) provides an excellent approximation of CFF(t). A discrete-time numerical solution for the CNF(t) and CFF(t) system based on a Markov matrix is also presented.

Why a Workplace Barrier Face Covering is a Bad Idea.

Editor's Note: This is a commentary on "Barrier Face Coverings for Workers" by Lisa Brosseau and Jeffrey Stull, which appeared in NEW SOLUTIONS 32(3).

A critique of Occupational Safety and Health Administration's halfmask respirator assigned protection factor.

Halfmask air-purifying respirators are used by millions of workers to reduce inhaling air contaminants, both chemical (e.g., asbestos, styrene) and biological (e.g., SARS-CoV-2, Mycobacterium tuberculosis). In 2006, the federal Occupational Safety and Health Administration (OSHA) promulgated a standard that gave halfmask respirators an assigned protection factor (APF) of 10. This signified that OSHA assumes a fit-tested and trained wearer will experience a 10% maximum total inward leakage of contaminated air into the facepiece. To derive APF = 10, OSHA analyzed data from 16 workplace studies of the efficacy of halfmask respirators worn against particulate contaminants. In this commentary, I contend that, in considering the data, OSHA made several errors that overstated halfmask respirator efficacy. The errors were (i) failing to properly account for within-wearer and between-wearer variability in respirator efficacy; (ii) ignoring the effect of particle deposition in the respiratory tract; (iii) aggregating unbalanced data within and between studies, and effectively double-counting the data in some studies; and (iv) ignoring the effect that particle size exerts in penetrating respirator facepiece leak paths. The net result is that OSHA's APF = 10 can lead to excessive toxicant exposure for many workers.

Correcting Coal Miner Respirator Total Inward Leakage Values for Respiratory Tract Deposition.

The great majority of workplace respirator efficacy studies have measured total inward leakage (TIL) for particulate contaminants. One of the first such studies, designated the Harris study, was conducted in the early 1970s in US underground coal mines. As in other particle-based studies, inside-the-facepiece dust sampling was continuously conducted across the inhalation and exhalation phases of the breathing cycle, although unlike in other studies, respirable dust cyclones were used in air sampling. Because exhaled air was partially depleted of dust particles due to deposition in the respiratory tract, the measured time-averaged dust concentration inside the facepiece underestimated the time-averaged dust concentration inspired into the facepiece. In turn, the reported TIL values underestimated the true TIL values experienced, which is to say, overestimated respirator efficacy. This paper describes a method to correct the Harris study's reported TIL values for respiratory tract deposition while accounting for particle size-selective sampling by the cyclone devices. Given the estimated coal mine particle size distribution outside the respirator, it is shown that the reported TIL values should be increased by the multiplicative factor 1.69. This paper also discusses the assigned protection factor (APF) of five for the quartermask respirator class and shows that 4/5 quartermasks in the Harris study did not meet the criterion for complying with this APF value when using the corrected TIL values.

Estimating Exposure Intensity Based on Odor.

The odor detection threshold for a chemical typically varies widely across population members, and the values can be described by a lognormal distribution. Assuming that the parameters of a chemical's odor detection threshold distribution can be estimated, a method is presented to retrospectively estimate exposure intensity based on detecting the chemical's odor. The context is a single exposure period involving a single air contaminant. In brief, where k out of n identically exposed persons detect the chemical's odor, the best estimate of the chemical's concentration in air corresponds to the k ÷ n fractile of the odor detection threshold distribution. Where n is small and/or k ÷ n is close to zero or one, exact 100×(1-α)% confidence bounds for the fractile estimate can be computed without using the normal distribution assumption. In addition, statistical uncertainty in the parameter estimates of the chemical's odor detection threshold distribution can be considered via a parametric bootstrap procedure, such that an overall 100×(1-α)% confidence interval on the chemical's concentration in air is obtained. The method is illustrated for benzene. Analysis of the available benzene odor detection threshold literature provides best estimates of a population geometric mean equal to 37.8 ppm and geometric standard deviation equal to 1.92. In a hypothetical example in which two out of six workers detect the odor of benzene, the point estimate of the benzene exposure level is 28.5 ppm, and the approximate one-sided lower 95% confidence limit is 8.2 ppm. The present analysis also makes clear that odor does not provide an adequate warning of excessive levels of airborne benzene.

Informing optimal environmental influenza interventions: how the host, agent, and environment alter dominant routes of transmission.

Influenza can be transmitted through respirable (small airborne particles), inspirable (intermediate size), direct-droplet-spray, and contact modes. How these modes are affected by features of the virus strain (infectivity, survivability, transferability, or shedding profiles), host population (behavior, susceptibility, or shedding profiles), and environment (host density, surface area to volume ratios, or host movement patterns) have only recently come under investigation. A discrete-event, continuous-time, stochastic transmission model was constructed to analyze the environmental processes through which a virus passes from one person to another via different transmission modes, and explore which factors increase or decrease different modes of transmission. With the exception of the inspiratory route, each route on its own can cause high transmission in isolation of other modes. Mode-specific transmission was highly sensitive to parameter values. For example, droplet and respirable transmission usually required high host density, while the contact route had no such requirement. Depending on the specific context, one or more modes may be sufficient to cause high transmission, while in other contexts no transmission may result. Because of this, when making intervention decisions that involve blocking environmental pathways, generic recommendations applied indiscriminately may be ineffective; instead intervention choice should be contextualized, depending on the specific features of people, virus strain, or venue in question.

A quantitative method for estimating dermal benzene absorption from benzene-containing hydrocarbon liquids.

This study examines a method for estimating the dermal absorption of benzene contained in hydrocarbon liquids that contact the skin. This method applies to crude oil, gasoline, organic solvents, penetrants, and oils. The flux of benzene through occluded skin as a function of the percent vol/vol benzene in the liquid is derived by fitting a curve to experimental data; the function is supralinear at benzene concentrations < or = 5% vol/vol. When a liquid other than pure benzene is on nonoccluded skin, benzene may preferentially evaporate from the liquid, which thereby decreases the benzene flux. We present a time-averaging method here for estimating the reduced dermal flux during evaporation. Example calculations are presented for benzene at 2% vol/vol in gasoline, and for benzene at 0.1% vol/vol in a less volatile liquid. We also discuss other factors affecting dermal absorption.

Non-invasive measurement of carbon monoxide burden in Guatemalan children and adults following wood-fired temazcal (sauna-bath) use.

The use of wood-fired steam baths, or temazcales, is a potentially dangerous source of CO exposure in Guatemalan Highland communities where adults and children use them regularly for bathing, relaxation, and healing purposes. Physical characteristics of children predispose them to absorb CO faster than adults, placing them at greater exposure and health risks. Efforts to quantify temazcal exposures across all age groups, however, have been hampered by the limitations in exposure measurement methods. In this pilot study we measured COHb levels in children and adults following use of the temazcal using three field-based, non-invasive CO measurement methods: CO-oximetry, exhaled breath, and by estimation of COHb using micro-environmental concentrations and time diaries. We then performed a brief comparison of methods. Average CO concentrations measured during temazcal use were 661 ± 503 ppm, approximately 10 times the 15 min WHO guideline. Average COHb levels for all participants ranged from 12-14% (max of 30%, min 2%), depending on the method. COHb levels measured in children were not significantly different from adults despite the fact that they spent 66% less time exposed. COHb measured by CO-oximetry and exhaled breath had good agreement, but precision of the former was affected substantially by random instrument error. The version of the field CO-oximeter device used in this pilot could be useful in screening for acute CO exposure events in children but may lack the precision for monitoring the burden from less extreme, but more day-to-day CO exposures (e.g. indoor solid fuel use). In urban settings, health effects in children and adults have been associated with chronic exposure to ambient CO concentrations much lower than measured in this study. Future research should focus on reducing exposure from temazcales through culturally appropriate modifications to their design and practices, and targeted efforts to educate communities on the health risks they pose and actions they can take to reduce this risk.

Relative contributions of four exposure pathways to influenza infection risk.

The relative contribution of four influenza virus exposure pathways-(1) virus-contaminated hand contact with facial membranes, (2) inhalation of respirable cough particles, (3) inhalation of inspirable cough particles, and (4) spray of cough droplets onto facial membranes-must be quantified to determine the potential efficacy of nonpharmaceutical interventions of transmission. We used a mathematical model to estimate the relative contributions of the four pathways to infection risk in the context of a person attending a bed-ridden family member ill with influenza. Considering the uncertainties in the sparse human subject influenza dose-response data, we assumed alternative ratios of 3,200:1 and 1:1 for the infectivity of inhaled respirable virus to intranasally instilled virus. For the 3,200:1 ratio, pathways (1), (2), and (4) contribute substantially to influenza risk: at a virus saliva concentration of 10(6) mL(-1), pathways (1), (2), (3), and (4) contribute, respectively, 31%, 17%, 0.52%, and 52% of the infection risk. With increasing virus concentrations, pathway (2) increases in importance, while pathway (4) decreases in importance. In contrast, for the 1:1 infectivity ratio, pathway (1) is the most important overall: at a virus saliva concentration of 10(6) mL(-1), pathways (1), (2), (3), and (4) contribute, respectively, 93%, 0.037%, 3.3%, and 3.7% of the infection risk. With increasing virus concentrations, pathway (3) increases in importance, while pathway (4) decreases in importance. Given the sparse knowledge concerning influenza dose and infectivity via different exposure pathways, nonpharmaceutical interventions for influenza should simultaneously address potential exposure via hand contact to the face, inhalation, and droplet spray.

Characterizing the risk of infection from Mycobacterium tuberculosis in commercial passenger aircraft using quantitative microbial risk assessment.

Quantitative microbial risk assessment was used to predict the likelihood and spatial organization of Mycobacterium tuberculosis (Mtb) transmission in a commercial aircraft. Passenger exposure was predicted via a multizone Markov model in four scenarios: seated or moving infectious passengers and with or without filtration of recirculated cabin air. The traditional exponential (k = 1) and a new exponential (k = 0.0218) dose-response function were used to compute infection risk. Emission variability was included by Monte Carlo simulation. Infection risks were higher nearer and aft of the source; steady state airborne concentration levels were not attained. Expected incidence was low to moderate, with the central 95% ranging from 10(-6) to 10(-1) per 169 passengers in the four scenarios. Emission rates used were low compared to measurements from active TB patients in wards, thus a "superspreader" emitting 44 quanta/h could produce 6.2 cases or more under these scenarios. Use of respiratory protection by the infectious source and/or susceptible passengers reduced infection incidence up to one order of magnitude.

Reduction of respirable silica following the introduction of water spray applications in Indian stone crusher mills.

Respirable crystalline silica dust generated during stone crushing operations has been linked to chronic lung disease and increased risk of tuberculosis. In India, most stone crushing mills operate without any dust control or containment systems. This investigation in the Khurda District of Orissa demonstrated a reduction in respirable particulate mass following the application of a fine mist of water. Average respirable quartz and cristobalite levels declined 82% and 69%, respectively, after water spray controls were installed. This finding suggests that relatively inexpensive modifications that are available in the local market can be effective at reducing silica exposures. Although average exposure levels, particularly during the dry season, may exceed the Permissible Exposure Limit for silica, the overall reductions observed were substantial. Widespread adoption of this simple control technology by stone crushers in India could have a positive public health impact.

A study quantifying the hand-to-face contact rate and its potential application to predicting respiratory tract infection.

A substantial portion of human respiratory tract infection is thought to be transmitted via contaminated hand contact with the mouth, eyes, and/or nostrils. Thus, a key risk factor for infection transmission should be the rate of hand contact with these areas termed target facial membranes. A study was conducted in which 10 subjects were each videotaped for 3 hr while performing office-type work in isolation from other persons. The number of contacts to the eyes, nostrils, and lips was scored during subsequent viewing of the tapes. The total contacts per subject had sample mean x = 47 and sample standard deviation s = 34. The average total contact rate per hour was 15.7. The authors developed a relatively simple algebraic model for estimating the dose of pathogens transferred to target facial membranes during a defined exposure period. The model considers the rate of pathogen transfer to the hands via contact with contaminated environmental surfaces, and the rate of pathogen loss from the hands due to pathogen die-off and transfer from the hands to environmental surfaces and to target facial membranes during touching. The estimation of infection risk due to this dose also is discussed. A hypothetical but plausible example involving influenza A virus transmission is presented to illustrate the model.