Photokeratitis among restaurant workers: A case series.

This case report highlights the challenges associated with the diagnosis and workplace evaluation of occupationally acquired ultraviolet (UV) radiation-induced photokeratitis and associated skin burns in a group of restaurant workers. UV-C spectrum bulbs were inadvertently shipped and installed in insect light traps. Ocular and dermal symptoms were reported in 18 of 85 restaurant employees to varying degrees of severity over a 2-day period. One patient was formally diagnosed with a chemical burn/irritation of the cornea. More severe symptoms were reported by individuals working in close proximity to the lights. This clinical picture can resemble mass chemical or irritant exposure when multiple individuals are affected, and a multidisciplinary approach was required for rapid identification of the source to limit morbidity. Prevention strategies for similar events should be considered which can include limiting hardware compatibility and improving warning labels.

Descriptive review of asbestosis and silicosis hospitalization trends in North Carolina, 2002-2011.

BACKGROUND: Asbestosis and silicosis are debilitating pulmonary conditions resulting from inhalation of asbestos fibers or silica dust. PURPOSE: We provide a descriptive analysis of asbestosis and silicosis hospitalizations in North Carolina to assess trends over a 10-year period. METHODS: Events were defined as inpatient hospital discharges during the period 2002-2011 with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 501 or 502. Using statewide discharge data for 2002-2011, we calculated asbestosis and silicosis hospitalization rates in North Carolina (by demographics, hospital length of stay, cost, and payment type) and compared them with national rates. RESULTS: In North Carolina, average annual age-standardized hospitalization rates for asbestosis and silicosis were 71.2 hospitalizations per 1 million residents and 6.2 hospitalizations per 1 million residents, respectively. Rates for asbestosis and silicosis decreased significantly (less than .01 for both conditions) between 2002 and 2011, by 46% and 67%, respectively. Men had significantly higher rates than women (less than .01), more than half of hospitalizations were among persons aged 65-84 years, and Medicare was the predominant payment source. The highest silicosis rates by county were clustered in Western North Carolina; no geographic patterns were observed for asbestosis. The estimated average annual cost statewide for these hospitalizations was $10,170,417 for asbestosis and $886,143 for silicosis. LIMITATIONS: ICD-9-CM misclassification and duplicate hospitalization records may have biased the observed rates of asbestosis and silicosis. CONCLUSIONS: Decreases in hospitalization rates in North Carolina may be due to misdiagnosis, underreporting, or the declining use of asbestos in industries. Obtaining complete exposure histories at diagnosis is useful for continued public health surveillance.

Consequences of respiratory exposures in the farm environment.

Depending on the type of farming practice, respiratory symptoms are common among agricultural workers. Farmers are at risk for pulmonary illnesses, including chronic bronchitis, organic dust toxic syndrome, farmer's lung diseases, allergic and nonallergic asthma, nasal irritation and polyps, and chemical pneumonitis.

Adverse encounters with alligators in the United States: an update.

OBJECTIVE: Severe injuries and fatalities can occur from an alligator attack. Encounters with alligators appear to be increasing in the United States. This review provides information from alligator attacks reported in the United States as well as infections that may occur after an alligator bite. METHODS: Telephone interviews were conducted with state wildlife offices in all Southern states in order to collect information on the number of alligator bites, nuisance calls, and the estimated alligator population of each state. Detailed information from alligator attacks in Florida is presented, including basic demographic information on the victims and description of the types of injuries and the activity of the victim at the time of injury. Additional information regarding the size and behavior of the alligator involved in the attack is also provided in many cases. RESULTS: There have been 567 reports of adverse encounters with alligators with 24 deaths reported in the United States from 1928 to January 1, 2009. In addition, thousands of nuisance calls are made yearly and the number of nuisance calls as well as the alligator population is increasing in many states. CONCLUSIONS: Injuries from encounters with alligators may range from minor scratches and punctures to amputations and death. The larger the alligator, the more likely that serious injury will occur. As the human population encroaches on the habitat of the alligator, attacks and nuisance complaints will continue to occur. A uniform reporting system among states should be developed to obtain more complete information on alligator encounters. Guidelines have been developed by many state wildlife officials to reduce adverse encounters with alligators.

Occupational Hazards and Health and Safety Risks for Latino Tree Trimmers in the Pine Forest Industry.

A pilot project was conducted to evaluate the working conditions and work-related body pain among Latino immigrant tree trimmers (n = 57) in the commercial pine forest service industry. Participants were interviewed about personal and work characteristics, job-related occupational hazards, and body pain. A structured questionnaire and a body pain diagram were used as measures for evaluating associations between personal and work characteristics and body pain. The most common health complaints were physical exhaustion (80.7 percent) and headache (33.9 percent). The reported percent of work-related body pain was 54.4 percent. Statistically significant associations were identified between experiencing body pain in knees, working more than two years, and working more than six hours per day (p < .05) as a tree trimmer. Thorough clinical evaluations are needed to confirm these findings. Future research including a larger sample size and more in-depth evaluations are needed to better evaluate worker tasks, musculoskeletal risk factors, and safety climate issues among this highly vulnerable occupational group.

Carbon Monoxide Poisonings from Forklift Use During Produce Packing Operations.

In August 2013, the North Carolina Division of Public Health investigated a carbon monoxide (CO) exposure on a farm. Two employees were overcome by CO and lost consciousness while using a propane-powered forklift to load produce into a refrigerated trailer backed up to a warehouse. One employee died, and the second employee was admitted to the hospital for hyperbaric oxygen treatment. Eighteen people, ranging in age from 18 to 69 years, were potentially exposed to CO, including the two employees, a family member who discovered the employees, two bystanders who stopped to offer assistance, and 13 first responders. Thirteen people who assisted in the emergency response experienced symptoms such as headache and dizziness, and all 16 who assisted were evaluated in a local hospital emergency department and released after receiving 100% oxygen. Blood tests showed five people (the two employees, family member, and two bystanders) had elevated blood carboxyhemoglobin levels, but all first responders had levels within normal range. Firefighters measured a peak CO concentration of 2214 parts per million in the warehouse. The North Carolina Division of Occupational Safety and Health investigated and determined that the forklift, operated inside the trailer with no ventilation, was the source of the CO. Public health investigation activities included interviewing responders, obtaining ambient CO concentration measurements from the fire department, advising the local health director, reviewing medical records, and developing a line listing of exposed persons. To prevent CO poisoning, employers should consider replacing gas-powered equipment with electric equipment, which does not produce CO.

Adverse neurodevelopmental effects and hearing loss in children associated with manganese in well water, North Carolina, USA.

AIM: Heavy metals such as manganese, arsenic and lead can act as neurotoxins. There have been few human studies of neurobehavioral/neurodevelopmental effects of arsenic and manganese on children in the United States. Since 1998, North Carolina has tested all new private wells for manganese, arsenic and lead. This study was conducted to evaluate adverse neurodevelopmental effects (delayed milestones, speech/language disorders and hearing loss) in children and metal concentrations in well water. METHODS: A quasi-regression model of the number of children (0-35 months of age) with adverse neurodevelopmental effects as outcome measures and aggregate mean metal concentration (arsenic, lead, and manganese) in private well water in each county as exposures. RESULTS: Over 70,000 private well water samples from 1998 to 2011 were analyzed for metal content. From 2008 to 2011, an average of 17,000 children was enrolled in the Infant Toddler Program. On average, 1.7% of children in this age range in each county had a speech/language disorder, 0.24% had a diagnosis of delayed milestones, and 0.026% had a diagnosis of hearing loss. The county mean manganese concentration was significantly and positively associated with the prevalence of delayed milestones and hearing loss in the children. No association was found for metal concentrations and speech/language disorders. CONCLUSION: This ecological study indicates that further investigation of manganese in well water and associated neurodevelopmental health outcomes in children is needed.

Episodic neurological dysfunction due to mass hysteria.

We describe 10 students from a small rural secondary school with episodes resembling seizures or syncopal attacks. Several students were initially treated for epilepsy or syncope, but the temporal pattern of the attacks, the simultaneous resolution of the episodes during a school holiday, and the fact that 4 students subsequently had pseudoseizures confirmed by video-electroencephalography strongly suggest mass hysteria. Seven students were treated with antiepileptic medications, and most underwent multiple diagnostic studies. Prompt recognition of mass hysteria allows physicians to avoid unnecessary tests and treatments and to reassure those affected as well as the general public.

Aldicarb: a case series of watermelon-borne carbamate toxicity.

Improper use of pesticides on food plants can result in significant toxicity. In spite of regulations, enforcement, and prior episodes of poisonings, poisonings from misapplication of pesticides continues to occur. The objective of this study was to present a case series of toxicity resulting from ingestion of watermelon inappropriately treated with the carbamate insecticide aldicarb. A restrospective review of medical records, impounding the suspected watermelons, and chemical analysis of the watermelon samples using liquid chromatography and mass spectroscopy were carried out. Seven farm workers shared a watermelon and presented to a rural emergency department with symptoms of cholinergic poisoning. They were treated empirically with atropine and pralidoxime. The farmer denied use of insecticides other than rat poison on the watermelon patch. Chemical analyst verified aldicarb in the watermelon samples from the field, but none in control samples. Despite government regulations, application of restricted pesticides such as aldicarb continues to occur and cause significant poisonings.

Human exposures to pesticides in the United States.

Pesticides are used in most homes, businesses, and farms to control a variety of pests, including insects, weeds, fungi, rodents, and even microbial organisms. Inappropriate use of pesticides can lead to adverse effects to humans and the environment. This study provides updated information on the magnitude of adverse pesticide exposures in the United States. Data on pesticide exposure were obtained from calls to poison control centers (PCCs) reported by the American Association of Poison Control Centers. Estimates of emergency department visits, hospitalizations, and health care costs were reported by the Agency for Healthcare Research and Quality (AHRQ), and deaths from pesticide poisonings reported by the Centers for Disease Control and Prevention (CDC) WONDER (Wide-ranging Online Data for Epidemiologic Research). An average of 23 deaths occur each year with pesticides as the underlying cause of death, most due to suicidal ingestions. An average of 130,136 calls to poison control centers were reported from 2006 to 2010, with an average of 20,116 cases (17.8%) treated in health care facilities annually. AHQR reported an annual average of 7385 emergency room visits during 2006 to 2008, and 1419 annual hospitalizations during 2005 to 2009. Excluding cost from lost work time, hospital physician fees, and pesticide-induced cancers, the annual national cost associated with pesticide exposures was estimated as nearly $200 million USD based on data from emergency department visits, hospitalizations, and for deaths. Pesticide exposures remain a significant public health issue. Health care providers, cooperative extension agents, and pesticide manufactures can help prevent exposures by increasing education of parents and workers, encourage use of less toxic agents, and encourage the practice of integrated pest management.

Communities near toluene diisocyanate sources: an investigation of exposure and health.

Toluene diisocyanate (TDI) is a well-known cause of occupational asthma, but we know little about the potential for exposure and health effects among residents who live near facilities that release TDI. In the mid-1990's, the North Carolina Department of Health and Human Services and the Agency for Toxic Substances and Disease Registry investigated exposures to TDI and health outcomes in one community, which left some unanswered questions. This cross-sectional study evaluated the potential associations between living near a TDI source and the prevalence of three variables: asthma or asthma-like respiratory symptoms, antibodies specific to TDI, and verifiable levels of TDI in residential air. Results among North Carolina residents living near such facilities (five target communities) were compared with the results from residents living further away (five comparison communities). Overall, the prevalence of reporting either asthma or asthma-like respiratory symptoms was higher (odds ratio = 1.60; 95% confidence interval = 0.97-2.54) among residents in target communities than those in comparison communities. However, this difference was not statistically significant. Symptom prevalence varied greatly among the community populations. The prevalence of respiratory symptoms was higher near facilities with historically higher TDI emissions. Among the 351 participants who provided blood samples, only one had immunoglobulin G specific antibodies to TDI. This participant lived in a target area and may have had non-occupational exposure. TDI was detected at an extremely low level (1 ppt) in one of the 45 air samples from target communities. One ppt is one-tenth the EPA reference concentration. Overall, air sample and antibody test results are not consistent with recent or ongoing exposure to TDI.

Livestock handling--minimizing worker injuries.

Numerous hazards may occur on farms raising livestock. Animal contact is often ranked as the first or second leading cause of injuries on the farm. In addition to direct trauma from the animal, other injuries may occur from injection of medications, chemical splashes from cleaning the facility, and repetitive motion injuries. Exposures to toxic gases from decomposition of animal waste such as in manure pits and exposure to animal allergens may cause adverse health effects in humans. One additional consideration is the risk of developing various zoonotic infections. Human injuries happen more often when people are handling animals than during any other activity performed in pork production. The National Pork Board of the United States, in response to a request from pork producers, has developed a program designed to improve worker safety, pig welfare, and pork quality when pigs are moved for whatever reason. The objective of the Transport Quality Assurance (TQA) program is to help all those who transport, produce, or handle swine to do so in a way that is optimal for the pigs' well-being, the health of the handler, and to improve the quality of the pork produced. Understanding basic pig behavior, proper handling practices, and using proper handling equipment will help animal handling be a safe activity. This paper was prepared for the Agricultural Safety and Health Council of America/National Institute of Occupational Safety and Health Conference, "Be Safe, Be Profitable: Protecting Workers in Agriculture," January 27-28, 2010, Dallas/Fort Worth, Texas.

Deaths from reptile bites in the United States, 1979-2004.

INTRODUCTION: Bites from reptiles cause thousands of injuries but fortunately few deaths in the U.S. each year. This article reviews deaths from reptile bites over the last 25 years. METHODS: Mortality data was obtained using CDC WONDER to evaluate deaths that occurred from 1979 to 2004 due to reptile bites. Information on race, gender, ages, and state where death occurred is reported. RESULTS: There were 134 deaths reported over this 25-year time period. Whites were 93.3% of the victims, and males were 79.1% of the victims. The age group reporting the most deaths was the 25 to 34 year old category. There were 17 (12.7%) victims less than 15 years of age, and 25 (18.7%) victims older than 65 years of age. Seventy-five of the fatalities (55.9%) occurred in five states. CONCLUSIONS: An average of five deaths occurs from reptile bites each year in the U.S. White males living in the Southern part of the United States are more likely to be the victim of a fatal reptile envenomation.

Human fatalities resulting from dog attacks in the United States, 1979-2005.

INTRODUCTION: Dog attacks are a major public health concern worldwide. Dogs bite over 4 million people resulting in the hospitalization of 6000 to 13,000 people each year in the United States. Rarely deaths may occur after an attack. METHODS: This study utilized the compressed mortality files from CDC WONDER to evaluate deaths from dog attacks over the 27-year period 1979-2005. RESULTS: An average of approximately 19 deaths was reported annually from dog attacks during this time period. Males and children less than 10 years of age had the highest rate of death from dog attacks. Deaths have been reported in 49 states with Alaska reporting the highest death rate from dog attacks. The number of deaths and death rate from dog attacks appear to be increasing. CONCLUSIONS: Deaths from dog attacks appear to be increasing as the population of both humans and dogs has increased during this time period. Children have the greatest risk of death. There is a need for a national reporting system on dog bites to fully capture the extent of fatalities and look at risk factors surrounding the attack. The development of effective prevention practices is dependent upon examination of these risk factors.

Animal bites and stings reported by United States poison control centers, 2001-2005.

OBJECTIVE: There is not a single data source for information on the extent of nonfatal injuries inflicted by animals. Although individuals bitten or stung by animals may not visit a health care provider, they may call poison control centers (PCCs) for information. These centers are one source of information on the frequency of occurrence of injuries from animals. METHODS: The American Association of Poison Control Centers compiles an annual report of exposure calls to various agents, including chemicals, medications, animal bites and stings, plants, and use of antivenoms from their network of PCCs. An estimate of the severity of exposure for each call is also determined. This review examines summary data on different species of animal bites and stings reported by PCCs from 2001 to 2005. RESULTS: From 2001 to 2005 there were 472 760 reports of animal bites and stings, an average of 94,552 per year. There was a trend noted for increasing use of antivenom over this period. Twenty-seven deaths were recorded, most from snakebites. CONCLUSIONS: Poison control centers are a source of information for health care workers on management of animal bites and stings. The database maintained by the American Association of Poison Control Centers is another source of information on the magnitude and public health impact of injuries from animals.

Haff disease after eating salmon.

While fish consumption is considered a component of a heart-healthy diet, many illnesses have been associated with eating contaminated fish. The authors describe two cases of muscle weakness and rhabdomyolysis that occurred after eating salmon. Cases of rhabdomyolysis and muscle weakness after consumption of fresh water fish have rarely been reported in the United States but have been frequently reported from the Baltic region. This illness is known as Haff disease. While the etiology is unknown, it is felt to be a toxin. Palytoxin, found in marine fish, has been associated with rhabdomyolysis, and may serve as a model for further study of the suspected toxin responsible for rhabdomyolysis after consumption of fresh water fish. If a case of Haff disease is suspected, contact the Centers for Disease Control and Prevention and collect any uneaten fish, which may be sent for laboratory analysis.

Alligator attacks on humans in the United States.

OBJECTIVE: Encounters with alligators are increasing in the United States. Both severe injuries and fatalities can occur from an alligator attack. This study provides information on alligator attacks reported in the United States as well as infections that are commonly associated with alligator bites. METHODS: In order to collect information on the number of alligator bites, nuisance calls, and estimated alligator population of each state, calls were made to wildlife offices in all southern US states, and an online search for lay press articles was performed. Detailed information was available from Florida and is presented regarding the types of injuries and the activities of the victims at the time of the injuries. RESULTS: From 1948 to August 1, 2004, 376 injuries and 15 deaths have been reported in the United States as a result of encounters with alligators. The number of nuisance calls as well as the alligator population is increasing. CONCLUSIONS: As the human population encroaches on the habitat of alligators, attacks and nuisance complaints increase. A uniform reporting system among states should be developed to obtain more complete information on alligator encounters.

Animal-related fatalities in the United States-an update.

OBJECTIVE: To evaluate the causes of human fatalities in the United States from 1991 to 2001 that were caused by venomous and nonvenomous animal encounters exclusive of zoonotic infections or animal-vehicle collisions. METHODS: An inquiry of CDC Wonder, a database for epidemiologic research, was used to provide information on animal-related fatalities on the basis of ICD-9 and ICD-10 codes. RESULTS: From 1991 to 2001, 1943 persons died in the United States after venomous and non-venomous animal encounters. An average of 177 fatalities per year were recorded. Venomous animal encounters were responsible for 39% of the fatalities. White males appear to be the group most likely to die from an encounter. Most fatalities occurred in the southern United States. CONCLUSIONS: Although the average number of fatalities from animal encounters has increased compared with the previous decade, the death rate has remained essentially unchanged. The medical and financial costs from both fatal and nonfatal animal encounters have a significant impact on public health.

Infectious disease occurrence in forestry workers: a systematic review.

Forestry workers are a classic example of how environmental exposures put workers in some occupation at higher risk for infectious disease. Foresters are exposed to wild animals, arthropods, vegetation, and soil, all of which may harbor bacteria, viruses, fungi, or other eukaryotic parasites that are harmful to humans. Common routes of exposure to these pathogens include inhalation, direct contact, and vector-borne inoculation through the skin in injuries. A variety of vectors can transmit diseases of importance to foresters. They include ticks, flies, mosquitoes, and Reduviidae bugs. This is a systematic review of the scientific literature that details the risk of forestry workers face.