Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-11 (of 11 Records) |
Query Trace: Harduar Morano L[original query] |
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Evaluation and revision of historical ESSENCE syndromic surveillance definition used to identify work-related emergency department visits
Harduar Morano L , Kite Powell A , Luckhaupt SE . Public Health Rep 2024 333549241287929 OBJECTIVES: Occupational health surveillance programs have rarely incorporated syndromic surveillance. We documented a process for evaluating and revising syndromic surveillance definitions, using the example of work-related emergency department (ED) visits. MATERIALS AND METHODS: Of 140 331 481 ED visits in the National Syndromic Surveillance Program from May 15, 2016, through October 31, 2017, we extracted 391 827 records for phase 1 that met the previously unevaluated original work-related definition or included a work-related employment status ICD-10-CM code (Y99.0/Y99.1; International Classification of Diseases, Tenth Revision, Clinical Modification). Also for phase 1, we evaluated the performance of the original work-related definition using ICD-10-CM work-related employment status codes as a reference standard. In phase 2, we extracted 99 109 records containing candidate work-related keywords. Finally, in phase 3, we examined individual keywords and developed and evaluated a revised definition. RESULTS: The revised work-related definition identified 259 153 visits by keyword alone, 104 342 visits by ICD-10-CM work-related employment status codes alone, and 16 385 ED visits by both methods. Sensitivity (13.6% vs 11.3%) and positive predictive value (5.9% vs 4.8%) were higher for the revised definition than for the original work-related definition. Manual review indicated that 91.3% (95% CI, 89.6%-93.0%) of visits identified by the revised definition keywords met the study criteria for work-related visits as compared with 75.5% (95% CI, 73.0%-78.4%) of visits for the original work-related definition. PRACTICE IMPLICATIONS: The original work-related definition performed suboptimally because keywords were not sufficiently specific. The revised definition is an improvement but requires testing in real-world scenarios. The presented methods for developing a syndromic surveillance definition are useful, not only for occupational health, but for identification of other subpopulations treated in the ED. |
Legionnaires' disease in transportation, construction and other occupations in 39 US jurisdictions, 2014-2016
Harduar Morano L , Morawski BM , Herzig CTA , Edens C , Barskey AE , Luckhaupt SE . Occup Environ Med 2024 BACKGROUND: Certain workers are at increased risk for acquiring Legionnaires' disease compared with other workers. This study aims to identify occupations at increased risk for acquiring Legionnaires' disease. METHODS: Using data from the US Centers for Disease Control and Prevention's Supplemental Legionnaires' Disease Surveillance System, this study identified Legionnaires' disease confirmed patients ≥16 years of age in 39 states with reported symptom onset during 2014-2016. Age-adjusted and sex-adjusted incidence rate ratios (IRR) stratified by occupation group were calculated by comparing Legionnaires' disease patients in an occupation group (eg, transportation) to those in all other occupation groups (eg, non-transportation). RESULTS: A total of 2553 patients had a known occupation group. The two occupations with the highest burden were transportation (N=287; IRR=2.11) and construction (N=269; IRR=1.82). Truck drivers comprised the majority (69.7%) of the transportation occupation group and construction labourers comprised almost half (49%) of the construction occupation group. The healthcare support occupation had the highest IRR (N=75; IRR=2.16). CONCLUSION: Transportation and construction workers, who are generally not covered by guidance related to building water systems, have increased risk of Legionnaires' disease compared with other workers. One hypothesised risk factor for truck drivers is the use of non-genuine windshield cleaner in their vehicles. A simple intervention is to use genuine windshield cleaner with bactericidal properties (ie, includes isopropanol/methanol) which can reduce the risk of Legionella growth and transmission. To improve surveillance of Legionnaires' disease and identification of similar exposures, the authors encourage the collection of occupation and industry information for all patients with Legionnaires' disease. |
Excess risk of SARS-CoV-2 infection among in-person nonhealthcare workers in six states, September 2020-June 2021
Groenewold MR , Billock R , Free H , Burrer SL , Sweeney MH , Wong J , Lavender A , Argueta G , Crawford HL , Erukunuakpor K , Karlsson ND , Armenti K , Thomas H , Gaetz K , Dang G , Harduar-Morano L , Modji K , Luckhaupt SE . Am J Ind Med 2023 66 (7) 587-600 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. |
Industry-specific prevalence of elevated blood lead levels among Pennsylvania workers, 2007-2018
Tsai RJ , Lu JW , Henn SA , Hasanali SH , Harduar-Morano L , Nair A . Occup Environ Med 2022 OBJECTIVES: To use industry-specific denominators to more accurately examine trends in prevalence rates for occupational cases of elevated blood lead levels (eBLLs) in Pennsylvania. METHODS: We used adult (aged ≥16 years) blood lead level data from Pennsylvania (2007-2018) and industry-specific denominator data from the US Census Bureau's County Business Patterns to calculate prevalence rates for eBLLs, defined as ≥25 µg/dL. RESULTS: Of the 19 904 cases with eBLLs, 92% were due to occupational lead exposure, with 83% from workers in the battery manufacturing industry. In 2018, the prevalence rate of eBLLs for battery manufacturing (8036.4 cases per 100 000 employed battery manufacturing workers) was 543 times the overall Pennsylvania prevalence rate. The prevalence rate for battery manufacturing steeply declined 71% from 2007 to 2018. CONCLUSIONS: The battery manufacturing industry had the highest burden of occupational lead exposure in Pennsylvania, illustrating the importance of using industry-specific denominators to accurately identify sources of lead exposure. Although the prevalence rate of eBLLs declined over time, lead exposure remains a major concern among battery manufacturing workers. |
Reported exposures among in-person workers with SARS-CoV-2 infection in 6 states, September 2020-June 2021.
Free H , Luckhaupt SE , Billock RM , Groenewold MR , Burrer S , Sweeney MH , Wong J , Gibb K , Rodriguez A , Vergara X , Cummings K , Lavender A , Argueta G , Crawford HL , Erukunuapor K , Karlsson ND , Armenti K , Thomas H , Gaetz K , Dang G , Harduar-Morano L , Modji K . Clin Infect Dis 2022 75 S216-S224 BACKGROUND: Surveillance systems lack detailed occupational exposure information from workers with SARS-CoV-2 infection. The National Institute for Occupational Safety and Health partnered with six states to collect information from adults diagnosed with SARS-CoV-2 infection (either COVID-19 or asymptomatic infection) who worked in person (outside the home) in non-healthcare settings during the two weeks prior to illness onset. METHODS: The survey captured demographic, medical, 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 COVID-19 was categorized by setting as: exposure at work, exposure outside of work only, or no known exposure/didn't know if they had exposures. Frequencies and percentages of exposure types are compared by respondent characteristics and risk factors for SARS-CoV-2 infection. RESULTS: Of 1,111 qualified respondents, 19.4% reported exposure at work, 23.4% reported exposure outside of work only, and 57.2% reported no known exposure/didn't know if they had exposures. Workers in protective service occupations (48.8%) and public administration industries (35.6%) reported exposure at work most often. Over a 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 SARS-CoV-2 at work was common among respondents. Examining differences in exposures among different groups of workers 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. |
Deaths in Children and Adolescents Associated With COVID-19 and MIS-C in the United States.
McCormick DW , Richardson LC , Young PR , Viens LJ , Gould CV , Kimball A , Pindyck T , Rosenblum HG , Siegel DA , Vu QM , Komatsu K , Venkat H , Openshaw JJ , Kawasaki B , Siniscalchi AJ , Gumke M , Leapley A , Tobin-D'Angelo M , Kauerauf J , Reid H , White K , Ahmed FS , Richardson G , Hand J , Kirkey K , Larson L , Byers P , Garcia A , Ojo M , Zamcheck A , Lash MK , Lee EH , Reilly KH , Wilson E , de Fijter S , Naqvi OH , Harduar-Morano L , Burch AK , Lewis A , Kolsin J , Pont SJ , Barbeau B , Bixler D , Reagan-Steiner S , Koumans EH . Pediatrics 2021 148 (5) OBJECTIVES: To describe the demographics, clinical characteristics, and hospital course among persons <21 years of age with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated death. METHODS: We conducted a retrospective case series of suspected SARS-CoV-2-associated deaths in the United States in persons <21 years of age during February 12 to July 31, 2020. All states and territories were invited to participate. We abstracted demographic and clinical data, including laboratory and treatment details, from medical records. RESULTS: We included 112 SARS-CoV-2-associated deaths from 25 participating jurisdictions. The median age was 17 years (IQR 8.5-19 years). Most decedents were male (71, 63%), 31 (28%) were Black (non-Hispanic) persons, and 52 (46%) were Hispanic persons. Ninety-six decedents (86%) had at least 1 underlying condition; obesity (42%), asthma (29%), and developmental disorders (22%) were most commonly documented. Among 69 hospitalized decedents, common complications included mechanical ventilation (75%) and acute respiratory failure (82%). The sixteen (14%) decedents who met multisystem inflammatory syndrome in children (MIS-C) criteria were similar in age, sex, and race and/or ethnicity to decedents without MIS-C; 11 of 16 (69%) had at least 1 underlying condition. CONCLUSIONS: SARS-CoV-2-associated deaths among persons <21 years of age occurred predominantly among Black (non-Hispanic) and Hispanic persons, male patients, and older adolescents. The most commonly reported underlying conditions were obesity, asthma, and developmental disorders. Decedents with coronavirus disease 2019 were more likely than those with MIS-C to have underlying medical conditions. |
Media Reports as a Tool for Timely Monitoring of COVID-19-Related Deaths Among First Responders-United States, April 2020.
Kelly-Reif K , Rinsky JL , Chiu SK , Burrer S , de Perio MA , Trotter AG , Miura SS , Seo JY , Hong R , Friedman L , Hand J , Richardson G , Sokol T , Sparer-Fine EH , Laing J , Oliveri A , McGreevy K , Borjan M , Harduar-Morano L , Luckhaupt SE . Public Health Rep 2021 136 (3) 315-319 We aimed to describe coronavirus disease 2019 (COVID-19) deaths among first responders early in the COVID-19 pandemic. We used media reports to gather timely information about COVID-19-related deaths among first responders during March 30-April 30, 2020, and evaluated the sensitivity of media scanning compared with traditional surveillance. We abstracted information about demographic characteristics, occupation, underlying conditions, and exposure source. Twelve of 19 US public health jurisdictions with data on reported deaths provided verification, and 7 jurisdictions reported whether additional deaths had occurred; we calculated the sensitivity of media scanning among these 7 jurisdictions. We identified 97 COVID-19-related first-responder deaths during the study period through media and jurisdiction reports. Participating jurisdictions reported 5 deaths not reported by the media. Sixty-six decedents worked in law enforcement, and 31 decedents worked in fire/emergency medical services. Media reports rarely noted underlying conditions. The media scan sensitivity was 88% (95% CI, 73%-96%) in the subset of 7 jurisdictions. Media reports demonstrated high sensitivity in documenting COVID-19-related deaths among first responders; however, information on risk factors was scarce. Routine collection of data on industry and occupation could improve understanding of COVID-19 morbidity and mortality among all workers. |
Symptom Profiles of a Convenience Sample of Patients with COVID-19 - United States, January-April 2020.
Burke RM , Killerby ME , Newton S , Ashworth CE , Berns AL , Brennan S , Bressler JM , Bye E , Crawford R , Harduar Morano L , Lewis NM , Markus TM , Read JS , Rissman T , Taylor J , Tate JE , Midgley CM . MMWR Morb Mortal Wkly Rep 2020 69 (28) 904-908 Coronavirus disease 2019 (COVID-19) was first detected in the United States in January 2020 (1), and by mid-July, approximately 3.4 million cases had been reported in the United States (2). Information about symptoms among U.S. COVID-19 patients is limited, especially among nonhospitalized patients. To better understand symptom profiles of patients with laboratory-confirmed COVID-19 in the United States, CDC used an optional questionnaire to collect detailed information on a convenience sample of COVID-19 patients from participating states. Symptom data were analyzed by age group, sex, hospitalization status, and symptom onset date relative to expansion of testing guidelines on March 8, 2020 (3). Among 164 symptomatic patients with known onset during January 14-April 4, 2020, a total of 158 (96%) reported fever, cough, or shortness of breath. Among 57 hospitalized adult patients (aged >/=18 years), 39 (68%) reported all three of these symptoms, compared with 25 (31%) of the 81 nonhospitalized adult patients. Gastrointestinal (GI) symptoms and other symptoms, such as chills, myalgia, headache, and fatigue, also were commonly reported, especially after expansion of testing guidelines. To aid prompt recognition of COVID-19, clinicians and public health professionals should be aware that COVID-19 can cause a wide variety of symptoms. |
Anhydrous ammonia chemical release - Lake County, Illinois, April 2019
Rispens JR , Jones SA , Clemmons NS , Ahmed S , Harduar-Morano L , Johnson MD , Edge C3rd , Vyas A , Bourgikos E , Orr MF . MMWR Morb Mortal Wkly Rep 2020 69 (4) 109-113 On April 25, 2019, a farm tractor towing two 2-ton ammonia tanks on a county road in Lake County, Illinois, experienced a mechanical failure that resulted in the release of anhydrous ammonia, a colorless, pungent, irritating gas that can cause severe respiratory and ocular damage (1). Approximately 80% of anhydrous ammonia produced in the United States is used as a fertilizer in agriculture (1). Eighty-three persons, including first responders, motorists, and neighborhood residents, were evaluated at area hospitals because of exposure to the gas. Two weeks after the release, the Agency for Toxic Substances and Disease Registry (ATSDR) and CDC's National Center for Environmental Health (NCEH) collaborated with the Lake County Health Department and the Illinois Department of Public Health on an investigation using ATSDR's Assessment of Chemical Exposures program to describe the release, review the emergency response, and determine health effects associated with the exposure. First responders, community residents, and hospital personnel reported communication challenges related to the nature of the gas release and effective protective measures. Among the 83 persons evaluated at six area hospitals for effects of the chemical release, 14 (17%) were hospitalized, including eight (10%) who were admitted to the intensive care unit (ICU), seven (8%) of whom required endotracheal intubation and mechanical ventilation; no deaths occurred. In addition, ICU health care providers experienced symptoms of secondary exposure. The National Institute for Occupational Safety and Health's Emergency Responder Health Monitoring and Surveillance Program has specific recommendations and tools to protect responders during all phases of a response (2). Hospitals also need to review institutional policies and procedures for chemical mass casualty events, including decontamination (3). Prompt and correct identification of hazardous material (hazmat) events, and clear communication among responding entities, including on-scene and hospital responders, is important to ensure effective response after a chemical release. |
Occupational patterns in unintentional and undetermined drug-involved and opioid-involved overdose deaths - United States, 2007-2012
Harduar Morano L , Steege AL , Luckhaupt SE . MMWR Morb Mortal Wkly Rep 2018 67 (33) 925-930 The opioid epidemic affects multiple segments of the U.S. population (1). Occupational patterns might be critical to understanding the epidemic. Opioids are often prescribed for specific types of work-related injuries, which vary by occupation* (2). CDC used mortality data from the National Occupational Mortality Surveillance (NOMS) system to examine unintentional or undetermined drug overdose mortality within 26 occupation groups. This study included data from the 21 U.S. states participating in NOMS during 2007-2012.(dagger) Drug overdose mortality was compared with total mortality using proportional mortality ratios (PMRs) indirectly standardized for age, sex, race, year, and state. Mortality patterns specific to opioid-related overdose deaths were also assessed. Construction occupations had the highest PMRs for drug overdose deaths and for both heroin-related and prescription opioid-related overdose deaths. The occupation groups with the highest PMRs from methadone, natural and semisynthetic opioids, and synthetic opioids other than methadone were construction, extraction (e.g., mining, oil and gas extraction), and health care practitioners. The workplace is an integral part of life for the majority of the adult U.S. population; incorporating workplace research and interventions likely will benefit the opioid epidemic response. |
Fatal work-related injuries: southeastern United States, 2008-2011
Brinker K , Jacobs T , Shire J , Bunn T , Chalmers J , Dang G , Flammia D , Higgins S , Lackovic M , Lavender A , Lewis JS , Li Y , Harduar Morano L , Porter A , Rauscher K , Slavova S , Watkins S , Zhang L , Funk R . Workplace Health Saf 2015 64 (4) 135-40 In 2008, the work-related injury fatality rate was 3.8 per 100,000 workers in the United States but was 5.2 per 100,000 workers for the southeast region. Work-related fatalities in the southeast were examined for the period 2008 to 2011. Median work-related injury fatality rates are reported for the southeast region, each of the 12 states, and the United States. The percentages of employees in high fatality industries and work-related fatalities by cause were calculated. Finally, the Occupational Safety and Health Administration's database was searched for fatality reports. States with the highest rates (per 100,000 workers) included Arkansas (7.2), Louisiana (6.8), and West Virginia (6.6). Arkansas, Louisiana, Mississippi, and West Virginia each had more than 20% of their employees in high fatality industries. Forty percent of work-related injury fatalities were from transportation incidents in the southeast and the United States. Future analyses should include work-related injury fatality rates by industry and compare rates with other U.S. regions. |
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