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.

BACKGROUND: Health risks of using styrene to manufacture windblades for the green energy sector are unknown. METHODS: Using data collected from 355 (73%) current windblade workers and regression analysis, we investigated associations between health outcomes and styrene exposure estimates derived from urinary styrene metabolites. RESULTS: The median current styrene exposure was 53.6 mg/g creatinine (interquartile range: 19.5-94.4). Color blindness in men and women (standardized morbidity ratios 2.3 and 16.6, respectively) was not associated with exposure estimates, but was the type previously reported with styrene. Visual contrast sensitivity decreased and chest tightness increased (odds ratio 2.9) with increasing current exposure. Decreases in spirometric parameters and FeNO, and increases in the odds of wheeze and asthma-like symptoms (odds ratios 1.3 and 1.2, respectively) occurred with increasing cumulative exposure. CONCLUSIONS: Despite styrene exposures below the recommended 400 mg/g creatinine, visual and respiratory effects indicate the need for additional preventative measures in this industry.

Collins and colleagues1 focus on cancer risk in their study of more than 15,000 workers at 30 US reinforced-plastic facilities. Yet their demonstration of excess mortality from nonmalignant respiratory disease warrants further discussion. For this cohort of styrene workers, the standardized mortality ratio (SMR) for “bronchitis, emphysema, and asthma” was elevated at 1.35 (95% confidence interval [CI] = 1.17–1.56). | The authors attribute this excess of deaths to smoking. Certainly, smoking is a recognized contributor to obstructive lung diseases. Furthermore, the observed inverse relationship with employment duration may appear to be inconsistent with an occupational cause of disease. However, previous studies have demonstrated excess mortality from nonmalignant respiratory disease in short-term styrene workers. An earlier examination of this same cohort found excess mortality (SMR = 1.40 [95% CI = 1.04–1.84]) from “other nonmalignant respiratory diseases,” with the highest risk (SMR 1.79) in those with less than 1 year of styrene exposure.2 Similarly, among US fiberglass boat builders employed between 1959 to 1978 and followed to 1998, those with high styrene exposures had elevated mortality (SMR = 2.54 [95% CI = 1.31–4.44]) from “pneumoconioses and other respiratory diseases”; the excess mortality was associated with short (<1 year) employment duration.3 | How could occupational styrene exposure be responsible for an excess of mortality from obstructive lung disease among mostly short-term workers? A recent report of obliterative bronchiolitis in styrene-exposed workers is informative.4 Obliterative bronchiolitis is a disabling lung disease that follows, with short latency, certain inhalational exposures. Obliterative bronchiolitis is likely under-recognized and confused with other obstructive lung diseases. Hence the excess mortality due to “bronchitis, emphysema, and asthma” described by Collins et al may represent not a consequence of smoking but a burden of misdiagnosed obliterative bronchiolitis in workers who were disabled by styrene exposure early in their tenure and thus left employment.