Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
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Query Trace: Meiman J [original query] |
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Impact of Epidemic Intelligence Service training in occupational respiratory epidemiology
Tomasi SE , Fechter-Leggett ED , Materna BL , Meiman JG , Nett RJ , Cummings KJ . ATS Sch 2023 4 (4) [Epub ahead of print] The Centers for Disease Control and Prevention's Epidemic Intelligence Service (EIS)is a fellowship in applied epidemiology for physicians, veterinarians, nurses, scientists, and other health professionals. Each EIS fellow is assigned to a position at a federal, state, or local site for 2 years of on-the-job training in outbreak investigation, epidemiologic research, surveillance system evaluation, and scientific communication. Although the original focus of the program on the control of infectious diseases remains salient, positions are available for training in other areas of public health, including occupational respiratory disease. In this Perspective, we describe the EIS program, highlight three positions (one federal and two state-based) that provide training in occupational respiratory epidemiology, and summarize trainees' experiences in these positions over a30-year period. For early-career health professionals interested in understanding and preventing occupational respiratory hazards and diseases, EIS offers a unique career development opportunity. |
Description of Kratom Exposure Events in Wisconsin as Reported to the Wisconsin Poison Center - January 1, 2010-September 1, 2022 (preprint)
DeJonge P , Gummin D , Titelbaum N , Meiman J . medRxiv 2023 05 Background: Consumption of kratom (Mitragyna speciosa), an herbal substance, can result in adverse health effects. We characterized kratom-associated adverse events in Wisconsin to provide pertinent recommendations for clinicians and public health practitioners. Method(s): Using Wisconsin Poison Center (WPC) data, we searched for and summarized all records associated with exposure to "kratom", "electronic delivery device containing kratom", or "mitragyna" during January 1, 2010-September 1, 2022. Result(s): Kratom-associated exposure calls to WPC increased 3.75 times during 2016-2020. Among all 59 calls, 26 (44.1%) reported concomitant use of another substance, agitation was the most common symptom reported (23, 39%), and 7 persons required critical care. Three unintentional ingestions were reported in infants aged <2 years. Discussion(s): Kratom-associated exposure calls to WPC have been generally increasing in frequency since 2011. Wisconsinites who choose to use kratom might benefit from education regarding health risks and safe storage practices to avoid unintentional pediatric exposure. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
SARS-CoV-2 transmission in intercollegiate athletics not fully mitigated with daily antigen testing (preprint)
Moreno GK , Braun KM , Pray IW , Segaloff HE , Lim A , Poulson K , Meiman J , Borcher J , Westergaard RP , Moll MK , Friedrich TC , O'Connor DH . medRxiv 2021 BACKGROUND: High frequency, rapid turnaround SARS-CoV-2 testing continues to be proposed as a way of efficiently identifying and mitigating transmission in congregate settings. However, two SARS-CoV-2 outbreaks occurred among intercollegiate university athletic programs during the fall 2020 semester despite mandatory directly observed daily antigen testing. METHODS: During the fall 2020 semester, athletes and staff in both programs were tested daily using Quidel's Sofia SARS Antigen Fluorescent Immunoassay (FIA), with positive antigen results requiring confirmatory testing with real-time reverse transcription polymerase chain reaction (RT-PCR). We used genomic sequencing to investigate transmission dynamics in these two outbreaks. RESULTS: In Outbreak 1, 32 confirmed cases occurred within a university athletics program after the index patient attended a meeting while infectious despite a negative antigen test on the day of the meeting. Among isolates sequenced from Outbreak 1, 24 (92%) of 26 were closely related, suggesting sustained transmission following an initial introduction event. In Outbreak 2, 12 confirmed cases occurred among athletes from two university programs that faced each other in an athletic competition despite receiving negative antigen test results on the day of the competition. Sequences from both teams were closely related and unique from strains circulating in the community, suggesting transmission during intercollegiate competition. CONCLUSIONS: These findings suggest that antigen testing alone, even when mandated and directly observed, may not be sufficient as an intervention to prevent SARS-CoV-2 outbreaks in congregate settings, and highlights the importance of supplementing serial antigen testing with appropriate mitigation strategies to prevent SARS-CoV-2 outbreak in congregate settings. SUMMARY: High frequency, rapid turnaround SARS-CoV-2 testing continues to be proposed as a way of efficiently identifying and mitigating transmission in congregate settings. However, here we describe two SARS-CoV-2 outbreaks occurred among intercollegiate university athletic programs during the fall 2020 semester. |
Description of kratom exposure events in Wisconsin as reported to the Wisconsin Poison Center, January 1, 2010 to September 1, 2022
DeJonge P , Gummin D , Titelbaum N , Meiman J . WMJ 2023 122 (3) 187-190 BACKGROUND: Consumption of kratom (Mitragyna speciosa), an herbal substance, can result in adverse health effects. We characterized kratom-associated adverse events in Wisconsin to provide pertinent recommendations for clinicians and public health practitioners. METHODS: Using Wisconsin Poison Center data, we searched for and summarized all records associated with exposure to "kratom," "electronic delivery device containing kratom," or "mitragyna" from January 1, 2010, to September 1, 2022. RESULTS: Kratom-associated exposure calls to the Wisconsin Poison Center increased 3.75 times during 2016 - 2020. Among all 59 calls, 26 (44.1%) reported concomitant use of another substance, agitation was the most common symptom reported (n = 23, 39%), and 7 persons required critical care. Three unintentional ingestions were reported in children aged less than 2 years old. DISCUSSION: Kratom-associated exposure calls to the Wisconsin Poison Center generally have been increasing in frequency since 2011. Wisconsinites who choose to use kratom might benefit from education regarding health risks and safe storage practices to avoid unintentional pediatric exposure. |
Pulmonary Illness Related to E-Cigarette Use. Reply
Layden JE , King BA , Meiman J . N Engl J Med 2020 382 (4) 386 Diaz et al. highlight the potential for severe airway reactivity and perioperative challenges when performing bronchoscopy and BAL in patients with EVALI, and Russell and Cevik stress the importance of ruling out infectious causes in these patients. These two points reflect the complexities of evaluating patients with EVALI and managing their care. Recent Centers for Disease Control and Prevention clinical guidance emphasizes that the decision to perform a bronchoscopy and BAL should be made on a case-by-case basis and in consultation with pulmonary specialists.1 Many patients with EVALI have required intubation and mechanical ventilation, and consultation with critical care specialists is also recommended. |
School District Prevention Policies and Risk of COVID-19 Among In-Person K-12 Educators, Wisconsin, 2021.
DeJonge PM , Pray IW , Gangnon R , McCoy K , Tomasallo C , Meiman J . Am J Public Health 2022 112 (12) 1791-1799 Objectives. To assess the rate of COVID-19 among in-person K-12 educators and the rate's association with various COVID-19 prevention policies in school districts. Methods. We linked actively working, in-person K-12 educators in Wisconsin to COVID-19 cases with onset from September 2 to November 24, 2021. A mixed-effects Cox proportional hazards model, adjusted for pertinent person- and community-level confounders, compared the hazard rate of COVID-19 among educators working in districts with and without specific COVID-19 prevention policies. Results. In-person educators working in school districts that required masking for students and staff experienced 19% lower hazards of COVID-19 than did those in districts without any masking policy (hazard ratio = 0.81; 95% confidence interval = 0.72, 0.92). Reduced COVID-19 hazards were consistent and remained statistically significant when educators were stratified by elementary, middle, and high school environments. Conclusions. In Wisconsin's K-12 school districts, during the fall 2021 academic semester, a policy that required both students and staff to mask was associated with significantly reduced risk of COVID-19 among in-person educators across all grade levels. (Am J Public Health. 2022;112(12):1791-1799. https://doi.org/10.2105/AJPH.2022.307095). |
Lost time: COVID-19 indemnity claim reporting and results in the Wisconsin workers' compensation system from March 12 to December 31, 2020.
Modji KKS , Morris CR , Creswell PD , McCoy K , Aiello T , Grajewski B , Tomasallo CD , Pray I , Meiman JG . Am J Ind Med 2022 65 (12) 1006-1021 BACKGROUND: The COVID-19 pandemic introduced a new compensable infectious disease to workplaces. METHODS: This was a descriptive analysis of Wisconsin COVID workers' compensation (WC) claims between March 12 and December 31, 2020. The impact of the presumption law (March 12 to June 10, 2020) was also evaluated. RESULTS: Less than 1% of working-age residents with COVID-19 filed a claim. COVID-19 WC claim rates (per 100,000 FTE) were notably low for frontline industry sectors such as Retail Trade (n = 115), Manufacturing (n = 88), and Wholesale Trade (n = 31). Healthcare workers (764 claims per 100,000 FTE) comprised 73.2% of COVID-19 claims. Most claims (52.8%) were denied and the proportion of denied claims increased significantly after the presumption period for both first responders and other occupations. CONCLUSION: The presumption law made benefits accessible primarily to first responders. Further changes to WC systems are needed to offset the individual and collective costs of infectious diseases. |
Measuring work-related risk of COVID-19: comparison of COVID-19 incidence by occupation and industry - Wisconsin, September 2020-May 2021.
Pray IW , Grajewski B , Morris C , Modji K , DeJonge P , McCoy K , Tomasallo C , DeSalvo T , Westergaard RP , Meiman J . Clin Infect Dis 2022 76 (3) e163-e171 BACKGROUND: Work-related exposures play an important role in SARS-CoV-2 transmission, yet few studies have measured the risk of COVID-19 across occupations and industries. METHODS: During September 2020 - May 2021, the Wisconsin Department of Health Services collected occupation and industry data as part of routine COVID-19 case investigations. Adults aged 18-64 years with confirmed or probable COVID-19 in Wisconsin were assigned standardized occupation and industry codes. Cumulative incidence rates were weighted for non-response and calculated using full-time equivalent (FTE) workforce denominators from the 2020 American Community Survey. RESULTS: An estimated 11.6% of workers (347,013 of 2.98 million) in Wisconsin, ages 18-64 years, had COVID-19 from September 2020 to May 2021. The highest incidence by occupation (per 100 full-time equivalents) occurred among personal care and services workers (22.4), healthcare practitioners and support staff (20.7), and protective services workers (20.7). High risk sub-groups included nursing assistants and personal care aides (28.8), childcare workers (25.8), food and beverage service workers (25.3), personal appearance workers (24.4), and law enforcement workers (24.1). By industry, incidence was highest in healthcare (18.6); the highest risk sub-sectors were nursing care facilities (30.5) and warehousing (28.5). CONCLUSIONS: This analysis represents one of the most complete examinations to date of COVID-19 incidence by occupation and industry. Our approach demonstrates the value of standardized occupational data collection by public health, and may be a model for improved occupational surveillance elsewhere. Workers at higher risk of SARS-CoV-2 exposure may benefit from targeted workplace COVID-19 vaccination and mitigation efforts. |
SARS-CoV-2 Wastewater Surveillance for Public Health Action.
McClary-Gutierrez JS , Mattioli MC , Marcenac P , Silverman AI , Boehm AB , Bibby K , Balliet M , de Los Reyes FL 3rd , Gerrity D , Griffith JF , Holden PA , Katehis D , Kester G , LaCross N , Lipp EK , Meiman J , Noble RT , Brossard D , McLellan SL . Emerg Infect Dis 2021 27 (9) 1-8 Wastewater surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has garnered extensive public attention during the coronavirus disease pandemic as a proposed complement to existing disease surveillance systems. Over the past year, methods for detection and quantification of SARS-CoV-2 viral RNA in untreated sewage have advanced, and concentrations in wastewater have been shown to correlate with trends in reported cases. Despite the promise of wastewater surveillance, for these measurements to translate into useful public health tools, bridging the communication and knowledge gaps between researchers and public health responders is needed. We describe the key uses, barriers, and applicability of SARS-CoV-2 wastewater surveillance for supporting public health decisions and actions, including establishing ethics consideration for monitoring. Although wastewater surveillance to assess community infections is not a new idea, the coronavirus disease pandemic might be the initiating event to make this emerging public health tool a sustainable nationwide surveillance system, provided that these barriers are addressed. |
Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in Intercollegiate Athletics Not Fully Mitigated With Daily Antigen Testing.
Moreno GK , Braun KM , Pray IW , Segaloff HE , Lim A , Poulsen K , Meiman J , Borcher J , Westergaard RP , Moll MK , Friedrich TC , O'Connor DH . Clin Infect Dis 2021 73 S45-S53 BACKGROUND: High-frequency, rapid-turnaround SARS-CoV-2 testing continues to be proposed as a way of efficiently identifying and mitigating transmission in congregate settings. However, two SARS-CoV-2 outbreaks occurred among intercollegiate university athletic programs during the fall 2020 semester despite mandatory directly observed daily antigen testing. METHODS: During the fall 2020 semester, athletes and staff in both programs were tested daily using Quidel's Sofia SARS Antigen Fluorescent Immunoassay (FIA), with positive antigen results requiring confirmatory testing with real-time reverse transcription polymerase chain reaction (RT-PCR). We used genomic sequencing to investigate transmission dynamics in these two outbreaks. RESULTS: In Outbreak 1, 32 confirmed cases occurred within a university athletics program after the index patient attended a meeting while infectious despite a negative antigen test on the day of the meeting. Among isolates sequenced from Outbreak 1, 24 (92%) of 26 were closely related, suggesting sustained transmission following an initial introduction event. In Outbreak 2, 12 confirmed cases occurred among athletes from two university programs that faced each other in an athletic competition despite receiving negative antigen test results on the day of the competition. Sequences from both teams were closely related and distinct from viruses circulating in Team 1's community, suggesting transmission during intercollegiate competition in Team 2's community. CONCLUSIONS: These findings suggest that antigen testing alone, even when mandated and directly observed, may not be sufficient as an intervention to prevent SARS-CoV-2 outbreaks in congregate settings, and highlight the importance of supplementing serial antigen testing with appropriate mitigation strategies to prevent SARS-CoV-2 outbreak in congregate settings. |
The biomonitoring of Great Lakes populations-iii program: The Milwaukee Angler Project
Li Z , Serio T , Meiman J , He X , Ragin-Wilson A . J Environ Health 2021 83 (6) 40-43 The Great Lakes ecosystem has been contaminated by industrial, agricultural, and other | human activities. Both Canada and the U.S. | have been mitigating this historical contamination across the Great Lakes. Particularly, | the U.S. established the Great Lakes Restoration Initiative (GLRI) in 2009 to accelerate | and coordinate efforts to protect and restore | the Great Lakes region. GLRI provided funds | to the Agency for Toxic Substances and | Disease Registry (ATSDR) to establish the | Biomonitoring of Great Lakes Populations | (BGLP) Programs in 2010. In these programs, ATSDR and state health departments | conducted a series of cross-sectional studies | to assess body burden levels of legacy and | emerging contaminants among populations | with potential high exposure in the Great | Lakes region. The programs also aimed to | use biomonitoring data to inform and guide | public health actions to protect Great Lakes | populations from harmful exposure (Wattigney et al., 2017; Wattigney, Irvin-Barnwell, | Li, Davis, et al., 2019). |
Trends in Outbreak-Associated Cases of COVID-19 - Wisconsin, March-November 2020.
Pray IW , Kocharian A , Mason J , Westergaard R , Meiman J . MMWR Morb Mortal Wkly Rep 2021 70 (4) 114-117 During September 3-November 16, 2020, daily confirmed cases of coronavirus disease 2019 (COVID-19) reported to the Wisconsin Department of Health Services (WDHS) increased at a rate of 24% per week, from a 7-day average of 674 (August 28-September 3) to 6,426 (November 10-16) (1). The growth rate during this interval was the highest to date in Wisconsin and among the highest in the United States during that time (1). To characterize potential sources of this increase, the investigation examined reported outbreaks in Wisconsin that occurred during March 4-November 16, 2020, with respect to their setting and number of associated COVID-19 cases. |
E-cigarette, or vaping, product use-associated lung injury among clusters of patients reporting shared product use - Wisconsin, 2019
Pray IW , Atti SK , Tomasallo C , Meiman JG . MMWR Morb Mortal Wkly Rep 2020 69 (9) 236-240 On July 10, 2019, Wisconsin Department of Health Services (WDHS) was notified of five previously healthy adolescents with severe lung injuries who reported use of e-cigarette, or vaping, products before symptom onset. As of December 31, 2019, 105 confirmed or probable cases of e-cigarette, or vaping, product use-associated lung injury (EVALI)* had been reported to WDHS . Three social clusters (A, B, and C), comprising eight EVALI patients (cluster A = two patients, cluster B = three, and cluster C = three) were identified. WDHS investigated these clusters with standard and follow-up interviews; laboratory analysis of e-cigarette, or vaping, products; and analysis of bronchoalveolar lavage (BAL) fluid. All eight patients reported daily use of tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, product cartridges (THC cartridges) in the month preceding symptom onset. All THC cartridges were purchased from local illicit dealers, and all patients reported using THC cartridges labeled as "Dank Vapes," among other illicit brand names. At least two members of each cluster reported frequent sharing of THC cartridges before symptom onset. All eight patients also reported daily use of nicotine-containing e-cigarette, or vaping, products. Vitamin E acetate (VEA) was detected in all five THC cartridges tested from two patients, and in BAL fluid from two other patients. These findings suggest that THC cartridges containing VEA and sold on the illicit market were likely responsible for these small clusters of EVALI. Based on information presented in this and previous reports (1,2) CDC recommends not using THC-containing e-cigarette, or vaping, products, especially those obtained from informal sources such as friends, family, or in-person or online dealers (1). VEA is strongly linked to the EVALI outbreak and should not be added to e-cigarette, or vaping, products (1). |
E-cigarette product use, or vaping, among persons with associated lung injury - Illinois and Wisconsin, April-September 2019
Ghinai I , Pray IW , Navon L , O'Laughlin K , Saathoff-Huber L , Hoots B , Kimball A , Tenforde MW , Chevinsky JR , Layer M , Ezike N , Meiman J , Layden JE . MMWR Morb Mortal Wkly Rep 2019 68 (39) 865-869 In July 2019, the Illinois Department of Public Health and the Wisconsin Department of Health Services launched a coordinated epidemiologic investigation after receiving reports of several cases of lung injury in previously healthy persons who reported electronic cigarette (e-cigarette) use, or vaping (1). This report describes features of e-cigarette product use by patients in Illinois and Wisconsin. Detailed patient interviews were conducted by telephone, in person, or via the Internet with 86 (68%) of 127 patients. Overall, 75 (87%) of 86 interviewed patients reported using e-cigarette products containing tetrahydrocannabinol (THC), and 61 (71%) reported using nicotine-containing products. Numerous products and brand names were identified by patients. Nearly all (96%) THC-containing products reported were packaged, prefilled cartridges, and 89% were primarily acquired from informal sources (e.g., friends, family members, illicit dealers, or off the street). In contrast, 77% of nicotine-containing products were sold as prefilled cartridges, and 83% were obtained from commercial vendors. The precise source of this outbreak is currently unknown (2); however, the predominant use of prefilled THC-containing cartridges among patients with lung injury associated with e-cigarette use suggests that they play an important role. While this investigation is ongoing, CDC recommends that persons consider refraining from using e-cigarette, or vaping, products, particularly those containing THC. Given the diversity of products reported and frequency of patients using both THC- and nicotine-containing e-cigarette products, additional methods such as product testing and traceback could help identify the specific cause of this outbreak. |
Pulmonary illness related to e-cigarette use in Illinois and Wisconsin - preliminary report
Layden JE , Ghinai I , Pray I , Kimball A , Layer M , Tenforde M , Navon L , Hoots B , Salvatore PP , Elderbrook M , Haupt T , Kanne J , Patel MT , Saathoff-Huber L , King BA , Schier JG , Mikosz CA , Meiman J . N Engl J Med 2019 382 (10) 903-916 BACKGROUND: E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of pulmonary disease associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation. METHODS: We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools. RESULTS: There were 53 case patients, 83% of whom were male; the median age of the patients was 19 years. The majority of patients presented with respiratory symptoms (98%), gastrointestinal symptoms (81%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging (which was part of the case definition). A total of 94% of the patients were hospitalized, 32% underwent intubation and mechanical ventilation, and one death was reported. A total of 84% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018. CONCLUSIONS: Case patients presented with similar clinical characteristics. Although the features of e-cigarette use that were responsible for injury have not been identified, this cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes. |
Severe pulmonary disease associated with electronic-cigarette-product use - interim guidance
Schier JG , Meiman JG , Layden J , Mikosz CA , VanFrank B , King BA , Salvatore PP , Weissman DN , Thomas J , Melstrom PC , Baldwin GT , Parker EM , Courtney-Long EA , Krishnasamy VP , Pickens CM , Evans ME , Tsay SV , Powell KM , Kiernan EA , Marynak KL , Adjemian J , Holton K , Armour BS , England LJ , Briss PA , Houry D , Hacker KA , Reagan-Steiner S , Zaki S , Meaney-Delman D . MMWR Morb Mortal Wkly Rep 2019 68 (36) 787-790 On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available. |
Notes from the Field: Occupational carbon monoxide exposure in an industrial kitchen facility - Wisconsin, 2017
Wilson E , Tomasallo C , Meiman J . MMWR Morb Mortal Wkly Rep 2018 67 (28) 786 On September 6, 2017, the Wisconsin Poison Center was contacted by emergency department (ED) health care providers at two hospitals who requested consultation for management of multiple patients with occupational carbon monoxide (CO) exposure. CO is an odorless, colorless gas that kills approximately 400 persons annually in the United States (1). The Wisconsin Division of Public Health received a surveillance alert from the Wisconsin Poison Center and launched an investigation to characterize the exposures and provide public health recommendations. The Wisconsin Division of Public Health conducted key informant interviews with emergency responders and reviewed ED medical records. |
Occupational mercury exposure at a fluorescent lamp recycling facility - Wisconsin, 2017
Wilson E , Lafferty JS , Thiboldeaux R , Tomasallo C , Grajewski B , Wozniak R , Meiman J . MMWR Morb Mortal Wkly Rep 2018 67 (27) 763-766 On May 9, 2017, Public Health Madison & Dane County contacted the Wisconsin Division of Public Health for assistance with investigation of mercury exposure among workers at a fluorescent lamp recycling facility. Public Health Madison & Dane County had been contacted by the Wisconsin Department of Natural Resources as part of an investigation of potential environmental contamination at the facility. Fluorescent lamps are composed of a phosphor-coated glass tube containing mercury vapor and argon. During the recycling process, lamps are crushed, releasing mercury vapor and mercury-containing dusts. State and county health officials, in collaboration with Wisconsin Department of Natural Resources, conducted an investigation of mercury exposure of workers and an environmental assessment of the facility, surrounding areas, and worker vehicles. All five workers who were tested had urine mercury levels exceeding the American Conference of Governmental Industrial Hygienists (ACGIH) biologic exposure index of 20.0 mug/g creatinine, and two had tremor on physical exam. Workers wore inadequate personal protective equipment (PPE). Mercury levels in indoor air varied within the building, with a maximum of 207.4 mug/m(3) at floor level on the crushing platform, approximately eightfold higher than the ACGIH threshold limit value of 25 mug/m(3) (1). Mercury also was found in workers' vehicles, indicating risk for take-home exposure. Workers at risk for mercury exposure need to have access to and consistently wear National Institute of Occupational Safety and Health (NIOSH)-approved respiratory protection for mercury vapor, nitrile or other suitable gloves to prevent contact exposure, and disposable suits with booties and change shoes before leaving the worksite to prevent take-home exposures. |
Lead exposure among workers at a shipyard - Wisconsin, 2015-2016
Weiss D , Baertlein LA , Yendell SJ , Christensen KY , Tomasallo CD , Creswell PD , Camponeschi JL , Meiman JG , Anderson HA . J Occup Environ Med 2018 60 (10) 928-935 OBJECTIVE: In March 2016, the state health departments of Wisconsin and Minnesota learned of three shipyard workers with blood lead levels (BLLs) >40 mug/dL. An investigation was conducted to determine the extent of and risk factors for the exposure. METHODS: We defined a case as an elevated BLL >/=5 mug/dL in a shipyard worker. Workers were interviewed regarding their symptoms and personal protective equipment (PPE) use. RESULTS: Of 357 workers, 65.0% had received >/=1 BLL test. Among tested workers, 171 (73.7%) had BLLmax >/=5 mug/dL. Workers who received respirator training or fit testing had a median BLLmax of 18.0 mug/dL, similar to the median BLLmax of workers who did not receive such training (22.6 mug/dL, P = 0.20). CONCLUSIONS: Our findings emphasize the importance of adequate provision and use of PPE to prevent occupational lead exposure. |
Elevated blood lead levels associated with retained bullet fragments - United States, 2003-2012
Weiss D , Tomasallo CD , Meiman JG , Alarcon W , Graber NM , Bisgard KM , Anderson HA . MMWR Morb Mortal Wkly Rep 2017 66 (5) 130-133 An estimated 115,000 firearm injuries occur annually in the United States, and approximately 70% are nonfatal. Retained bullet fragments (RBFs) are an infrequently reported, but important, cause of lead toxicity; symptoms are often nonspecific and can appear years after suffering a gunshot wound. Adult blood lead level (BLL) screening is most commonly indicated for monitoring of occupational lead exposure; routine testing of adults with RBFs is infrequent. States collaborate with CDC's National Institute for Occupational Safety and Health (NIOSH) to monitor elevated BLLs through the Adult Blood Lead Epidemiology and Surveillance (ABLES) program. To help assess the public health burden of RBFs, data for persons with BLLs ≥10 mug/dL reported to ABLES during 2003-2012 were analyzed. An RBF-associated case was defined as a BLL ≥10 mug/dL in a person with an RBF. A non-RBF-associated case was defined as a BLL ≥10 mug/dL without an RBF. During 2003-2012, a total of 145,811 persons aged ≥16 years with BLLs ≥10 mug/dL were reported to ABLES in 41 states. Among these, 457 RBF-associated cases were identified with a maximum RBF-associated BLL of 306 mug/dL. RBF-associated cases accounted for 0.3% of all BLLs ≥10 mug/dL and 4.9% of BLLs ≥80 mug/dL. Elevated BLLs associated with RBFs occurred primarily among young adult males in nonoccupational settings. Low levels of suspicion of lead toxicity from RBFs by medical providers might cause a delay in diagnosis. Health care providers should inquire about an RBF as the potential cause for lead toxicity in an adult with an elevated BLL whose lead exposure is undetermined. |
Electronic cigarette exposure: Calls to Wisconsin Poison Control Centers, 2010–2015
Weiss D , Tomasallo CD , Meiman JG , Creswell PD , Melstrom PC , Gummin DD , Patel DJ , Michaud NT , Sebero HA , Anderson HA . WMJ 2016 115 (6) 306-310 Background: E-cigarettes are battery-powered devices that deliver nicotine and flavorings by aerosol and have been marketed in the United States since 2007. Because e-cigarettes have increased in popularity, toxicity potential from device misuse and malfunction also has increased. National data indicate that during 2010–2014, exposure calls to US poison control centers increased only 0.3% for conventional cigarette exposures, whereas calls increased 41.7% for e-cigarette exposures. Methods: We characterized cigarette and e-cigarette exposure calls to the Wisconsin Poison Center January 1, 2010 through October 10, 2015. We compared cigarette and e-cigarette exposure calls by exposure year, demographic characteristics, caller site, exposure site, exposure route, exposure reason, medical outcome, management site, and level of care at a health care facility. Results: During January 2010 to October 2015, a total of 98 e-cigarette exposure calls were reported, and annual exposure calls increased approximately 17-fold, from 2 to 35. During the same period, 671 single-exposure cigarette calls with stable annual call volumes were reported. E-cigarette exposure calls were associated with children aged ≤5 years (57/98, 58.2%) and adults aged ≥20 years (30/98, 30.6%). Cigarette exposure calls predominated among children aged ≤5 years (643/671, 95.8%). Conclusion: The frequency of e-cigarette exposure calls to the Wisconsin Poison Center has increased and is highest among children aged ≤5 years and adults. Strategies are warranted to prevent future poisonings from these devices, including nicotine warning labels and public advisories to keep e-cigarettes away from children. |
Notes from the field: Occupational lead exposures at a shipyard - Douglas County, Wisconsin, 2016
Weiss D , Yendell SJ , Baertlein LA , Christensen KY , Tomasallo CD , Creswell PD , Camponeschi JL , Meiman JG , Anderson HA . MMWR Morb Mortal Wkly Rep 2017 66 (1) 34 On March 28, 2016, the Minnesota Poison Control System was consulted by an emergency department provider regarding clinical management of a shipyard worker with a blood lead level (BLL) >60 μg/dL; the National Institute for Occupational Safety and Health defines elevated BLLs as ≥5 μg/dL (1). The Minnesota Poison Control System notified the Minnesota Department of Health (MDH). Concurrently, the Wisconsin Department of Health Services (WDHS) received laboratory reports concerning two workers from the same shipyard with BLLs >40 μg/dL. These three workers had been retrofitting the engine room of a 690-foot vessel since January 4, 2016. | Work was suspended during March 29–April 4 in the vessel’s engine room, the presumptive primary source of lead exposure. On March 29, the shipyard partnered with a local occupational health clinic to provide testing for workers. Employees and their household members were also tested by general practitioners and local laboratories. The shipyard hired sanitation crews for lead clean-up and abatement and provided personal protective equipment for its employees. On April 1, WDHS and MDH issued advisories to alert regional health care organizations, local public health agencies, and tribal health departments to the situation and launched a joint investigation on April 4. Subsequently, WDHS activated its Incident Command System and worked with MDH to compile a list of potentially exposed workers. By August 31, a total of 357 workers who might have been employed at the shipyard during December 2015–March 2016 had been identified. | During April–July 2016, WDHS and MDH attempted telephone interviews with workers. The goal of the interviews was to gather information regarding employment history, work tasks, personal exposure prevention, symptoms commonly associated with lead exposures, and take-home contamination prevention and household composition and to convey health messages. |
Risk factors for primary Middle East respiratory syndrome coronavirus illness in humans, Saudi Arabia, 2014
Alraddadi BM , Watson JT , Almarashi A , Abedi GR , Turkistani A , Sadran M , Housa A , Almazroa MA , Alraihan N , Banjar A , Albalawi E , Alhindi H , Choudhry AJ , Meiman JG , Paczkowski M , Curns A , Mounts A , Feikin DR , Marano N , Swerdlow DL , Gerber SI , Hajjeh R , Madani TA . Emerg Infect Dis 2016 22 (1) 49-55 Risk factors for primary Middle East respiratory syndrome coronavirus (MERS-CoV) illness in humans are incompletely understood. We identified all primary MERS-CoV cases reported in Saudi Arabia during March-November 2014 by excluding those with history of exposure to other cases of MERS-CoV or acute respiratory illness of unknown cause or exposure to healthcare settings within 14 days before illness onset. Using a case-control design, we assessed differences in underlying medical conditions and environmental exposures among primary case-patients and 2-4 controls matched by age, sex, and neighborhood. Using multivariable analysis, we found that direct exposure to dromedary camels during the 2 weeks before illness onset, as well as diabetes mellitus, heart disease, and smoking, were each independently associated with MERS-CoV illness. Further investigation is needed to better understand animal-to-human transmission of MERS-CoV. |
Exposure to elevated carbon monoxide levels at an indoor ice arena - Wisconsin, 2014
Creswell PD , Meiman JG , Nehls-Lowe H , Vogt C , Wozniak RJ , Werner MA , Anderson H . MMWR Morb Mortal Wkly Rep 2015 64 (45) 1267-70 On December 13, 2014, the emergency management system in Lake Delton, Wisconsin, was notified when a male hockey player aged 20 years lost consciousness after participation in an indoor hockey tournament that included approximately 50 hockey players and 100 other attendees. Elevated levels of carbon monoxide (CO) (range = 45 ppm-165 ppm) were detected by the fire department inside the arena. The emergency management system encouraged all players and attendees to seek medical evaluation for possible CO poisoning. The Wisconsin Department of Health Services (WDHS) conducted an epidemiologic investigation to determine what caused the exposure and to recommend preventive strategies. Investigators abstracted medical records from area emergency departments (EDs) for patients who sought care for CO exposure during December 13-14, 2014, conducted a follow-up survey of ED patients approximately 2 months after the event, and conducted informant interviews. Ninety-two persons sought ED evaluation for possible CO exposure, all of whom were tested for CO poisoning. Seventy-four (80%) patients had blood carboxyhemoglobin (COHb) levels consistent with CO poisoning (1); 32 (43%) CO poisoning cases were among hockey players. On December 15, the CO emissions from the propane-fueled ice resurfacer were demonstrated to be 4.8% of total emissions when actively resurfacing and 2.3% when idling, both above the optimal range of 0.5%-1.0% (2,3). Incomplete fuel combustion by the ice resurfacer was the most likely source of elevated CO. CO poisonings in ice arenas can be prevented through regular maintenance of ice resurfacers, installation of CO detectors, and provision of adequate ventilation. |
Lead poisoning and anemia associated with use of Ayurvedic medications purchased on the internet - Wisconsin, 2015
Meiman J , Thiboldeaux R , Anderson H . MMWR Morb Mortal Wkly Rep 2015 64 (32) 883 On April 30, 2015, the Wisconsin Division of Public Health (WDPH) was notified by a local health department of an elevated blood lead level (BLL) in a female patient aged 64 years. All Wisconsin laboratories are required to provide BLL testing results performed on any state resident to WDPH, and WDPH and local health departments are statutorily mandated to investigate any single BLL ≥20 microg/dL or BLLs that are persistently ≥15 microg/dL. Review of medical records revealed that the patient had developed progressive fatigue and shortness of breath during a period of multiple weeks that prompted inpatient medical evaluation. Hemoglobin level was 8.3 g/dL (normal range for age and sex of patient = 12.5-15.0 g/dL), and peripheral blood smear showed normochromic, normocytic red blood cells with basophilic stippling. A BLL was obtained and found to be 85.8 microg/dL. Urine toxic metals tests revealed mercury and aluminum levels in the normal range. Combined methylated and inorganic urine arsenic levels were slightly elevated at 53.3 microg/L (normal = <18.9 microg/L). The patient was discharged for outpatient lead chelation therapy with oral meso-2,3-dimercaptosuccinic acid. |
Trends and characteristics of heroin overdoses in Wisconsin, 2003-2012
Meiman J , Tomasallo C , Paulozzi L . Drug Alcohol Depend 2015 152 177-84 BACKGROUND: Heroin abuse has increased substantially during the past decade in the United States. This study describes trends and demographic shifts of heroin overdoses and heroin-related fatalities in Wisconsin and contrasts these with prescription opioid overdoses. METHODS: This study was cross-sectional using databases of emergency department (ED) visits, hospital admissions, and death certificates in Wisconsin, United States, during 2003-2012. Cases were Wisconsin residents treated for heroin or prescription opioid overdose, and residents who died of heroin-related drug poisoning. Primary measurements were rates over time and by geographic region, and rates and rate ratios for selected demographic characteristics. RESULTS: During 2003-2012, age-adjusted rates of heroin overdoses treated in EDs increased from 1.0 to 7.9/100,000 persons; hospitalized heroin overdoses increased from 0.7 to 3.5/100,000. Whites accounted for 68% of hospitalized heroin overdoses during 2003-2007 but 80% during 2008-2012. Heroin-related deaths were predominantly among urban residents; however, rural fatalities accounted for zero deaths in 2003 but 31 (17%) deaths in 2012. Among patients aged 18-34 years, those hospitalized with heroin overdose were more often men (73.0% versus 54.9%), uninsured (44.2% versus 29.9%), and urban (84.3% versus 73.2%) than those with prescription opioid overdose. Rates of ED visits for heroin overdose in this age group exceeded rates for prescription opioid overdose in 2012 (26.1/100,000 versus 12.6/100,000 persons, respectively). CONCLUSIONS: An epidemic of heroin abuse is characterized by demographic shifts toward whites and rural residents. Rates of heroin overdose in younger persons now exceed rates of prescription opioid overdose. |
Hypothermia-related deaths - Wisconsin, 2014, and United States, 2003-2013
Meiman J , Anderson H , Tomasallo C . MMWR Morb Mortal Wkly Rep 2015 64 (6) 141-3 Hypothermia is defined as a core body temperature of <95 degrees F (<35 degrees C) and is caused by environmental exposure, drug intoxication, or metabolic or nervous system dysfunction. Exposure to cold is a leading cause of weather-related mortality and is responsible for approximately twice the number of deaths annually as exposure to heat in the United States. To understand the risk factors for hypothermia-related death and improve prevention efforts, during January 1-April 30, 2014, a period of record low temperatures, the Wisconsin Division of Public Health began active surveillance for hypothermia. Suspected hypothermia-related deaths were reported by coroners or medical examiners and identified in death records. Hypothermia was confirmed as the cause of death by review of death investigation narratives. This report describes three selected cases of hypothermia-related deaths in Wisconsin and summarizes characteristics of all cases that occurred in the state during the period of active surveillance. A summary of hypothermia-related deaths for the United States during 2003-2013 also is presented for comparison and to assess national mortality trends. Hypothermia continues to be an important cause of weather-related death. Key risk factors include drug intoxication, mental illness, and social isolation. State and local health agencies might need to focus outreach on vulnerable populations and target interventions for groups at highest risk for death. |
Notes from the field: update on Lyme carditis, groups at high risk, and frequency of associated sudden cardiac death - United States
Forrester JD , Meiman J , Mullins J , Nelson R , Ertel SH , Cartter M , Brown CM , Lijewski V , Schiffman E , Neitzel D , Daly ER , Mathewson AA , Howe W , Lowe LA , Kratz NR , Semple S , Backenson PB , White JL , Kurpiel PM , Rockwell R , Waller K , Johnson DH , Steward C , Batten B , Blau D , DeLeon-Carnes M , Drew C , Muehlenbachs A , Ritter J , Sanders J , Zaki SR , Molins C , Schriefer M , Perea A , Kugeler K , Nelson C , Hinckley A , Mead P . MMWR Morb Mortal Wkly Rep 2014 63 (43) 982-983 On December 13, 2013, MMWR published a report describing three cases of sudden cardiac death associated with Lyme carditis. State public health departments and CDC conducted a follow-up investigation to determine 1) whether carditis was disproportionately common among certain demographic groups of patients diagnosed with Lyme disease, 2) the frequency of death among patients diagnosed with Lyme disease and Lyme carditis, and 3) whether any additional deaths potentially attributable to Lyme carditis could be identified. Lyme disease cases are reported to CDC through the Nationally Notifiable Disease Surveillance System; reporting of clinical features, including Lyme carditis, is optional. For surveillance purposes, Lyme carditis is defined as acute second-degree or third-degree atrioventricular conduction block accompanying a diagnosis of Lyme disease. During 2001-2010, a total of 256,373 Lyme disease case reports were submitted to CDC, of which 174,385 (68%) included clinical information. Among these, 1,876 (1.1%) were identified as cases of Lyme carditis. Median age of patients with Lyme carditis was 43 years (range = 1-99 years); 1,209 (65%) of the patients were male, which is disproportionately larger than the male proportion among patients with other clinical manifestations (p<0.001). Of cases with this information available, 69% were diagnosed during the months of June-August, and 42% patients had an accompanying erythema migrans, a characteristic rash. Relative to patients aged 55-59 years, carditis was more common among men aged 20-39 years, women aged 25-29 years, and persons aged ≥75 years. |
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