Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-22 (of 22 Records) |
Query Trace: Wilken J[original query] |
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Building local climate health equity into a resilience hub framework
Wilken JA , Huff ME , Baja K , Balbus J . Public Health Rep 2023 333549231210248 The COVID-19 pandemic highlighted the tragic consequences of underlying health disparities in racial and ethnic minority populations and other underresourced and medically underserved populations experiencing social discrimination in the United States.1 A high prevalence of chronic conditions in these communities is largely attributable to differences in multigenerational discrimination, living conditions, and societally mediated stressors, which are often collectively called the social determinants of health (SDOH).2 The co-occurrence of climate change–related extreme weather events during the COVID-19 pandemic starkly illustrated a grim parallel: the same chronic conditions that contribute to the poor health outcomes from COVID-19—namely, diabetes, obesity, hypertension, and cardiovascular and respiratory diseases—are also risk factors for the poor health outcomes resulting from heat waves, wildfires, and other natural disasters.3-8 | The COVID-19 pandemic is one of a spectrum of public health crises whose outcomes are anchored in SDOH.9,10 Effective solutions targeting underlying disparities in SDOH need to be locally designed and managed; indeed, first on the 2021 Presidential COVID-19 Health Equity Task Force’s list of recommendations is to invest in community-led solutions to address health equity with flexible funding options to address the needs of the community.1 What is less well appreciated is that local actions that improve SDOH can simultaneously build climate resilience by reducing disparities in chronic conditions and vulnerability to poor health outcomes from climate-related hazards. Local actions that address SDOH (eg, housing and food security, home environments, safe spaces to gather, social capital, health care access) can provide health benefits that reduce COVID-19–related risks and climate-related risks. |
Coccidioidomycosis outbreak among inmate wildland firefighters: California, 2017
Laws RL , Jain S , Cooksey GS , Mohle-Boetani J , McNary J , Wilken J , Harrison R , Leistikow B , Vugia DJ , Windham GC , Materna BL . Am J Ind Med 2021 64 (4) 266-273 BACKGROUND: In California, state prison inmates are employed to fight wildfires, which involves performing soil-disrupting work. Wildfires have become more common, including areas where Coccidioides, the soil-dwelling fungus that causes coccidioidomycosis, proliferates. However, work practices that place wildland firefighters at risk for coccidioidomycosis have not been investigated. METHODS: On August 17, 2017, the California Department of Public Health was notified of a cluster of coccidioidomycosis cases among Wildfire A inmate wildland firefighters. We collected data through medical record abstraction from suspected case-patients and mailed a survey assessing potential job task risk factors to Wildfire A inmate firefighters. We described respondent characteristics and conducted a retrospective case-control investigation to assess coccidioidomycosis risk factors. RESULTS: Among 198 inmate firefighters who worked on Wildfire A, 112 (57%) completed the survey. Of 10 case-patients (four clinical and six laboratory-confirmed), two were hospitalized. In the case-control analysis of 71 inmate firefighters, frequently cutting fire lines with a McLeod tool (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 1.1-37.2) and being in a dust cloud or storm (OR: 4.3; 95% CI: 1.1-17.4) were associated with illness. Two of 112 inmate firefighters reported receiving coccidioidomycosis training; none reported wearing respiratory protection on this wildfire. CONCLUSIONS: Wildland firefighters who use hand tools and work in dusty conditions where Coccidioides proliferates are at risk for coccidioidomycosis. Agencies that employ them should provide training about coccidioidomycosis and risk reduction, limit dust exposure, and implement respiratory protection programs that specify where respirator use is feasible and appropriate. |
Notes from the Field: E-cigarette, or Vaping, Product Use-Associated Lung Injury Cases During the COVID-19 Response - California, 2020.
Armatas C , Heinzerling A , Wilken JA . MMWR Morb Mortal Wkly Rep 2020 69 (25) 801-802 In April 2020, during the early coronavirus disease 2019 (COVID-19) pandemic, eight patients hospitalized with e-cigarette, or vaping, product use–associated lung injury (EVALI) were reported to the California Department of Public Health (CDPH). Patients resided in five counties and were aged 14–50 years (median = 17 years); seven were aged <21 years. All hospitalizations occurred in April 2020, a median of 4 days (range = 4–13 days) after symptom onset. Four patients were admitted to an intensive care unit; two required mechanical ventilation. Nucleic acid testing for SARS-CoV-2, the virus that causes COVID-19, was performed on all patients at the time of hospitalization; all tests yielded negative results. Seven patients were tested two or more times, and lower respiratory tract specimens were tested from the intubated and mechanically ventilated patients. Patients met California and CDC EVALI case definitions, including negative respiratory pathogen testing and chest imaging findings consistent with EVALI (Box).* Health care providers first documented suspicion for EVALI in their notes on hospital days 1–8 (median = day 3), after testing for SARS-CoV-2 returned negative results. Six patients reported vaping tetrahydrocannabinol (THC)-containing products, one reported vaping only nicotine-containing products, and one did not specify products vaped. Seven patients had positive test results for THC on urine drug screen; one patient not tested by urine drug screen reported vaping THC. No epidemiologic links were identified among the patients. Two patients reported obtaining their vaping products from friends; six patients were not asked or did not disclose vaping product source. Recreational cannabis use is legal in California for adults aged ≥21 years. Products might have been acquired from informal or unlicensed sources by patients aged <21 years who reported THC product use. |
Severe lung injury associated with use of e-cigarette, or vaping, products - California, 2019
Heinzerling A , Armatas C , Karmarkar E , Attfield K , Guo W , Wang Y , Vrdoljak G , Moezzi B , Xu D , Wagner J , Fowles J , Dean C , Cummings KJ , Wilken JA . JAMA Intern Med 2020 180 (6) 861-869 Importance: Since August 2019, more than 2700 patients have been hospitalized with e-cigarette, or vaping, product use-associated lung injury (EVALI) across the United States. This report describes the outbreak in California, a state with one of the highest case counts and with a legal adult-use (recreational) cannabis market. Objective: To present clinical characteristics and vaping product exposures of patients with EVALI in California. Design, Setting, and Participants: Case series describing epidemiologic and laboratory data from 160 hospitalized patients with EVALI reported to the California Department of Public Health by local health departments, who received reports from treating clinicians, from August 7 through November 8, 2019. Exposures: Standardized patient interviews were conducted to assess vaping products used, frequency of use, and method of product acquisition. Vaping products provided by a subset of patients were tested for active ingredients and other substances. Main Outcomes and Measures: Demographic and clinical characteristics, level of care, and outcomes of hospitalization were obtained from medical record review. Results: Among 160 patients with EVALI, 99 (62%) were male, and the median age was 27 years (range, 14-70 years). Of 156 patients with data available, 71 (46%) were admitted to an intensive care unit, and 46 (29%) required mechanical ventilation. Four in-hospital deaths occurred. Of 86 patients interviewed, 71 (83%) reported vaping tetrahydrocannabinol (THC)-containing products, 36 (43%) cannabidiol (CBD)-containing products, and 39 (47%) nicotine-containing products. Sixty-five of 87 (75%) THC-containing products were reported as obtained from informal sources, such as friends, acquaintances, or unlicensed retailers. Of 87 vaping products tested from 24 patients, 49 (56%) contained THC. Vitamin E or vitamin E acetate was found in 41 (84%) of the THC-containing products and no nicotine products. Conclusions and Relevance: Patients' clinical outcomes and vaping behaviors, including predominant use of THC-containing products from informal sources, are similar to those reported by other states, despite California's legal recreational cannabis market. While most THC products tested contained vitamin E or vitamin E acetate, other underlying cause(s) of injury remain possible. The California Department of Public Health recommends that individuals refrain from using any vaping or e-cigarette products, particularly THC-containing products from informal sources, while this investigation is ongoing. |
Occupational coccidioidomycosis surveillance and recent outbreaks in California
de Perio MA , Materna BL , Sondermeyer Cooksey GL , Vugia DJ , Su CP , Luckhaupt SE , McNary J , Wilken JA . Med Mycol 2019 57 S41-s45 Workers in Coccidioides-endemic areas performing soil-disturbing work or exposed to windy and dusty conditions are at increased risk for coccidioidomycosis. Four occupational coccidioidomycosis outbreaks from 2007 to 2014 in California are described, involving construction workers in a number of excavation projects and an outdoor filming event involving cast and crew. These outbreaks highlight the importance of identifying industries and occupations at high risk for coccidioidomycosis, conducting targeted occupational health surveillance to assess the burden of illness, developing and implementing prevention strategies, and setting research priorities. |
Coccidioidomycosis outbreak among workers constructing a solar power farm - Monterey County, California, 2016-2017
Laws RL , Cooksey GS , Jain S , Wilken J , McNary J , Moreno E , Michie K , Mulkerin C , McDowell A , Vugia D , Materna B . MMWR Morb Mortal Wkly Rep 2018 67 (33) 931-934 In January 2017, two local health departments notified the California Department of Public Health (CDPH) of three cases of coccidioidomycosis among workers constructing a solar power installation (solar farm) in southeastern Monterey County. Coccidioidomycosis, or Valley fever, is an infection caused by inhalation of the soil-dwelling fungus Coccidioides, which is endemic in the southwestern United States, including California. After a 1-3 week incubation period, coccidioidomycosis most often causes influenza-like symptoms or pneumonia, but rarely can lead to severe disseminated disease or death (1). Persons living, working, or traveling in areas where Coccidioides is endemic can inhale fungal spores; workers who are performing soil-disturbing activities are particularly at risk. CDPH previously investigated one outbreak among solar farm construction workers that started in 2011 and made recommendations for reducing risk for infection, including worker education, dust suppression, and use of personal protective equipment (2,3). For the current outbreak, the CDPH, in collaboration with Monterey County and San Luis Obispo County public health departments, conducted an investigation that identified nine laboratory-confirmed cases of coccidioidomycosis among 2,410 solar farm employees and calculated a worksite-specific incidence rate that was substantially higher than background county rates, suggesting that illness was work-related. The investigation assessed risk factors for potential occupational exposures to identify methods to prevent further workplace illness. |
Knowledge, attitudes, and practices among members of households actively monitored or quarantined to prevent transmission of Ebola virus disease - Margibi County, Liberia: February-March 2015
Wilken JA , Pordell P , Goode B , Jarteh R , Miller Z , Saygar BG , Maximore L , Borbor WM , Carmue M , Walker GW , Yeiah A . Prehosp Disaster Med 2017 32 (6) 1-6 BACKGROUND: In early 2015, a patient from a cluster of cases of Ebola Virus Disease (EVD) in Monrovia, Liberia traveled to a rural village in Margibi County, potentially exposing numerous persons. The patient died in the village and post-mortem testing confirmed Ebola Virus infection. Problem The Margibi County Health Team (CHT; Kakata, Margibi, Liberia) needed to prevent further transmission of EVD within and outside of the affected villages, and they needed to better understand the factors that support or impede compliance with measures to stop the spread of EVD. METHODS: In February-March 2015, the Margibi CHT instituted a 21-day quarantine and active monitoring for two villages where the patient had contact with numerous residents, and a 21-day active monitoring for five other villages where the patient had possible contact with an unknown number of persons. One contact developed EVD and quarantine was extended an additional 12 days in one village. In April 2015, the Margibi CHT conducted a household-based EVD knowledge, attitudes, and practices (KAP) survey of the seven villages. From April 24-29, 2015, interview teams approached every household in the seven villages and collected information on demographics, knowledge of EVD, attitudes about quarantine to prevent the spread of EVD, and their quarantine experiences and practices. Descriptive statistics were calculated. RESULTS: One hundred fifteen interviews were conducted, representing the majority of the households in the seven villages. Most (99%) correctly identified touching an infected person's body fluids and contact with the body of someone who has died from EVD as transmission routes. However, interviewees sometimes incorrectly identified mosquito bites (58%) and airborne spread (32%) as routes of EVD transmission, and 72% incorrectly identified the longest EVD incubation period as ≤seven days. Eight of 16 households in the two quarantined villages (50%) reported times when there was not enough water or food during quarantine. Nine of 16 (56%) reported that a household member had illnesses or injuries during quarantine; of these, all (100%) obtained care from a clinic, hospital, or Ebola treatment unit (ETU). CONCLUSION: Residents' knowledge of EVD transmission routes and incubation period were suboptimal. Public health authorities should consider assessing residents' understanding of Ebola transmission routes and effectively educate them to ensure correct understanding. Quarantined residents should be provided with sufficient food, water, and access to medical care. |
Dust exposure and coccidioidomycosis prevention among solar power farm construction workers in California
Sondermeyer Cooksey GL , Wilken JA , McNary J , Gilliss D , Shusterman D , Materna BL , Vugia DJ . Am J Public Health 2017 107 (8) e1-e8 OBJECTIVES: To investigate if work activities, dust exposure, and protection measures were associated with a 2011 to 2014 coccidioidomycosis outbreak among workers constructing 2 solar farms in California. METHODS: In 2013, we mailed self-administered questionnaires to employees who were onsite at the solar farms where the outbreak occurred to identify cases of clinical coccidioidomycosis and compare with asymptomatic workers by using multivariate logistic regression. RESULTS: When we compared 89 workers with clinical coccidioidomycosis to 325 asymptomatic workers, frequently being in a dust cloud or storm (odds ratio [OR] = 5.93; 95% confidence interval [CI] = 3.18, 11.06) significantly increased the odds of clinical coccidioidomycosis, whereas frequently wetting soil before soil-disturbing activity (OR = 0.42; 95% CI = 0.24, 0.75) was protective. When we controlled for being in a dust cloud or storm, frequent soil disturbance significantly increased the odds of clinical coccidioidomycosis only among those who reported wearing a respirator infrequently (OR = 2.31; 95% CI = 1.27, 4.21). CONCLUSIONS: Utilization of personal and employer-driven safety practices and increased coccidioidomycosis awareness among construction workers should be considered during the planning of any construction work in coccidioidomycosis-endemic regions to prevent occupational infections and outbreaks. (Am J Public Health. Published online ahead of print June 22, 2017: e1-e8. doi:10.2105/AJPH.2017.303820). |
Inhalational chlorine injuries at public aquatic venues - California, 2008-2015
Wilken JA , DiMaggio M , Kaufmann M , O'Connor K , Smorodinsky S , Armatas C , Barreau T , Kreutzer R , Ancheta L . MMWR Morb Mortal Wkly Rep 2017 66 (19) 498-501 In June 2015, personnel from California's Contra Costa Health Services Environmental Health and Hazardous Materials (hazmat) divisions were alerted to a possible chemical release at a swimming pool in an outdoor municipal water park. Approximately 50 bathers were in the pool when symptoms began; 34 (68%) experienced vomiting, coughing, or eye irritation. Among these persons, 17 (50%) were treated at the scene by Contra Costa's Emergency Medical Services (EMS) and released, and 17 (50%) were transported to local emergency departments; five patients also were evaluated later at an emergency department or by a primary medical provider. Environmental staff members determined that a chemical controller malfunction had allowed sodium hypochlorite and muriatic acid (hydrochloric acid) solutions to be injected into the main pool recirculation line while the recirculation pump was off; when the main recirculation pump was restarted, toxic chlorine gas (generated by the reaction of concentrated sodium hypochlorite and muriatic acid) was released into the pool. A review of 2008-2015 California pesticide exposure records identified eight additional such instances of toxic chlorine gas releases at public aquatic venues caused by equipment failure or human error that sickened 156 persons. Chemical exposures at public aquatic venues can be prevented by proper handling, storage, and monitoring of pool chemicals; appropriate equipment operation and maintenance; training of pool operators and staff members on pool chemical safety; and reporting of chemical exposures. |
Physical, mental, and financial impacts from drought in two California counties, 2015
Barreau T , Conway D , Haught K , Jackson R , Kreutzer R , Lockman A , Minnick S , Roisman R , Rozell D , Smorodinsky S , Tafoya D , Wilken JA . Am J Public Health 2017 107 (5) e1-e8 OBJECTIVES: To evaluate health impacts of drought during the most severe drought in California's recorded history with a rapid assessment method. METHODS: We conducted Community Assessments for Public Health Emergency Response during October through November 2015 in Tulare County and Mariposa County to evaluate household water access, acute stressors, exacerbations of chronic diseases and behavioral health issues, and financial impacts. We evaluated pairwise associations by logistic regression with pooled data. RESULTS: By assessment area, households reported not having running water (3%-12%); impacts on finances (25%-39%), property (39%-54%), health (10%-20%), and peace of mind (33%-61%); worsening of a chronic disease (16%-46%); acute stress (8%-26%); and considering moving (14%-34%). Impacts on finances or property were each associated with impacts on health and peace of mind, and acute stress. CONCLUSIONS: Drought-impacted households might perceive physical and mental health effects and might experience financial or property impacts related to the drought. Public Health Implications. Local jurisdictions should consider implementing drought assistance programs, including behavioral health, and consider rapid assessments to inform public health action. (Am J Public Health. Published online ahead of print March 21, 2017: e1-e8. doi:10.2105/AJPH.2017.303695). |
Establishing a timeline to discontinue routine testing of asymptomatic pregnant women for Zika virus infection - American Samoa, 2016-2017
Hancock WT , Soeters HM , Hills SL , Link-Gelles R , Evans ME , Daley WR , Piercefield E , Anesi MS , Mataia MA , Uso AM , Sili B , Tufa AJ , Solaita J , Irvin-Barnwell E , Meaney-Delman D , Wilken J , Weidle P , Toews KE , Walker W , Talboy PM , Gallo WK , Krishna N , Laws RL , Reynolds MR , Koneru A , Gould CV . MMWR Morb Mortal Wkly Rep 2017 66 (11) 299-301 The first patients with laboratory-confirmed cases of Zika virus disease in American Samoa had symptom onset in January 2016. In response, the American Samoa Department of Health (ASDoH) implemented mosquito control measures, strategies to protect pregnant women, syndromic surveillance based on electronic health record (EHR) reports, Zika virus testing of persons with one or more signs or symptoms of Zika virus disease (fever, rash, arthralgia, or conjunctivitis), and routine testing of all asymptomatic pregnant women in accordance with CDC guidance. All collected blood and urine specimens were shipped to the Hawaii Department of Health Laboratory for Zika virus testing and to CDC for confirmatory testing. Early in the response, collection and testing of specimens from pregnant women was prioritized over the collection from symptomatic nonpregnant patients because of limited testing and shipping capacity. The weekly numbers of suspected Zika virus disease cases declined from an average of six per week in January-February 2016 to one per week in May 2016. By August, the EHR-based syndromic surveillance indicated a return to pre-outbreak levels. The last Zika virus disease case detected by real-time, reverse transcription-polymerase chain reaction (rRT-PCR) occurred in a patient who had symptom onset on June 19, 2016. In August 2016, ASDoH requested CDC support in assessing whether local transmission had been reduced or interrupted and in proposing a timeline for discontinuation of routine testing of asymptomatic pregnant women. An end date (October 15, 2016) was determined for active mosquito-borne transmission of Zika virus and a timeline was developed for discontinuation of routine screening of asymptomatic pregnant women in American Samoa (conception after December 10, 2016, with permissive testing for asymptomatic women who conceive through April 15, 2017). |
Occupational HIV transmission among male adult film performers - multiple states, 2014
Wilken JA , Ried C , Rickett P , Arno JN , Mendez Y , Harrison RJ , Wohlfeiler D , Bauer HM , Joyce MP , Switzer WM , Heneine W , Shankar A , Mark KE . MMWR Morb Mortal Wkly Rep 2016 65 (5) 110-4 In 2014, the California Department of Public Health was notified by a local health department of a diagnosis of acute human immunodeficiency virus (HIV) infection* and rectal gonorrhea in a male adult film industry performer, aged 25 years (patient A). Patient A had a 6-day history of rash, fever, and sore throat suggestive of acute retroviral syndrome at the time of examination. He was informed of his positive HIV and gonorrhea test results 6 days after his examination. Patient A had a negative HIV-1 RNA qualitative nucleic acid amplification test (NAAT)(dagger) 10 days before symptom onset. This investigation found that during the 22 days between the negative NAAT and being informed of his positive HIV test results, two different production companies directed patient A to have condomless sex with a total of 12 male performers. Patient A also provided contact information for five male non-work-related sexual partners during the month before and after his symptom onset. Patient A had additional partners during this time period for which no locating information was provided. Neither patient A nor any of his interviewed sexual partners reported taking HIV preexposure prophylaxis (PrEP). Contact tracing and phylogenetic analysis of HIV sequences amplified from pretreatment plasma revealed that a non-work-related partner likely infected patient A, and that patient A likely subsequently infected both a coworker during the second film production and a non-work-related partner during the interval between his negative test and receipt of his positive HIV results. Adult film performers and production companies, medical providers, and all persons at risk for HIV should be aware that testing alone is not sufficient to prevent HIV transmission. Condom use provides additional protection from HIV and sexually transmitted infections (STIs). Performers and all persons at risk for HIV infection in their professional and personal lives should discuss the use of PrEP with their medical providers. |
Thyroid hormones and timing of pubertal onset in a longitudinal cohort of females, Northern California, 2006-11
Wilken JA , Greenspan LC , Kushi LH , Voss RW , Windham GC . Paediatr Perinat Epidemiol 2016 30 (3) 285-93 BACKGROUND: Pubertal timing is regulated by a complex interplay of hormones. Few studies have evaluated the role of thyroid hormones in pubertal onset. We investigated the associations between blood concentrations of free and total thyroxine (FT4, TT4), free triiodothyronine, and thyroid stimulating hormone and pubertal onset among females. METHODS: Participants included 323 Kaiser Permanente Northern California members followed at annual intervals during 2004-11, who provided a blood sample during the first 3 years of the study. Thyroid hormone concentrations were measured in serum in the first blood specimen available for each participant. Pubertal onset was defined as Tanner stage ≥2 for breast (thelarche) and pubic hair (pubarche) development. Associations between thyroid hormones and pubertal onset were assessed by multivariable logistic regression and Cox proportional hazards modelling. RESULTS: At blood draw, participants were age 6.5-10.1 (median 7.7) years, 10% had reached thelarche, and 12% had reached pubarche. Participants were followed 0-5 years after blood draw (median 4). At most recent clinical visit, participants were age 6.7-14.7 (median 12.3) years, 92% had reached thelarche, and 89% had reached pubarche. No associations were identified between having reached thelarche or pubarche at time of blood draw and thyroid hormones. Examined longitudinally, higher concentrations of pre-pubertal FT4 and TT4 were associated with earlier pubarche (adjusted hazard ratio (HR) 1.41, 95% confidence interval (CI) 1.06, 1.86; per ng/dL and aHR 1.07, 95% CI 1.02, 1.12; per mug/dL respectively). CONCLUSIONS: Higher pre-pubertal concentrations of FT4 and TT4 are associated with earlier pubarche. |
Coccidioidomycosis among workers constructing solar power farms, California, USA, 2011-2014
Wilken JA , Sondermeyer G , Shusterman D , McNary J , Vugia DJ , McDowell A , Borenstein P , Gilliss D , Ancock B , Prudhomme J , Gold D , Windham GC , Lee L , Materna BL . Emerg Infect Dis 2015 21 (11) 1997-2005 Coccidioidomycosis is associated with soil-disruptive work in Coccidioides-endemic areas of the southwestern United States. Among 3,572 workers constructing 2 solar power-generating facilities in San Luis Obispo County, California, USA, we identified 44 patients with symptom onset during October 2011-April 2014 (attack rate 1.2 cases/100 workers). Of these 44 patients, 20 resided in California outside San Luis Obispo County and 10 resided in another state; 9 were hospitalized (median 3 days), 34 missed work (median 22 days), and 2 had disseminated disease. Of the 25 patients who frequently performed soil-disruptive work, 6 reported frequent use of respiratory protection. As solar farm construction in Coccidioides-endemic areas increases, additional workers will probably be exposed and infected unless awareness is emphasized and effective exposure reduction measures implemented, including limiting dust generation and providing respiratory protection. Medical providers, including those in non-Coccidioides-endemic areas, should suspect coccidioidomycosis in workers with compatible illness and report cases to their local health department. |
Injuries and traumatic psychological exposures associated with the South Napa Earthquake - California, 2014
Attfield KR , Dobson CB , Henn JB , Acosta M , Smorodinsky S , Wilken JA , Barreau T , Schreiber M , Windham GC , Materna BL , Roisman R . MMWR Morb Mortal Wkly Rep 2015 64 (35) 975-8 On August 24, 2014, at 3:20 a.m., a magnitude 6.0 earthquake struck California, with its epicenter in Napa County (1). The earthquake was the largest to affect the San Francisco Bay area in 25 years and caused significant damage in Napa and Solano counties, including widespread power outages, five residential fires, and damage to roadways, waterlines, and 1,600 buildings (2). Two deaths resulted (2). On August 25, Napa County Public Health asked the California Department of Public Health (CDPH) for assistance in assessing postdisaster health effects, including earthquake-related injuries and effects on mental health. On September 23, Solano County Public Health requested similar assistance. A household-level Community Assessment for Public Health Emergency Response (CASPER) was conducted for these counties in two cities (Napa, 3 weeks after the earthquake, and Vallejo, 6 weeks after the earthquake). Among households reporting injuries, a substantial proportion (48% in Napa and 37% in western Vallejo) reported that the injuries occurred during the cleanup period, suggesting that increased messaging on safety precautions after a disaster might be needed. One fifth of respondents overall (27% in Napa and 9% in western Vallejo) reported one or more traumatic psychological exposures in their households. These findings were used by Napa County Mental Health to guide immediate-term mental health resource allocations and to conduct public training sessions and education campaigns to support persons with mental health risks following the earthquake. In addition, to promote community resilience and future earthquake preparedness, Napa County Public Health subsequently conducted community events on the earthquake anniversary and provided outreach workers with psychological first aid training. |
Exposures and symptoms among workers after an offsite train derailment and vinyl chloride release
Wilken JA , Graziano L , Vaouli E , Markiewicz K , Helverson R , Brinker K , Shumate AM , Duncan MA . Am J Disaster Med 2015 10 (2) 153-165 OBJECTIVE: In 2012 in New Jersey, a train derailment resulted in the puncture of a tanker car carrying liquid vinyl chloride under pressure, and a resulting airborne vinyl chloride plume drifted onto the grounds of a nearby refinery. This report details the investigation of exposures and symptoms among refinery workers. DESIGN AND SETTING: The investigation team met with refinery workers to discuss their experience after the derailment and provided workers a self-administered survey to document symptoms and worker responses during the incident. Associations among categorical variables and experiencing symptoms were evaluated using Fisher's exact test. PARTICIPANTS: Twenty-six of 155 (17 percent) workers present at the refinery or driving on the access road the date the spill occurred completed the survey. MAIN OUTCOME MEASURE(S): Any self-reported symptom following exposure from the vinyl chloride release. RESULTS: Fifteen workers (58 percent) reported ≥1 symptom, most commonly headache (12, 46 percent). Three (12 percent) reported using respiratory protection. No differences in reporting symptoms were observed by location during the incident or by the building in which workers sheltered. Workers who moved from one shelter to another during the incident (ie, broke shelter) were more likely to report symptoms (Fisher's exact test, p = 0.03); however, there are only limited data regarding vinyl chloride concentrations in shelters versus outside. CONCLUSIONS: Breaking shelter might result in greater exposures, and managers and health and safety officers of vulnerable facilities with limited physical access should consider developing robust shelter-in-place plans and alternate emergency egress plans. Workers should consider using respiratory protection if exiting a shelter is necessary during a chemical incident. |
Assessing prevention measures and Sin Nombre hantavirus seroprevalence among workers at Yosemite National Park
Wilken JA , Jackson R , Materna BL , Windham GC , Enge B , Messenger S , Xia D , Knust B , Buttke D , Roisman R . Am J Ind Med 2015 58 (6) 658-67 BACKGROUND: During 2012, a total of 10 overnight visitors to Yosemite National Park (Yosemite) became infected with a hantavirus (Sin Nombre virus [SNV]); three died. SNV infections have been identified among persons with occupational exposure to deer mice (Peromyscus maniculatus). METHODS: We assessed SNV infection prevalence, work and living environments, mice exposures, and SNV prevention training, knowledge, and practices among workers of two major employers at Yosemite during September-October, 2012 by voluntary blood testing and a questionnaire. RESULTS: One of 526 participants had evidence of previous SNV infection. Participants reported frequently observing rodent infestations at work and home and not always following prescribed safety practices for tasks, including infestation cleanup. CONCLUSION: Although participants had multiple exposures to deer mice, we did not find evidence of widespread SNV infections. Nevertheless, employees working around deer mice should receive appropriate training and consistently follow prevention policies for high-risk activities. |
Assessment of emergency responders after a vinyl chloride release from a train derailment - New Jersey, 2012
Brinker K , Lumia M , Markiewicz KV , Duncan MA , Dowell C , Rey A , Wilken J , Shumate A , Taylor J , Funk R . MMWR Morb Mortal Wkly Rep 2015 63 (53) 1233-7 On November 30, 2012, at approximately 7:00 am, a freight train derailed near a small town in New Jersey. Four tank cars, including a breached tank car carrying vinyl chloride, landed in a tidal creek. Vinyl chloride, a colorless gas with a mild, sweet odor, is used in plastics manufacture. Acute exposure can cause respiratory irritation and headache, drowsiness, and dizziness; chronic occupational exposure can result in liver damage, accumulation of fat in the liver, and tumors (including angiosarcoma of the liver). Because health effects associated with acute exposures have not been well studied, the New Jersey Department of Health requested assistance from the Agency for Toxic Substances and Disease Registry (ATSDR) and CDC. On December 11, teams from these agencies deployed to assist the New Jersey Department of Health in conducting an assessment of exposures in the community as well as the occupational health and safety of emergency personnel who responded to the incident. This report describes the results of the investigation of emergency personnel. A survey of 93 emergency responders found that 26% of respondents experienced headache and upper respiratory symptoms during the response. A minority (22%) reported using respiratory protection during the incident. Twenty-one (23%) of 92 respondents sought medical evaluation. Based on these findings, CDC recommended that response agencies 1) implement the Emergency Responder Health Monitoring and Surveillance (ERHMS) system for ongoing health monitoring of the emergency responders involved in the train derailment response and 2) ensure that in future incidents, respiratory protection is used when exposure levels are unknown or above the established occupational exposure limits. |
Coccidioidomycosis among cast and crew members at an outdoor television filming event - California, 2012
Wilken JA , Marquez P , Terashita D , McNary J , Windham G , Materna B . MMWR Morb Mortal Wkly Rep 2014 63 (15) 321-4 In March 2013, the California Department of Public Health (CDPH) identified two Doctor's First Reports of Occupational Injury or Illness (DFRs) regarding Los Angeles County residents who had worked at the same jobsite in January 2012 and had been evaluated for possible work-associated coccidioidomycosis (valley fever). Occupational exposure to Coccidioides, the causative fungi, typically is associated with soil-disrupting activities. The physicians noted that both workers were cast or crew members filming a television series episode, and the site of possible exposure was an outdoor set in Ventura County, California. On the basis of their job titles, neither would have been expected to have been engaged in soil-disrupting activities. Los Angeles County Department of Public Health (LACDPH) conducted an outbreak investigation by using CDPH-provided occupational surveillance records, traditional infectious disease surveillance, and social media searches. This report describes the results of that investigation, which identified a total of five laboratory-confirmed and five probable cases linked to this filming event. The employer and site manager were interviewed. The site manager stated that they would no longer allow soil-disruptive work at the site and would incorporate information about the potential risk for Coccidioides exposure onsite into work contracts. Public health professionals, clinicians, and the television and film industry should be aware that employees working outdoors in areas where Coccidioides is endemic (e.g., central and southern California), even those not engaged in soil-disruptive work, might be at risk for coccidioidomycosis. |
The management of work-related asthma guidelines: a broader perspective
Baur X , Aasen TB , Burge PS , Heederik D , Henneberger PK , Maestrelli P , Schlunssen V , Vandenplas O , Wilken D . Eur Respir Rev 2012 21 (124) 125-139 The aim of the European Respiratory Society work-related asthma guidelines is to present the management and prevention options of work-related asthma and their effectiveness. Work-related asthma accounts for 5-25% of all adult asthma cases and is responsible for a significant socioeconomic burden. Several hundred occupational agents, mainly allergens but also irritants and substances with unknown pathological mechanisms, have been identified as causing work-related asthma. The essential message of these guidelines is that the management of work-related asthma can be considerably optimised based on the present knowledge of causes, risk factors, pathomechanisms, and realistic and effective interventions. To reach this goal we urgently require greatly intensified primary preventive measures and improved case management. There is now a substantial body of evidence supporting the implementation of comprehensive medical surveillance programmes for workers at risk. Those workers who fail surveillance programmes need to be referred to a clinician who can confirm or exclude an occupational cause. Once work-related asthma is confirmed, a revised risk assessment in the workplace is needed to prevent further cases. These new guidelines confirm and extend already existing statements and recommendations. We hope that these guidelines will initiate the much-needed research that is required to fill the gaps in our knowledge and to initiate substantial improvements in preventative measures. |
Guidelines for the management of work-related asthma
Baur X , Sigsgaard T , Aasen TB , Burge PS , Heederik D , Henneberger P , Maestrelli P , Rooyackers J , Schlunssen V , Vandenplas O , Wilken D . Eur Respir J 2012 39 (3) 529-545 Work-related asthma, which includes occupational asthma and work-aggravated asthma, has become one of the most prevalent occupational lung diseases. These guidelines aim to upgrade occupational health standards, contribute importantly to transnational legal harmonisation and reduce the high socio-economic burden caused by this disorder. A systematic literature search related to five key questions was performed: diagnostics; risk factors; outcome of management options; medical screening and surveillance; controlling exposure for primary prevention. Each of the 1,329 retrieved papers was reviewed by two experts, followed by Scottish Intercollegiate Guidelines Network grading, and formulation of statements graded according to the Royal College of General Practitioners' three-star system. Recommendations were made on the basis of the evidence-based statements, which comprise the following major evidence-based strategic points. 1) A comprehensive diagnostic approach considering the individual specific aspects is recommended. 2) Early recognition and diagnosis is necessary for timely and appropriate preventative measures. 3) A stratified medical screening strategy and surveillance programme should be applied to at-risk workers. 4) Whenever possible, removing exposure to the causative agent should be achieved, as it leads to the best health outcome. If this is not possible, reduction is the second best option, whereas respirators are of limited value. 5) Exposure elimination should be the preferred primary prevention approach. |
Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence
Vandenplas O , Dressel H , Wilken D , Jamart J , Heederik D , Maestrelli P , Sigsgaard T , Henneberger P , Baur X . Eur Respir J 2011 38 (4) 804-11 Reduction of exposure to sensitising agents causing occupational asthma has been proposed as an alternative to total avoidance in order to minimise the adverse socio-economic impact of the condition. The aim of this systematic review was to compare the effects of these two management options on asthma and socio-economic outcomes. A bibliographic search was conducted to identify studies examining the outcome of workers with occupational asthma after reduction or cessation of exposure to the causal agent. The changes in asthma symptoms and nonspecific bronchial hyperresponsiveness after reduction or cessation of exposure were described in nine and five studies, respectively. The meta-analysis of pooled data showed that a reduction of exposure was associated with a lower likelihood of improvement (OR 0.16, 95% CI 0.03-0.91) and recovery (OR 0.30, 95% CI 0.11-0.84) of asthma symptoms and a higher risk of worsening of the symptoms (OR 10.23, 95% CI 2.97-35.28) and nonspecific bronchial hyperresponsiveness (OR 5.65, 95% CI 1.11-28.82), compared with complete avoidance of exposure. This systematic review indicates that reduction of exposure cannot be routinely recommended as an alternative to cessation of exposure in the management of occupational asthma. However, further investigations are required before drawing evidence-based conclusions on the cost-effectiveness of this approach. |
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