Coccidioidomycosis outbreak among inmate wildland firefighters: California, 2017

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.

Challenges with controlling varicella in prison settings: experience of California, 2010 to 2011

This article describes the epidemiology of varicella in one state prison in California during 2010 and 2011, control measures implemented, and associated costs. Eleven varicella cases were reported, of which nine were associated with two outbreaks. One outbreak consisted of three cases and the second consisted of six cases with two generations of spread. Among exposed inmates serologically tested, 98% (643/656) were varicella-zoster virus seropositive. The outbreaks resulted in > 1,000 inmates exposed, 444 staff exposures, and > $160,000 in costs. The authors documented the challenges and costs associated with controlling and managing varicella in a prison setting. A screening policy for evidence of varicella immunity for incoming inmates and staff and vaccination of susceptible persons has the potential to mitigate the impact of future outbreaks and reduce resources necessary to manage cases and outbreaks.

Tobacco smoke load and non-lung cancer mortality associations in Austrian and German males

The millstone around the neck of tobacco control in Europe has been the influence of the tobacco industry on the governments of German speaking countries. This study attempts to estimate non-lung cancer mortality attributable to smoking in Austria during 1967-2006 and in Germany during 1973-2006. National estimates of the annual smoking-attributable fractions (SAF) were calculated for all ages in males, using lung cancer mortality rates as indicators of "tobacco smoke load" associated with cancer from active and passive smoking. In both countries non-lung cancer rates showed a nearly perfect linear correlation with lung cancer rates (R (2) = 0.95 in Austria and 0.94 in Germany) with a slope of 1.86 (95% confidence intervals [CI]: 1.71-1.99) in Austria and 1.77 (95% CI: 1.60-1.93) in Germany. In 2006 SAF of male cancer mortality for all ages were 61% in Austria (sensitivity range [SR]: 45%-70%) without autocorrelation and 61% in Germany (SR: 41-75%), if adjusted for possible autocorrelation. The similarity of the results is in line with the poor tobacco control measures in both countries until recently. Cancer prevention programs in Austria and Germany should focus on tobacco control, because 61% of male cancer mortality was associated with tobacco smoke load.

Smoker Suicide Rates and Risks in the United States and Frankfurt, Germany

Background:

Suicide and smoking are immense, growing, associated global problems. Recent general population suicide rates and ratios by smoking status are unknown though in past reports, smokers had near three-fold hazard ratios of suicide among health professionals. So we assessed recent suicide rates and rate ratios in the general population of the United States (US) and Frankfurt, Germany.

Methods:

US National Health Interview Survey interviewees from 1987, 1988, and 1990-94 with near complete follow up through 2002 (representing the US adult non-institutionalized population) and all suicides in 1999-2000 among adult residents of Frankfurt, their proxy respondents, control subjects, and census data were studied using survival time methods. Age was categorized in both samples as 18-30, 31-60 and 61+ years.

Results:

The respective US versus Frankfurt crude suicide rates per 100,000 were 13.8 (95% confidence interval (CI) 12.4-15.5) versus 17.7 (CI 15.0-20.5) overall, 7.9 (CI 6.4-9.9) versus 12.0 (CI 9.2-14.7) in never smokers, and 22.9 (CI 19.5-27.0) versus 32.0 (CI 24.5-39.6) in current smokers. Smoker suicide rate ratios relative to never smokers ranged from 2.1 (males) to 4.2 (females) in US groups and 1.5 (ages 61+ years) to 3.7 (ages 31-60 years) in Frankfurt groups (each p< 0.05).

Discussion:

In both the US and Frankfurt, Germany, large absolute and relative excesses of suicide are seen in smokers. Reducing the prevalence of smoking might greatly reduce suicide rates, especially in young and middle-aged adults and US females.

Acknowledgements:

This study was funded by Pfizer, Inc.

Smoke load/cancer death rate associations in Korea females, 1985-2004

BACKGROUND

Korea female death rates from many cancers have risen rapidly since 1985. The sources of those cancer death epidemics are unclear but may be related to rising cumulative tobacco smoke damage (smoke load). We assessed Korea female smoke load/cancer death rate associations from 1985 to 2004.

METHODS

Lung cancer rates were used as a smoke load bio-index. Subtracting lung, stomach, and uterine corpus cancer death World age standard rates (rates) from all-sites rates gave us non-lung-stomach-uterine corpus (NLSUc) rates. Lung/NLSUc linear regressions were run, adjusted for autocorrelation. Estimated, lower, and upper bound smoking-attributable fractions (SAFs) were calculated using the formula SAF=1-{(unexposeds' cancer death rate)/(observed rate)}, based on the linear regression and respective best, upper, and lower bound estimated lung, stomach, and uterine cancer death rates in the unexposed.

RESULTS

Lung cancer death rates (smoke load) can explain 88% of the variance in NLSUc rates from 1985 to 2004 after adjusting for autocorrelation. The estimated Korea female all-sites cancer death rate SAF in 2004 was 43% (sensitivity range 29-56%).

CONCLUSIONS

Smoke load, probably from tobacco given the epidemic time course, may cause a large cancer death burden in Korea females despite their very low self-reported prevalence of smoking.

Lung cancer rates as an index of tobacco smoke exposures: validation against black male approximate non-lung cancer death rates, 1969-2000

BACKGROUND

Researchers use lung cancer death rates (rates) as an index of the cumulative burdens of smoking. That index lacks direct validation and calibration. So this study directly validates and calibrates that index against annual approximately non-lung (all-sites minus lung and stomach) rates from 1969 to 2000 in United States black men, then estimates their cancer death rate smoking-attributable fractions (SAFs).

METHODS

This study uses linear regression, age-adjusted rates from http://www.seer.cancer.gov/canques, and the formula SAF = (1- ((rate in the unexposed) / (rate in the exposed))). Estimated rates in the unexposed range between the 1969 rate and the rate predicted for a population with no smoking-attributable lung cancers. Stomach and lung cancer rate SAFs were based on published cohort studies.

RESULTS

Lung cancer death rates predicted 98% and 97% of the variances in approximately non-lung cancer death rates throughout their 1969-1990 34% rise and subsequent declines, respectively (each P < 0.0001). The findings suggest that the SAF of the all-sites cancer death rate in black men peaked at 66% in 1990.

CONCLUSIONS

Lung cancer death rates were a good index of smoke exposure for predicting approximately non-lung cancer death rates in black men. Smoking may cause most premature cancer deaths in black men.

Estimating the costs of job related arthritis

OBJECTIVE

To present the first estimate of the costs of job related osteoarthritis (OA) in the USA.

METHODS

Data were drawn from national data sets collected by the US Bureau of Labor Statistics, the US National Center for Health Statistics, and existing cost estimates for arthritis in the literature. We used proportional attributable risk (PAR) models to estimate the percentage of acute and repetitive injuries resulting in OA. These PAR vary between men and women. We used the human capital method that decomposes costs into direct categories such as medical expense and indirect categories such as lost earnings.

RESULTS

We estimate job related OA costs US$3.41 to 13.23 billion per year (1994 dollars). Our point estimate is that job related OA contributes about 9% ($8.3 billion) to the total costs for all OA. About 51% of job related costs result from medical costs and 49% from lost productivity at work and at home. These costs are likely to underestimate the true burden since costs of pain and suffering as well as costs to family members and others who provide home care are ignored.

CONCLUSION

The cost of job related arthritis is significant and has implications for both clinical and public policy. Depending on the PAR selected, job related arthritis is at least as costly as job related renal and neurological disease combined, and is on a par with the costs of job related chronic obstructive pulmonary disease and all asthma, whether job related or not.

Environmental tobacco smoke hazards and benefits of work-site nonsmoking programs

The Council on Scientific Affairs of the California Medical Association presents the following inventory of items of progress in occupational medicine. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of these items of progress in occupational medicine that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Occupational Medicine of the California Medical Association, and the summaries were prepared under its direction.