Public Health Actions to Control Measles Among Afghan Evacuees During Operation Allies Welcome - United States, September-November 2021

On August 29, 2021, the United States government oversaw the emergent establishment of Operation Allies Welcome (OAW), led by the U.S. Department of Homeland Security (DHS) and implemented by the U.S. Department of Defense (DoD) and U.S. Department of State (DoS), to safely resettle U.S. citizens and Afghan nationals from Afghanistan to the United States. Evacuees were temporarily housed at several overseas locations in Europe and Asia* before being transported via military and charter flights through two U.S. international airports, and onward to eight U.S. military bases,† with hotel A used for isolation and quarantine of persons with or exposed to certain infectious diseases.§ On August 30, CDC issued an Epi-X notice encouraging public health officials to maintain vigilance for measles among Afghan evacuees because of an ongoing measles outbreak in Afghanistan (25,988 clinical cases reported nationwide during January-November 2021) (1) and low routine measles vaccination coverage (66% and 43% for the first and second doses, respectively, in 2020) (2).

COVID-19 Outbreaks in Correctional Facilities with Work-Release Programs - Idaho, July-November 2020

As of April 16, 2021, U.S. correctional and detention facilities reported 399,631 cases of COVID-19 in incarcerated persons, resulting in 2,574 deaths (1). During July 14-November 30, 2020, COVID-19 was diagnosed in 382 persons incarcerated in Idaho correctional facilities with work-release programs. Work-release programs (which place incarcerated persons in community businesses) have social and economic benefits, but might put participants at increased risk for bidirectional transmission of SARS-CoV-2, the virus that causes COVID-19. The Idaho Department of Correction (IDOC) operates 13 state-run correctional facilities, including six low-security facilities dedicated to work-release programs. This report describes COVID-19 outbreaks in five IDOC facilities with work-release programs,* provides the mitigation strategies that IDOC implemented, and describes the collaborative public health response. As of November 30, 2020, 382 outbreak-related COVID-19 cases were identified among incarcerated persons in five Idaho correctional facilities with work-release programs; two outbreaks were linked to food processing plants. Mitigation strategies that helped to control outbreaks in IDOC facilities with work-release programs included isolation of persons with COVID-19, identification and quarantine of close contacts, mass testing of incarcerated persons and staff members, and temporary suspension of work-release programs. Implementation of public health recommendations for correctional and detention facilities with work-release programs, including mass testing and identification of high-risk work sites, can help mitigate SARS-CoV-2 outbreaks. Incarcerated persons participating in work-release should be included in COVID-19 vaccination plans.

Children's inhalation exposure to methamidophos from sprayed potato fields in Washington State: exploring the use of probabilistic modeling of meteorological data in exposure assessment

We examined the significance of meteorology and postspray volatilization of methamidophos (an organophosphorus insecticide) in assessing potential inhalation risk to children in an agricultural community. We combined fluxes from sources and dispersion modeling with a range of possible local meteorology to create output to study the variability in potential community exposure as a result of changing temperature, wind speeds and wind directions. This work is based on an aerial spray drift study where air sampling measurements of methamidophos were made before, during and after a spray event were used to examine acute inhalation risk for children living in an Eastern Washington State community in close proximity (between 15 and 200 m) to sprayed potato fields. We compared the measured average air concentrations of methamidophos in the community to a "no observed adverse effect level" for subchronic inhalation to characterize acute and subchronic inhalation risks. The baseline estimates of inhalation exposure were below Environment Protection Agency's (EPA) level of concern based on a target margin of exposure of 300. As meteorological conditions during and after spraying influence the amount of material moving into areas where children reside we used historical meteorological data to drive model simulations that predicted likely air residue concentrations under different wind and temperature conditions. We also added variability to the decay constant and initial emission fluxes to create a 2-D simulation of estimated air concentrations in the community near the fields. This work provides a methodological framework for the assessment of air concentrations of pesticides from agricultural sprays in the absence of extended measurements, although including variability from meteorological conditions. The deterministic as well as the probabilistic risk analyses in this study indicated that postspray volatilization in the specific spray situation analyzed (methamidophos applied on potato fields in Eastern Washington) did not pose acute or subchronic risks as defined by the EPA. However, this study did not consider any pathway of exposure other than inhalation (e.g. diet, dermal, etc.) and the risk assessment should be evaluated in that context.

Risk of childhood cancers associated with residence in agriculturally intense areas in the United States

BACKGROUND

The potential for widespread exposure to agricultural pesticides through drift during application raises concerns about possible health effects to exposed children living in areas of high agricultural activity.

OBJECTIVES

We evaluated whether residence in a county with greater agricultural activity was associated with risk of developing cancer in children < 15 years of age.

METHODS

Incidence data for U.S. children 0-14 years of age diagnosed with cancer between 1995 and 2001 were provided by member registries of the North American Association of Central Cancer Registries. We determined percent cropland for each county using agricultural census data, and used the overall study distribution to classify agriculturally intense counties. We estimated odds ratios and 95% confidence intervals for all ages and 5-year age groups for total cancers and selected cancer sites using logistic regression.

RESULTS

Our study results showed statistically significant increased risk estimates for many types of childhood cancers associated with residence at diagnosis in counties having a moderate to high level of agricultural activity, with a remarkably consistent dose-response effect seen for counties having >or= 60% of the total county acreage devoted to farming. Risk for different cancers varied by type of crop.

CONCLUSIONS

Although interpretation is limited by the ecologic design, in this study we were able to evaluate rarer childhood cancers across a diverse agricultural topography. The findings of this exploratory study support a continued interest in the possible impact of long-term, low-level pesticide exposure in communities located in agriculturally intense areas.

Comparison of global positioning system (GPS) tracking and parent-report diaries to characterize children's time-location patterns

Respondent error, low resolution, and study participant burden are known limitations of diary timelines used in exposure studies such as the National Human Exposure Assessment Survey (NHEXAS). Recent advances in global positioning system (GPS) technology have produced tracking devices sufficiently portable, functional and affordable to utilize in exposure assessment science. In this study, a differentially corrected GPS (dGPS) tracking device was compared to the NHEXAS diary timeline. The study also explored how GPS can be used to evaluate and improve such diary timelines by determining which location categories and which respondents are least likely to record "correct" time-location responses. A total of 31 children ages 3-5 years old wore a dGPS device for all waking hours on a weekend day while their parents completed the NHEXAS diary timeline to document the child's time-location pattern. Parents misclassified child time-location approximately 48% of the time using the NHEXAS timeline in comparison to dGPS. Overall concordance between methods was marginal (kappa=0.33-0.35). The dGPS device found that on average, children spent 76% of the 24-h study period in the home. The diary underestimated time the child spent in the home by 17%, while overestimating time spent inside other locations, outside at home, outside in other locations, and time spent in transit. Diary data for time spent outside at home and time in transit had the lowest response concordance with dGPS. The diaries of stay-at-home mothers and mothers working unskilled labor jobs had lower concordance with dGPS than did those of the other participants. The ability of dGPS tracking to collect continuous rather than categorical (ordinal) data was also demonstrated. It is concluded that automated GPS tracking measurements can improve the quality and collection efficiency of time-location data in exposure assessment studies, albeit for small cohorts.

Childhood Cancer in Texas Counties with Moderate to Intense Agricultural Activity

With few established risk factors, cancer remains the second leading cause of death for children in the U.S. Agricultural pesticide use is one of many suspected factors that may contribute to the etiology of childhood cancer. This study tests the hypothesis that birth in Texas counties with moderate to intense agricultural activity increases childhood cancer risk. This case-control study analyzed 6974 cases and controls ages 0 to 14, identified through the Texas Cancer Registry and Texas birth records, respectively. Exposure data were obtained from the Census of Agriculture. Percent cropland in the county of birth and total county-specific pesticide exposure incorporating the EPA's carcinogenicity classification served as surrogates for pesticide exposure. Cancer sites examined include: all cancers, leukemia, lymphoma, CNS tumors, and several specific subsites. Elevated, although not statistically significant, ORs for the association between birth in counties with > or =50% cropland were produced for all CNS tumors (OR = 1.3, 95% CI = 0.9-1.8), astrocytoma (OR = 1.4, 95% CI = 0.8-2.2), and PNET (OR = 1.3, 95% CI = 0.7-2.5). A similar pattern was not observed using the index of total county-specific pesticide exposure. Although imprecise, these exposure assessment methods represent novel applications of agricultural census data. Although a pattern of increased risk was observed between percent cropland and CNS tumors, this study's results do not support an association between birth in Texas counties with moderate to intense agricultural activity and childhood cancer. Due to study limitations, such an association should not be ruled out. Future research should incorporate individual-level data from various sources to increase precision and decrease misclassification in the exposure assessment.

The Washington aerial spray drift study: children's exposure to methamidophos in an agricultural community following fixed-wing aircraft applications

This study characterized exposures of eight children living in an agricultural community near potato fields that were treated by aerial application with the organophosphorus (OP) insecticide, methamidophos (O,S-dimethyl phosphoramidothioate). Exposure monitoring included air and deposition samples in the outdoor community environment, outdoor and indoor air samples at each residence, wipe samples of playground equipment, toys, indoor surfaces, and children's hands, and periodic urine samples. Monitoring occurred prior to, the day of, and 1 day following applications. Methamidophos deposition in the community was very low compared to deposition inside the boundaries of the treated fields. Community air concentrations increased from 0.05 microg/m3 (prespray) to 0.11 and 0.48 microg/m3 (spray day morning and afternoon, respectively), decreasing to 0.10 microg/m3 on the postspray day. Air concentrations outside residences followed a similar pattern; indoor levels did not exceed 0.03 pg/m3. Methamidophos residues were found on playground equipment following applications, but not on indoor residential surfaces. The median hand wipe levels increased from < 0.02 (prespray) to 0.08 microg/sample (spray day), decreasing to 0.05 microg/sample (postspray day). Median concentrations of the primary methamidophos urinary metabolite were 61 microg/l before 1100 hours on the spray day, 170 microg/l after 1100 hours on the spray day, and 114 microg/l on the postspray day. Spray day metabolite levels were correlated with time outside on the spray day (rs = 0.68), with spray day hand wipe levels (rs = 0.67), and with postspray day metabolite levels (rs = 0.64). Postspray day metabolites levels were also positively associated with postspray day hand wipe levels (rs = 0.66). The documentation of children's exposure in this study does not necessarily mean that risks for these children were significantly altered, since nearly all children in the United States are exposed to some level of OP pesticides through dietary intake and other pathways. The association of metabolite levels with time spent outside, and the absence of methamidophos in homes indicates that children's exposures occurred primarily outdoors.

Organophosphorus pesticide exposure of urban and suburban preschool children with organic and conventional diets

We assessed organophosphorus (OP) pesticide exposure from diet by biological monitoring among Seattle, Washington, preschool children. Parents kept food diaries for 3 days before urine collection, and they distinguished organic and conventional foods based on label information. Children were then classified as having consumed either organic or conventional diets based on analysis of the diary data. Residential pesticide use was also recorded for each home. We collected 24-hr urine samples from 18 children with organic diets and 21 children with conventional diets and analyzed them for five OP pesticide metabolites. We found significantly higher median concentrations of total dimethyl alkylphosphate metabolites than total diethyl alkylphosphate metabolites (0.06 and 0.02 micro mol/L, respectively; p = 0.0001). The median total dimethyl metabolite concentration was approximately six times higher for children with conventional diets than for children with organic diets (0.17 and 0.03 micro mol/L; p = 0.0003); mean concentrations differed by a factor of nine (0.34 and 0.04 micro mol/L). We calculated dose estimates from urinary dimethyl metabolites and from agricultural pesticide use data, assuming that all exposure came from a single pesticide. The dose estimates suggest that consumption of organic fruits, vegetables, and juice can reduce children's exposure levels from above to below the U.S. Environmental Protection Agency's current guidelines, thereby shifting exposures from a range of uncertain risk to a range of negligible risk. Consumption of organic produce appears to provide a relatively simple way for parents to reduce their children's exposure to OP pesticides.

Time-location analysis for exposure assessment studies of children using a novel global positioning system instrument

Global positioning system (GPS) technology is used widely for business and leisure activities and offers promise for human time-location studies to evaluate potential exposure to environmental contaminants. In this article we describe the development of a novel GPS instrument suitable for tracking the movements of young children. Eleven children in the Seattle area (2-8 years old) wore custom-designed data-logging GPS units integrated into clothing. Location data were transferred into geographic information systems software for map overlay, visualization, and tabular analysis. Data were grouped into five location categories (in vehicle, inside house, inside school, inside business, and outside) to determine time spent and percentage reception in each location. Additional experiments focused on spatial resolution, reception efficiency in typical environments, and sources of signal interference. Significant signal interference occurred only inside concrete/steel-frame buildings and inside a power substation. The GPS instruments provided adequate spatial resolution (typically about 2-3 m outdoors and 4-5 m indoors) to locate subjects within distinct microenvironments and distinguish a variety of human activities. Reception experiments showed that location could be tracked outside, proximal to buildings, and inside some buildings. Specific location information could identify movement in a single room inside a home, on a playground, or along a fence line. The instrument, worn in a vest or in bib overalls, was accepted by children and parents. Durability of the wiring was improved early in the study to correct breakage problems. The use of GPS technology offers a new level of accuracy for direct quantification of time-location activity patterns in exposure assessment studies.

Butyltins in shellfish, finfish, water and sediment from the Coos Bay estuary (Oregon, USA)

Butyltin was measured in tissue, water and sediment samples collected throughout Coos Bay estuary between 1986 and 1997. Butyltin-induced shell deformation in commercial oysters prompted this assessment. Butyltins are released from tributyltin oxide (TBTO)-containing boat paint. Clams from three sites contained tributyltin (TBT) levels ranging from 168 to 457 microg/kg in 1992-1994. Consequently, Oregon Health Division (OHD) issued a shellfish consumption advisory in 1995; it was rescinded in 1997 after US Environmental Protection Agency (EPA) revised the TBTO oral reference dose (RfD). The revised RfD changed the tissue screening level from 112 to 1120 microg TBT/kg. Fifty percent of sediment samples collected during 1991-1997 and analyzed for total butyltins (TotBT) exceeded the Puget Sound Dredge Disposal Analysis Screening Level (PSDDA SL) of 73 microg TBT/kg dw. TotBT at three shipyards selected for site assessment by EPA ranged from 24 to 68,613 microg/kg dw. Sediment and tissue butyltins have been decreasing in all but one area of the estuary.