1
|
Groenewold MR, Billock R, Free H, Burrer SL, Sweeney MH, Wong J, Lavender A, Argueta G, Crawford HL, Erukunuakpor K, Karlsson ND, Armenti K, Thomas H, Gaetz K, Dang G, Harduar-Morano L, Modji K, Luckhaupt SE. Excess risk of SARS-CoV-2 infection among in-person nonhealthcare workers in six states, September 2020-June 2021. Am J Ind Med 2023. [PMID: 37153939 DOI: 10.1002/ajim.23487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND While the occupational risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for healthcare personnel in the United States has been relatively well characterized, less information is available on the occupational risk for workers employed in other settings. Even fewer studies have attempted to compare risks across occupations and industries. Using differential proportionate distribution as an approximation, we evaluated excess risk of SARS-CoV-2 infection by occupation and industry among non-healthcare workers in six states. METHODS We analyzed data on occupation and industry of employment from a six-state callback survey of adult non-healthcare workers with confirmed SARS-CoV-2 infection and population-based reference data on employment patterns, adjusted for the effect of telework, from the U.S. Bureau of Labor Statistics. We estimated the differential proportionate distribution of SARS-CoV-2 infection by occupation and industry using the proportionate morbidity ratio (PMR). RESULTS Among a sample of 1111 workers with confirmed SARS-CoV-2 infection, significantly higher-than-expected proportions of workers were employed in service occupations (PMR 1.3, 99% confidence interval [CI] 1.1-1.5) and in the transportation and utilities (PMR 1.4, 99% CI 1.1-1.8) and leisure and hospitality industries (PMR 1.5, 99% CI 1.2-1.9). CONCLUSIONS We found evidence of significant differences in the proportionate distribution of SARS-CoV-2 infection by occupation and industry among respondents in a multistate, population-based survey, highlighting the excess risk of SARS-CoV-2 infection borne by some worker populations, particularly those whose jobs require frequent or prolonged close contact with other people.
Collapse
Affiliation(s)
- Matthew R Groenewold
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Rachael Billock
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Hannah Free
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Sherry L Burrer
- Emergency Preparedness and Response Office, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marie Haring Sweeney
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Jessie Wong
- California Department of Public Health, Sacramento, California, USA
| | | | | | | | | | - Nicole D Karlsson
- New Hampshire Department of Health and Human Services, Concord, New Hampshire, USA
| | - Karla Armenti
- University of New Hampshire, Durham, New Hampshire, USA
| | - Hannah Thomas
- New Hampshire Department of Health and Human Services, Concord, New Hampshire, USA
| | - Kim Gaetz
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - Gialana Dang
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
- Western States Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado, USA
| | - Laurel Harduar-Morano
- Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Komi Modji
- Wisconsin Department of Health Services, Division of Public Health, Madison, Wisconsin, USA
| | - Sara E Luckhaupt
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| |
Collapse
|
2
|
Tsai RJ, Lu JW, Henn SA, Hasanali SH, Harduar-Morano L, Nair A. Industry-specific prevalence of elevated blood lead levels among Pennsylvania workers, 2007-2018. Occup Environ Med 2022; 79:oemed-2022-108340. [PMID: 35738891 PMCID: PMC9780397 DOI: 10.1136/oemed-2022-108340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/06/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To use industry-specific denominators to more accurately examine trends in prevalence rates for occupational cases of elevated blood lead levels (eBLLs) in Pennsylvania. METHODS We used adult (aged ≥16 years) blood lead level data from Pennsylvania (2007-2018) and industry-specific denominator data from the US Census Bureau's County Business Patterns to calculate prevalence rates for eBLLs, defined as ≥25 µg/dL. RESULTS Of the 19 904 cases with eBLLs, 92% were due to occupational lead exposure, with 83% from workers in the battery manufacturing industry. In 2018, the prevalence rate of eBLLs for battery manufacturing (8036.4 cases per 100 000 employed battery manufacturing workers) was 543 times the overall Pennsylvania prevalence rate. The prevalence rate for battery manufacturing steeply declined 71% from 2007 to 2018. CONCLUSIONS The battery manufacturing industry had the highest burden of occupational lead exposure in Pennsylvania, illustrating the importance of using industry-specific denominators to accurately identify sources of lead exposure. Although the prevalence rate of eBLLs declined over time, lead exposure remains a major concern among battery manufacturing workers.
Collapse
Affiliation(s)
- Rebecca J Tsai
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John W Lu
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott A Henn
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephanie H Hasanali
- Bureau of Epidemiology, Division of Environmental Health Epidemiology, Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA
| | - Laurel Harduar-Morano
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bureau of Epidemiology, Division of Environmental Health Epidemiology, Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA
| | - Anil Nair
- Bureau of Epidemiology, Division of Environmental Health Epidemiology, Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA
| |
Collapse
|
3
|
Free H, Luckhaupt SE, Billock RM, Groenewold MR, Burrer S, Sweeney MH, Wong J, Gibb K, Rodriguez A, Vergara X, Cummings K, Lavender A, Argueta G, Crawford HL, Erukunuapor K, Karlsson ND, Armenti K, Thomas H, Gaetz K, Dang G, Harduar-Morano L, Modji K. Reported Exposures Among In-Person Workers With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in 6 States, September 2020-June 2021. Clin Infect Dis 2022; 75:S216-S224. [PMID: 35717638 PMCID: PMC9214180 DOI: 10.1093/cid/ciac486] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Surveillance systems lack detailed occupational exposure information from workers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The National Institute for Occupational Safety and Health partnered with 6 states to collect information from adults diagnosed with SARS-CoV-2 infection who worked in person (outside the home) in non-healthcare settings during the 2 weeks prior to illness onset. METHODS The survey captured demographic, medical, and occupational characteristics and work- and non-work-related risk factors for SARS-CoV-2 infection. Reported close contact with a person known or suspected to have SARS-CoV-2 infection was categorized by setting as exposure at work, exposure outside of work only, or no known exposure/did not know. Frequencies and percentages of exposure types are compared by respondent characteristics and risk factors. RESULTS Of 1111 respondents, 19.4% reported exposure at work, 23.4% reported exposure outside of work only, and 57.2% reported no known exposure/did not know. Workers in protective service occupations (48.8%) and public administration industries (35.6%) reported exposure at work most often. More than one third (33.7%) of respondents who experienced close contact with ≥10 coworkers per day and 28.8% of respondents who experienced close contact with ≥10 customers/clients per day reported exposures at work. CONCLUSIONS Exposure to occupational SARS-CoV-2 was common among respondents. Examining differences in exposures among different worker groups can help identify populations with the greatest need for prevention interventions. The benefits of recording employment characteristics as standard demographic information will remain relevant as new and reemerging public health issues occur.
Collapse
Affiliation(s)
| | - Sara E Luckhaupt
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Rachael M Billock
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Matthew R Groenewold
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Sherry Burrer
- Emergency Preparedness and Response Office, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Marie Haring Sweeney
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | | | | | | | | | | | | | | | | | | | | | | | - Hannah Thomas
- New Hampshire Department of Health and Human Services
| | - Kim Gaetz
- North Carolina Department of Health and Human Services
| | - Gialana Dang
- North Carolina Department of Health and Human Services,Western States Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Laurel Harduar-Morano
- Pennsylvania Department of Health,Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention
| | | |
Collapse
|
4
|
McCormick DW, Richardson LC, Young PR, Viens LJ, Gould CV, Kimball A, Pindyck T, Rosenblum HG, Siegel DA, Vu QM, Komatsu K, Venkat H, Openshaw JJ, Kawasaki B, Siniscalchi AJ, Gumke M, Leapley A, Tobin-D’Angelo M, Kauerauf J, Reid H, White K, Ahmed FS, Richardson G, Hand J, Kirkey K, Larson L, Byers P, Garcia A, Ojo M, Zamcheck A, Lash MK, Lee EH, Reilly KH, Wilson E, de Fijter S, Naqvi OH, Harduar-Morano L, Burch AK, Lewis A, Kolsin J, Pont SJ, Barbeau B, Bixler D, Reagan-Steiner S, Koumans EH. Deaths in Children and Adolescents Associated With COVID-19 and MIS-C in the United States. Pediatrics 2021; 148:peds.2021-052273. [PMID: 34385349 PMCID: PMC9837742 DOI: 10.1542/peds.2021-052273] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To describe the demographics, clinical characteristics, and hospital course among persons <21 years of age with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated death. METHODS We conducted a retrospective case series of suspected SARS-CoV-2-associated deaths in the United States in persons <21 years of age during February 12 to July 31, 2020. All states and territories were invited to participate. We abstracted demographic and clinical data, including laboratory and treatment details, from medical records. RESULTS We included 112 SARS-CoV-2-associated deaths from 25 participating jurisdictions. The median age was 17 years (IQR 8.5-19 years). Most decedents were male (71, 63%), 31 (28%) were Black (non-Hispanic) persons, and 52 (46%) were Hispanic persons. Ninety-six decedents (86%) had at least 1 underlying condition; obesity (42%), asthma (29%), and developmental disorders (22%) were most commonly documented. Among 69 hospitalized decedents, common complications included mechanical ventilation (75%) and acute respiratory failure (82%). The sixteen (14%) decedents who met multisystem inflammatory syndrome in children (MIS-C) criteria were similar in age, sex, and race and/or ethnicity to decedents without MIS-C; 11 of 16 (69%) had at least 1 underlying condition. CONCLUSIONS SARS-CoV-2-associated deaths among persons <21 years of age occurred predominantly among Black (non-Hispanic) and Hispanic persons, male patients, and older adolescents. The most commonly reported underlying conditions were obesity, asthma, and developmental disorders. Decedents with coronavirus disease 2019 were more likely than those with MIS-C to have underlying medical conditions.
Collapse
Affiliation(s)
| | | | | | | | | | - Anne Kimball
- CDC COVID-19 Response Team,Epidemic Intelligence Service, CDC
| | | | | | | | | | | | - Heather Venkat
- Arizona Department of Health Services,CDC Career Epidemiology Field Officer Program
| | | | | | | | | | | | | | | | | | | | | | | | | | - Kim Kirkey
- Michigan Department of Health and Human Services
| | | | | | - Ali Garcia
- Nevada Department of Health and Human Services
| | | | | | - Maura K. Lash
- New York City Department of Health and Mental Hygiene
| | - Ellen H. Lee
- New York City Department of Health and Mental Hygiene
| | | | - Erica Wilson
- North Carolina Department of Health and Human Services
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Kelly-Reif K, Rinsky JL, Chiu SK, Burrer S, de Perio MA, Trotter AG, Miura SS, Seo JY, Hong R, Friedman L, Hand J, Richardson G, Sokol T, Sparer-Fine EH, Laing J, Oliveri A, McGreevy K, Borjan M, Harduar-Morano L, Luckhaupt SE. Media Reports as a Tool for Timely Monitoring of COVID-19-Related Deaths Among First Responders-United States, April 2020. Public Health Rep 2021; 136:315-319. [PMID: 33617374 DOI: 10.1177/0033354921999171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We aimed to describe coronavirus disease 2019 (COVID-19) deaths among first responders early in the COVID-19 pandemic. We used media reports to gather timely information about COVID-19-related deaths among first responders during March 30-April 30, 2020, and evaluated the sensitivity of media scanning compared with traditional surveillance. We abstracted information about demographic characteristics, occupation, underlying conditions, and exposure source. Twelve of 19 US public health jurisdictions with data on reported deaths provided verification, and 7 jurisdictions reported whether additional deaths had occurred; we calculated the sensitivity of media scanning among these 7 jurisdictions. We identified 97 COVID-19-related first-responder deaths during the study period through media and jurisdiction reports. Participating jurisdictions reported 5 deaths not reported by the media. Sixty-six decedents worked in law enforcement, and 31 decedents worked in fire/emergency medical services. Media reports rarely noted underlying conditions. The media scan sensitivity was 88% (95% CI, 73%-96%) in the subset of 7 jurisdictions. Media reports demonstrated high sensitivity in documenting COVID-19-related deaths among first responders; however, information on risk factors was scarce. Routine collection of data on industry and occupation could improve understanding of COVID-19 morbidity and mortality among all workers.
Collapse
Affiliation(s)
- Kaitlin Kelly-Reif
- 114426 Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Jessica L Rinsky
- 114426 Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Sophia K Chiu
- 114426 Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Sherry Burrer
- Emergency Preparedness and Response Office, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marie A de Perio
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Alexis Grimes Trotter
- 114426 Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Sarah Selica Miura
- 114426 Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Jennifer Y Seo
- 11056 Chicago Department of Public Health, Chicago, IL, USA
| | - Rick Hong
- 516953 Division of Public Health, Delaware Department of Health and Social Services, Dover, DE, USA
| | - Lee Friedman
- 50739 Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Julie Hand
- 51530 Louisiana Department of Health, New Orleans, LA, USA
| | | | - Theresa Sokol
- 51530 Louisiana Department of Health, New Orleans, LA, USA
| | - Emily H Sparer-Fine
- 366942 Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, MA, USA
| | - James Laing
- 366942 Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, MA, USA
| | - Anthony Oliveri
- 3078 Division of Occupational and Environmental Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Marija Borjan
- 8012 New Jersey Department of Health, Trenton, NJ, USA
| | - Laurel Harduar-Morano
- 6616 Pennsylvania Department of Health, Harrisburg, PA, USA.,60613 Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sara E Luckhaupt
- 114426 Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| |
Collapse
|
6
|
Rispens JR, Jones SA, Clemmons NS, Ahmed S, Harduar-Morano L, Johnson MD, Edge C, Vyas A, Bourgikos E, Orr MF. Anhydrous Ammonia Chemical Release — Lake County, Illinois, April 2019. MMWR Morb Mortal Wkly Rep 2020; 69:109-113. [PMID: 31999683 PMCID: PMC7004403 DOI: 10.15585/mmwr.mm6904a4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
7
|
Nadimpalli M, Rinsky JL, Wing S, Hall D, Stewart J, Larsen J, Nachman KE, Love DC, Pierce E, Pisanic N, Strelitz J, Harduar-Morano L, Heaney CD. Persistence of livestock-associated antibiotic-resistant Staphylococcus aureus among industrial hog operation workers in North Carolina over 14 days. Occup Environ Med 2014; 72:90-9. [PMID: 25200855 PMCID: PMC4316926 DOI: 10.1136/oemed-2014-102095] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aimed to evaluate the persistence of nasal carriage of Staphylococcus aureus, methicillin-resistant S. aureus and multidrug-resistant S. aureus over 14 days of follow-up among industrial hog operation workers in North Carolina. METHODS Workers anticipating at least 24 h away from work were enrolled June-August 2012. Participants self-collected a nasal swab and completed a study journal on the evening of day 1, and each morning and evening on days 2-7 and 14 of the study. S. aureus isolated from nasal swabs were assessed for antibiotic susceptibility, spa type and absence of the scn gene. Livestock association was defined by absence of scn. RESULTS Twenty-two workers provided 327 samples. S. aureus carriage end points did not change with time away from work (mean 49 h; range >0-96 h). Ten workers were persistent and six were intermittent carriers of livestock-associated S. aureus. Six workers were persistent and three intermittent carriers of livestock-associated multidrug-resistant S. aureus. One worker persistently carried livestock-associated methicillin-resistant S. aureus. Six workers were non-carriers of livestock-associated S. aureus. Eighty-two per cent of livestock-associated S. aureus demonstrated resistance to tetracycline. A majority of livestock-associated S. aureus isolates (n=169) were CC398 (68%) while 31% were CC9. No CC398 and one CC9 isolate was detected among scn-positive isolates. CONCLUSIONS Nasal carriage of livestock-associated S. aureus, multidrug-resistant S. aureus and methicillin-resistant S. aureus can persist among industrial hog operation workers over a 14-day period, which included up to 96 h away from work.
Collapse
Affiliation(s)
- Maya Nadimpalli
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica L Rinsky
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steve Wing
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Devon Hall
- Rural Empowerment Association for Community Help (REACH), Warsaw, North Carolina, USA
| | - Jill Stewart
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jesper Larsen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Keeve E Nachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore Maryland, USA Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dave C Love
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore Maryland, USA Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Pierce
- Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nora Pisanic
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jean Strelitz
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laurel Harduar-Morano
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher D Heaney
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
8
|
Harduar-Morano L, Watkins S. Review of unintentional non-fire-related carbon monoxide poisoning morbidity and mortality in Florida, 1999-2007. Public Health Rep 2011; 126:240-50. [PMID: 21387954 DOI: 10.1177/003335491112600215] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Previous Florida evaluations of carbon monoxide (CO) poisoning have been disaster focused. The majority of prevention messages and risk-factor identification efforts have revolved around hurricane season (June-November). We evaluated the prevalence, risk factors, and causes of CO poisoning within Florida throughout the year to produce a more complete presentation of the burden of CO poisoning. METHODS We obtained data from death certificates, hospital discharge records, and emergency department records. We limited our analysis to unintentional poisonings, calculating rates for age, gender, race, and ethnicity, and reviewing poisoning chronology, location, and exposure situation. RESULTS From 1999 to 2007, 493 people were hospitalized, and 230 individuals died as a result of non-fire-related CO poisoning. From 2005 to 2007, 781 people visited emergency departments for non-fire-related CO poisoning. Rates of severe poisoning resulting in hospitalization or death were highest among the elderly (0.56 visits and 0.63 deaths per 100,000 Floridians). Acute poisoning rates were highest among people 25-34 years of age (2.48 visits per 100,000 Floridians). Poisonings were primarily due to motor vehicle exhaust (21%-69%) and generator exposure (12%-33%), and the majority (50%-70%) occurred within the home. A large number of poisonings (25%-29%) occurred during the winter months, outside of hurricane season. CONCLUSION The findings of this study indicate a need for additional prevention strategies in conjunction with current activities to more effectively reduce the number of CO poisonings in Florida. Prevention activities should be conducted year-round, and additional strategies should include public awareness of the hazards of motor vehicle exhaust.
Collapse
Affiliation(s)
- Laurel Harduar-Morano
- Division of Environmental Health, Florida Department of Health, Tallahassee, FL 32399, USA
| | | |
Collapse
|
9
|
Harduar-Morano L, Simon MR, Watkins S, Blackmore C. Algorithm for the diagnosis of anaphylaxis and its validation using population-based data on emergency department visits for anaphylaxis in Florida. J Allergy Clin Immunol 2010; 126:98-104.e4. [PMID: 20541247 DOI: 10.1016/j.jaci.2010.04.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Revised: 04/15/2010] [Accepted: 04/20/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Epidemiologic studies of anaphylaxis have been limited by significant underdiagnosis. OBJECTIVE The purpose of this study was to develop and validate a method for capturing previously unidentified anaphylaxis cases by using International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) based datasets. METHODS Florida emergency department data for the years 2005 and 2006 from the Florida Agency for Health Care Administration were used. Patients with anaphylaxis were identified by using ICD-9-CM codes specifically indicating anaphylaxis or an ICD-9-CM algorithm based on the definition of anaphylaxis proposed at the 2005 National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network symposium. Cases ascertained with the algorithm were compared with the traditional case-ascertainment method. Comparisons included demographic and clinical risk factors, proportion of monthly visits, and age/sex-specific rates. Cases ascertained with anaphylaxis ICD-9-CM codes were excluded from those ascertained with the algorithm. RESULTS One thousand one hundred forty-nine patients were identified by using anaphylaxis ICD-9-CM codes, and 1,602 patients were identified with the algorithm. The clinical risk factors and demographics of cases were consistent between the 2 methods. However, the algorithm was more likely to identify older subjects (P < .0001), those with hypertension or heart disease (P < .0001), and subjects with venom-induced anaphylaxis (P < .0001). CONCLUSION This study introduces and validates an ICD-9-CM-based diagnostic algorithm for the diagnosis of anaphylaxis to capture subjects missed by using the ICD-9-CM anaphylaxis codes. Fifty-eight percent of anaphylaxis cases would be missed without the use of the algorithm, including 88% of venom-induced cases.
Collapse
Affiliation(s)
- Laurel Harduar-Morano
- Florida Department of Health, Division of Environmental Health, Bureau of Environmental Public Health Medicine, Tallahassee, FL, USA
| | | | | | | |
Collapse
|
10
|
Harduar-Morano L, Price JR, Parker D, Blackmore C. PACE EH post project assessment of quality of life changes in a Florida community related to infrastructure improvements. J Environ Health 2008; 70:40-67. [PMID: 18561568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The Indian River county health department, environmental health division (IRCHD EH) in Florida implemented the Protocol for Assessing Community Excellence in Environmental Health (PACE EH) in the low-income community of West Wabasso, Florida. Over two and a half years, IRCHD EH worked with the community and various governmental agencies to bring much-needed improvements to the area. At the end of the two and a half years, a survey was conducted to discover if the residents' quality of life had increased due to the community's improvements. The survey results yielded high satisfaction rates among residents. The general response was that their feelings of safety and overall well-being attributed to infrastructure improvements in their community had increased significantly. An unforeseen benefit realized by all parties involved was a renewed trust in government. The majority of surveyed residents (91%) felt that governmental agencies were better able to respond to their issues.
Collapse
Affiliation(s)
- Laurel Harduar-Morano
- Florida Department of Health, Division of Environmental Health, Tallahassee, FL 32399, USA.
| | | | | | | |
Collapse
|
11
|
Van Sickle D, Chertow DS, Schulte JM, Ferdinands JM, Patel PS, Johnson DR, Harduar-Morano L, Blackmore C, Ourso AC, Cruse KM, Dunn KH, Moolenaar RL. Carbon monoxide poisoning in Florida during the 2004 hurricane season. Am J Prev Med 2007; 32:340-6. [PMID: 17383566 DOI: 10.1016/j.amepre.2006.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 11/09/2006] [Accepted: 12/01/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND During August-September 2004, four major hurricanes hit Florida, resulting in widespread power outages affecting several million households. Carbon monoxide (CO) poisonings during this period were investigated to identify ways to prevent future poisoning. METHODS Medical records from ten hospitals (two with hyperbaric oxygen chambers) were reviewed to identify individuals diagnosed with unintentional CO poisoning between August 13 and October 15, 2004. Multiple attempts were made to interview one person from each nonfatal incident. Medical examiner records and reports of investigations conducted by the U.S. Consumer Product Safety Commission of six fatal poisonings from five additional incidents were also reviewed. RESULTS A total of 167 people treated for nonfatal CO poisoning were identified, representing 51 incidents. A portable, gasoline-powered generator was implicated in nearly all nonfatal incidents and in all fatal poisonings. Generators were most often located outdoors, followed by inside the garage, and inside the home. Telephone interviews with representatives of 35 (69%) incidents revealed that concerns about theft or exhaust most often influenced the choice of location. Twenty-six (74%) households did not own a generator before the hurricanes, and 86% did not have a CO detector at the time of the poisoning. Twenty-one (67%) households reported reading or hearing CO education messages before the incident. CONCLUSIONS Although exposure to public education messages may have encouraged more appropriate use of generators, a substantial number of people were poisoned even when the devices were operated outdoors. Additional educational efforts and engineering solutions that reduce CO emission from generators should be the focus of public health activities.
Collapse
Affiliation(s)
- David Van Sickle
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|