June 25, 2019 / Kay Bechtold

Agencies Focus on Infectious Diseases in the Workplace

Infectious diseases have commanded their share of headlines in recent years, and federal agencies like CDC, OSHA, and NIOSH have dedicated resources and staff to address outbreaks and provide timely guidance for the public and workers who may be at risk of infection. From Ebola to measles, here are a few of the diseases that have captured the attention of news outlets and government agencies alike.

A recent Ebola outbreak in the eastern Democratic Republic of the Congo is confirmed to have killed more than 1,400 people as of June 23, 2019. The DRC’s Ministry of Health first declared the outbreak on Aug. 1, 2018, in the country’s North Kivu Province. As of last month, more than 100 health workers had been infected during the outbreak, including 34 who died from the disease, according to a news article published on May 21 by the University of Minnesota Center for Infectious Disease Research and Policy. Violence and threats of arson against health facilities present additional challenges for response workers. CIDRAP’s report describes a third attack on burial teams working in the region and explains that some healthcare workers “are so scared for their safety due to arson threats, they have stopped wearing personal protective equipment and are reluctant to institute infection prevention and control practices.”

The 2018–2019 outbreak comes on the heels of the 2014–2016 Ebola outbreak in West Africa, the largest in history. More than 28,000 people were infected with Ebola virus disease in Guinea, Liberia, and Sierra Leone, and over 11,000 died. Ebola spread to seven other countries, including the United States, over the course of the epidemic. In October 2014, OSHA published a safety and health topic page to provide information about the Ebola virus, including how to protect workers from exposure on the job. A fact sheet developed jointly by OSHA, NIOSH, and EPA was released two months later to help employers protect workers whose jobs involve handling, treatment, transport, and disposal of medical, laboratory, and other waste suspected or known to be contaminated with the Ebola virus. And in January 2015, OSHA, NIOSH, and CDC released Ebola resources related to fatigue and personal protective equipment for workers, employers, responders, and healthcare facilities. (An article in the October 2015 Synergist described infection control lessons from the 2014 Ebola outbreak.)

This year, measles has been commanding much of the spotlight with 1,077 individual cases reported in the U.S. in 2019 as of June 20. According to CDC, this is the greatest number of cases since 1992. At a more local level, the New York City Department of Health and Mental Hygiene has recorded 609 confirmed cases of measles in the city since September. In March, officials in New York’s Rockland County declared a state of emergency related to the measles outbreak. The declaration barred from public places anyone who was under age 18 and unvaccinated against the measles. A global measles outbreak notice published this month by CDC cautions all international travelers to ensure that they are fully protected against measles before leaving the U.S. The June 21 issue of OSHA’s e-newsletter QuickTakes announced the publication of a new web page to provide information about preventing and reducing workers' exposure to measles as well as information on vaccination and treatment. According to OSHA, workers in childcare and healthcare, laboratories, and environmental services and those who travel abroad have the greatest risk of exposure and infection.

OSHA recently called attention to a lesser known virus that also poses an increased risk to childcare and healthcare workers. Cytomegalovirus, or CMV, is a common virus that is often spread through saliva and other body fluids of young children. According to OSHA, CMV is present in many other body fluids such as urine, tears, mucus, breastmilk, and blood, and can spread through direct, prolonged contact with these fluids. CMV is especially hazardous for workers who are or may become pregnant. OSHA cautions that CMV can cause intellectual and motor disabilities in infants born to mothers infected with the virus during pregnancy.

At CDC and NIOSH, a broader focus on infectious diseases appears to be growing. In November, NIOSH for the first time proposed a national research agenda to address the prevention of immune, infectious, and dermal disease. The research agenda was finalized in March 2019 (PDF) and includes objectives such as reducing the incidence and transmission of infectious disease in the workplace and investigating effects of recurring low-level occupational exposures on dermal, immune, and infectious diseases. According to the National Occupational Research Agenda, transmission of infectious disease in the workplace can contribute to “substantial costs and loss of productivity.” NORA also stresses the importance of additional respiratory, enteric, and dermally shed pathogens as sources of occupational illness in addition to more traditional concerns such as bloodborne pathogens and tuberculosis.

“Additional diseases now recognized to have an occupational risk of transmission include Norovirus, Methicillin-resistant Staphylococcus aureus, Helicobacter pylori, and Legionella, among others,” the research agenda reads. “Still other emerging infectious diseases, such as Ebola or Middle East Respiratory Syndrome (MERS), in addition to antibiotic-resistant strains of common bacteria, may pose a risk of occupational transmission.”

As concerns related to infectious diseases continue to grow and shift, it’s our goal to keep readers informed about the latest developments related to industrial hygiene and occupational health and safety. Examples of recent Synergist articles related to infectious diseases include an April 2018 article about industrial hygiene’s role in preventing the transmission of highly hazardous communicable diseases and an October 2018 article on using mathematical models to guide risk management for infectious diseases in the occupational setting. An article in the September 2016 Synergist discussed preventive measures to protect workers against Zika virus, a mosquito-borne disease that has been reported in several countries in Africa, the Americas, Asia, and the Pacific. Last month, Synergist Editor in Chief Ed Rutkowski covered a session at AIHce EXP 2019 in Minneapolis about “superbugs” and the challenges of antimicrobial resistance.

Are infectious diseases a concern in your workplace? Let us know in the comments.

Kay Bechtold

Kay Bechtold is senior editor of The Synergist.


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