D. Kevin Horton

Secondary contamination of ED personnel from hazardous materials events, 1995–2001

Hazardous materials (hazmat) events pose a health threat not only for those individuals in the immediate vicinity of the release (ie, members of the general public, on-site first responders, employees), but also for ED personnel (ie, physicians and nurses) treating the chemically contaminated victims arriving at the hospital. Secondary contamination injuries to ED personnel result when exposed victims enter the ED without being properly decontaminated. Data from the Agency for Toxic Substances and Disease Registrys Hazardous Substances Emergency Events Surveillance System were used to conduct a retrospective analysis on hazmat events occurring in 16 states from 1995 through 2001 that involved secondary injury to ED personnel. Six events were identified in which 15 ED personnel were secondarily injured while treating contaminated victims. The predominant injuries sustained were respiratory and eye irritation. Proper victim decontamination procedures, good field-to-hospital communication, and appropriate personal protective equipment (PPE) use can help prevent ED personnel injuries and contamination of the ED.

Libby vermiculite exposure and risk of developing asbestos-related lung and pleural diseases.

Purpose of review The vermiculite ore formerly mined in Libby, Montana, contains asbestiform amphibole fibers of winchite, richterite, and tremolite asbestos. Because of the public health impact of widespread occupational and nonoccupational exposure to amphiboles in Libby vermiculite, numerous related studies have been published in recent years. Here we review current research related to this issue. Recent findings Excess morbidity and mortality classically associated with asbestos exposure have been well documented among persons exposed to Libby vermiculite. Excess morbidity and mortality have likewise been documented among persons with only nonoccupational exposure. A strong exposure–response relationship exists for many malignant and nonmalignant outcomes and the most common outcome, pleural plaques, may occur at low lifetime cumulative exposures. Summary The public health situation related to Libby, Montana, has led to huge investments in public health actions and research. The resulting studies have added much to the body of knowledge concerning health effects of exposures to Libby amphibole fibers specifically and asbestos exposure in general.

The public health consequences from acute chlorine releases, 1993-2000.

Learning ObjectivesContrast acute chlorine events, as assessed in 16 states during the years 1993-2000, with non-chlorine events with regard to the frequency of injury and the need for evacuation and decontamination.Recall whether and how chlorine exposures changed in frequency during the period under review, as well as the seasonal occurrence of events, the most common causes, symptoms of victims, and the use of protective equipment.Identify possible measures that could be taken in attempting to prevent chlorine-related injuries. Chlorine, a commonly used hazardous substance, can be harmful to human health when improperly released. Data from the Agency for Toxic Substances and Disease Registry’s Hazardous Substances Emergency Events Surveillance system were used to conduct a retrospective analysis on the public health consequences from acute chlorine releases in 16 states during 1993 through 2000. There was an overall decline in the number of chlorine events during the period analyzed; however, chlorine events were more likely to result in events with victims, evacuations, and decontaminations when compared with nonchlorine events (relative risk [RR] = 4.5, 95% confidence interval [CI] = 4.1 to 5.0; [RR] = 4.8, CI 4.3 to 5.3; and [RR] = 2.0, CI 1.7 to 2.4, respectively). Most chlorine victims were employees and members of the general public. The predominant symptoms sustained were respiratory and eye irritation. Equipment failure and human error were the most frequent factors leading to an event. Continuous employee training and preventive equipment maintenance can help prevent chlorine releases from occurring and minimize exposure to the general public.

Potential Environmental Factors in Amyotrophic Lateral Sclerosis

The causes of amyotrophic lateral sclerosis (ALS) are largely unknown, and may always be multiple, including environmental factors. Monogenetic determinants of ALS are involved in roughly 20% of all cases (including 10% familial cases). Less well understood multigenetic causes may contribute to another 20% to 80%. Environmental factors likely play a role in the development of ALS in susceptible individuals, but proved causation remains elusive. This article discusses the possible factors of male gender (males are selectively exposed to different influences, or genetically predisposed to be susceptible), smoking, military service, exercise, electrical exposure, heavy metals, agricultural chemicals, and geographic clusters.

Acute public health consequences associated with hazardous substances released during transit, 1993-2000.

Massive quantities of hazardous substances are transported each day throughout the United States. While most arrive safely at their destination, uncontrolled releases of substances in transit do occur and have the potential of causing acute public health consequences for those individuals at or near the release. Data from 16 state health departments participating in the Agency for Toxic Substances and Disease Registrys (ATSDR) Hazardous Substances Emergency Events Surveillance (HSEES) system were analyzed to determine the public health consequences that occurred from actual releases in transit. Of the 9392 transportation events analyzed, 9.1% resulted in 2008 victims, including 115 deaths. The population groups injured most often were employees and the general public. The most common injury sustained was respiratory irritation. Evacuations were ordered in 5.5% of events effecting at least 63,686 people. Human error and equipment failure were the most common factors leading to events. These findings underscore the importance of job safety training, community planning, and effective emergency response to prevent adverse public health consequences from occurring or lessen their effect on the public.

The Acute Health Consequences to Children Exposed to Hazardous Substances Used in Illicit Methamphetamine Production, 1996 to 2001

Children who are raised in an environment where illicit methamphetamine production occurs can experience acute health effects from hazardous substances used. Common substances used include anhydrous ammonia, hydrochloric acid, and acetone. Many of these are hazardous upon exposure and can lead to emergency events such as fires, explosions, spills, and toxic emissions. Data from 17 states participating in the Agency for Toxic Substances and Disease Registrys Hazardous Substances Emergency Events Surveillance system were used to analyze the acute health consequences among children exposed to hazardous substances released in association with illicit methamphetamine production during 1996 through 2001. Of the 519 methamphetamine-related emergency events identified where releases occurred, at least 8 known events involved 13 children who were injured. In four of these eight events, lethal substances such as anhydrous ammonia were released. The predominant injuries sustained by these children were respiratory ...

Racial and ethnic differences among amyotrophic lateral sclerosis cases in the United States

Abstract Our objective was to describe racial and ethnic differences of amyotrophic lateral sclerosis (ALS) in distinct geographic locations around the United States (U.S.). ALS cases for the period 2009–2011 were identified using active case surveillance in three states and eight metropolitan areas. Of the 5883 unique ALS cases identified, 74.8% were white, 9.3% were African-American/black, 3.6% were Asian, 12.0% were an unknown race, and 0.3% were marked as some other race. For ethnicity, 77.5% were defined as non-Hispanic, 10.8% Hispanic, and 11.7% were of unknown ethnicity. The overall crude average annual incidence rate was 1.52 per 100,000 person-years and the rate differed by race and ethnicity. The overall age-adjusted average annual incidence rate was 1.44 per 100,000 person-years and the age-adjusted average incidence rates also differed by race and ethnicity. Racial differences were also found in payer type, time from symptom onset to diagnosis, reported El Escorial criteria, and age at diagnosis. In conclusion, calculated incidence rates demonstrate that ALS occurs less frequently in African-American/blacks and Asians compared to whites, and less frequently in Hispanics compared to non-Hispanics in the U.S. A more precise understanding of racial and ethnic variations in ALS may help to reveal candidates for further studies of disease etiology and disease progression.

Changes in the concentrations of biochemical indicators of diet and nutritional status of pregnant women across pregnancy trimesters in Trujillo, Peru, 2004–2005

BackgroundIn developing countries, deficiencies in essential micronutrients are common, particularly in pregnant women. Although, biochemical indicators of diet and nutrition are useful to assess nutritional status, few studies have examined such indicators throughout pregnancy in women in developing countries.MethodsThe primary objective of this study was to assess the nutritional status of 78 Peruvian women throughout pregnancy for 16 different nutritional indicators including fat-soluble vitamins and carotenoids, iron-status indicators, and selenium. Venous blood samples from which serum was prepared were collected during trimesters one (n = 78), two (n = 65), three (n = 62), and at term via the umbilical cord (n = 52). Questionnaires were completed to determine the demographic characteristics of subjects. Linear mixed effects models were used to study the associations between each maternal indicator and the demographic characteristics.ResultsNone of the women were vitamin A and E deficient at any stage of pregnancy and only 1/62 women (1.6%) was selenium deficient during the third trimester. However, 6.4%, 44% and 64% of women had ferritin levels indicative of iron deficiency during the first, second and third trimester, respectively. Statistically significant changes (p ≤ 0.05) throughout pregnancy were noted for 15/16 nutritional indicators for this Peruvian cohort, with little-to-no association with demographic characteristics. Three carotenoids (beta-carotene, beta-cryptoxanthin and trans-lycopene) were significantly associated with education status, while trans-lycopene was associated with age and beta-cryptoxanthin with SES (p < 0.05). Concentrations of retinol, tocopherol, beta-cryptoxanthin, lutein + zeaxanthin and selenium were lower in cord serum compared with maternal serum (p < 0.05). Conversely, levels of iron status indicators (ferritin, transferrin saturation and iron) were higher in cord serum (p < 0.05).ConclusionThe increasing prevalence of iron deficiency throughout pregnancy in these Peruvian women was expected. It was surprising though not to find deficiencies in other nutrients. The results highlight the importance of continual monitoring of women throughout pregnancy for iron deficiency which could be caused by increasing fetal needs and/or inadequate iron intake as pregnancy progresses.

Select Mortality and Cancer Incidence Among Residents in Various U.S. Communities that Received Asbestos-Contaminated Vermiculite Ore from Libby, Montana

In response to the significantly elevated asbestosis mortality rates found in Libby, Montana, in 2000, this analysis evaluated whether other communities throughout the United States that received asbestos-contaminated vermiculite ore from Libby experienced similar excess rates of asbestos-related diseases. Standardized mortality ratios were calculated using state death certificates, and standardized incidence ratios were calculated using cancer registry records for populations living near facilities that processed or received Libby vermiculite. This analysis focused primarily on diseases that are directly associated with asbestos exposure (e.g., asbestosis; cancer of the peritoneum, retroperitoneum, and pleura, including mesothelioma; and mesothelioma). Lung cancer and cancers of the digestive system, also associated with asbestos exposure, were not included in the analysis because they have additional risk factors for which exposure information was not available. Data from 70 unique sites in 23 states were evaluated. No statistically significant excesses of asbestosis mortality similar to those in Libby were noted; however, 11 sites (plus a state with 6 pooled sites that were counted as 1 site) had excess rates of mesothelioma and cancer of the peritoneum, retroperitoneum, and pleura. Further investigation should be conducted at these sites with excess rates of mesothelioma and cancer of the peritoneum, retroperitoneum, and pleura by participating state health departments to determine whether exposure to Libby vermiculite might have been a contributing factor.

Secondary Contamination of Medical Personnel, Equipment, and Facilities Resulting From Hazardous Materials Events, 2003–2006

BACKGROUND When not managed properly, a hazardous material event can quickly extend beyond the boundaries of the initial release, creating the potential for secondary contamination of medical personnel, equipment, and facilities. Secondary contamination generally occurs when primary victims are not decontaminated or are inadequately decontaminated before receiving medical attention. This article examines the secondary contamination events reported to the Agency for Toxic Substances and Disease Registry (ATSDR) and offers suggestions for preventing such events. METHODS Data from the ATSDR Hazardous Substances Emergency Events Surveillance system were used to conduct a retrospective analysis of hazardous material events occurring in 17 states during 2003 through 2006 involving secondary contamination of medical personnel, equipment, and facilities. RESULTS Fifteen (0.05%) Hazardous Substances Emergency Events Surveillance events were identified in which secondary contamination occurred. At least 17 medical personnel were injured as a result of secondary contamination while they were treating contaminated victims. Of the medical personnel injured, 12 were emergency medical technicians and 5 were hospital personnel. Respiratory irritation was the most common injury sustained. CONCLUSIONS Adequate preplanning and drills, proper decontamination procedures, good field-to-hospital communication, appropriate use of personal protective equipment, and effective training can help prevent injuries of medical personnel and contamination of transport vehicles and medical facilities.