David J. Blackley

Molecular Evidence of Sexual Transmission of Ebola Virus

A suspected case of sexual transmission from a male survivor of Ebola virus disease (EVD) to his female partner (the patient in this report) occurred in Liberia in March 2015. Ebola virus (EBOV) genomes assembled from blood samples from the patient and a semen sample from the survivor were consistent with direct transmission. The genomes shared three substitutions that were absent from all other Western African EBOV sequences and that were distinct from the last documented transmission chain in Liberia before this case. Combined with epidemiologic data, the genomic analysis provides evidence of sexual transmission of EBOV and evidence of the persistence of infective EBOV in semen for 179 days or more after the onset of EVD. (Funded by the Defense Threat Reduction Agency and others.).

Reduced evolutionary rate in reemerged Ebola virus transmission chains.

Surveillance of Ebola virus disease flare-ups uncovers a reduced rate of Ebola virus evolution during persistent infections. On 29 June 2015, Liberia’s respite from Ebola virus disease (EVD) was interrupted for the second time by a renewed outbreak (“flare-up”) of seven confirmed cases. We demonstrate that, similar to the March 2015 flare-up associated with sexual transmission, this new flare-up was a reemergence of a Liberian transmission chain originating from a persistently infected source rather than a reintroduction from a reservoir or a neighboring country with active transmission. Although distinct, Ebola virus (EBOV) genomes from both flare-ups exhibit significantly low genetic divergence, indicating a reduced rate of EBOV evolution during persistent infection. Using this rate of change as a signature, we identified two additional EVD clusters that possibly arose from persistently infected sources. These findings highlight the risk of EVD flare-ups even after an outbreak is declared over.

Resurgence of a Debilitating and Entirely Preventable Respiratory Disease among Working Coal Miners

To the Editor: For more than 40 years, the National Institute for Occupational Safety and Health (NIOSH) has monitored trends in coal workers’ pneumoconiosis, including progressive massive fibrosis (PMF). PMF is an advanced, debilitating, and lethal form of coal workers’ pneumoconiosis with limited, primarily palliative treatment options and no cure. As part of ongoing surveillance efforts, NIOSH administers the Coal Workers’ Health Surveillance Program (CWHSP), which offers underground coal miners periodic chest radiographs and confidentially informs them of their pneumoconiosis status (1). Just 15 years ago, PMF was virtually eradicated, with a prevalence of 0.08% among all CWHSP participants and 0.33% among active underground miners with at least 25 years of mining tenure. Since that time, the national prevalence of PMF identified through the CWHSP has increased; the rate of increase in the central Appalachian states of Kentucky, Virginia, and West Virginia has been especially pronounced (Figure 1). Excessive inhalation of coal mine dust is the sole cause of PMF in working coal miners, so this increase can only be the result of overexposures and/or increased toxicity stemming from changes in dust composition (2). During 1998 to 2012, NIOSH identified 154 cases of PMF among CWHSP participants, 125 of whom were long-tenured underground coal miners in central Appalachia. In 2012, the prevalence of PMF in this group of working miners reached 3.23% (5-year moving average), the highest level since the early 1970s. At the same time, NIOSH documented cases of PMF among surface coal miners with little or no underground mining tenure (3). Figure 1. Prevalence of progressive massive fibrosis among working underground coal miners with 25 or more years of underground mining tenure (1974–2012) in Kentucky, Virginia, and West Virginia, according to the Coal Workers’ Health Surveillance ... Each of these cases is a tragedy and represents a failure among all those responsible for preventing this severe disease. This year marks the 45th anniversary of the Federal Coal Mine Health and Safety Act. In that legislation, Congress enacted enforceable dust standards to reduce the incidence of coal workers’ pneumoconiosis and eliminate PMF among underground coal miners (4). Despite readily available dust control technology and best practices guidance (5), recent findings suggest dust exposures have not been adequately controlled and that a substantial portion of U.S. coal miners continue to develop PMF. On August 1, 2014, NIOSH issued an interim final rule modifying existing regulations to include surface coal miners in the CWHSP (6). In addition, the interim final rule expands medical surveillance beyond occupational history and chest radiography to include respiratory symptom assessment and spirometry testing for the recognition of undiagnosed chronic obstructive pulmonary disease among all working coal miners. We believe that expanded medical surveillance is an important part of ensuring success in efforts to protect U.S. coal miners from this deadly but entirely preventable disease.

Decreased Ebola Transmission after Rapid Response to Outbreaks in Remote Areas, Liberia, 2014.

Basic interventions and community acceptance can result in rapid control of outbreaks.

Small mine size is associated with lung function abnormality and pneumoconiosis among underground coal miners in Kentucky, Virginia and West Virginia

Objectives To describe the prevalence of lung function abnormality and coal workers’ pneumoconiosis (CWP) by mine size among underground coal miners in Kentucky, Virginia and West Virginia. Methods During 2005–2012, 4491 miners completed spirometry and chest radiography as part of a health surveillance programme. Spirometry was interpreted according to American Thoracic Society and European Respiratory Society guidelines, and radiography per International Labour Office standards. Prevalence ratios (PR) were calculated for abnormal spirometry (obstructive, restrictive or mixed pattern using lower limits of normal derived from National Health and Nutrition Examination Survey (NHANES) III) and CWP among workers from small mines (≤50 miners) compared with those from large mines. Results Among 3771 eligible miners, those from small mines were more likely to have abnormal spirometry (18.5% vs 13.8%, p<0.01), CWP (10.8% vs 5.2%, p<0.01) and progressive massive fibrosis (2.4% vs 1.1%, p<0.01). In regression analysis, working in a small mine was associated with 37% higher prevalence of abnormal spirometry (PR 1.37, 95% CI 1.16 to 1.61) and 2.1 times higher prevalence of CWP (95% CI 1.68 to 2.70). Conclusions More than one in four of these miners had evidence of CWP, abnormal lung function or both. Although 96% of miners in the study have worked exclusively under dust regulations implemented following the 1969 Federal Coal Mine Safety and Health Act, we observed high rates of respiratory disease including severe cases. The current approach to dust control and provision of safe work conditions for central Appalachian underground coal miners is not adequate to protect them from adverse respiratory health effects.

Health and Social Conditions of the Poorest Versus Wealthiest Counties in the United States.

Objectives To more clearly articulate, and more graphically demonstrate, the impact of poverty on various health outcomes and social conditions by comparing the poorest counties to the richest counties in the United States and to other countries in the world. Methods We used 5-year averages for median household income to form the 3141 US counties into 50 new “states”-each representing 2% of the counties in the United States (62 or 63 counties each). We compared the poorest and wealthiest “states.” Results We documented dramatic and statistically significant differences in life expectancy, smoking rates, obesity rates, and almost every other measure of health and well-being between the wealthiest and poorest “states” in the country. The populations of more than half the countries in the world have a longer life expectancy than do US persons living in the poorest “state.” Conclusions This analysis graphically demonstrates the true impact of the extreme socioeconomic disparities that exist in the United States. These differences can be obscured when one looks only at state data, and suggest that practitioners and policymakers should increasingly focus interventions to address the needs of the poorest citizens in the United States.

Secondary Infections with Ebola Virus in Rural Communities, Liberia and Guinea, 2014–2015

Persons who died of Ebola virus disease at home in rural communities in Liberia and Guinea resulted in more secondary infections than persons admitted to Ebola treatment units. Intensified monitoring of contacts of persons who died of this disease in the community is an evidence-based approach to reduce virus transmission in rural communities.

Bolstering Community Cooperation in Ebola Resurgence Protocols: Combining Field Blood Draw and Point-of-Care Diagnosis.

Alison Galvani and colleagues describe a community-based protocol to improve cooperation with Ebola testing as well as contact tracing, quarantining, and treatment.

Progressive Massive Fibrosis in Coal Miners From 3 Clinics in Virginia

This study describes the demographic and radiographic characteristics of 416 coal miners with progressive massive pulmonary fibrosis (PMF) identified by pneumoconiosis screening as part of the US Coal Workers’ Health Surveillance Program.

Injury rates on new and old technology oil and gas rigs operated by the largest United States onshore drilling contractor

BACKGROUND Occupational fatality rates among oil and gas extraction industry and specifically among drilling contractor workers are high compared to the U.S. all-industry average. There is scant literature focused on non-fatal injuries among drilling contractors, some of which have introduced engineering controls to improve rig efficiency and reduce injury risk. METHODS We compared injury rates on new and old technology rigs operated by the largest U.S. drilling contractor during 2003-2012, stratifying by job type and grouping outcomes by injury severity and body part affected. RESULTS Six hundred seventy-one injuries were recorded over 77.4 million person-hours. The rate on new rigs was 66% of that on old rigs. Roughnecks had lower injury rates on new rigs, largely through reduced limb injury rates. New rigs had lower rates in each non-fatal injury severity category. CONCLUSIONS For this company, new technology rigs appear to provide a safer environment for roughnecks. Future studies could include data from additional companies.