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Volume
8 Number 1 May 2010
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From the Director's Desk
--John Howard, M.D. Director, NIOSH
May eNews 2010
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The 9/11 Responder Health Literature: Recent Additions
The images
are indelibly fixed in our collective memory. More than 8 years have passed,
but we vividly remember the terrible plume of pulverized materials—the
dust cloud—that billowed through Lower Manhattan as the twin towers of
the World Trade Center (WTC) collapsed in the September 11, 2001, terrorist
attack. We remember the lingering pall of smoke, dust, and ash that
confronted rescue and recovery workers at the Ground Zero site. For the
responders, adverse health effects associated with exposures to those
contaminants continue to impose a heavy burden.
Since
these tragic events, more than 51,000 responders and 2,000 residents of Lower
Manhattan have been served through multicenter clinical programs made
available with federal funding administered by the National Institute for
Occupational Safety and Health (NIOSH) (see http://www.cdc.gov/niosh/topics/wtc/responder.html;
http://www.cdc.gov/niosh/topics/wtc/nonResponder.html).
For responders, the multicenter occupational health programs provide
standardized exposure assessment, medical and mental health assessments,
occupational health education, and targeted treatment and support services.
Medical examinations include a physical exam, pre- and post-bronchodilator
spirometry, blood cell counts and chemistry, urinalysis, and chest
radiography. The monitoring program continues to inform our scientific
understanding of the health impacts associated with working the 9/11 WTC
disaster site (http://www.cdc.gov/niosh/topics/wtc/ScienceSumm.html).
Recently
published studies from these programs highlight persistent changes in
responders’ lung functions and explore the pathophysiology - that is,
the nature and processes - of lung disease in those who served the nation in
this heroic response and recovery effort. Two most recently published
articles are the following:
In the
study by Aldrich et al. [2010], pre-9/11 occupational health records were
available to study the impacts of the WTC exposures on responders from the
Fire Department of New York City (FDNY). In the first year after those
responders’ service in 9/11 duties, FDNY fire fighters expelled 439 ml
less air in the first second of forced exhalation than they had in baseline
medical tests of lung function preceding 9/11. Emergency medical service
workers at FDNY showed a loss of 267 ml. Those included in the analyses had
never smoked. These declines in lung function persisted 7 years later, with
little or no recovery.
A recent
study by Wu et al. [2010] describes clinical, pathologic, and mineralogic
findings in seven previously healthy responders who developed severe
respiratory impairment, or unexplained changes in the lungs that were
identified on x-rays, after being exposed to WTC dust on either September 11
or September 12, 2001. Pathologic evaluations showed interstitial and small
airways disease. Mineralogical studies of lung tissues demonstrated the
presence of aluminum and magnesium silicates in unusual platy (sheet)
structures, chrysotile asbestos, calcium phosphate, calcium sulfate, small
shards of glass, and carbon nanotubes of various sizes and lengths. Platy
silicates and carbon nanotubes were not found in lung tissue samples from
people not exposed to WTC dust. Carbon nanotubes were also unexpectedly found
in WTC dust samples. The authors suggest that the carbon nanotubes found in
dust samples and lung biopsy specimens were generated as incidental
contaminants during the disaster by combustion and high temperatures in the
presence of carbon and metals. For NIOSH and others who research occupational
exposures to engineered carbon nanotubes, the implications of those findings
are unclear. The study by Wu et al. does not attempt to address the complex
question of possible causality—that is, what individual contaminants in
WTC dust might have been linked with specific health effects?
A critical
element in the occupational health monitoring of the 9/11 responders is an
assessment of lung function using spirometry. Spirometry is an unusual
medical test in that doing the test requires the active participation of
patients. Thus, accuracy depends not only on quality control of spirometry
equipment, but also on the training and consistent performance proficiency of
spirometry technicians in coaching patients to do the test. NIOSH provides
training materials and certifies spirometry training courses for those doing
the test (see http://www.cdc.gov/niosh/topics/spirometry/training.html).
A recent publication, Quality of Spirometry
Performed by 13,599 Participants in the World Trade Center Worker and
Volunteer Medical Screening Program[Enright 2010], describes
the intensive efforts of the WTC Worker and Volunteer Medical Screening
Program to obtain spirometry tests of the highest possible quality.
These WTC
medical monitoring centers are also looking for additional health burdens
that might emerge over time. Environmental monitoring identified airborne and
settled dust containing toxic combustion products and pulverized building
materials, including asbestos, silica, and polyaromatic hydrocarbons (PAH)—agents
that may cause cancer or pneumoconiosis over the long term. Last year, eight
cases of multiple myeloma were detected in one of the clinical centers, with
four cases in law enforcement officers under the age of 45. Those findings
were reported in Multiple
Myeloma in World Trade Center Responders: A Case Series [Moline 2009].
Unfortunately,
actual WTC occupational exposures were not well characterized, many cancers
have multiple contributing factors, and these rare events occur with varying
latency—all of which will challenge epidemiological study. While we
await the numbers, responders may be enduring disease that will be difficult
to scientifically attribute to exposure using Austin Bradford Hill’s
criteria for causation, a standard reference [Hill 1967]. As such,
legislative efforts continue to advocate for long-term funding to support the
clinical programs and extend the care needed by those afflicted [James
Zadroga 9/11 Health and Compensation Act of 2009 (H.R. 847)]. NIOSH has
encouraged its partners to publish peer-reviewed studies that will provide a
scientific basis for decision-making. For the sake of the 9/11 responders and
all who are working diligently to address their health needs, we are pleased
that this literature continues to grow. (I want to thank Dori Reissman, M.D.,
Senior Medical Advisor, NIOSH Office of the Director, for her assistance in
preparing this month’s column.)
References
Aldrich TK, Gustave J, Hall CB, Cohen HW, Webber MP,
Zeig-Owens R, Cosenza K, Christodoulou V, Glass L, Al-Othman F, Weiden MD,
Kelly KJ, Prezant DJ [2010]. Lung function in rescue workers at the World
Trade Center after 7 years. N Engl J Med 362(14):1263-1272.
Enright PL, Skloot GS, Cox-Ganser JM, Udasin IG, Herbert R [2010]. Quality of
spirometry performed by 13,599 participants in the World Trade Center Worker
and Volunteer Medical Screening Program. Respir Care 55(3):303-9.
Hill AB [1965]. The environment and disease: association or causation? Proc R
Soc Med 58: 295-300.
Moline JM, Herbert R, Crowley L, Troy K, Hodgman E, Shukla G, Udasin I, Luft
B, Wallenstein S, Landrigan P, Savitz DA [2009]. Multiple myeloma in World
Trade Center responders: a case series. J Occup Environ Med 51(8):896-902.
Wu M, Gordon RE, Herbert R, Padilla M, Moline J, Mendelson D, Litle V, Travis
WD, Gil J [2010]. Case report: lung disease in world trade center responders
exposed to dust and smoke: carbon nanotubes found in the lungs of World Trade
Center patients and dust samples. Environ Health Perspect 118(4):499-504.
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NIOSH Offers Resources for Oil Spill Responder Safety
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As federal, state, and local governments mobilize
efforts to assist in the containment and cleanup of the Deepwater Horizon oil
spill in the Gulf of Mexico, NIOSH posts a web page with resources for
protecting response workers from potential safety and health risks. http://www.cdc.gov/niosh/topics/oilspillresponse/
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Workers Memorial Day: A Day to Mourn, a Day to Honor, a
Day to Rededicate
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On Workers Memorial Day, April 28, the nation honored
men and women who have suffered job-related injury, illness, and death. In a
Workers Memorial Day 2010 statement, NIOSH Director John Howard, MD,
reflected on the toll of workers’ pain, impairment, and death; the role
of NIOSH in national efforts to prevent such tragedies; and the challenges of
occupational safety and health in today’s world (http://www.cdc.gov/niosh/updates/upd-04-22-10.html).
NIOSH’s commemoration of Workers Memorial Day was highlighted in a
recent MMWR article (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5915a1.htm),
supplemented with a NIOSH research article on risk of occupational injury and
death for young workers (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5915a2.htm).
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Safe and Sound Radio Highlights Exposomes
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NIOSH Announces Associate Director, Deputy Associate
Director for Emergency Preparedness
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Congratulations to Jim Spahr and Lisa Delaney. Jim was
appointed Associate Director for Emergency Preparedness and Response in the
NIOSH Office of the Director, effective April 28, and Lisa was appointed
Deputy Associate Director for Emergency Preparedness and Response. Both have
served in interim capacities since February. The Office of Emergency
Preparedness and Response in the Office of the Director provides rapid
on-site support to protect emergency response providers and others in the
event of a disaster and advances research to support such efforts.
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News Coverage Highlights NIOSH Mine Safety Research
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Recent
news articles in the wake of the Upper Big Branch Mine disaster highlighted
NIOSH’s research and technical resources for mining safety and health.
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Download a NIOSH Chemical Hazards App for your iPad
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The NIOSH Chemical Hazard Guide application, or App as they are sometimes called, is now available for iPad
(a version of the iPhone application of the same name).
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National Nanotechnology Initiative Review Results
Released
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On March 25, the President’s Council of Advisors
on Science and Technology released its review of the National Nanotechnology
Initiative, noting the importance of health, safety, and environmental
research to the success of nanotechnology and NIOSH’s role in that
research. www.whitehouse.gov/ostp/pcast
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Project Seeks to Increase Adoption of the NIOSH E-Stop
Among Commercial Fishermen
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Researchers from NIOSH’s Alaska Pacific Regional
Office will gather information at ports in Alaska this spring to assess
barriers to the adoption of an innovative safety device. In 2007, NIOSH
licensed the device, the emergency stop or E-Stop for capstan winches, to
Emerald Marine (http://www.go2marine.com/product.do?no=162904F)
of Seattle, WA. Since that time the system has been used by commercial
fishermen in Alaska and Washington to reduce the likelihood of injury from
entanglement in their deck winches, though adoption of the technology has
been slower than anticipated. NIOSH researchers will engage fishermen and
ascertain what barriers remain to the adoption of what has been shown to be a
reliable and useful safety technology for fishermen on purse seine vessels.
Information gathered in the field will be used to develop a social marketing
and traditional marketing program in partnership with the licensee to address
fishermen’s concerns about the E-Stop. For more information on the
product go to http://www.kodiakdailymirror.com/?pid=19&id=8701
or contact Ted Teske at tteske@xxxxxxx
or 509-354-8070.
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Journal Posts Research Paper on Biodegradation of Carbon
Nanotubes
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Dr. Anna Shvedova of NIOSH and outside colleagues
reported on the discovery that carbon nanotubes were biodegraded by an enzyme
found in white blood cells—neutrophils. The results, published in Nature Nanotechnology,
are important for scientists in evaluating the biological effects of carbon
nanotubes, particularly their fate and role in inflammation. More research is
needed for determining the applicability of the findings in assessing
potential risk in occupational exposures. http://www.nature.com/nnano/journal/vaop/ncurrent/abs/nnano.2010.44.html
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NIOSH and USFA Initiate Study of Cancer Among
Firefighters
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NIOSH and the United States Fire Administration (USFA)
are partnering on a study to examine the potential for increased risk of
cancer among firefighters due to exposures from smoke, soot, and other
contaminants in the line of duty. http://www.cdc.gov/niosh/updates/upd-04-23-10.html
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Congratulations
to Doug Evans for receiving the 2010 Federal Service Excellence Award in the
Professional/Scientific category. The award is given by the Cincinnati
Federal Executive Board. Doug was recognized for his work in ultrafine
aerosols and contributions to the nanotechnology program. Dawn Farwick, Jerry
Kratzer, Thais Morata, Ron Hall, Doug Evans, and Jim Grosch were also
recognized by the board at this ceremony.
NIOSH salutes Leslie MacDonald and Jennifer
Hornsby-Myers, for dedicated service during deployment by the U.S. Department
of Health and Human Services (HHS) to Haiti as commissioned officers of the
U.S. Public Health Service as part of the U.S. relief effort in
earthquake-ravaged Haiti. The two provided technical assistance on reducing
health risks from air pollution, asbestos, silica dust, and psychological
stressors. More information about the HHS-led recovery efforts in Haiti can
be found at http://www.hhs.gov/haiti/.
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NIOSH Seeks Assistance From Pesticide Handlers
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NIOSH is seeking assistance from pesticide handlers in
the agriculture sector to learn about potential barriers to the proper
selection and use of PPE by agricultural pesticide handlers and their
employers. Additional information is available under "Spotlights"
at http://www.cdc.gov/niosh/npptl/
or email KFaulkner@xxxxxxx.
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NIOSH Requests Comments on the Following:
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Ten-Year
Review of the NIOSH Radiation Dose Reconstruction Program NIOSH Docket 194.
Comments will be accepted through June 4. http://www.cdc.gov/niosh/review/public/194/
Proposed Rule on Total Inward Leakage Requirements for
Respirators.
The proposed rule establishes total inward leakage requirements under 42 CFR
Part 84 for half-mask air-purifying particulate respirators, including both
elastomeric facepiece and filtering facepiece types. Comment period extended
through September 30. http://www.cdc.gov/niosh/docket/nioshdocket0137.html
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 John Gibbins and
Scott Brueck from the NIOSH HHE Program collaborated on a paper titled
"Epidemiologic Investigation of Immune-Mediated Polyradiculoneuropathy
among Abattoir Workers Exposed to Porcine Brain." This paper is based on
an investigation conducted with the Minnesota Department of Health when the
department was notified that some employees involved in the removal of brain
tissue from severed pig heads were experiencing neurological symptoms that
resulted in weakness and partial paralysis in their legs and arms. Symptoms
of patients were unlike previously described occupational illnesses. The
novel disease was associated with removing porcine brains using compressed
air. This outbreak highlights the potential for respiratory or mucosal
exposure to foreign neurological tissue causing an immune-mediated illness in
an occupational setting. It also highlights the importance of health care
providers obtaining a careful workplace exposure history and the benefits of
close cooperation between state and federal agencies.http://dx.plos.org/10.1371/journal.pone.0009782.
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New Health Hazard Evaluation Report Now Available
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Click here
to read about these recent releases and access the full HHE reports.
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Child Ag Safety Resources From NIOSH Partner
The
National Children’s Center for Rural and Agricultural Health and Safety
offers two versatile resources for preventing injury or death of children
living or working on farms:
EPA Launches Website With Safety Information on Spray
Polyurethane Foam (SPF)
The Environmental Protection Agency released a new Web
site aimed at helping to ensure the safe use of spray polyurethane foam (SPF)
by workers and for building occupants where SPF is installed (http://www.epa.gov/dfe/pubs/projects/spf/spray_polyurethane_foam.html)and
provides safety and scientific information to professionals in business,
nongovernmental organizations, academic institutions, and regulatory
agencies. As a supplemental resource, the page also refers site visitors to
the NIOSH Alert: Preventing Asthma and Death From MDI Exposure During
Spray-on Truck Bed Liner and Related Application (http://www.cdc.gov/niosh/docs/2006-149/).
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Collaboration at the Intersection of the "Three Safeties"
in Healthcare
The NORA Healthcare and Social Assistance Sector
Council has undertaken a number of activities to implement the sector’s
National Agenda (http://www.cdc.gov/niosh/nora/).
One activity is a collaboration with a global effort integrating the
"three safeties" (patient, worker and environmental safety and
health). A report by the Health Care Without Harm/Global Health and Safety
Initiative (HCWH/GHSI) Research Collaborative identifies research priorities
at the intersection of the three safeties, including the NORA priorities, (www.noharm.org/us_canada/reports/2009/oct/rep2009-10-22.php).
Continued collaboration between the NORA Council and the HCWH/GHSI Research
Collaborative is likely to bring increased visibility for worker safety
issues in this important and growing sector of the economy.
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 NIOSH
Announces Bullard-Sherwood r2p Award Winners
On April
28, NIOSH recognized significant contributions made by NIOSH researchers and
their partners to occupational safety and health over the past year.
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What’s New on the NIOSH Blog?
Strains and Sprains and Home Healthcare Workers
Strains, sprains, and other musculoskeletal injuries
from lifting and moving patients are painful and potentially disabling
occupational hazards for home healthcare workers. The science of designing
and using safe lifting practices is discussed in the most recent NIOSH
Science Blog. http://www.cdc.gov/niosh/blog/
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New Communication Products
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VISIT our new interactive NIOSH exhibit (Booth No. 531)
at AIHCe in Colorado May 24-26. Learn about the latest NIOSH research
projects and our e-promotion health communication activities. Find out what
happening as it happens. Follow our tweets from the booth via NIOSH Twitter.
ATTEND the NIOSH Luncheon Discussion — “Implementing NORA Strategic
Plans” on Tuesday, May 25 from 12:30 p.m.-1:30 p.m.
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Upcoming Conferences & Workshops
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Global
Regulation of Nanotechnologies Conference, hosted by Northeastern University
School of Law, May 7-8 in Boston, MA. www.northeastern.edu/law/nano-conference
Workshop
on Personal Protective Equipment for Healthcare Workers, Institute of
Medicine, June 3 in Washington, DC. http://www.iom.edu/Activities/PublicHealth/PPECurrentResearch.aspx
Respirator
Manufacturers Meeting, July 14 in Pittsburgh, PA. http://www.cdc.gov/niosh/npptl/resources/pressrel/letters/lttr-07142010.html
Nanomaterials
and Worker Health: Medical Surveillance, Exposure Registries, and
Epidemiologic Research, cohosted by NIOSH and the Mountain and Plains
Education and Research Center, July 21-23 in Keystone, CO. http://www.cdc.gov/niosh/topics/nanotech/keystone2010/
National
Conference on Health Communication, Marketing, and Media, Centers for Disease
Control and Prevention, August 17-19 in Atlanta, GA. http://www.cdc.gov/healthmarketing/NCHCMM2009/
Respirator
Manufacturers Meeting, cohosted by NIOSH National Personal Protective
Technology Laboratory and China Medical University, August 24-26 in Taichung,
Taiwan. http://www.cdc.gov/niosh/npptl/resources/pressrel/letters/lttr-08242010.html
A comprehensive list of upcoming conferences can be
found at http://www.cdc.gov/niosh/exhibits.html.
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