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Objective: In 2016, North Carolina blood lead level (BLL) surveillance activities identified elevated BLLs among 3 children exposed to take-home lead by household members employed at a lead oxide manufacturing facility. We characterized BLLs among employees and associated children and identified risk factors for occupational and take-home lead exposure. Methods: We reviewed BLL surveillance data for 2012-2016 to identify facility employees and associated children. We considered a BLL ≥5 μg/dL elevated for adults and children and compared adult BLLs with regulatory limits and recommended health-based thresholds. We also conducted an environmental investigation and interviewed current employees about exposure controls and cleanup procedures. Results: During 2012-2016, 5 children associated with facility employees had a confirmed BLL ≥5 μg/dL. Among 77 people employed during 2012-2016, median BLLs increased from 22 μg/dL (range, 4-45 μg/dL) in 2012 to 37 μg/dL (range, 16-54 μg/dL) in 2016. All employee BLLs were <60 μg/dL, the national regulatory threshold for immediate medical removal from lead exposure; however, 55 (71%) had a BLL ≥20 μg/dL, a recommended health-based threshold for removal from lead exposure. Because of inadequate controls in the facility, areas considered clean were visibly contaminated with lead dust. Employees reported bringing personal items to work and then into their cars and homes, resulting in take-home lead exposure. Conclusions: Integration of child and adult BLL surveillance activities identified an occupational source of lead exposure among workers and associated children. Our findings support recent recommendations that implementation of updated lead standards will support better control of lead in the workplace and prevent lead from being carried home. [ABSTRACT FROM AUTHOR]

Farming is among the most dangerous industries for fatal and nonfatal injuries. A comprehensive agricultural injury surveillance system is absent in North Carolina (NC), and data sets traditionally used to provide estimates of nonfatal farm injuries surveillance in the United States are relatively incomplete. In the absence of a comprehensive farm injury surveillance system, individual local administrative data sources can provide a useful profile of the epidemiology of injuries in a population. The objective of this study was to use emergency department data to help describe the burden of farm-related injuries in NC and explore its usefulness in conducting work-related injury surveillance. Emergency department data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) was utilized to identify farm injury cases. The study sample included all farm injury cases for the period of 2008–2012 that contained International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) E code 919.0 (agricultural machinery) or 849.1 (place of occurrence = farm; this E code excludes farm house and home premises of farm). Results indicated that an average of 459 cases of farm injury occurred annually from 2008 to 2012, with no significant change between years. Among the patients, 79.7% were male, 74.7% were between 18 and 64 years old, and 28.1% had no form of insurance coverage. Injuries were more heavily concentrated in the Piedmont and Coastal Plains regions (41.3% and 42.2%, respectively). Of farm-coded incidents, 73.2% were given injury- or poisoning-related primary diagnosis codes, and of these, the most frequent specific codes were related to open wounds of upper limbs (16.2%), contusions (12.0%), and sprains and strains (9.3%). Some significant relationships between diagnoses and sex, region, and age are also identified. Injuries occurring on a farm have been well documented and constitute a significant public health problem. Exploring emergency department data provides an opportunity to better characterize nonfatal farm-related injuries in NC for prevention purposes. The data provided by this study may serve to direct prevention programs, whereas the methods used offer a potential farm-related injury surveillance tool. [ABSTRACT FROM AUTHOR]

The article presents a case study of birth defect clusters that involves farm workers in North Carolina and Florida who are susceptible to pesticide exposure. Investigations made by the federal government revealed the proliferation of pesticide poisoning which led to the creation and passage of legislation continuously improve occupational illness and ensuring every individual's pesticide awareness. It also highlights the positive effects when surveillance programs are introduced.

Background: Asbestosis and silicosis are debilitating pulmonary conditions resulting from inhalation of asbestos fibers or silica dust., Purpose: We provide a descriptive analysis of asbestosis and silicosis hospitalizations in North Carolina to assess trends over a 10-year period., Methods: Events were defined as inpatient hospital discharges during the period 2002-2011 with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 501 or 502. Using statewide discharge data for 2002-2011, we calculated asbestosis and silicosis hospitalization rates in North Carolina (by demographics, hospital length of stay, cost, and payment type) and compared them with national rates., Results: In North Carolina, average annual age-standardized hospitalization rates for asbestosis and silicosis were 71.2 hospitalizations per 1 million residents and 6.2 hospitalizations per 1 million residents, respectively. Rates for asbestosis and silicosis decreased significantly (less than .01 for both conditions) between 2002 and 2011, by 46% and 67%, respectively. Men had significantly higher rates than women (less than .01), more than half of hospitalizations were among persons aged 65-84 years, and Medicare was the predominant payment source. The highest silicosis rates by county were clustered in Western North Carolina; no geographic patterns were observed for asbestosis. The estimated average annual cost statewide for these hospitalizations was $10,170,417 for asbestosis and $886,143 for silicosis., Limitations: ICD-9-CM misclassification and duplicate hospitalization records may have biased the observed rates of asbestosis and silicosis., Conclusions: Decreases in hospitalization rates in North Carolina may be due to misdiagnosis, underreporting, or the declining use of asbestos in industries. Obtaining complete exposure histories at diagnosis is useful for continued public health surveillance.

Work-related injury data suggest that agricultural workers in North Carolina are experiencing high rates of injury and death compared with workers in other occupations. However, current occupational injury data sources are insufficient to calculate accurate injury and mortality rates. We propose recommendations to improve existing farm injury surveillance, to guide prevention.

In 2008,161 North Carolina workers died from work-related injuries, 3,324 were hospitalized, and 119,000 reported work-related injuries. Workers' compensation costs in the state exceeded $1.3 billion in 2007. Concerted efforts by the private and public sectors will be needed to reach goals to reduce the incidence of occupational injuries.

Context: There is little evidence linking adverse reproductive effects to exposure to specific pesticides during pregnancy., Case Presentation: In February 2005, three infants with congenital anomalies were identified in Collier County, Florida, who were born within 8 weeks of one another and whose mothers worked for the same tomato grower. The mothers worked on the grower's Florida farms in 2004 before transferring to its North Carolina farms. All three worked during the period of organogenesis in fields recently treated with several pesticides. The Florida and North Carolina farms were inspected by regulatory agencies, and in each state a large number of violations were identified and record fines were levied., Discussion: Despite the suggestive evidence, a causal link could not be established between pesticide exposures and the birth defects in the three infants. Nonetheless, the prenatal pesticide exposures experienced by the mothers of the three infants is cause for concern. Farmworkers need greater protections against pesticides. These include increased efforts to publicize and comply with both the U.S. Environmental Protections Agency's Worker Protection Standard and pesticide label requirements, enhanced procedures to ensure pesticide applicator competency, and recommendations to growers to adopt work practices to reduce pesticide exposures. RELEVANCE TO PROFESSIONAL PRACTICE: The findings from this report reinforce the need to reduce pesticide exposures among farmworkers. In addition, they support the need for epidemiologic studies to examine the role of pesticide exposure in the etiology of congenital anomalies.