May 22, 2015
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California prison workers at increased risk for coccidioidomycosis

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The average annual incidence of coccidioidomycosis among prison employees at two California prisons appeared higher than that of the general population in surrounding counties, according to recent findings.

Researchers examined employee rosters and the Confidential Morbidity Reports from the California Department of Public Health to identify confirmed cases of coccidioidomycosis — also known as desert or valley fever — among staff at two prisons between 2009 and 2013. Prison A employs approximately 1,300 custodial and support staff, and prison B employs roughly 1,500 custodial and support workers. During visits in 2013, researchers also surveyed a convenience sample of 172 employees across all job categories regarding their work habits and exposures, and they met with staff to discuss efforts toward dust reduction.

The researchers found that among Prison A employees, there were 65 confirmed cases of coccidioidomycosis, and there were 38 confirmed cases among Prison B employees. All but three employees lived in one of six counties known to be coccidioidomycosis hyperendemic.

Between 2009 and 2012, the crude average annual incidence for prison A employees was 1,039 cases per 100,000 employees; for prison B employees, it was 511 cases per 100,000 employees. The crude annual average incidence among the noninmate adult population in county A was 40 cases per 100,000 persons, and it was 110 cases per 100,000 individuals in county B.

Eighty-two percent of the 103 confirmed cases were male (median age, 43 years). The median duration of employment at the prison before symptom onset was 5 years.

Among the interviewed employees, 45% worked in custodial services, 17% in administration, 13% in plant operations, and 13% in health care.

Meetings with facilities and engineering staff at both prisons revealed that dust exposure prevention efforts included wetting soil before soil disruption, decreasing soil disking, use of a soil stabilizer and planting grass or other vegetation. The researchers said, however, that data is limited regarding the effectiveness of these efforts in decreasing airborne dispersal and occupational coccidioidomycosis.

“We recommended that prison management weigh the advantages and disadvantages of various environmental mitigation efforts to reduce dust exposures,” the researchers wrote. “Our recommendations included providing employees with education and training about coccidioidomycosis symptoms and transmission, risk factors for disseminated disease and ways to minimize exposures; closing the prison yards during dust storms; and using respirators … as part of a respiratory protection program for employees who must work outside during unusually dusty days or who may disturb soil.” – by Jen Byrne

Disclosure: The researchers report no relevant financial disclosures.