MMWR – Morbidity and Mortality Weekly Report

1. Fatal Injuries in Offshore Oil and Gas Operations — United States, 2003–2010

CDC
Division of News & Electronic Media
404-639-3286

Catastrophic events, such as the Deepwater Horizon explosion, attract intense media attention but do not account for the majority of work-related fatalities during offshore operations. This report found that transportation events—specifically helicopter crashes—were the most frequent fatal event in this industry. During 2003-2010, workers in the U.S. oil and gas extraction industry experienced a fatality rate seven times higher than all U.S. workers. A recent NIOSH study identified fatalities during offshore oil and gas operations. The study found that 128 workers were killed during offshore oil and gas operations during 2003-2010. Transportation events were the leading cause of death. Seventy-five percent of all transportation events were associated with helicopters, and all of the helicopter events occurred in Gulf of Mexico operations. To improve safety, pilots, passengers and life rafts should have emergency beacons, people should wear life jackets on flights over water, and receive appropriate egress training. Helicopter floatation gear should inflate automatically on impact with water and life rafts should be externally mounted.

2. Obliterative Bronchiolitis Among Workers in a Coffee-Processing Facility — Texas 2009–2012

CDC
Division of News & Electronic Media
404-639-3286

A new report described two cases of obliterative bronchiolitis in a coffee processing facility, a rare, irreversible form of fixed obstructive lung disease that has not been previously identified in workers outside of the popcorn manufacturing industry. This reinforces the need for exposure evaluation in all industries where workers are potentially exposed to flavoring chemicals. Early detection is important in taking appropriate steps to remove workers from the exposure and preventing further deterioration of their lung function. These cases support the need for wide-spread hazard assessment in all industries using flavoring chemicals or generating diacetyl to better determine the risk for workers in these industries for developing obliterative bronchiolitis. The symptoms may not be recognized as work-related, but absence of recognized cases in companies which use or produce flavoring chemicals does not mean absence of risk.

3.Progress in Introduction of Pneumococcal Conjugate Vaccine — Worldwide, 2000–2012

CDC
Division of News & Electronic Media
404-639-3286

Globally, Streptococcus pneumoniae is a significant cause of pneumonia, meningitis, and sepsis in children aged <5 years. Pneumococcal conjugate vaccines (PCVs) are safe and effective for prevention of this disease, and the World Health Organization (WHO) recommends that PCV be included in all routine immunization programs. By 2012, 86 (44 percent) WHO member states had included PCV in routine immunization programs. Gaps in PCV introductions were noted in Asia and countries with large birth cohorts, as only 31 percent of the world’s birth cohort currently has access to PCV; concerted efforts should be focused in these settings. The success of PCV introductions and the lessons learned from countries that have added PCV to their immunization programs will help guide decisions about future PCV introductions and sustained use. Findings in this report suggest that efforts to increase PCV introduction and use globally are succeeding; however, gaps in PCV use remain in Asia and countries with large birth cohorts, where concerted efforts should be focused.

4. National Shortage of Purified-Protein Derivative Tuberculin Products

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
NCHHSTPMediaTeam@cdc.gov
404-639-8895

In light of recent shortages of skin tests for tuberculosis that have been reported nationwide, CDC has issued guidance for public health programs on how to adapt to the shortage.  Two types of tests are available to detect latent TB infection; tuberculin skin tests (TSTs) and interferon-y release assay (IGRA) blood tests.  One of the TSTs, Tubersol, is in short supply until at least the end of May, and the only other TST, Aplisol, is available in limited quantities.  As a result, CDC currently recommends that public health programs either: 1). Switch to using IGRA blood tests instead of TSTs; 2). Prioritize the use of TSTs, such as in the instances of TB contact investigations; and 3). Substitute Apisol for Tubersol for skin testing where available.  In settings where TB exposure is unlikely, the deferment of routine serial testing should be considered. 

Notes from the Field

• Acute Pesticide-Related Illness Resulting from Occupational Exposure to Acrolein — Washington and California, 1993–2012

Over the past 20 years, NIOSH identified 8 individuals poisoned by exposure to acrolein, a highly toxic aquatic herbicide used in the western United States to prevent impaired water flow in irrigation canals.  The most recent case in August 2012 involved a licensed aquatic pesticide applicator, aged 57 years and previously healthy.  He was exposed to a whiff of acrolein while investigatinga leak in his acrolein application equipment and wasn’t wearing personal protective equipment.  Almost immediately after exposure he developed burning, watery eyes that, within two hours, led to throat tightness, difficulty breathing, inability to swallow, sweating, and vomiting.  He was admitted to an intensive care unit where he had a stroke and a life-threatening heart rhythm disturbance.  He was ultimately stabilized and discharged to home. Acrolein poisoning can be prevented.  Using a closed application system combined with annual training of applicators, adherence to the manufacturer’s operating procedures, and compliance with personal protective equipment requirements can effectively prevent exposures of concern to workers.

• Exposures to Discarded Sulfur Mustard Munitions — Mid-Atlantic and New England States 2004–2012

Since 2004, CDC has received notification of three separate incidents involving exposure to sulfur mustard munitions. This report highlights the importance of considering exposure to sulfur mustard in the diagnosis of signs and symptoms compatible with exposure to a mustard agent, especially among persons involved with clam fishing or sea dredging operations.  Clinicians suspecting mustard exposure should notify and consult with their state or local health departments and poison control center about the potential need for follow-up and investigation of potential exposures. CDC’s Chemical Weapons Elimination Program can provide technical consultation and laboratory services to assist clinicians with testing, diagnosis, and management of suspected cases..

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES