A trip through the catalog of infectious diseases one can contract at work is enough to make many want to stay home. The obvious cold and influenza spores and pathogens that glide through the air with the greatest of ease have more nuisance value than real danger, though there are virulent strains of influenza. But many workers in a variety of industries face serious threats to their health-to their lives. The newest of these is SARS (Severe Acute Respiratory Syndrome), of course, seen as a guerilla fighter of sorts. SARS invades as an airborne microbe, and passes easily through such filters as those found in aviation, industrial or commercial air filters. Many early cases were reported after intercontinental airline flights. Add aircrews then, to the list later in this article, of those work groups at risk for an infectious disease caught at work. Chinese scientists have discovered (People Daily, June 6, 2003) that the virus can live 15 days without a human host. It can live, for instance, for three days on paper, wood, cotton, cloth, metal, plastic, glass, and in soil. If there’s good news about SARS, it is that the virus dies earlier as the local environmental temperature rises. The virus lives only about 30 minutes at 75 degrees Celsius. You don’t want to watch though-that’s 167 degrees Fahrenheit!
The most common debilitating and life-threatening diseases found in the workplace include TB, HIV and Hepatitis C, though smallpox and poliomyelitis lurk nearby. Health care workers are at risk because-think of emergency crews especially-cannot know the medical histories of patients they must treat in immediate, critical situations. However, occupational exposure is not confined to the health care industry. Literally any institutional environment can put workers at increased risk. Prisons are especially fertile, yet environments from office buildings to college dormitories and military camps yield uncomfortable statistics.
Tuberculosis is rarely bloodborne, and, while its incidence has declined in recent years, certain areas have cases in numbers well above average. For example, in 1999, the latest year for which data is available, six states, California, Florida, Illinois, New Jersey, New York and Texas, accounted for 57% of the TB cases but had only 40% of the U.S. population (from a report by the Institute of Medicine, through the Center for Disease Control). That report further stated that 40% of those cases were among foreign-born people, mostly from Mexico, the Philippines and Vietnam.
HIV and HIV/AIDS are “contact sports.” Transmission of these lethal diseases happens through blood or other bodily fluid exchange. While we think mostly about drug addicts sharing dirty needles, or sexual partners not being “safe,” research facts support the case for more innocent exposures-food utensils, drinking glasses, even non-sexual physical contact. The disease destroys the immune system, opening the door for “infections of opportunity” (many AIDS patients actually die from pneumonia). Dr. P. T. Goodall, of Infectious Disease Consultants, reported in a recent seminar (April, 2003) that there are over 30 million AIDS cases worldwide, and that of the some 500,000 HIV infected individuals in the U.S., over half are unaware of their status.
Hepatitis C affects some 2% of the U.S. population, and its incidence is highest among drug users, prison inmates, sex workers (think prostitutes and adult entertainment) and minorities. The disease most frequently degrades to cirrhosis of the liver, and accounts for more than 50% of the liver transplants in our country (Goodall). One of the more sobering facts about Hepatitis C is that as much as 15% of the documented cases have no obvious source.
While the last case of smallpox (worldwide) was reported in 1978, recent events raise the level of concern that quantities sufficient to cause epidemic loss of life exist in the hands of those who see such a catastrophe as a good thing.
Who is at risk for infectious disease contracted at work? In addition to the groups identified earlier, custodial and housekeeping workers, sanitation workers, and child and elder care workers, even good Samaritans and family members face exposure. In March 2000, a Baltimore embalmer became infected with TB while prepping a body for burial. Add rubella. Add West Nile.
The cost to U.S. businesses in lost time, wages, benefits, increased premiums for health care and life insurance, as well as lost revenue through the entire tax pipeline, is billions, and is impossible to calculate without a team of actuaries and a fair amount of time. The best protections include awareness, common sense, and training. The best attitude, one of caution.