ATW1H%ASUACAD.BITNET@oac.ucla.edu (Dr David Dodell) (06/13/89)
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Volume 2, Number 24 June 12, 1989
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Center for Disease Control Reports
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Morbidity and Mortality Weekly Report
Thursday June 1, 1989
Current Trends
Coordinated Community Programs for HIV Prevention among Intravenous-Drug
Users -- California, Massachusetts
This report describes two coordinated communitywide programs that provide
education for intravenous-drug users (IVDUs) and their sex partners to reduce
the transmission of human immunodeficiency virus (HIV).Sacramento, California
In 1985, the University of California, Davis (UCD), detected HIV antibody
in less than 1 (0.6%) of 178 IVDUs in two drug-treatment programs in
Sacramento (S. Jain, UCD, personal communication, October 1988). Subsequently,
UCD collaborated with the Sacramento AIDS Foundation, Sacramento's drug-
treatment programs, the Sacramento County health and sheriff's departments,
and the Sacramento Police Department to form a task force to slow the spread
of HIV among IVDUs in the community. An acquired immunodeficiency syndrome
(AIDS) education, prevention, and testing (EPT) program was developed in the
spring of 1987 for the estimated 8000 or more IVDUs in the area (1) and funded
by the State of California and Sacramento County.
The EPT program consists of individual counseling of IVDUs about their
risk for HIV infection and AIDS and about practical methods to avoid becoming
infected, including stopping drug injections, "safer shooting" for those who
would not desist, and "safer sex." After informed consent is obtained, each
IVDU is given a standardized, questionnaire-guided interview and a
confidential HIV-antibody test. In a second counseling session, HIV test
results are given in private to each IVDU, and knowledge of HIV-infection
risk-reduction techniques is reassessed. IVDUs are recruited from drug-
treatment programs, major public hospitals, correctional facilities, and the
county counseling and testing site. Seronegative IVDUs are encouraged to
return for follow-up HIV testing and interview 4 months after initial testing.
IVDUs are paid for follow-up HIV-antibody tests.
Although most participating IVDUs have been clients of drug-treatment
programs, the EPT program recently has been offered to IVDUs receiving medical
care at the UCD Medical Center (UCDMC), the primary source of medical care for
IVDUs in the county. Serologic testing has been conducted in city and county
correctional facilities, but the entire EPT program has not yet been
implemented in these sites.
Overall, 42% of IVDUs offered the EPT program in drug-treatment centers
have participated: 235 (24%) of 970 in the outpatient methadone program and
365 (80%) of 459 in drug-free programs (Table 1). Of the 701 IVDUs recruited
at drug-treatment programs and the medical-care facilities, 14 (2%) have HIV
antibody (Table 1). Of those eligible for retesting after an initial negative
test, 116 (24%) of 490 returned to be retested, and none have seroconverted.
Self-reported high-risk drug use has decreased since the beginning of the
program. Of 720 IVDUs recruited in 1988, 295 (41%) report that either they did
not share or they "usually" or "always" disinfected their paraphernalia with
an effective disinfectant ("safer shooting"), compared with 19 (23%) of 83
IVDUs recruited in 1986. Among IVDUs returning for retesting, 44 (57%) of 77
of those still injecting drugs reported using "safer shooting"
techniques.Worcester, Massachusetts
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Volume 2, Number 24 June 12, 1989
The Worcester AIDS Consortium was established in spring 1987 to provide
comprehensive, coordinated communitywide AIDS education and risk-reduction
efforts for IVDUs and their sex partners. The Consortium includes the local
health and school departments, drug-treatment program, neighborhood health
centers, community agencies, AIDS Project Worcester, jail, and the University
of Massachusetts. This program, which is funded by the Commonwealth of
Massachusetts, the National Institute on Drug Abuse, and CDC and administered
through the Massachusetts Department of Public Health, is coordinated with the
Worcester Department of Public Health hepatitis B prevention program (2).
The Consortium activities include 1) educational programs in schools and
the community and 2) educational/voluntary HIV-antibody testing programs for
IVDUs and their sex partners offered at health-care facilities, drug-treatment
programs, and the local correctional facility (3-6).
An estimated 3000-4000 IVDUs reside in metropolitan Worcester (total
population, 175,000). The drug rehabilitation program educates IVDUs in drug-
treatment programs and provides interventions to reduce transmission of HIV
among IVDUs not in treatment, including distribution of bleach to clean drug
paraphernalia and expedited admission of seropositive addicts to drug
treatment.
The approximately 600 inmates of the Worcester County House of Corrections
are offered weekly educational sessions, voluntary individual HIV/AIDS
counseling, and confidential HIV testing, with follow-up support available
through the advocacy services of AIDS Project Worcester.
Free voluntary pre- and post-test counseling and HIV-antibody testing have
been incorporated into the routine activities of all drug-treatment programs
of the rehabilitation program; the two major community health centers serving
indigent, disadvantaged minority populations; the Worcester Department of
Public Health Hepatitis B/ HIV Clinic; and the Worcester City Hospital.
A standardized interview is used at all sites to obtain demographic data
and information on the drug use and sexual behaviors of participants.
As of July 31, 1988, 1081 persons had participated in individual
interviews and counseling sessions, including approximately 90% of clients in
drug-treatment programs, 85% of persons referred for HIV counseling and
testing to clinics, and 50% of inmates who attended group educational sessions
(Table 2). Participants were predominantly male (76%) and white (69%); 19%
were Hispanic and 9%, black; 29% were 17-24 years of age, 49%, 25-34 years,
and 22%, greater than or equal to 35 years.
Recent needle use was reported by 263 (76%) of 348 clients in drug
treatment and 175 (38%) of 459 jail inmates*, compared with 38 (14%) of 274
clinic patients interviewed (4). One hundred fifty-eight (58%) of 274 clinic
patients and 173 (38%) of 459 jail inmates interviewed reported no needle use
and no sexual contact with needle users at any time.
Among the reported recent needle users, 122 (70%) of 175 of jail inmates,
28 (74%) of 38 of clinic patients, and 157 (60%) of 263 current drug-treatment
clients reported they had never been in a drug-treatment program. Among recent
needle users, 144 (48%) of 301 in drug-treatment programs and medical clinics
had previously been in jail, in contrast to 144 (82%) of 175 prisoners. In
addition, 365 (77%) of the 476 recent needle users reported recent sharing of
needles; 37% had shared drug injection equipment in a "shooting gallery" and
8% had shared drug injection equipment in New York City.
Of the 792 (73%) persons for whom HIV-antibody test results were
available, 71 (9%) were seropositive. Seropositivity prevalences were
proportionate to reported risk activities: three (10%) of 31 persons with no
needle use or sexual contact with IVDUs; two (5%) of 42 former sex partners of
IVDUs; two (4%) of 52 recent sex partners of IVDUs; nine (11%) of 81 former
Health InfoCom Network News Page 16
Volume 2, Number 24 June 12, 1989
needle users; and 55 (18%) of 304 recent needle users.
HIV seropositivity in recent needle users was higher among Hispanics (23
(36%) of 64) and blacks (nine (35%) of 26) than among whites (22 (12%) of 183)
(p less than 0.001). HIV seropositivity among recent needle users also varied
by site of recruitment: eight (10%) positive of 80 in the drug-treatment
programs, 36 (21%) of 169 in jail, and 11 (30%) of 37 in clinics (p=0.02).
However, because the proportion of all those interviewed who agreed to HIV
testing varied from 119 (34%) of 348 in the drug-treatment programs to 434
(95%) of 459 at the jail, the overall HIV seropositivity prevalences among
persons in these institutions are unknown.
Among recent needle users, there was no statistically significant
association between HIV seropositivity and age, sex, marital status, previous
drug treatment, and previous incarceration (5,6). Of the reported drug-use
behaviors among recent needle users, only sharing drug injection equipment in
a "shooting gallery" was associated with HIV seropositivity (27% vs. 15%)
(p=0.009).
Reported by: N Flynn, MD, S Jain, MBBS, A Sweha, MBBCh, V Bailey, MSC, N
Nassar, MBBCh, B Siegel, MD, N Levy, MD, S Enders, Univ of California at Davis
Medical Center; G Acuna, PhD, Sacramento AIDS Foundation; P Hom, MD, B Hinton,
MD, D Webb, MA, Sacramento County Health Dept; D Ding, Bi-Valley Medical
Clinic, Sacramento and the Sacramento AIDS-IV Drug Abuse Task Force. B Koblin,
PhD, J McCusker, MD, Div of Public Health, Univ of Massachusetts, Amherst; J
Sullivan, MD, S Noone, Dept of Pediatrics, Univ of Massachusetts Medical
School, Worcester; B Lewis, EdD, Spectrum House, Inc; S Sereti, F Birch,
Worcester Dept of Public Health. Office of the Director, Center for Prevention
Svcs, CDC.
Editorial Note: In 1988, 30% of U.S. adults with AIDS reported only IV-drug
use (24%) or both IV-drug use and male homosexual/bisexual behavior (6%) as
risk factors. This represents an increase from 25% in previous years (in part
due to revision of the AIDS case definition in 1987 (7)). In addition, 55% of
AIDS cases in the heterosexual-contact exposure category in 1988 were
attributed to HIV infections acquired from IVDUs.
The programs in Sacramento and Worcester represent coordinated efforts to
educate IVDUs about HIV/AIDS and to change their sexual and drug-use
behaviors. These programs have coordinated the HIV prevention activities of
universities, health departments, correctional facilities, police departments,
health-care institutions, and drug-treatment programs. Because only 10%-15% of
IVDUs are in drug-treatment programs at any time, HIV counseling and testing
of IVDUs in health-care facilities and in correctional/criminal justice
facilities are also important. Data from Sacramento and Worcester suggest that
different populations of IVDUs were reached at each of the different
institutions.
The Worcester program illustrates the potential impact of HIV prevention
programs on IVDUs in correctional institutions. More than half of the recent
needle users recruited at medical clinics and drug-treatment programs had
previously been in jail. In addition, among the recent needle users recruited
in jail, 83% had been in jail at least once before the current incarceration.
Although street/community outreach teams are important elements of
comprehensive HIV prevention programs for IVDUs, such teams were not part of
the initial Worcester and Sacramento programs. A street outreach program will
be added in Sacramento.
The changes in the behaviors reported by IVDUs participating in the
educational programs were modest. In Sacramento, the proportion of IVDUs
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Volume 2, Number 24 June 12, 1989
reporting "safer shooting" drug-use practices increased from 23% in 1986 to
41% in 1988 (8). Among IVDUs returning for follow-up interviews and HIV
testing, 57% of those using drugs reported using "safer shooting" techniques.
While these results suggest that some IVDUs will adopt lower risk behaviors,
many of the IVDUs interviewed did not report adoption of safer behaviors.
Programs to prevent HIV transmission among IVDUs and their sex partners
should be carefully evaluated with follow-up surveys of self-reports of drug
use and sexual behaviors; admission to and success of drug-treatment; follow-
up serologic testing of IVDUs who are seronegative; and monitoring of other
infections (e.g., hepatitis B virus, bacterial endocarditis).
Among IVDUs, seroprevalence of HIV antibody is highest in New York City
and Puerto Rico (45%-60%), high in the Northeast, and low in the Central and
Southwestern United States (9,10). The high seropositivity levels in the New
York City area and Puerto Rico indicate the potential for rapid transmission
of HIV to uninfected IVDUs, unless effective HIV education and prevention
programs are developed for IVDUs in areas of the United States where
seroprevalence is presently low.
Worcester and Sacramento are medium-sized cities (populations of 175,000
and 330,000, respectively) with an estimated 3000-4000 and at least 8000
IVDUs, respectively. Similar efforts in larger cities with larger numbers of
IVDUs may be more difficult to achieve. Nevertheless, attempts to coordinate
efforts through integration of educational activities in health-care
institutions, correctional/criminal justice facilities, health department
clinics, and drug-treatment programs (combined with street outreach) are
important in reducing the risk of transmission of HIV among IVDUs and their
sex partners.
References
1. Flynn N, Bailey V, Jain S, et al. Prevention of HIV infection in IV drug
users (IVDU) in an area of low prevalence: a comprehensive approach
(Abstract). IV International Conference on AIDS. Book 2. Stockholm, June 12-
16, 1988:391.
2. CDC. Delta hepatitis--Massachusetts. MMWR 1984;33:493-4.
3. Noone S, Birch F, Sereti S, et al. A comprehensive prison program for AIDS
risk reduction (Abstract). IV International Conference on AIDS. Book 1.
Stockholm, June 12-16, 1988:313.
4. McCusker J, Koblin B, Lewis B, Sullivan J, Birch F, Hagan H. Differential
characteristics of IVDU populations by enrollment site in a single community
(Abstract). IV International Conference on AIDS. Book 2. Stockholm, June 12-
16, 1988:197.
5. Koblin B, McCusker J, Lewis B, Sullivan J, Birch F, Hagan H. Racial
differences in HIV infection in IVDUs (Abstract). IV International Conference
on AIDS. Book 2. Stockholm, June 12-16, 1988:196.
6. Lewis B, Sullivan J, McCusker J, Birch F, Koblin B, Hagan H.
Comprehensive surveillance of HIV among IVDUs in Worcester, Massachusetts
(Abstract). IV International Conference on AIDS. Book 2. Stockholm, June 12-
16, 1988:197.
7. CDC. Update: acquired immunodeficiency syndrome--United States, 1981-1988.
MMWR 1989;38:229-36.
8. Jain S, Flynn N, Bailey V, et al. IV drug users and AIDS: changing
attitudes and behavior (Abstract). IV International Conference on AIDS. Book
1. Stockholm, June 12-16, 1988:449.
9. CDC. Human immunodeficiency virus infection in the United States: a review
of current knowledge. MMWR 1987;36(suppl S-6):40.
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Volume 2, Number 24 June 12, 1989
10. Hahn RA, Onorato IM, Jones TS, Dougherty J. Prevalence of HIV infection
among intravenous drug users in the United States. JAMA 1989;261:2677-84.
*Since drug-treatment clients are interviewed on entry into treatment, recent
needle use for them would be before admission to drug treatment. For jail
inmates, recent needle use refers to the period before incarceration.
Epidemiologic Notes and Reports
Lead Poisoning Following Ingestion of Homemade Beverage Stored in a
Ceramic Jug -- New York
In the summer of 1987, seven persons living in Westchester County, New
York, developed lead poisoning after ingesting a homemade beverage stored in a
ceramic bean jug. The six adults and one child were relatives and lived at or
frequently visited the home where the jug was kept.
The 140-ounce brown ceramic jug had been obtained in Mexico and is of a
type commonly used to cook beans. The first person to experience illness used
the jug to store a beverage he prepared frequently from sugar, water, and
mara, a grain imported from Colombia. After the beverage fermented, family
members consumed it several times daily throughout the summer.
In October 1987, the first patient--a 67-year-old man--consulted a
physician because of severe abdominal pain, fatigue, and weight loss. The
physician initially suspected gastric carcinoma. However, because severe
anemia (hemoglobin 8 gm) and red blood cells with basophilic stippling were
detected, a blood-lead level was obtained. Both the blood-lead level (70 ug
divided by L) and the erythrocyte protoporphyrin (EP) (382 ug divided by L)
were markedly elevated. He received chelation treatment for lead during a 2-
week hospitalization.
After the initial case was diagnosed, a public health sanitarian visited
the home to search for the source of lead. Interviews and a search of the
premises identified the bean jug, which was severely corroded on the inside.
Analysis of the jug by the New York State Department of Health (NYSDH)
detected a lead content of 730 ppm, 100 times the normal value for a hollow
vessel of this size.
Other household members were tested for lead. Six persons, aged 8-90
years, had elevated blood-lead levels (range: 35-70 ug divided by L). An 8-
year-old child had a lead level of 35 ug divided by L and an EP of 152 ug
divided by L (CDC risk classification III (high risk)).* One of the five
adults was also hospitalized.
Investigation by NYSDH revealed other earthenware with high lead contents
in shops and bodegas in this town. The Westchester County Department of Health
distributed bilingual fliers in ethnic communities in the county warning of
the possible hazards from the use of ceramic ware.
No additional cases have been identified. All patients have been followed
by their personal physician, and their blood values have returned to normal.
Reported by: KA Raciti, MD, Child Health Svcs, G Haloukas, Bur of Public
Health Protection, AS Curran, MD, G Argentina, R Morrisey, Westchester County
Dept of Health; B Friedman, MD; P Parsons, PhD, DL Morse, MD, State
Epidemiologist, New York State Dept of Health. Div of Environmental Hazards
and Health Effects, Center for Environmental Health and Injury Control, CDC.
Editorial Note: Because of industrialization, lead is ubiquitous in the human
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Volume 2, Number 24 June 12, 1989
environment. Common sources of lead exposure include lead-based paints
(present on the interior surfaces of an estimated 30-40 million U.S. homes),
airborne lead from combusted lead additives in gasolines or from factories
using lead, occupations such as the production or repair of lead-acid storage
batteries or automobile radiators, and a variety of ethnic remedies,
particularly those used by Asian and South American groups (1-3). Although
lead-glazed pottery is not a widespread source of lead, it can release large
amounts of lead into food and drink (1,4,5). Lead-glazed pottery has been
responsible for outbreaks of serious poisoning; in several episodes similar to
this one, imported pottery has been implicated (1,5). Homemade or craft
pottery and porcelain-glazed vessels can release large quantities of lead,
particularly if the glaze is chipped, cracked, or improperly applied. If the
vessels are repeatedly washed, the glaze may deteriorate, and pottery
previously tested as safe can become unsafe. Acidic foods, beverages, or even
water can leach lead from the containers.
Excessive absorption of lead is one of the most prevalent and preventable
childhood environmental health problems in the United States (1). Once thought
to be a problem confined to poor urban children, lead poisoning is now known
to involve children in all socioeconomic strata (1,6). Although the toxic
properties of lead affect all age groups, attention is generally focused on
the serious consequences of elevated lead exposure on the developing central
nervous system of children less than 6 years of age (1,6-8). The level in
children at which further diagnostic follow-up is recommended is 25 ug divided
by L of lead in whole blood; however, recent studies have shown that blood-
lead levels as low as 10 ug divided by L may adversely affect childhood
neurobehavioral function and development (1,7).
References
1. CDC. Preventing lead poisoning in young children: a statement by the
Centers for Disease Control, January 1985. Atlanta: US Department of Health
and Human Services, Public Health Service, 1985:5-7; DHHS publication no. 99-
2230.
2. Mahaffey KR. Sources of lead in the urban environment (Editorial). Am J
Public Health 1983;73:1357-8.
3. Bose A, Vashistha K, O'Loughlin BJ. Azarcon por empacho--another cause of
lead toxicity. Pediatrics 1983;72:106-8.
4. Molina-Ballesteros G, Zuniga-Charles MA, Cardenas Ortega A, et al. Lead
concentrations in the blood of children from pottery-making families exposed
to lead salts in a Mexican village. Bull Pan Am Health Organ 1983;17:35-41.
5. Klein M, Namer R, Harpur E, Corbin R. Earthenware containers as a source of
fatal lead poisoning: case study and public health considerations. N Engl J
Med 1970;283:669-72.
6. Thatcher RW, Lester ML, McAlaster R, Horst R, Ignasias SW. Intelligence
and lead toxins in rural children. J Learn Disabil 1983;16:355-9.
7. Needleman HL. The neurobehavioral consequences of low lead exposure in
childhood. Neurobehav Toxicol Teratol 1982;4:729-32.
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Volume 2, Number 24 June 12, 1989
8. Chisolm JJ Jr. The continuing hazard of lead exposure and its effects in
children. Neurotoxicology 1984;5:23-42.
*CDC defines an elevated blood-lead level in children as a confirmed
concentration of lead in whole blood of greater than or equal to 25 ug divided
by L; lead toxicity is defined by an elevated blood level with an EP in whole
blood of greater than or equal to 35 ug divided by L (1).
Current Trends Exposure Trends in Silica Flour Plants -- United States, 1975-
1986
A 1979 National Institute for Occupational Safety and Health (NIOSH)
investigation of excessive free silica exposures identified 23 cases of acute
silicosis in employees at two Illinois silica flour plants (1). This led to a
NIOSH report (2) emphasizing the hazards of silica exposure in the silica
flour industry. NIOSH subsequently issued a description (3) of engineering
controls designed to reduce exposures, and has followed this in 1988 by an
analysis of the exposure levels and exposure trends in all U.S. silica flour
producers for 1975-1986.
The data used for the analysis were collected by the Mine Safety and
Health Administration (MSHA). MSHA measured respirable quartz exposures at 28
plants while conducting routine inspections for compliance with safety and
health regulations promulgated under the 1977 Federal Mine Safety and Health
Act. Quartz is a form of crystalline free silica, the principal agent
responsible for silicosis. The dust samples were collected using personal
breathing-zone air samplers. The quartz content in each respirable dust sample
is used in computing the permissible exposure limit (PEL) for that sample (4).
For samples with a high percentage of respirable quartz, as is typically the
case in the silica flour industry, this computation results in an effective
PEL of approximately 0.1 mg/m3.
Free silica levels in 52% of the samples tested exceeded the corresponding
MSHA PEL. Although the percentage of samples exceeding the PEL decreased from
1982 to 1986, 32% still exceeded the PEL in 1986 (Figure 1). The proportion of
the samples exceeding twice the PEL followed a similar pattern; the highest
concentration recorded in 1986 was 11.3 times the PEL.
At one of the two Illinois plants investigated by NIOSH (1,5), 14% of
environmental samples exceeded the PEL in 1984, 29% in 1985, and 30% in 1986.
Overexposures in the other plant (1,6) were 60% in 1984, 50% in 1985, and 30%
in 1986.
Reported by: Div of Respiratory Disease Studies, National Institute for
Occupational Safety and Health, CDC.
Editorial Note: Silicosis is a debilitating fibrotic disease of the lungs that
is caused by inhalation, retention, and pulmonary reaction to respirable
particles of crystalline free silica. Chronic silicosis is pathologically and
radiologically characterized by the silicotic nodule. In early stages, the
nodules remain isolated, but as the disease progresses the nodules coalesce to
form mass lesions, or progressive massive fibrosis. Acute and accelerated
forms of silicosis may develop after shorter and more intense exposures to
crystalline silica. Silicosis may be associated with pulmonary infections
(particularly tuberculosis), restrictive ventilatory impairment, cor
pulmonale, respiratory failure, and premature death.
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Volume 2, Number 24 June 12, 1989
Despite long recognition of the cause of silicosis and the means to
prevent it, this disease remains an important source of occupational morbidity
and mortality. Reliable morbidity statistics are not available, but NIOSH has
used death certificate data to estimate that 2152 silicosis-attributable
deaths among men greater than or equal to 25 years of age occurred in the
United States during 1975-1986 (7,8).
"Silica flour" is produced by the drying and milling of mined quartz and
consists of fine particles, a large percentage of which are respirable. The
very small particle size makes this one of the most hazardous forms of silica.
Despite some exposure reduction since 1982, the continued overexposures to
respirable free silica in silica flour plants indicate a continued need for
control measures in the silica flour industry. When compared with all metal
and nonmetal mines regulated by MSHA, silica flour plants had a frequency of
overexposure to free silica more than three times that of the other facilities
during 1975-1986.
The data on which these analyses were based have limitations. First, the
data do not represent a randomized or systematic sample of workers' exposures
and are not subject to rigorous statistical treatment. Second, the data set
does not provide information on the level of plant activity at the time of
sampling. Third, exposures to individual workers may actually be less than
those reported here because of the use of respirators. Despite these
limitations, the data confirm the continued existence of overexposure to free
silica at levels associated with adverse health effects.
Prevention of silicosis was targeted as a 1990 health objective for the
United States (9). NIOSH has recommended a 10-hour, time-weighted average
level of 0.05 mg/m3 (free silica) as the level required to prevent silicosis
(10). Silicosis is reportable under the Sentinel Event Notification System for
Occupational Risks (SENSOR) program. As a cooperative program between NIOSH
and 10 state health departments*, SENSOR is designed to improve state and
local capacity to conduct surveillance of selected occupational illnesses.
Unless efforts to achieve a work environment within the NIOSH-recommended
level are increased, the 1990 objective will not be met, and respirable free
silica exposures will continue to constitute a health hazard in the silica
flour industry.
References
1. CDC. Silicosis--Illinois. MMWR 1980;29:205-6.
2. CDC. Silica flour: silicosis (crystalline silica). Cincinnati, Ohio: US
Department of Health and Human Services, Public Health Service, 1981; DHHS
document no. (NIOSH)81-137. (NIOSH current intelligence bulletin no. 36).
3. CDC. Health hazard control technology assessment of the silica flour
milling industry. Cincinnati, Ohio: US Department of Health and Human
Services, Public Health Service, 1984; DHHS publication no. (NIOSH)84-110.
4. Office of the Federal Register. Code of federal regulations: mineral
resources--exposure limits for airborne contaminants. Washington, DC: Office
of the Federal Register, National Archives and Records Administration, 1988.
(30 CFR ***56.5001).
5. CDC. Hazard evaluation and technical assistance report no. 79-104-107.
Cincinnati, Ohio: US Department of Health and Human Services, Public Health
Service, 1979.
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Volume 2, Number 24 June 12, 1989
6. CDC. Hazard evaluation and technical assistance report no. 79-103-108.
Cincinnati, Ohio: US Department of Health and Human Services, Public Health
Service, 1979.
7. CDC. Health, United States, 1986. Hyattsville, Maryland: US Department of
Health and Human Services, Public Health Service, 1987; DHHS publication no.
(PHS)87-1232.
8. CDC. Health, United States, 1988. Hyattsville, Maryland: US Department of
Health and Human Services, Public Health Service, 1989; DHHS publication no.
(PHS)89-1232.
9. Public Health Service. Promoting health/preventing disease: objectives for
the nation. Washington, DC: US Department of Health and Human Services, Public
Health Service, 1980:41.
10. CDC. Criteria for a recommended standard: occupational exposure to .
Education, and Welfare, Health Services and Mental Health Administration,
1974; document no. (NIOSH)75-120.
*California, Colorado, Massachusetts, Michigan, New Jersey, New York, Ohio,
Oregon, Texas, and Wisconsin.
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Volume 2, Number 24 June 12, 1989
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Columns
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CDC CALENDAR OF EVENTS
(For more information, contact Iris Lansing, 404/639-3243)
June 14-15 Advisory Committee on Construction Safety and Health; Wash., DC
June 14-16 Society for Epidemiologic Research Conference; Birmingham, AL
June 15-16 National Vaccine Program Advisory Committee; Wash., DC
June 18-22 2nd International Conference on Preventive Cardiology, and the
Annual Meeting of the American Heart Association Council on
Epidemiology; Wash., DC
June 19 Environmental Data Base Workshop; San Antonio, TX
June 20-23 4th National Environmental Health Conference; San Antonio, TX
June 26-27 CDC AIDS Prevention Advisory Committee
June 28-July 2 Fourth International Interdisciplinary Conference on
Hypertension in Blacks; Nairobi, Kenya
July 5-28 EIS Course; Atlanta, GA
July 15-18 Annual National Association of County Health Officials (NACHO)
Conference; Cincinnati, OH
July 15-20 National Medical Association; Orlando, FL
July 17-19 Public Health Conference on Records and Statistics, 22nd Biennial;
Wash., DC
July 23-27 American Association for Clinical Chemistry; Atlanta, GA
July 26-27 Advisory Committee for the Elimination of Tuberculosis; Atlanta, GA
August 6-10 149th Annual Meeting (and 150th Anniversary) of the American
Statistical Association - Joint Meeting with Biometric
Society and Institute of Mathematical Statistics; Wash.,
DC
August 14-17 National Conference on HIV Infection and AIDS Among Racial and
Ethnic Populations; Wash., DC
August 20-24 Second Latin American Congress on Family Planning; Rio de
Janeiro, Brazil
Aug. 27-Sep. 1 Pan-American Congress on AIDS; Caracas, Venezuela
August 28-30 International Conference on Blood-Borne Infections in the
Workplace; Stockholm, Sweden
Health InfoCom Network News Page 24
Volume 2, Number 24 June 12, 1989
September 5-8 5th International Conference on Pharmacoepidemiology;
Minneapolis, MN
September 6-8 National Pediatric AIDS Conference, Fifth Annual, & September 8-
9 Followup Workshop; Los Angeles, CA
September 10-15 198th National American Chemical Society Meeting; Dallas, TX
September l7-20 Interscience Conference on Antimicrobial Agents and
Chemotherapy (ICAAC); Houston, TX
September l7-21 First World Conference on Accident and Injury Prevention;
Stockholm, Sweden
September 20-22 4th National Conference on Chronic Disease Prevention and
Control; San Diego, CA
October 4-6 American College of Epidemiology Annual Meeting; Wash., DC
October 11-13 Safety and Occupational Health Study Section Meeting; Bethesda,
MD
October 22-26 APHA 117th Annual Meeting; Chicago, IL
October 30- Diseases of the Chest--Sixteenth World Congress and 55th November
3 Annual Scientific Assembly; Boston, MA
November 2-3 Mine Health Research Advisory Committee Meeting; Atlanta, GA
November 2-5 National Association for the Education of Young Children Annual
Conference; Atlanta, GA
December 10-14 American Society of Tropical Medicine & Hygiene; Honolulu, HI
1990 March 14-18 The Coalition of Hispanic Health & Human Services
Organizations (COSSMHO) National Hispanic Conference on
Health and Human Services; San Francisco, CA
March 31- Association of State and Territorial Dental Director/ April 4
National Oral Health Conference; San Diego, CA
April 22-27 199th National American Chemical Society Meeting; Boston, MA
April 23-27 39th Annual EIS Conference; Atlanta, GA
May 13-18 American Industrial Hygiene Conference; Orlando, FL
May 20-24 World Conference on Lung Health; Boston, MA
June 19-23 VI International Conference on Acquired Immunodeficiency Syndrome;
San Francisco, CA
Health InfoCom Network News Page 25
Volume 2, Number 24 June 12, 1989
July 29- 5th International Conference on Indoor Air Quality and August 3
Climate; Toronto, Canada
August 26-31 200th National American Chemical Society Meeting; Wash., DC
Sep. 30-Oct. 4 APHA Annual Meeting; New York City, NY
November 4-8 American Society of Tropical Medicine & Hygiene; New Orleans, LA
1991 April 14-19 201st National American Chemical Society Meeting; Atlanta, GA
May 12-15 American Lung Association/American Thoracic Society Annual Meeting;
Anaheim, CA
May 19-24 American Industrial Hygiene Conference; Salt Lake City, UT
June 16-21 VII International AIDS Conference; Florence, Italy
November 4-8 American College of Chest Physicians; San Francisco, CA
December 1-5 American Society of Tropical Medicine & Hygiene; Boston, MA
1992 April 5-10 202nd National American Chemical Society Meeting;
San Francisco, CA
May 17-20 American Lung Association/American Thoracic Society Annual Meeting;
Miami, FL
May 3l-June 5 American Industrial Hygiene Conference; Boston, MA
October 26-30 American College of Chest Physicians; Chicago, IL
November 15-19 American Society of Tropical Medicine & Hygiene; Seattle, WA
1993 November 7-11 American Society of Tropical Medicine & Hygiene; Atlanta,
GA
Health InfoCom Network News Page 26
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