NIOSH Respiratory Diseases Research Program

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 Document describing resurgence of TB between 1985 and 1992

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Strategic Plan for the Elimination of TB in the U.S

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National Action Plan to Combat Multidrug-Resistant TB in the U.S

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Ending Neglect: the Elimination of TB in the U.S.

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Ending Neglect: the Elimination of TB in the U.S.

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CDC’s Response to Ending Neglect

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Federal Tuberculosis Task Force Plan in Response to the Institute of Medicine Report, Ending Neglect…]

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RDRP staff developed strategies for inclusion in both of these reports. Efforts by NIOSH/RDRP and CDC in general have also been guided by a report developed by IOM in response to a Cogressional request “TB in the Workplace,” that was issued in 2001. It outlined criteria that could be used to develop an effective and acceptable OSHA standard on occupational TB

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List: in the last 10 years, RDRP has produced 79 papers published in peer-reviewed journals, 32 abstracts and presentations at professional conferences, eight book chapters, six NIOSH numbered documents and NIOSH videos on TB, and 10 other reports

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NIOSH document describing HHEs on Tuberculosis 1990-1999” (Pub No. 2001-116) published by RDRP staff

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NIOSH Respiratory Protection Program In Health Care Facilities—Administrator's Guide” (Pub No. 99-143)

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“Protect Yourself Against T.B.— A Respiratory Protection Guide For Health Care Workers” (96-102)

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In 1990, CDC released “Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Settings, with Special Focus on HIV-Related Issues”

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CDC [1994]. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health–Care Facilities. MMWR 43 (No. RR–13) 1 -141.

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CDC [2005]. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings. MMWR 54(No. RR-17):1–140.

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To develop practical approaches for implementation of guidelines in workplaces, RDRP entered into cooperative agreements with the Washington University School of Medicine

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Tuberculosis in Health Care Workers. Final Project Report. May 7, 1999. RDRP entered into cooperative agreements with the California Department of Health Sciences.

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To develop practical approaches for implementation of guidelines in workplaces, RDRP entered into cooperative agreements with the National Jewish Medical and Research Center

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To develop practical approaches for implementation of guidelines in workplaces, RDRP entered into cooperative agreements with the State of New Jersey Department of Health and Senior Services

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WHO/CDC [1999]. Guidelines for the Prevention Of Tuberculosis In Health Care Facilities In Resource-Limited Settings. Geneva, Switzerland, World Health  Organization 1999 

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Xu, Peng, et al. Efficacy of Ultraviolet Germicidal Irradiation of Upper-room Air in Inactivating Airborne Bacterial Spores and Mycobacteria in Full-scale Studies. Atmospheric Environment. 2003. Vol. 37: 405-419

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Xu, Peng, et al. Impact of Environmental Factors on Efficacy of Upper-Room Air Ultraviolet Germicidal Irradiation for Inactivating Airborne Mycobacteria. Environ. Sci. Technol. 2005. Vol 39, No. 24: 9656-9664.

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Efficacy of Ultraviolet Irradiation in Controlling the Spread of Tuberculosis. Final Project Report. Oct 19, 2002.

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Evaluating Portable Air Cleaner Removal Efficiencies for Bioaerosols. Final Project Report. April 2002. RDRP entered into cooperative agreements with the University of Colorado.

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Hayden CS, et al. Air Volume Migration from Negative Pressure Isolation Rooms During Entry/Exit. Appl. Occup. Environ. Hyg. July 1998. Vol. 13, No. 7: 518-527.

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Proceedings of the Workshop on Engineering Controls for Preventing Airborne Infections in Workers in Health Care and Related Facilities. NIOSH Publication No. 1994-106.

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McCullough NV, et al. Improved Methods for Generation, Sampling, and Recovery of Biological Aerosols in Filter Challenge Tests. American Industrial Hygiene Association Journal. 1998. 59:234-241.

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McCullough, NV, et al. Collection of Three Bacterial Aerosols by Respirator and Surgical Mask Filters Under Varying Conditions of Flow and Relative Humidity. Ann. Occup. Hyg. 1997. Vol. 41, No. 6:677-690.

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Brosseau LM, et al. Mycobacterial Aerosol Collection Efficiency of Respirator and Surgical Mask Filters Under Varying Conditions of Flow and Humidity. Appl. Occup. Environ. Hyg. June 1997. 12(6):435-445.

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Qian, Y, et al. Performance of N95 Respirators: Filtration Efficiency for Airborne Microbial and Inert Particles. American Industrial Hygiene Association Journal. 1998. 59:128–132.

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Qian, Y, et al. Performance of N95 Respirators: Reaerosolization of Bacteria and Solid Particles. American Industrial Hygiene Association Journal. 1997. 58:876-880.

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Respirator Filter Reuse Test Using the Laboratory Simulant Mycobacterium Tuberculosis (H37RA Strain). Journal of the American Biological Safety Association. 1998. 3(3):105-116.

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Coffey CC, Lawrence RB, Campbell DL, Zhuang Z, Calvert CA, Jensen PA. Fitting characteristics of eighteen N95 filtering-facepiece respirators. JOEH 1:262-271, 2004.

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Coffey CC, Lawrence RB, Zhuang Z, Duling MG, Campbell DL. Errors associated with three methods of assessing respirator fit. JOEH 3:44-52, 2006.

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RDRP disseminated results of respirator related research to OSHA in comments to the docket on the proposed OSHA rule on occupational exposure to tuberculosis

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RDRP disseminated results of respirator related research to OSHA in comments to the docket on the proposed OSHA rule on occupational exposure to tuberculosis

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RDRP disseminated results of respirator related research to OSHA in comments to the docket on the proposed OSHA rule on occupational exposure to tuberculosis

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NIOSH method for the detection of airborne mycobacterium tuberculosis

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HETA close-out letter for a study of TB at a homeless shelter

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RDRP provided funding to the SENSOR program for a state-based occupational surveillance program for occupationally related TB

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2006 update of these American Institute of Architects guidelines retains the RDRP-generated recommendations

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Prevention and Control of TB in Correctional and Detention Facilities: Recommendations from CDC, published in 2006

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The Joint Commission on Accreditation of Healthcare Organizations (http://www.jointcommission.org [External link]) has used the CDC guidelines as a basis for their standards for reviewing of health-care organizations

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The effectiveness of the broad approach to TB prevention is reflected in the 46 percent decline in the total number of TB cases in the U.S. decreases from 1992 to 2004

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In 2001, seven anthrax- contaminated letters (investigators recovered four and presumed three others) sent through the U.S. Postal Service (USPS) killed five people and infected at least 17 others with inhalational or cutaneous anthrax

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It is estimated that $42 million was spent decontaminating the Hart Senate Office Building and other Capitol Hill offices

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Decontaminating the Brentwood postal facilities in Washington, D.C. and Hamilton Township, New Jersey, cost in excess of another $100 million

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Since the anthrax attacks of 2001, RDRP scientists have produced 33 technical journal articles, six books or book chapters, four NIOSH numbered publications, 12 abstracts and presentations at professional conferences and meetings, 10 control technology reports, and four HHE reports (list of RDRP reports)

A6-49

Along with partner agencies, RDRP scientists provided information on-site to employers, workers, facility managers, and a labor-management task force (postal worker unions and the USPS) in efforts to assess exposures at postal facilities, on Capitol Hill: Fact Sheet – Protecting workers from anthrax

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CDC Anthrax Emergency Preparedness and Response Web site
http://www.bt.cdc.gov/agent/anthrax (External link)

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“CDC Interim Recommendations for Protecting Workers from Exposure to Bacillus anthracis in Work Sites Where Mail Is Handled or Processed”

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RDRP released an interim notice to responders and investigators describing appropriate personal protective equipment (PPE), including respiratory devices, protective clothing, and gloves

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Detailed notice on appropriate PPE for investigators collecting B. anthracis sampling

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Combined guidelines “Notice to Readers: Occupational Health Guidelines for Remediation Workers at Bacillus anthracis-Contaminated Sites—U.S., 2001-2002” released on September 6, 2002

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RDRP-generated document entitled “Procedures for Collecting Surface Environmental Samples for Culturing Bacillus anthracis,” describing methods for environmental sampling to detect the presence of anthrax spores in indoor environments. (In subsequent revisions, the title was modified to “Comprehensive Procedures for Collecting Environmental Samples for Culturing Bacillus anthracis”)

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Teshale EH et al. Environmental sampling for spores of Bacillus anthracis. Emerging Infectious Diseases 8: 1083-1087, 2002.

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Sanderson WT et al. Surface Sampling Methods for Bacillus anthracis Spore Contamination. Emerging Infectious Diseases 8: 1145-1151, 2002.

A6-58

In response to requests from the USPS, the U.S. Office of Personnel Management, the Sergeant at Arms of the U.S. Senate, and the Chief Administrative Officer of the U.S. House of Representatives, RDRP conducted three HHEs on handling of irradiated mail by postal employees, federal workers, and Congressional employees.

A6-59

In response to requests from the USPS, the U.S. Office of Personnel Management, the Sergeant at Arms of the U.S. Senate, and the Chief Administrative Officer of the U.S. House of Representatives, RDRP conducted three HHEs on handling of irradiated mail by postal employees, federal workers, and Congressional employees.

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Irradiated Mail Handling and Opening at the Capitol Office Buildings. NIOSH Health Hazard Evaluation Report: HETA No. 2002-0136-2880. July 2002.

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In response to the anthrax attacks, the USPS developed an emergency preparedness plan to protect postal employees and customers from future exposures to biohazardous agents and to ensure mail security from future bioterror attacks

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Beamer BR, Topmiller JL, Crouch KG. Development of Evaluation Procedures for Local Exhaust Ventilation for United States Postal Service Mail-Processing Equipment. JOEH 1: 423-429, 2004.

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Martin SB, Beamer BR, Moyer ES. Evaluation of a High-Efficiency Filter Bank System. JOEH 3:204-213, 2006.

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RDRP contributed to a widely distributed CDC educational video to promote protection of workers who process, sort, and deliver mail

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RDRP contributed to development of documents pertaining to anthrax and worker health and safety for the NIOSH Web page

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NIOSH [2003]. Guidance for filtration and air-cleaning systems to protect building environments from airborne chemical, biological, or radiological attacks. Cincinnati, OH: Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2003–136. [Online] Available at: http://www.cdc.gov/niosh/docs/2003-136/pdfs/2003-136.pdf

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RDRP helped the USPS to decontaminate its facilities and install and operate equipment for future routine processing of mail. Based on RDRP testing results, the USPS awarded approximately $125 million in contracts for 280 VFS to be installed at mail processing and distribution centers throughout the country

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The installation of new VFS and BDS systems, which improve local exhaust ventilation and offer biological agent detection capabilities to reduce the vulnerability of postal workers to bioterrorism agents, while ensuring safe mail to all postal customers, is scheduled for completion by the end of 2006

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RDRP scientists continue to address issues related to irradiated mail through participation in the Legislative Mail Task Force, convened by the Sergeant at Arms of the U.S. Senate and the Chief Administrative Officer of the U.S. House of Representatives

A6-71

Testimony to Subcommittee on National Security, Emerging Threats, International Relations Stamping out anthrax in USPS facilities: technologies and protocols for bioagent detection James L. Hadler, MD, MPH Director, Division of Infectious Diseases and State Epidemiologist Connecticut Department of Public Health May 19, 2003

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A Google search shows RDRP has been cited by a variety of governmental and non-governmental organizations, including the White House

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Facts Sheet on SARS: Basic information about SARS

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Facts Sheet on SARS: CDC Public Health Guidance for Community-Level Preparedness and Response SARS Version 2, Supplement I: Infection Control in Healthcare, Home, and Community Settings

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Facts Sheet on SARS: CDC Public Health Guidance for Community-Level Preparedness and Response SARS Version 2, Supplement I: Infection Control in Healthcare, Home, and Community Settings

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NIOSH Web site: Understanding Respiratory Protection Against SARS

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Topic Area Web site on SARS http://www.cdc.gov/niosh/topics/SARS/

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Facts Sheet on SARS http://www.cdc.gov/niosh/npptl/topics/respirators/factsheets/respsars.html

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Frequently asked questions about SARS
http://www.cdc.gov/ncidod/sars/faq.htm

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SARS in Schools and Workplaces
http://www.cdc.gov/ncidod/sars/schoolsworkplace.htm

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Infection Control: SARS
http://www.cdc.gov/ncidod/sars/ic.htm

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Guidance for air medical transport for SARS patients
http://www.cdc.gov/ncidod/sars/airtransport-sarspatients.htm

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Healthcare workers and SARS
http://www.cdc.gov/niosh/healthpg.html

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RDRP scientists co-authored a peer-reviewed paper: Christian et al.  Possible SARS Coronavirus Transmission during Cardiopulmonary Resuscitation. Emerging Infectious Diseases 10:287-293, 2004  

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RDRP scientists co-authored an MMWR article providing an update on the SARS epidemic (MMWR 52 pp1202-1206, 2003).

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Facts Sheet on Guidance about SARS for Airline Flight Crews, Cargo and Cleaning Personnel, and Personnel Interacting with Arriving Passengers.

A6-87

RDRP staff has presented emerging issue information to various groups (e.g., poultry industry, etc.) about avian and pandemic flu

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RDRP developed a guidance document prepared in collaboration with OSHA concerning avian flu. This is an ongoing project from the NIOSH-OSHA Issues Exchange Group to develop an existing safety and health bulletin into a NIOSH Alert. The draft Alert is in review. http://www.osha.gov/dts/shib/shib121304.html (External link)

A6-89

RDRP developed guidelines for Protecting Healthcare Workers Caring for Patients with Avian Influenza.”  http://www.cdc.gov/flu/avian/professional/infect-control.htm

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RDRP developed recommendations concerning Respiratory Hygiene/Cough Etiquette in Healthcare Settings http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm 

A6-91

RDRP contributed to a CDC Web site offering guidance on occupational health and safety aspects of avian influenza; http://www.cdc.gov/flu/avian/index.htm

A6-92

RDRP developed a NIOSH Topic Page on occupational aspects of avian influenza. It provides guidance and a number of useful links to other sites with occupational health and safety information.
http://www.niosh.cdc.gov/niosh/topics/avianflu/ 

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Extramural RDRP research on the efficacy of N95 respirators against virus size particles was presented at a national conference in 2005

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RDRP scientists played in integral role in convincing the WHO to revise their posted recommendations for respiratory protection by emphasizing that some respirators certified by governments of other countries provide protection equivalent to NIOSH-certified N-95 respirators

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In 2006, RDRP issued a Request for Applications Number: RFA-OH-06-002 titled - Prevention of Airborne Infections in Occupational Settings

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Federal Registry notice on reusability of respirators

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Schwartz J. Air Pollution and Daily Mortality: A Review and Meta Analysis. Environmental Research. 1994. 64:36-52.

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Birnbaum HG, Morley M, Greenberg PE, Colice GL. Economic Burden of Respiratory Infections in an Employed Population. Chest Journal. 2002. 122:603-611.

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OSHA Web site documenting that as many as 1 million U.S. workers in the construction, transportation, mining, and other industries have at least part-time exposure to diesel exhaust particulate

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Bureau of Labor report that thousands of workers are exposed daily to welding fume (estimates indicate that there are over 358,000 full-time welders in the U.S.)

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Repot that inhalation exposure to different workplace particulates has been observed to predispose some workers in certain industries (e.g., welders, boilermakers)

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RDRP scientists have produced 35 presentations, 33 peer-reviewed manuscripts, and have organized one conference on mechanisms by which occupational exposures predispose to lung infections

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Antonini, JM, Roberts JR, Clarke RW, Yang HM, Barger MW, Ma JYC, Weissman DN [2001]. Effect of Age on Respiratory Defense Mechanisms : Pulmonary Bacterial Clearance in Fischer 344 Rats After Intratracheal Instillation of Listeria monocytogenes. Chest 120;240-249

A6-104

 Antonini JM, Yang HM, Ma JY, Roberts JR, Barger MW, Butterworth L, Charron TG, Castranova V [2000]. Subchronic silica exposure enhances respiratory defense mechanisms and the pulmonary clearance of Listeria monocytogenes in rats. Inhal Toxicol Nov;12(11):1017-36

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 Yang H-M, Antonini JM, Barger MW, Butterworth L, Roberts JR, Ma JKH, Castranova V, Ma JYC [2001]. Diesel exhaust particles suppress macrophage function and slow the pulmonary clearance of Listeria monocytogenes in Rats. Env Health Persp 109:515-521

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 Roberts JR, Taylor MD, Castranova V, Clarke RW, Antonini JM [2004]. Soluble metals associated with residual oil fly ash increase morbidity and lung injury after bacterial infection in rats. J Toxicol Environ Health Feb 13;67(3):251-63

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 Antonini JM, Taylor MD, Millecchia L, Bebout AR, Roberts JR [2004]. Suppression in lung defense responses after bacterial infection in rats pretreated with different welding fumes. Toxicol Appl Pharmacol Nov 1;200(3):206-18

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Antonini JM, Afshari AA, Stone S, Chen B, Schwegler-Berry D, Fletcher WG, Goldsmith WT, Vandestouwe KH, McKinney W, Castranova V, Frazer DG [2006]. Design, construction, and characterization of a novel robotic welding fume generator and inhalation exposure system for laboratory animals. Journ Occ Env Hyg 3:194-203

A6-109

RDRP research on occupational respiratory diseases in welders won the 2006 American Welding Society Safety and Health Award

A6-110

U.S. Environmental Protection Agency [2002] used RDRP research to develop a health assessment document for diesel engine exhaust.” Prepared by the National Center for Environmental Assessment, Washington, DC, for the Office of Transportation and Air Quality; EPA/600/8-90/057F. Available from: National Technical Information Service, Springfield, VA; PB2002-107661, and http://www.epa.gov/ncea (External link)

A6-111

U.S. Army Center for Environmental Health Research/NIOSH: Interagency Agreement – Effects of Mixed Dusts on Asthma and Pulmonary Infectivity [2000]. U.S. Army Center for Environmental Health Research, 568 Doughten Dr,, Fort Detrick, MD 21702.

A6-112

RDRP Neurotoxicity After Pulmonary Exposure to Welding Fumes Containing Manganese proposal well received

A6-113

This NTP-NIOSH Interagency Agreement was entitled - Design, Construction, and Characterization of a Welding Fume Generation and Inhalation Exposure System.

A6-114

NIOSH [2004]: Histoplasmosis: Protecting Workers at Risk. Cincinnati, OH: Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2005-109.

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The first documented cases of occupational histoplasmosis in the U.S. occurred in a 1938 outbreak among 23 Works Progress Administration workers removing pigeon droppings from a schoolhouse in Plattsburgh, New York

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Reid TM, Schafer MP. Direct detection of Histoplasma capsulatum in soil suspensions by two-stage PCR. Molecular and Cellular Probes. 1999. 13:269-273.

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RDRP transferred its research results on histoplasmosis to others through: two HHE reports

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RDRP transferred its research results on histoplasmosis to others through: two HHE reports

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Chamany S, Mirza SA, Fleming JW, Howell JF, Lenhart SW, Mortimer VD, Phelan MA, Lindsley MD, Iqbal NJ, Wheat LJ, Brandt ME, Warnock DW, Hajjeh RA [2004]. Large histoplasmosis outbreak among high school students in Indiana, 2001.  Pediatr Infect Dis J 23:909-914

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Lenhart SW [1994]. Recommendations for protecting workers from histoplasma capsulatum exposure during bat guano removal from a church’s attic. Appl Occup Envir Hyg April 9(4) 230-236

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Article in Poultry Growers News

A6-122

Fact sheet: on histoplasmosis in English

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Fact sheet: on histoplasmosis in Spanish

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Mortality and Morbidity Weekly Report article, 53:1020-1022, 2004

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Presentation at AIHCe

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Presentation at PCIH

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Presentation at AIHA

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RDRP recommendations on preventing histoplasmosis have been adopted by other agencies and organizations, including: Laborers’ Health and Safety Fund of North America

A6-129

RDRP recommendations on preventing histoplasmosis have been adopted by other agencies and organizations, including: Clemson University Research Medical Surveillance Program

A6-130

RDRP recommendations on preventing histoplasmosis have been adopted by other agencies and organizations, including: Defense Supply Center Richmond, Defense Logics Agency, Hazardous Technical Information Services

A6-131

RDRP recommendations on preventing histoplasmosis have been adopted by other agencies and organizations, including: StaffScapes Professional Employer Organization

A6-132

RDRP recommendations on preventing histoplasmosis have been adopted by other agencies and organizations, including: Korean Radiological Society

A6-133

RDRP recommendations on preventing histoplasmosis have been adopted by other agencies and organizations, including: New Jersey Department of Health and Senior Services, Division of Epidemiology, Environmental, and Occupational Health, Public Employees Occupational Safety and Health Program

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The new RDRP NIOSH publication on protecting workers against histoplasmosis is cited on the OSHA Respiratory Protection Hazard Recognition Web page

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The CPWR electronic library of construction occupational safety and health replicates verbatim “Histoplasmosis: Protecting Workers at Risk” (revised edition) in both English and Spanish

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The CPWR electronic library of construction occupational safety and health replicates verbatim “Histoplasmosis: Protecting Workers at Risk” (revised edition) in both English and Spanish

A6-137

Letters of Support etc. TB