NIOSH Respiratory Diseases Research Program

9. Respiratory Disease HHEs and Technical Assistance

 8.7 Letters of Support, Etc.

9.1 Flockworkers Lung Disease 

Employers, authorized representatives of workers, or a group of three current workers can request NIOSH staff to conduct investigations of suspected hazardous exposures in the workplace as described in 42 Code of Federal Regulations, Part 85. An investigation conducted in response to such a request is called a HHE. By providing NIOSH with “right of entry” into workplaces to conduct HHEs, the Occupational Safety and Health Act of 1970 (Public Law 91-596) enabled NIOSH to make important contributions in occupational health service and research. Accomplishments have included identification of new health hazards, identifying solutions, stimulating the development of medical and industrial hygiene methods, prompting toxicology and epidemiologic studies, and providing exposure and toxicity data in support of new and existing exposure standards. In response to requests by local, state, and other federal agencies, NIOSH staff can provide technical assistance, in which we enter workplaces under the authority of the requesting governmental entity. HHEs and investigations conducted in response to technical assistance requests are managed together by the HETA Program. The HETA program is going to be reviewed as a separate entity by the National Academies. This chapter will therefore only present a brief overview of how HETAs have been an important tool of RDRP in addressing occupational respiratory diseases.

HETA requests related to respiratory diseases constitute a significant proportion of total HETA requests. In the last 10 years, NIOSH received 4391 HETA requests of which 2424 (55 percent) had significant respiratory components. The number of requests received per year has ranged from 286 to 572 and those with respiratory issues have ranged from 40-68 percent of the annual total (Figure 8).

Almost half of all HHE requests received during this period (2029, or 46 percent) have been related to indoor air quality. However, there is no evidence that the spike in all requests (to 572) seen in 2001 had any particular request-specific cause.

Sentinel outbreaks of occupational respiratory disease investigated through the HETA program have identified and provided important information about emerging issues. This work has lead to a large body of applied, industry-wide, and laboratory research. RDRP research conducted through, or triggered by, the HETA program since 1996 includes a large number of industries, agents, and diseases. Some notable examples are:

• mycobacteria-related hypersensitivity pneumonitis outbreaks among metal workers (A9-1);
• new agents causing occupational asthma, including 3-amino-5-mercapto-1,2,4-triazole in pesticide manufacture (A9-2), bioaerosols in crab processing (A9-3) and powdering of shark cartilage (A9-4), and damp buildings (chapter 9.2);
• chloramines in poultry processing causing eye irritation and respiratory symptoms (A9-5); and
• TB in homeless shelter (A9-6), medical waste (A9-7) and correctional institution workers (A9-8).

References to the HETA program have been made where appropriate in the disease-focused chapters preceding this one. However, it is important to recognize the HETA program as a public health service activity and research tool in its own right. As already noted, the HETA program will receive a separate review by the NA in 2007. This chapter will briefly present three illustrative examples where the HETA program has played an important role in identification and mitigation of respiratory workplace hazards, focusing on the role played by the program. The three areas discussed, flock workers’ lung (chapter 3.3b), building-related asthma associated with damp indoor environments (chapter 4.1c), and flavoring-related bronchiolitis obliterans (chapter 4.2d), are addressed from a primarily research perspective in previous chapters.