Health hazard evaluation report: HETA-2002-0090; 2002-0096; 2002-0101-3028, Buildings in the Vicinity of the World Trade Center, New York City, New York.
On January 1, 2002, the National Institute for Occupational Safety and Health (NIOSH) received three health hazard evaluation (HHE) requests from employee representatives at four different work sites: Stuyvesant High School, the Borough of Manhattan Community College (BMCC), 120 Broadway and 40 Rector Street (housing four city agencies), near the World Trade Center (WTC) site. This report summarizes four separate NIOSH investigations, which document the extent of physical and psychological symptoms among workers at these sites in the months following the September 11, 2001 disaster at the WTC. Each of these reports compared physical and mental health symptoms among employees at these buildings with the same symptoms among employees at comparable New York City work sites distant from the WTC. NIOSH personnel conducted a questionnaire survey of employees at Stuyvesant High School and a comparison high school, La Guardia High School, in late January 2002. The survey occurred at BMCC and a comparison college, York Community College, in mid-March 2002; at 40 Rector Street in early April 2002, and at 120 Broadway (state attorney general's office) in early June 2002. The LeFrak Building, was surveyed in early April 2002 and was the comparison building for 40 Rector Street and 120 Broadway. We used a self-administered questionnaire to ask about physical and mental health symptoms that occurred since September 11 and symptoms still present at the time of the survey. In addition, we used the questionnaire to ask participants about experiences on September 11, about medical diagnoses since then, and about social support. Participation rates were 82%-83% at both high schools and at the 40 Rector Street building, 76% at the comparison office building, about 55%-60% at BMCC, about 45%-50% at the comparison college, and 37% at the 120 Broadway building. In all four studies, the prevalence of physical symptoms, including upper and lower respiratory symptoms, tended to be higher at the work sites near the WTC site than at the comparison work sites. The prevalence of persistent symptoms (upper and lower respiratory symptoms) also tended to be higher. Depressive symptoms and post traumatic stress disorder (PTSD) symptoms were prevalent at Stuyvesant and BMCC, but not at the two office buildings. Likewise, PTSD diagnosed since September 11 was more prevalent at Stuyvesant and BMCC than at their comparison sites, and a similar, though not statistically significant, prevalence ratio was found at the 40 Rector Street building. Newly diagnosed depression was not statistically more prevalent at any of the individual sites than at the comparison sites. All the surveys were limited by the lack of quantitative information about employees' exposures to dust and smoke from the collapsing buildings and fires on September 11 and our inability to infer medical diagnoses solely on the basis of a symptom survey. Since our interim letters were issued, published reports from several studies have described short- and medium-term physical health effects among rescue workers, office workers, and residents from the surrounding community. These studies have provided information suggesting that exposure to the dust cloud and the chemical/physical properties of the dust from the collapse of the buildings on September 11 as well as exposures to combustion products from the burning materials have contributed to the respiratory problems. Continued longitudinal follow-up of those exposed will be necessary to determine whether the changes in spirometry documented up to 5 years post-disaster will lead to chronic problems or whether the initial decline in respiratory function will be followed by recovery, as has been seen in other irritant-exposed groups. Reports of psychological problems have also been well documented since our interim letters were issued. On-going interventions addressing these reactions may help prevent the development of long-lasting psychological sequelae. NIOSH investigators determined that an occupational health hazard due to exposures surrounding the collapse of the World Trade Center existed among the working groups studied. A substantial burden of symptoms of depression and PTSD, as well as physical symptoms of eye irritation and upper airway irritation were present among those surveyed. Recommendations for medical evaluation of symptomatic persons, facilitating access to medical heath services, fostering social support, and training were given.