Burden, Need and Impact
NIOSH strives to maximize its impact in occupational safety and health. The Immune, Infectious, and Dermal Disease Program identifies priorities to guide investments, and base those priorities on the evidence of burden, need and impact. Below are the priority areas for the Immune, Infectious, and Dermal Disease Program.
Millions of people suffer from allergic conditions characterized by exaggerated immune responses. Work related asthma comprises 15-23% of new onset asthma cases in adults.1,2 It can cause recurrent attacks of symptoms such as wheezing, chest tightness, shortness of breath, and coughing. An estimated 11 million American workers are potentially exposed to materials that can produce occupational asthma. There are over 200 documented agents which have been associated with the development of occupational asthma including: dusts, plant and animal proteins, latex, low molecular weight reactive chemicals, pharmaceuticals and non-sensitizing respiratory tract irritants.3 Workers in most occupational sectors have potential for exposure to these agents.
Research is needed to develop, implement and evaluate thoughtful interventions that increase adherence to safe handling of chemical and biologics and reduce worker exposure. In the healthcare setting, employer and healthcare worker adherence to safe handling guidelines is an ongoing challenge for many other hazardous drugs and chemicals. Service sector workers are in need of targeted prevention information to limit their exposures to chemicals used in cleaning agents or personal care products. Most hazards are known but interventions have not been applied to these populations.
To prevent illness, workers need to be aware not only of the hazards associated with the chemicals in their environment but also the best ways to protect them from exposure and disease. Understanding the mechanisms of occupational diseases will allow for proper treatment and/or prevention. The identification of factors that can influence occupational exposure to chemicals will help to determine the most appropriate ways to prevent or minimize exposure. Ultimately hazard identification will lead to risk assessment which will ensure safe working environments. Guidance documents and other outreach through stakeholders could reduce risk factors for immunological diseases.
1 Dotson GS, Maier A, Siegel PD, et al. Setting Occupational Exposure Limits for Chemical Allergens Understanding
the Challenges Journal of occupational and environmental hygiene 2015;12 Suppl 1:S82-98.
2 Pralong JA, Cartier A, Vandenplas O, Labrecque M. Occupational asthma: new low-molecular-weight causal agents, 2000-2010 Journal of allergy 2012;2012:597306.
3 Mapp CE. Agents, Old and New, Causing Occupational Asthma Occupational and Environmental Medicine 2001;58:354-354.
Another focus area of the IID program is to reduce airborne transmission of infectious agents, such as influenza, that can adversely impact worker health and productivity. In the US, the annual direct costs of influenza are estimated at $4.6 billion. Additionally, up to 111 million workdays are lost because of influenza at an estimated $7 billion/year in sick days and lost productivity.1
To reduce infectious disease transmission, additional surveillance and basic research is needed to help with early detection and effective prevention strategies, such as increased respiratory protection. Prevention of transmission in healthcare workers depends on stopping sharps injuries and other blood and body fluid exposures. Unfortunately, surveillance for this issue is fragmented and only limited data is available to estimate the full burden of needlestick injuries.
In addition to Ebola, the potential threat of new and emerging infectious disease is concerning and includes Middle Eastern Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS), avian influenza, pandemic influenza, and multidrug-resistant pathogens, to name a few. Depending on the specific pathogen, transmission can occur via direct contact with patients and contaminated surfaces, or airborne bioaerosols, generated mainly by sneezing and coughing that range from large projectable droplets to small particles remaining in the air. In many cases, interventions exist to prevention transmission; however, much remains unknown regarding these emerging infectious diseases. Numerous opportunities exist for research with relevance and impact.
Although surveillance is performed for some infectious diseases, a national surveillance system is lacking. Research is needed to identify barriers to adherence and achieve better implementation of known, effective interventions such as handwashing and vaccination for influenza.
Addressing infectious disease threats will require a multifaceted approach driven by evidence-based practices, thoughtful occupational health research and comprehensive surveillance. In addition to increasing worker health and safety, these efforts can also reduce costs. Vaccinating employees for influenza and reducing influenza-related absenteeism can save U.S. employers $2.58 for every dollar invested in a vaccination program.2
1Molinari NA, Ortega-Sanchez IR, Messonnier ML, Thompson WW, Wortley PM, Weintraub E, Bridges CB. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine 2007;25(27):5086–5096.
2Campbell DS, Rumley MH. Cost-effectiveness of the influenza vaccine in a healthy, working-age population. J Occup Environ Med 1997;39:408–414.
The advancement of knowledge of occupational skin hazards and diseases in the workplace through field and laboratory research is a third focus of the IID program. CDC estimates that more than 13 million workers in the United States, spanning a variety of occupational industries and sectors, are potentially exposed to chemicals that can be absorbed through the skin. Approximately 82,000 chemicals are in industrial use with an estimated additional 700 new chemicals introduced annually, resulting in a high potential for dermal exposure to chemicals.1 Occupational skin exposures can result in numerous diseases which can adversely affect an individual’s health and capacity to perform at work. Associated costs are estimated to exceed $1 billion annually in the United States alone.2,3 In 2012, skin diseases alone accounted for 34,400 cases at a rate of 3.4 per 10,000 employees as reported by the Bureau of Labor Statistics, exceeding occupational respiratory illnesses (19,300 cases with a rate of 1.9 per 10,000 employees).4 Hundreds of chemicals present in virtually every industry (metals, epoxy and acrylic resins, rubber additives, chemical intermediates) have been identified to cause immune mediated skin disorders such as contact dermatitis, which is the second most common occupational illness.
To minimize the hazards of dermal occupational exposures, research is needed to understand the mechanisms driving the diseases related to exposure. Improved surveillance and proper implementation of protective measures are essential to ensure worker safety and health. Exposure monitoring to identify, evaluate and prevent occupational chemical exposure is important. This can help to determine the type and route of exposure, the effectiveness of engineering controls, how to improve work practices, appropriate personal protective equipment, and provide risk assessment guidance to regulators.
Workers should be aware not only of the hazards associated with the chemicals in their environment but also the best ways to protect them from exposure and disease. Understanding the mechanisms of occupational diseases will allow for proper treatment and/or prevention. The identification of factors that can influence occupational exposure to chemicals will help to determine the most appropriate ways to prevent or minimize exposure. Ultimately hazard identification will lead to risk assessment which will ensure safe working environments. Guidance documents and other outreach through stakeholders could reduce risk factors for dermal diseases.
1GAO (2005) Report to Congressional Requesters: CHEMICAL REGULATION Options Exist to Improve EPA’s Ability to Assess Health Risks and Manage Its Chemical Review Program. GAO-05-458. In: (Office. USGA, ed).
2Cashman MW, Reutemann PA, Ehrilich A (2012) Contact dermatitis in the United States: epidemiology, economic impact, and workplace prevention. Dermatologic Clinics 30:87-98.
3Mancini AJ, Kaulback K, Chamlin SL (2008) The socioesonomic impact of atopic dermatitis in the United States: a systematic review. Pediatriac Dermatology 25:1-6.
4Northwood JM, Sygnatur EF, Windau JA (2012) Updated BLS Occupational Injury and Illness Classification System. Monthly Labor Review.
- Page last reviewed: August 22, 2013
- Page last updated: December 5, 2016
- Content source:
- National Institute for Occupational Safety and Health Office of the Director