title: Occupational coccidioidomycosis in California: outbreak investigation, respirator recommendations, and surveillance findings.
abstract: OBJECTIVE
  To describe the investigation of a 2007 occupational coccidioidomycosis outbreak in California, recommend prevention measures, and assess statewide disease burden.
  
  
  METHODS
  We evaluated the worksite, observed work practices, interviewed the workers and employer, reviewed medical records, provided prevention recommendations including risk-based respirator selection, and analyzed statewide workers' compensation claims.
  
  
  RESULTS
  Ten of 12 workers developed acute pulmonary coccidioidomycosis; none used respiratory protection. We recommended engineering, work practice, and administrative controls, powered air-purifying respirator use, and medical care. Occupational coccidioidomycosis incidence nearly quadrupled in California from 2000 to 2006, with the highest rates in construction and agricultural workers.
  
  
  CONCLUSIONS
  Construction workers are at risk for occupational coccidioidomycosis. The high attack rate in this outbreak was due to lack of awareness, rainfall patterns, soil disruption, and failure to use appropriate controls. Multiple risk-based measures are needed to control occupational coccidioidomycosis in endemic areas.
authors.affiliation: Occupational Health Branch, California Department of Public Health, CA, USA. Rupali.das@cdph.ca.gov
authors.forename: Rupali
authors.initials: R
authors.lastname: Das
authors.forename: Jennifer
authors.initials: J
authors.lastname: McNary
authors.forename: Kathleen
authors.initials: K
authors.lastname: Fitzsimmons
authors.forename: Dina
authors.initials: D
authors.lastname: Dobraca
authors.forename: Kate
authors.initials: K
authors.lastname: Cummings
authors.forename: Janet
authors.initials: J
authors.lastname: Mohle-Boetani
authors.forename: Charlotte
authors.initials: C
authors.lastname: Wheeler
authors.forename: Ann
authors.initials: A
authors.lastname: McDowell
authors.forename: Yulia
authors.initials: Y
authors.lastname: Iossifova
authors.forename: Rachel
authors.initials: R
authors.lastname: Bailey
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kreiss
authors.forename: Barbara
authors.initials: B
authors.lastname: Materna
mesh_terms: D002140:California / Q000453:epidemiology; D003045:Coccidioides; D003047:Coccidioidomycosis / Q000453:epidemiology* / Q000517:prevention & control; D060389:Construction Industry / Q000458:organization & administration; D004196:Disease Outbreaks; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019570:Inhalation Exposure / Q000517:prevention & control*; D009784:Occupational Diseases / Q000453:epidemiology* / Q000517:prevention & control; D016134:Organizational Policy; D011159:Population Surveillance; D012134:Respiratory Protective Devices; D012988:Soil Microbiology; D014942:Workers' Compensation / Q000706:statistics & numerical data