CSTE ANNUAL MEETING CSTE POSITION STATEMENT 1996-2 COMMITTEE: Environmental/Occupational/Injury Committee TITLE: Adding Silicosis as a Condition Reportable to the National Public Health Surveillance System (NPHSS) ISSUE: Silicosis is a sentinel occupational disease. Surveillance for silicosis is needed to identify work sites where workers continue to be exposed to hazardous levels of silica dust. POSITION TO BE ADOPTED: CSTE recommends that silicosis be added as a condition reportable to the National Public Health Surveillance System (NPHSS). BACKGROUND AND JUSTIFICATION: Silicosis is a chronic, nonmalignant lung disease caused by the inhalation of respirable crystalline silica dust. Occupational exposure is regulated by the Occupational Safety and Health Administration (OSHA). The existing level of surveillance of silicosis has revealed neither the true burden nor the continuing risk of the disease. Prevention of silicosis will require improved surveillance in all 50 states or territories. Surveillance data from seven states that are piloting silicosis surveillance systems identified and confirmed 256 cases of silicosis that were ascertained during 1993.  Despite longstanding knowledge about its cause, this preventable occupational lung disease continues to occur. States which have these pilot surveillance systems have conducted follow-up studies in work places where individuals with this disease were exposed. These investigations have demonstrated ongoing exposure to silica dust at concentrations which pose a disease threat to currently exposed workers. Evaluation studies have demonstrated the efficacy of public health interventions to reduce silica dust levels in such work places. The National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC) currently supports state-based silicosis surveillance systems in seven states, (IL, MI, NC, NJ, OH, TX, WI) under its Sentinel Event Notification System for Occupational Risks (SENSOR) program. OUTCOME FOR SURVEILLANCE AND ACTION PROPOSED: Add silicosis as a condition reportable to the NPHSS. GOALS FOR SURVEILLANCE Local In partnership with state/territorial and national programs; identify individual sentinel cases and clusters of silicosis; demonstrate the need for public health intervention programs and resources; trigger appropriate prevention and control activities at identified sources of exposure; and assess the effectiveness of prevention activities. State/Territory Identify individual cases and clusters of silicosis; demonstrate the need for public health intervention programs and resources; assure appropriate prevention and control activities in work places with silica exposure; and monitor the effectiveness of prevention programs. National Assess the public health impact of silicosis including determinants and trends; evaluate prevention activities including screening programs and efforts to reduce work place silica exposure; demonstrate the need to public health intervention programs and resources, and help allocate resources for surveillance and intervention. PROPOSED METHOD OF SURVEILLANCE Local State/territorial health departments report confirmed cases of silicosis to local health agency for collaborative follow-up. State/Territory Receive reports of silicosis from secondary data including hospital discharge data and mortality data supplemented by physician reporting and employer screening data, if available, to the state or territorial health department. Identification followed by case confirmation and sharing of case and employer in- formation with appropriate local public health agencies. National State/territorial health departments pass along surveillance data on confirmed cases to CDC/NIOSH. PROPOSED CASE DEFINITION Clinical Description Silicosis is characterized by radiographic abnormalities. Typically the abnormalities are small opacities in the upper lung fields which are rounded in appearance. Clinical signs and symptoms of respiratory distress are uncommon until disease is advanced.  Individuals with silicosis are at higher risk of developing tuberculosis. Laboratory Criteria for Diagnosis Pulmonary tissue histopathology characteristic of silicosis Case Classification CDC has published a case definition in MMWR  Confirmed case: 1) a history of occupational exposure to airborne silica dust; and  2) a) a chest radiograph interpreted as characteristic of silicosis; and/or  b) lung histopathology characteristic of silicosis. DATA TO BE COLLECTED Local Reports provided by the state/territorial health department should include name and address, basic demographic data, occupational data including name of employers where silica exposure occurred, and, if available, date of first exposure and duration of exposure. Results of work place follow-up investigations conducted in collaboration with the state should be collected, including exposure findings, evidence of silicosis in co-workers, and the impact of the investigations on the reduction of exposure to silica dust. State/Territory Reports from source data, health providers, and/or employers may be followed up by interviews to supplement/capture demographic and occupational data. Reports are supplemented by medical records and reviews of x-rays in order to do case confirmation. Demographic and occupational data on confirmed cases are passed on to the relevant local health departments. If the state/territory is involved in public health activities at identified work sites, the state/territory should also collect data on work place exposure findings, evidence of silicosis in co-workers, and the impact on the investigations on the reduction of exposure to silica dust. National Core variables on confirmed cases to be reported to CDC should include demographics, employer and occupational classification, duration of exposure, radiologic findings, source(s) of data. SYSTEM TO COLLECT AND TRANSMIT INFORMATION TO CDC State/territorial health departments should compile confirmed case silicosis surveillance data in standardized format, using core variable definitions which have already been developed by CDC/NIOSH and state SENSOR programs. Preferably the cases should be reported to CDC/NIOSH electronically either through an Internet file transfer or via PC/WONDER. STATUS Permanent, with review of reporting need every five years. COORDINATION WITH OTHER ORGANIZATIONS Agencies for Response: Centers for Disease Control and Prevention Council of State and Territorial Epidemiologists National Institute for Occupational Safety and Health Agencies for Information: Association of State and Territorial Health Officials  Occupational Safety and Health Administration  Contact: Henry A. Anderson, M.D. Chief Medical Officer and State Environmental  and Occupational Disease Epidemiologist Wisconsin Bureau of Public Health 1414 East Washington Ave., Room 96 Madison, WI 53704 Telephone: (608)-266-1253 Fax: (608)-267-4853  HAA0@WONDER.EM.CDC.GOV