Mining has long been recognized as a hazardous occupation, and historically, it has been dominated by men. However, there is limited understanding of the specific injuries experienced by women mine workers. Previous studies have either excluded women from the analysis or aggregated the data without considering sex. Mine Accident, Injury, and Illness reports published by MSHA were analyzed from 1979–2023. Fatal and non-fatal injuries among women were analyzed by age at the time of injury, mining commodity, work activity performed at the time of the injury, job description, and part of body affected. Of the 17,848 injuries among women miners, 37.5

The recent death of a 33-year-old mother of three at a Central Appalachian surface coal mine highlights the persistent dangers faced by miners, particularly from powered haulage incidents. As of December 2, 28 mining fatalities have occurred in the U.S. in 2024, with four in Appalachian coal mines attributed to powered haulage. These deaths underscore the urgent need to address this cause of fatalities in the mining industry and to provide a safe workplace to protect all miners.

BACKGROUND:Small airways disease is a risk factor for the development of obstructive lung disease and may be present among coal miners without obstructive ventilatory impairment. Our study estimated the prevalence of reduced spirometric mid-expiratory flow among coal miners without obstructive ventilatory impairment. METHODS:Data were from coal miners participating in the Coal Workers' Health Surveillance Program (CWHSP) during 2014-2022 with forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) meeting quality criteria and no missing spirometry parameter values. We defined low forced expiratory flow at 25%-75% (FEF25%-75%) as < 65% predicted. RESULTS:The prevalence of FEF25%-75% < 65% predicted among miners without obstructive ventilatory impairment was 7.1% overall, 10.7% among retired miners, and 16.8% among miners with radiographic evidence of coal workers' pneumoconiosis (CWP). CONCLUSIONS:Among miners without obstructive ventilatory impairment, reduced mid-expiratory flow was more prevalent in older miners with longer tenure, specifically retired miners. From a surveillance perspective, reduced spirometric mid-expiratory flow can be an early indicator of more serious health problems in coal miners, including obstructive lung disease.

This study of US Black Lung Clinics (established to treat coal miners) reports the prevalence of progressive massive fibrosis identified through June 2023.

BackgroundInhalation injuries due to acute occupational exposures to chemicals are preventable. National surveillance of acute inhalation exposures is limited. This study identified the most common acute inhalation exposure-related incidents by industry sector among US workers.MethodsTo characterize inhalation-related injuries and their exposures during April 2011-March 2022, state and federal records from the Occupational Safety and Health Administration (OSHA) Occupational Safety and Health Information System (OIS) accident database were analyzed. Industry-specific injury, hospitalization, and fatality rates were calculated.ResultsThe most frequent acute inhalation incidents investigated by OSHA were caused by inorganic gases (52.9%) such as carbon monoxide (CO) or acids, bases, and oxidizing chemical agents (12.9%) such as anhydrous ammonia. The largest number of fatal and nonfatal injuries were reported in the manufacturing (28.6%) and construction (17.2%) sectors.ConclusionsWorkers were affected by acute inhalation exposures in most industries. Using this surveillance, employers can recognize frequently-occurring preventable acute inhalation exposures by industry, such as inorganic gases in the manufacturing sector, and implement prevention measures. Training of workers on exposure characteristics and limits, adverse health effects, and use of protective equipment by exposure agent can prevent inhalation injuries.

Objective: The aim of the study is to summarize Coal Workers' Health Surveillance Program findings since 2014, focusing on prevalence of radiographic pneumoconiosis and abnormal spirometry by region. Methods: Analysis included the most recent Coal Workers' Health Surveillance Program encounter for working miners during October 1, 2014-June 30, 2022. Central Appalachia consists of Kentucky, Virginia, and West Virginia. Results: Pneumoconiosis prevalence was highest among underground miners, with 318 (6.2%) having radiographic evidence of disease. Central Appalachian miners were more likely to have evidence of pneumoconiosis (relative risk = 4.1 [3.4-5.0]) and abnormal spirometry (relative risk = 1.4 [1.2-1.6]) compared with all others. Conclusions: Central Appalachia is a hotspot for pneumoconiosis, as well as for other indicators of respiratory impairment in coal miners. Outreach for occupational respiratory health surveillance should focus on those areas most heavily affected, ensuring that miners are not hindered by perceived or actual barriers to this secondary intervention.

Objective: To describe the work experience and respiratory health of women coal miners in the United States using Coal Workers' Health Surveillance Program (CWHSP) data. Methods: Analysis included CWHSP participants with self-reported sex of female between January 1, 1970, and December 31, 2022, and examined radiographic surveillance, demographics, and job history. National Institute for Occupational Safety and Health-certified physicians classified chest radiographs. Results: Among 8,182 women participants, most worked <10 years and a majority reported working in non-dusty jobs. Among 3,392 with >= 1 year of coal mining tenure, 18 (0.5%) had evidence of pneumoconiosis, with no cases of progressive massive fibrosis. Conclusion: Women coal miners participating in the CWSHP had short mining careers and low pneumoconiosis prevalence. Few worked in the most dusty jobs, indicating limited exposure to coal mine dust. This underscores the need to explore women's roles in mining, and for improved gender-specific employment reporting. Such changes can enhance health and work conditions for women in male-dominated industries.

BackgroundMandatory examination requirements for US coal miners newly entering the workforce have been in place since the 1969 Coal Act mandated chest radiographs and were updated to include spirometry with promulgation of the 2014 Mine Safety and Health Administration Dust Rule. Compliance with the mandatory respiratory screening series is described using data from the National Institute for Occupational Safety and Health Coal Workers' Health Surveillance Program (CWHSP). MethodsAmong all radiographic and spirometry submissions to the CWHSP during 30 June 1971-15 March 2022, new underground coal miners who began work in the industry after 30 June 1971, and new underground, surface miners and contractors who began work after new regulations were implemented 1 August 2014, were identified and included in analysis. ResultsOf the 115 093 unique miners who participated in the CWHSP and whose estimated entry into mining occurred during 30 June 1971-15 March 2019, 50 487 (43.9%) received their initial mandatory radiograph, and 15 452 (13.4%) submitted their initial and 3-year mandatory radiographs. Since new regulations were implemented, compliance with initial radiographs appeared to improve (80%) but compliance with 3-year radiographs remained low (11.6%). Compliance with spirometry testing was also low for initial (17.1%) and follow-up screenings (2.7%). ConclusionsThe majority of new coal miners eligible for health surveillance did not receive a baseline radiograph or spirometry test through the CWHSP even though coal mine operators are required by law to provide these. Ensuring coal miners' regular participation in health surveillance from early in their careers is an important way to monitor and protect their respiratory health.

"Low Participation in a Job Transfer Program Designed to Prevent Progression of Pneumoconiosis." Annals of the American Thoracic Society, 20(8), pp. 1223–1224

ObjectivesCoal miners suffer increased mortality from non-malignant respiratory diseases (NMRD), including pneumoconioses and chronic obstructive pulmonary disease, compared with the US population. We characterised mortality trends from NMRD, lung cancer and ischaemic heart disease (IHD) using data from the Federal Black Lung Program, National Coal Workers’ Health Surveillance Program and the National Death Index.MethodsWe compared mortality ORs (MORs) for NMRD, lung cancer and IHD in former US coal miners to US white males. MORs were computed for the study period 1979–2017 by birth cohort (<1920, 1920–1929, 1930–1939, ≥1940), with a subanalysis restricted to Central Appalachia.ResultsThe study population totalled 235 550 deceased miners, aged >45 years. Odds of death from NMRD and lung cancer across all miner birth cohorts averaged twice those of US males. In Central Appalachia, MORs significantly increased across birth cohorts. There was an eightfold increase in odds of death from NMRD among miners born after 1940 (MORBC≥19408.25; 95% CI 7.67 to 8.87). Miners with progressive massive fibrosis (PMF) were younger at death than those without PMF (74 vs 78 years; p<0.0001). We observed a pattern of reduced MORs from IHD in coal miners compared with national and regional counterparts.ConclusionUS coal miners have excess mortality from NMRD and lung cancer compared with total US and Appalachian populations. Mortality is highest in the most recent birth cohorts, perhaps reflecting increased rates of severe pneumoconiosis.

BACKGROUND In 2014, a federal rule reduced occupational exposure limits to coal mine dust and expanded medical surveillance eligibility beyond underground miners to surface and contract coal miners. This expansion may have provided an opportunity for more American Indian and Alaska Native (AI/AN) coal miners to participate in screening, since many surface coal mines are located near AI/AN communities and may employ AI/AN miners. Therefore we sought to better understand the respiratory health of AI/AN coal miners by characterizing prevalence of coal workers' pneumoconiosis (CWP), progressive massive fibrosis (PMF), and abnormal lung function in this population. METHODS Descriptive analysis of 1405 chest radiographs and 627 spirometry test results for AI/AN miners who participated in the Coal Workers' Health Surveillance Program (CWHSP) during 2014-2019 was conducted. RESULTS Most AI/AN miners (0-25+ years of tenure) were western United States residents (82.3%) and active surface miners (76.9%) with no underground tenure. Among miners with at least 10 years of tenure, prevalence of CWP was 3.0%, and of PMF was 0.3%. Lung function abnormalities were seen in 9.0% with primarily restrictive patterns. CONCLUSIONS The prevalence of CWP, PMF, and lung function abnormality among active and former AI/AN coal miners was higher than seen in a larger CWHSP study of active western miners working primarily underground with 10+ years of tenure. Interventions that eliminate or control coal mine dust exposure, identify miners with CWP early, and limit respiratory disease progression and complications remain vital for eliminating the preventable adverse health effects of coal mining. Comprehensive demographic data on the coal mining workforce are needed to improve CWHSP participation assessment.

Chronic obstructive pulmonary disease (COPD), a progressive lung disease, is characterized by long-term respiratory symptoms and airflow limitation (1). COPD accounts for most of the deaths from chronic lower respiratory diseases, the sixth leading cause of death in the United States in 2020.* Workplace exposures and tobacco smoking are risk factors for COPD; however, one in four workers with COPD have never smoked (2-4). To describe COPD mortality among U.S. residents aged ≥15 years categorized as ever-employed (i.e., with information on their usual industry and occupation), CDC analyzed the most recent 2020 multiple cause-of-death data† from 46 states and New York City.§ Among 3,077,127 decedents, 316,023 (10.3%) had COPD listed on the death certificate. The highest age-adjusted** COPD death rates per 100,000 ever-employed persons were for females (101.3), White persons (116.9), and non-Hispanic or Latino (non-Hispanic) persons (115.8). The highest proportionate mortality ratios (PMRs)†† were for workers employed in the mining industry (1.3) and in food preparation and serving related occupations (1.3). Elevated COPD mortality among workers in certain industries and occupations underscores the importance of targeted interventions (e.g., reduction or elimination of COPD-associated risk factors, engineering controls, and workplace smoke-free policies) to prevent COPD from developing and to intervene before illness becomes symptomatic or severe.

During July 2021, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.617.2 variant infections, including vaccine breakthrough infections, occurred after large public gatherings in Provincetown, Massachusetts, USA, prompting a multistate investigation. Public health departments identified primary and secondary cases by using coronavirus disease surveillance data, case investigations, and contact tracing. A primary case was defined as SARS-CoV-2 detected <14 days after travel to or residence in Provincetown during July 3–17. A secondary case was defined as SARS-CoV-2 detected <14 days after close contact with a person who had a primary case but without travel to or residence in Provincetown during July 3–August 10. We identified 1,098 primary cases and 30 secondary cases associated with 26 primary cases among fully and non–fully vaccinated persons. Large gatherings can have widespread effects on SARS-CoV-2 transmission, and fully vaccinated persons should take precautions, such as masking, to prevent SARS-CoV-2 transmission, particularly during substantial or high transmission.

BACKGROUND:The prevalence of pneumoconiosis among working United States underground coal miners has been increasing for the past two decades, with the highest rates of disease observed among miners in the central Appalachian states of Kentucky, Virginia, and West Virginia. Surveillance for this disease in the United States focuses on working coal miners, who continue to be occupationally exposed to dust. This study examines the radiographic evidence for postexposure progression of pneumoconiosis in a population of former coal miners no longer occupationally exposed to coal mine dust who were seen at a community radiology clinic in eastern Kentucky. METHODS:Data were obtained and analyzed from clinical records of former coal miners who had a clinic encounter during January 1, 2017-August 1, 2019, a recorded final year of employment, and ≥2 postemployment digital chest radiographs. Radiographs were classified according to the International Labour Office guidelines by at least two B Readers. A final summary pneumoconiosis severity score (range, 0-13), accounting for both small and large opacities, was assigned to each chest radiograph. Progression was defined as an increase in severity score between a miner's radiographs over time. RESULTS:Data for 130 former coal miners were analyzed. All miners were male and most (n = 114, 88%) had worked primarily in Kentucky. Information on race/ethnicity was not available. The most common job types were roof bolters (n = 51, 39%) and continuous miner operators (n = 46, 35%). Forty-one (31.5%) miners had evidence of radiographic disease progression after leaving the workforce, with a median of 3.6 years between first and latest postretirement radiograph. A total of 80 (62%) miners had evidence of pneumoconiosis on their latest radiograph, and two-thirds (n = 53) of these were classified as progressive massive fibrosis (PMF), the most severe form of the disease. CONCLUSIONS:Postexposure progression can occur in former coal miners, emphasizing the potential benefits of continued radiographic follow-up postemployment. In addition to participating in disease screening throughout their careers to detect pneumoconiosis early and facilitate intervention, radiographic follow-up of former coal miners can identify new or progressive radiographic findings even after workplace exposure to respirable coal mine dust ends. Identification of progressive pneumoconiosis in former miners has potential implications for clinical management and eligibility for disability compensation.

Objective: In March 2018, the US Department of Defense (DOD) added the smallpox vaccination, using ACAM2000, to its routine immunizations, increasing the number of persons receiving the vaccine. The following month, Fort Hood reported a cluster of 5 myopericarditis cases. The Centers for Disease Control and Prevention and the DOD launched an investigation. Methods: The investigation consisted of a review of medical records, establishment of case definitions, causality assessment, patient interviews, and active surveillance. A 2-sided exact rate ratio test was used to compare myopericarditis incidence rates. Results: This investigation identified 4 cases of probable myopericarditis and 1 case of suspected myopericarditis. No alternative etiology was identified as a cause. No additional cases were identified. There was no statistically significant difference in incidence rates between the observed cluster (5.23 per 1000 vaccinated individuals, 95% CI: 1.7-12.2) and the ACAM2000 clinical trial outcomes for symptomatic persons, which was 2.29 per 1000 vaccinated individuals (95% CI: 0.3-8.3). Conclusions: Vaccination with ACAM2000 is the presumptive cause of this cluster. Caution should be exercised before considering vaccination campaigns for smallpox given the clinical morbidity and costs incurred by a case of myopericarditis. Risk of myopericarditis should be carefully weighed with risk of exposure to smallpox.

During July 2021, 469 cases of COVID-19 associated with multiple summer events and large public gatherings in a town in Barnstable County, Massachusetts, were identified among Massachusetts residents; vaccination coverage among eligible Massachusetts residents was 69%. Approximately three quarters (346; 74%) of cases occurred in fully vaccinated persons (those who had completed a 2-dose course of mRNA vaccine [Pfizer-BioNTech or Moderna] or had received a single dose of Janssen [Johnson & Johnson] vaccine ≥14 days before exposure). Genomic sequencing of specimens from 133 patients identified the B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, in 119 (89%) and the Delta AY.3 sublineage in one (1%). Overall, 274 (79%) vaccinated patients with breakthrough infection were symptomatic. Among five COVID-19 patients who were hospitalized, four were fully vaccinated; no deaths were reported. Real-time reverse transcription-polymerase chain reaction (RT-PCR) cycle threshold (Ct) values in specimens from 127 vaccinated persons with breakthrough cases were similar to those from 84 persons who were unvaccinated, not fully vaccinated, or whose vaccination status was unknown (median = 22.77 and 21.54, respectively). The Delta variant of SARS-CoV-2 is highly transmissible (1); vaccination is the most important strategy to prevent severe illness and death. On July 27, CDC recommended that all persons, including those who are fully vaccinated, should wear masks in indoor public settings in areas where COVID-19 transmission is high or substantial.* Findings from this investigation suggest that even jurisdictions without substantial or high COVID-19 transmission might consider expanding prevention strategies, including masking in indoor public settings regardless of vaccination status, given the potential risk of infection during attendance at large public gatherings that include travelers from many areas with differing levels of transmission.