Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006–2015

Chia-ping Su; Marie A. de Perio; Kristin J. Cummings; Anna-Binney McCague; Sara E. Luckhaupt; Marie Haring Sweeney


Emerging Infectious Diseases. 2019;25(3):397-405. 

In This Article

Abstract and Introduction


Workers in specific settings and activities are at increased risk for certain infectious diseases. When an infectious disease case occurs in a worker, investigators need to understand the mechanisms of disease propagation in the workplace. Few publications have explored these factors in the United States; a literature search yielded 66 investigations of infectious disease occurring in US workplaces during 2006–2015. Reported cases appear to be concentrated in specific industries and occupations, especially the healthcare industry, laboratory workers, animal workers, and public service workers. A hierarchy-of-controls approach can help determine how to implement effective preventive measures in workplaces. Consideration of occupational risk factors and control of occupational exposures will help prevent disease transmission in the workplace and protect workers' health.


Despite ongoing efforts to reduce, eliminate, and eradicate infectious diseases, infections continue to pose a global threat to human health. More than 2,000 years ago, Hippocrates noted that "there are many handicrafts and arts which cause those who exercise them certain… plagues".[1] Recent experiences with anthrax, severe acute respiratory syndrome (SARS), influenza A(H1N1), and Ebola virus disease have highlighted the importance of focusing on workplaces not only to identify at-risk populations but also to understand mechanisms of disease propagation and to implement successful control and prevention measures.[2–5]

In the United States, work-related infectious diseases are identified in multiple ways. Workers, employers, or workplace health and safety offices may note an unusual case or cluster of disease. Local and state public health departments receive case reports of infectious disease from clinicians and laboratories, and they may conduct investigations, sometimes with assistance from the Centers for Disease Control and Prevention (CDC). CDC's National Institute for Occupational Safety and Health (NIOSH) is the federal public health agency responsible for conducting research and making recommendations to prevent occupational safety and health risks, including work-related infectious diseases. The NIOSH Health Hazard Evaluation (HHE) program responds to requests from workers, employers, and public health agencies and conducts investigations of hazards including infectious diseases that occur in workplaces. Nongovernmental researchers also carry out investigations.

Investigators of work-related infectious disease must consider multiple factors related to the disease, workplace, and workers. Few publications have explored these factors. To illustrate the range of work-related infectious diseases that have been identified in the United States during 2006–2015 and to benefit future investigations, we examined the peer-reviewed literature and HHE reports on infectious diseases occurring in US workplaces. We describe occupational factors to consider and a systematic approach to control and prevent infectious disease in the workplace. We also note ways that specialized resources may be useful during the course of an investigation.