Severe Silicosis in Engineered Stone Fabrication Workers

California, Colorado, Texas, and Washington, 2017-2019

Cecile Rose, MD; Amy Heinzerling, MD; Ketki Patel, MD, PhD; Coralynn Sack, MD; Jenna Wolff; Lauren Zell-Baran, MPH; David Weissman, MD; Emily Hall, MPH; Robbie Sooriash, MD; Ronda B. McCarthy, MD; Heidi Bojes, PhD; Brian Korotzer, MD; Jennifer Flattery, MPH; Justine Lew Weinberg, MSEHS; Joshua Potocko, MD; Kirk D. Jones, MD; Carolyn K. Reeb-Whitaker, MS; Nicholas K. Reul, MD; Claire R. LaSee, MPH, MSW; Barbara L. Materna, PhD; Ganesh Raghu, MD; Robert Harrison, MD


Morbidity and Mortality Weekly Report. 2019;68(38):813-818. 

In This Article

Abstract and Introduction


Silicosis is an incurable occupational lung disease caused by inhaling particles of respirable crystalline silica. These particles trigger inflammation and fibrosis in the lungs, leading to progressive, irreversible, and potentially disabling disease. Silica exposure is also associated with increased risk for lung infection (notably, tuberculosis), lung cancer, emphysema, autoimmune diseases, and kidney disease.[1] Because quartz, a type of crystalline silica, is commonly found in stone, workers who cut, polish, or grind stone materials can be exposed to silica dust. Recently, silicosis outbreaks have been reported in several countries among workers who cut and finish stone slabs for countertops, a process known as stone fabrication.[2–5] Most worked with engineered stone, a manufactured, quartz-based composite material that can contain >90% crystalline silica.[6] This report describes 18 cases of silicosis, including the first two fatalities reported in the United States, among workers in the stone fabrication industry in California, Colorado, Texas, and Washington. Several patients had severe progressive disease, and some had associated autoimmune diseases and latent tuberculosis infection. Cases were identified through independent investigations in each state and confirmed based on computed tomography (CT) scan of the chest or lung biopsy findings. Silica dust exposure reduction and effective regulatory enforcement, along with enhanced workplace medical and public health surveillance, are urgently needed to address the emerging public health threat of silicosis in the stone fabrication industry.