Electronic Case Reports Find Hidden Silicosis Cases in California, 2022–2023

Summary

Silicosis is a progressive, incurable scarring of the lungs caused by breathing respirable crystalline silica dust — from construction, quarrying, coal mining and, increasingly, cutting engineered stone (quartz) countertops. A resurgence among young countertop fabricators in California, and in Australia, Israel and Spain, has made finding cases quickly more urgent.

In December 2022 the California Department of Public Health (CDPH) began using electronic case reporting to find silicosis. The early results, reported in CDC's MMWR in 2023: 32 of 41 people reported this way had not been identified by any other route.

How electronic case reporting works

• eCR has electronic health records generate and send a disease report automatically, in real time, to the public health agency, using set criteria. All 50 states and other jurisdictions are connected.
• A health care organization's system sends an initial case report when a trigger is met — a diagnosis code or lab result. In California, every encounter involving COVID-19 or mpox triggers one.
• The Reportable Conditions Knowledge Management System (RCKMS) checks each report against each jurisdiction's rules, based on Council of State and Territorial Epidemiologists position statements, and forwards the matches.
• CDPH added a silicosis rule: any initial case report with silicosis on the patient's problem list goes to its silicosis surveillance.

What it found

From October 2022 to July 2023, CDPH received reports naming silicosis for 41 people. Staff reviewed medical records to confirm cases, gather work and exposure histories, and start follow-up.

Among the 35 confirmed or probable cases, the median age was 65 (range 33–89), and 32 (91%) were men.

Engineered-stone workers. At least 7 of the 19 confirmed cases were linked to fabricating engineered-stone countertops (two confirmed cases had no work or exposure information). These seven were much younger — median age 44 (range 33–51) — and all were Hispanic or Latino. One died; two had double lung transplants; one was evaluated for a transplant.

What it means

• Most reports so far piggyback on COVID-19. They came from COVID-19 case reports that happened to list silicosis. At one organization whose triggers go beyond COVID-19 and mpox, silicosis itself triggered reports for six more people. As more organizations add silicosis triggers, far more cases are expected.
• eCR is useful: 78% of these people would otherwise have gone unrecorded.
• Ask about work. Clinicians should routinely ask patients about their jobs and know the risks, regulations, medical monitoring and prevention for work exposures.
• Other jurisdictions can add silicosis rules to RCKMS, and eCR can be set up for other conditions.
• Further follow-up is needed to see whether earlier reporting improves outcomes and prevention.

Case definition (confirmed): a history of occupational exposure to airborne silica dust, plus a chest image consistent with silicosis, pathology findings characteristic of it, or both.

Sources

Based on Jennifer Flattery et al., "Notes from the Field: Surveillance of Silicosis Using Electronic Case Reporting — California, December 2022–July 2023," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention (2023), by authors from the California Department of Public Health, the Public Health Institute and CDC's National Institute for Occupational Safety and Health; published by CDC. The title's period starts in December 2022, when the reporting rule was added; the reports counted start in October 2022, as the text gives.