Workers employed in outdoor occupations such as farm; are exposed to hot and humid environments that put m at risk for heat-related illness or death. This report scribes one such death and summarizes heat-related alities among crop production workers in the United tes during 1992–2006. During this 15-year period, 423 rkers in agricultural and nonagricultural industries were orted to have died from exposure to environmental heat; (16%) of these workers were engaged in crop producn or support activities for crop production. The heatated average annual death rate for these crop workers 3 0.39 per 100,000 workers, compared with 0.02 for all 3. civilian workers. Data aggregated into 5-year periods icated that heat-related death rates among crop workers ght be increasing; however, trend analysis did not indie a statistically significant increase. Prevention of heatated deaths among crop workers requires educating ployers and workers on the hazards of working in hot 'ironments, including recognition of heat-related illness nptoms, and implementing appropriate heat stress

nagement measures.

nformation for the illustrative case described in this ort was collected by the Agricultural Safety and Health reau of the North Carolina Department of Labor. For nationwide analysis, fatality data were obtained from Bureau of Labor Statistics (BLS) Census of Fatal Occuional Injuries (CFOI) (1).* A heat-related death was ntified in CFOI as an exposure to environmental heat S Occupational Injury and Illness Classification Sys1 [OIICS] event/exposure code 321), with the nature of

r this report, CDC used a CFOI research file provided by BLS, which luded deaths in New York City. Because of confidentiality restrictions, individual e information from the CFOI data cannot be reported; information for the e described in this report was obtained solely from the North Carolina partment of Labor field investigation.

injury attributed to effects of heat and light (OIICS nature code 072). A crop worker death was indicated where the industry in which the decedent worked was crop production or support activities for crop production. Fatality rates were calculated as an average annualized rate per 100,000 workers during the 15-year study period for civilian noninstitutionalized workers aged ≥15 years. The numerator was the total of all fatalities during the 15-year period; the denominator was the total of the annual average worker population during the same period. Estimates of the number of workers employed were derived from the U.S. Current Population Survey (CPS) (2).§ To examine trends in fatality rates during the study period, data were aggregated in 5-year periods because the numbers of fatalities for several individual years in the study period were too low to

* Because of changes to the industry classification system in 2003, two comparable, though not identical, classification systems were used: the Standard Industrial Classification (major group 01 and 07, excluding industry group 078) for 1992-2002 and the North American Industry Classification System (NAICS) (industry codes 111 and 11511) for 2003-2006.

$CPS labor counts included workers in crop production industries (NAICS code 111) and support activities for agriculture and forestry (code 115). The latter industry category includes some workers who do not specifically support crop production activities. However, the inclusion of a small number of animal production and forestry support workers in the denominator value should have little influence on the crop worker fatality rate.

INSIDE

653 Influenza Vaccination Coverage Among Persons with Asthma United States, 2005-06 Influenza Season 657 Recommendations from an Ad Hoc Meeting of the WHO Measles and Rubella Laboratory Network (LabNet) on Use of Alternative Diagnostic Samples for Measles and Rubella Surveillance

660 False-Positive Oral Fluid Rapid HIV Tests - New York City, 2005-2008

666 QuickStats

William L. Roper, MD, MPH, Chapel Hill, NC, Chairman
Virginia A. Caine, MD, Indianapolis, IN
David W. Fleming, MD, Seattle, WA

William E. Halperin, MD, DrPH, MPH, Newark, NJ
Margaret A. Hamburg, MD, Washington, DC
King K. Holmes, MD, PhD, Seattle, WA
Deborah Holtzman, PhD, Atlanta, GA
John K. Iglehart, Bethesda, MD
Dennis G. Maki, MD, Madison, WI
Sue Mallonee, MPH, Oklahoma City, OK
Stanley A. Plotkin, MD, Doylestown, PA
Patricia Quinlisk, MD, MPH, Des Moines, IA
Patrick L. Remington, MD, MPH, Madison, WI
Barbara K. Rimer, DrPH, Chapel Hill, NC
John V. Rullan, MD, MPH, San Juan, PR
Anne Schuchat, MD, Atlanta, GA
Dixie E. Snider, MD, MPH, Atlanta, GA
John W. Ward, MD, Atlanta, GA

meet BLS publishing criteria. Poisson regression was use. to estimate confidence intervals for these aggregate rates

Case Report

In mid-July 2005, a male Hispanic worker with an H-2! work visa (i.e., a temporary, nonimmigrant foreign work: hired under contract to perform farm work) aged 56 year was hand-harvesting ripe tobacco leaves on a North Carolina farm. He had arrived from Mexico 4 days earlier an. was on his third day on the job. The man began work approximately 6:00 a.m. and took a short mid-morning break and a 90-minute lunch break. At approximately 2:45 p.m., the employer's son observed the man working slow and reportedly instructed him to rest, but the man contirued working. Shortly thereafter, the man's coworkers noticed that he appeared confused. Although the man was combative, his coworkers carried him to the shade and tried unsuccessfully to get him to drink water. At approximately 3:50 p.m., coworkers notified the employer of the mans condition. At 4:25 p.m., the man was taken by ambulance to an emergency department, where his core body temperature was recorded at 108°F (42°C) and, despite treatment, he died. The cause of death was heat stroke. On the day of the incident, the local high temperature was approximately 93°F (34°C) with 44% relative humidity and clear skies. The heat index was in the range of 86°-101°F (30°-38°C) at mid-morning and 97°-112°F (36°-44°C; at mid-afternoon. Similar conditions had occurred during the preceding 2 days.

The man had been given safety and health training o pesticides but nothing that addressed the hazards and prevention of heat-related stress. He reportedly only spoke Spanish. Fluids, such as water and soda, were always available to the workers in the field; however, whether the mar drank any of these fluids is unknown.

Heat-Related Fatalities, 1992-2006

During 1992-2006, a total of 423 worker deaths from exposure to environmental heat were reported in the United States, resulting in an average annual fatality rate of 0.02 deaths per 100,000 workers. Of these 423 deaths, 10 (24%) occurred in workers employed in the agricultureforestry, fishing, and hunting industries (rate: 0.16 per

The heat index, an indicator of the combined physiologic effect of air tempera and relative humidity, is presented in this report as a range, which is estimate by using the temperature and humidity to calculate the minimum value an then adding 15°F. This method better reflects exposure conditions in the fi under clear skies. Additional information available at http://www.nws.noaa.go om/heat/heat_wave.shtml.