SHIB 08-29-2003 (B);
This Safety and Health Information Bulletin is not a standard or regulation, and it creates no new legal obligations. The Bulletin is advisory in nature, informational in content, and is intended to assist employers in providing a safe and healthful workplace. Pursuant to the Occupational Safety and Health Act, employers must comply with hazard-specific safety and health standards and regulations promulgated by OSHA or by a state with an OSHA-approved state plan. In addition, pursuant to Section 5(a)(1), the General Duty Clause of the Act, employers must provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm.
OSHA has developed this safety and health bulletin on Workplace Precautions against West Nile Virus to provide relevant information regarding this illness to employers, workers, and other interested parties.
West Nile Virus (WNV) infection is a potentially serious illness transmitted to humans primarily by mosquitoes. WNV is known to infect birds and other animals as well as humans. While it is not known exactly how long this virus has been in the United States, the Centers for Disease Control and Prevention (CDC) has documented over 30,000 human cases of the infection in the U.S. since 1999. It is considered a seasonal epidemic that flares up in the summer and continues into the fall. Up-to-date information on the number of cases and fatalities due to WNV infection can be obtained on the CDC's WNV web page.
CDC reports that in four out of five cases, persons infected with WNV show no symptoms. In almost 20% of the cases, infections result in very mild flu-like symptoms, called West Nile fever. These mild cases of West Nile fever normally last only a few days and are not believed to cause any long-term effects. According to the CDC, severe cases occur in one out of 150 people infected with WNV and result in "West Nile encephalitis," an inflammation of the brain, "West Nile meningitis," inflammation of the membrane around the brain, or "West Nile meningoencephalitis," an inflammation of the brain and the membrane around it. The signs and symptoms of severe disease may last several weeks and may have permanent neurological effects.
The typical time from infection to the onset of signs and symptoms is 3 to 14 days. Signs and symptoms of the milder West Nile Fever illness can last a few days to several weeks and include:
The CDC reports that with more severe infection (West Nile encephalitis or meningitis), the signs and symptoms lasts several weeks, sometimes resulting in permanent neurological problems, and include:
There is no specific treatment for WNV infection. In mild cases the symptoms resolve on their own. In more severe cases, people usually need to go to the hospital where they can receive supportive treatment including intravenous fluids, help with breathing and nursing care. Pregnant women and nursing mothers should discuss with their doctor if there are concerns or if they develop symptoms that could be WNV.
Although the infection has been documented in laboratory workers working with the virus itself, most documented human cases in the U.S. have resulted from mosquito bites. The risk of getting infected with WNV can often be reduced or eliminated with use of preventive measures that minimize or eliminate mosquito bites. To lessen the chances of mosquito bites:
These and other methods of reducing risk of WNV-infection are discussed in the sections that follow.
In general, WNV is transmitted to humans via mosquito bites, therefore workers primarily working outside are at risk, particularly in warmer weather (when mosquitoes are more likely to be present). In regions of the U.S. with warm climates, workers are at risk for a longer period. At risk occupations include farm workers, loggers, landscapers/groundskeepers, construction workers, painters, summer camp workers, pavers, and other outdoor workers.
In at least two cases, laboratory workers handling WNV-infected fluids or tissues have become infected; therefore, these workers should also take precautions against WNV infection. An exposure may occur due to a needlestick, an accidental cut, or an existing open wound that comes in contact with infectious fluid or tissues. Laboratory workers who work with WNV- infected animals or who handle other tissue, fluid or other WNV-infected material should report to their supervisors if they believe they may have had an exposure that could result in infection. Laboratory workers handling human blood or other potentially infectious material require protection as described in OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030.
As of August 28, 2012, OSHA is not aware of any documented cases of healthcare workers who have become infected following treatment of patients with WNV infection. Nevertheless, healthcare workers and emergency response personnel must continue to use universal precautions to protect against exposure to human blood and other potentially infectious materials (OPIM) as required by OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030.
As with all workplace hazards, employers should use the following hierarchy of control- measures to minimize or eliminate WNV infections among their workers:
Employers with outdoor workers:
Employers should provide training to workers who may be at risk. Training should cover the potential hazards and the risks of WNV exposure and infection. Knowing key steps that workers themselves can take to minimize the risk of getting bitten by mosquitoes can help to reduce the risk of WNV infection. Workers who work outdoors in warm climates should be made aware of the appropriate personal protective equipment and work practices that protect against mosquito bites. Workers should also be made aware that mosquitoes are more likely to swarm during late evening and early morning hours and extra precautions should be followed at these times. Workers should also be encouraged to report dead birds and should be instructed not to pick up dead birds with bare hands.
Employers with outdoor workers:
In warm weather, encourage workers who work outdoors to wear light-weight, loose clothing. This type of clothing protects workers against the sun's harmful rays, and also provides a barrier to mosquitoes. Employers may also want to have insect repellents available for workers to protect against mosquitoes.
In laboratories and healthcare settings employers must provide gloves. As some workers may have allergies to latex gloves, employers should also make available non-latex gloves as an alternative. In workplaces where animal studies are performed on WNV-infected animals, employers must provide gloves that will prevent cutting injuries (e.g. stainless steel mesh gloves). Under 29 CFR 1910.132 , employers must evaluate the work environment and, where there is a potential for skin or mucous membrane contact with blood and or other tissues, also provide additional personal protective equipment (PPE) to affected workers (e.g., safety glasses, and/or face shields, where appropriate, and gowns). OSHA's bloodborne pathogen standard has provisions requiring the use of PPE when working with human blood.
Employers should keep in mind that eliminating mosquito breeding grounds is a highly effective way of reducing mosquito populations and the number of mosquito bites. Mosquitoes lay eggs in standing water. Take the following steps to eliminate standing water in the workplace:
It may not always be possible to eliminate all potential mosquito breeding grounds. For example, workers in logging operations may not be able to determine all areas of water accumulation in their work environment. Knowledge of some key steps that workers can take to minimize the risk of mosquito bites is, therefore, important in reducing the risk of WNV infection. Workers who work outdoors should be aware that the use of personal protective equipment and techniques is essential to preventing mosquito bites. Especially when working at sites where mosquitoes may be active and biting, workers should use the following steps to minimize the likelihood of getting bitten:
Note: Additional resources are provided below for information on the safe use of insect repellent.
The U.S. Environmental Protection Agency (EPA) provides information on how to safely use insect repellents. Information is located on-line in the U.S. EPA: How to Use Insect Repellents Safely page.
Additional information on the safe use of insect repellents can be obtained from a question and answer document posted on the Centers for Disease Control's (CDC) Website. The document is titled FAQ: Insect Repellent Use & Safety.
The National Pesticide Information Center (NPIC) provides useful contact information for persons with further questions on the use of insect repellents for mosquito control.
Healthcare workers, emergency personnel and laboratory workers who may be in contact with human blood or OPIM must follow OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030). These workers who are not exposed to human blood or OPIM, but may be exposed to WNV should follow the recommendations below:
Several public health agencies have published information on the prevention of WNV infection. Information published by the Centers for Disease Control and Prevention can be obtained at the CDC WNV Home Page.
Contacts for state and local health departments are listed.
The National Institute for Occupational Safety and Health offers information for employers and workers at West Nile Virus.
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