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Background The disasters at Seveso, Three Mile Island, Bhopal, Chernobyl, the World Trade Center (WTC) and Fukushima had historic health and economic sequelae for large populations of workers, responders and community members. Methods Comparative data from these events were collected to derive indications for future preparedness. Information from the primary sources and a literature review addressed: i) exposure assessment; ii) exposed populations; iii) health surveillance; iv) follow-up and research outputs; v) observed physical and mental health effects; vi) treatment and benefits; and vii) outreach activities. Results Exposure assessment was conducted in Seveso, Chernobyl and Fukushima, although none benefited from a timely or systematic strategy, yielding immediate and sequential measurements after the disaster. Identification of exposed subjects was overall underestimated. Health surveillance, treatment and follow-up research were implemented in Seveso, Chernobyl, Fukushima, and at the WTC, mostly focusing on the workers and responders, and to a lesser extent on residents. Exposure-related physical and mental health consequences were identified, indicating the need for a long-term health care of the affected populations. Fukushima has generated the largest scientific output so far, followed by the WTCHP and Chernobyl. Benefits programs and active outreach figured prominently in only the WTC Health Program. The analysis of these programs yielded the following lessons: 1) Know who was there; 2) Have public health input to the disaster response; 3) Collect health and needs data rapidly; 4) Take care of the affected; 5) Emergency preparedness; 6) Data driven, needs assessment, advocacy. Conclusions Given the long-lasting health consequences of natural and man-made disasters, health surveillance and treatment programs are critical for management of health conditions, and emergency preparedness plans are needed to prevent or minimize the impact of future threats.

Over 50 000 workers were exposed while responding to the World Trade Center (WTC) incident, attempting to rescue survivors and recover the dead, clearing the site, or cleaning the surrounding buildings.2 These workers were exposed to an incompletely characterised mix of asbestos, alkaline cement dust, pulverised building materials, and fire smoke for many days and weeks, often without proper protection.3 Hundreds of these people are disabled and can no longer work, and thousands have become ill and continue to receive medical treatment nearly 10 years after 9/11.4 Until now, documentation of illnesses in WTC rescue and recovery workers has been based on data collected during medical examinations or follow-up health interviews.4-6 The only study on cancer outcomes in these workers was a small case series of multiple myeloma (n=8).7 Case studies, although useful for alerting the health-care community about the potential for new or late emerging illnesses, are of little value for determining WTC-exposure-related health outcomes due to self-selection and case-ascertainment biases.

Aspergillus fumigatus (A. fumigatus), a fungus found in compost, is a respiratory allergen and can cause serious invasive disease in susceptible individuals. We conducted a study involving the collection of health symptom data and environmental monitoring data near a 40-acre grass and leaf composting facility. Analyses were based on symptom diary data from 63 individuals from the study area and 82 individuals from a reference area. Airborne A. fumigatus was not associated with increases in respiratory or irritative symptoms. Symptom incidence was associated with ragweed, ozone, temperature, and time since start of the study, although a tendency to report fewer symptoms as the study progressed may have confounded this result. Other features of the study design, including short-term spore count variability, lack of individual exposure data and gaps in the symptom diary data, complicated interpretation of the results. Although this study does not support an association between allergy and asthma symptom incidence and A. fumigatus spore levels, we could not assess the risk of unusual, but severe illnesses among very sensitive individuals.

Surveillance of occupational illness and injury is essential for targeting workplace prevention efforts. Surveillance systems should include mechanisms for standardized data collection, data analysis, and dissemination of results to \"all who need to know.\" In occupational health, surveillance systems are less developed than in communicable disease prevention. The disparity exists because occupational health surveillance is conceptually more complex and is limited by legal and social impediments. The National Institute for Occupational Safety and Health (NIOSH) has listed improvement in systems for occupational illness and injury surveillance as a top organizational priority. In this paper, we review current approaches to surveillance designed to identify cases of occupational illness or injury or to monitor secular trends. Gaps in the surveillance effort include the absence of a functional system for practitioner reporting of selected occupational disorders and a standard approach to collection of certain health data. NIOSH programs designed to address these limitations include a Sentinel Event Notification System for Occupational Risks (SENSOR) which links health care providers with state health departments for the purpose of reporting and follow-up of cases of occupational illness and injury. Other new programs are designed to improve the quality of existing data sources for use in surveillance and to develop new approaches to data collection.

A case-control interview study was used to evaluate the relationship between breast cancer risk and residential proximity to industrial facilities and traffic for pre- and postmenopausal women in Nassau and Suffolk Counties on Long Island, New York. A geographic information system was used to assign industry and traffic counts to 1-km 2 grid cells (5-km 2 grid cells for traffic) and to assign potential exposure values to study subjects, based on 20-y residential histories. A significantly elevated risk of breast cancer was observed among postmenopausal subjects who were ever potentially exposed to chemical facilities (Nassau County adjusted odds ratio [OR] = 1.61, 95% confidence interval [95% CI] = 1.06-2.43; Suffolk County adjusted OR = 1.58, 95% CI = 0.71-3.51. This elevated risk, however, was not observed among premenopausal subjects. Risk increased for postmenopausal subjects as number of chemical facilities increased from one (adjusted OR = 1.45, 95% CI = 0.93-2.25) to two or more (adjusted OR = 3.47, 95% CI = 1.06-11.38). Crude and adjusted ORs for high traffic density were elevated among Nassau-but not Suffolk-county subjects and were not significant statistically.

Application of the techniques of epidemiology and clinical toxicology has accelerated study of the reproductive effects of toxic chemical and physical exposures in the workplace. Three examples of work in progress are included in the present communication. The first concerns 1,2-dibromo-3-chloropropane, a known cause of male sterility, which continues to be used as a nematocide in Hawaii. Occupational exposures of Hawaiian agricultural workers to airborne 1,2-dibromo-3-chloropropane are mainly in the range of parts per billion. A prospective study of pineapple field workers has been undertaken to evaluate sperm counts and morphology before, during, and after 1,2-dibromo-3-chloropropane application. To date, no sperm count depression is evident at this level of exposure. The second example involves a cluster of seven spontaneous abortions in female office workers exposed to video display terminals. The cluster has been analyzed with the use of fetal life tables. Excess incidence was confirmed (p = 0.0045), but no etiology was determined. The findings may have been due to chance. The third example pertains to male chemical workers manufacturing diaminostilbene, an optical brightener, and the workers' reported sexual impotence. Impotence was confirmed in 7 of 29 workers by questionnaire and suggested for another 7. Serum testosterone analyses found depressed values (< 300 mg/ml) in 8 of 28 exposed workers. The luteinizing hormone and follicular stimulating hormone levels were generally normal.