Control and Prevention

Effective strategies for controlling and preventing worker exposure to Valley Fever depend on the risk of exposure and the work tasks performed. Appropriate precautions are critical to protect high-risk workers in endemic areas. There is no vaccine for Valley Fever, but employers can take steps to minimize the risk of acquiring an infection.

Recommendations for Employers

In regions where Coccidioides may be found, conduct a job hazard analysis (JHA) based on work-related operations to identify workers at risk of exposure to Valley Fever prior to instituting control measures. Employers should develop specific work instructions based on results of the hazard analysis including selection of appropriate engineering controls, administrative controls, safe work practices, and personal protective equipment (PPE). When performing construction activities in regions where Coccidioides may be found, the referenced JHA should be included in your site-specific safety and health program, mandated by 29 CFR 1926.20(b).

Other actions to protect workers in regions where Coccidioides may be found include:

• When possible, suspend outdoor work in windy conditions that disturb significant quantities of dust.
• Avoid excavation and dust-producing activities (e.g., driving, grading, plowing, drilling, blasting) or minimize soil disturbance when possible.
• Adopt engineering and work practice controls that reduce exposure to airborne dust:
  1. Use water or other material to stabilize soil.
  2. Use tarps to stabilize soil waste piles.
  3. Add landscaping and dust stabilizers to soil and pave frequently travelled areas.
  4. Ensure that work and heavy equipment vehicles have air-conditioned, enclosed cabs with HEPA filtration.
  5. Keep workers upwind of excavation and dust-producing activities.
  6. Wash equipment before moving it offsite.
  7. In indoor environments, keep windows and doors closed whenever possible. Clean and maintain air conditioning units and avoid dry sweeping of accumulated dust.
  8. Ensure that worker rest areas (e.g., bathrooms, breakrooms, sleeping quarters) are clean and free of dust.
  9. Lockers should be provided, and workers required to change clothing and shoes at the worksite before leaving for the day.
• Provide prompt medical evaluation and treatment for those with possible disease.
• Provide PPE as needed. Workers who are frequently exposed to airborne dust should wear respiratory protection. Activities that disturb soil and create airborne dust include:
  1. Digging (manually or using heavy equipment) for construction, roadwork, or agriculture,
  2. Driving,
  3. Moving vehicles and farm animals in dry conditions.

If it is determined that workers need respirators, use a NIOSH-Approved Particulate Filtering Facepiece Respirator that is rated N95 or higher. Respirators must be used as part of a comprehensive respiratory protection program that includes medical exams and fit testing, and meets the requirements of OSHA's Respiratory Protection standard (29 CFR 1910.134). If it is determined that workers do not need respirators, respirators may also be provided for voluntary use.

• Record and report Valley Fever infections or deaths. Under mandatory OSHA rules, all employers are required to notify OSHA when an employee suffers a work-related hospitalization, amputation, or loss of an eye or is killed on the job. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours. A fatality must be reported within 8 hours. More information is available on OSHA's website. Employers should also report outbreaks to local health departments as required by state laws.
• Educate workers on potential risks of exposure to Coccidioides spores. Provide information about how to recognize signs and symptoms of Valley Fever and how to prevent exposure.
• Implement protections from retaliation and set up an anonymous process for workers to voice concerns about Valley Fever-related hazards: Section 11(c) of the OSH Act prohibits discharging or in any other way retaliating against an employee for engaging in various occupational safety and health activities. Examples of violations of Section 11(c) could include retaliating against employees for raising a reasonable concern about infection control to the employer, the employer's agent, or a government agency; or for voluntarily providing and safely wearing their own appropriate PPE. In addition, employers should notify workers of their rights to a safe and healthful work environment in a language that they understand. Employers should also ensure that workers know who to contact with questions or concerns about workplace safety and health, and that there are prohibitions against retaliation for raising workplace safety and health concerns or engaging in other protected occupational safety and health activities.

Precautions for Workers

Valley Fever can be acquired when working outdoors in areas where the Coccidioides fungus is present. Any activity that involves digging, soil disruption, or generating dust in places where the Coccidioides fungus grows puts workers at risk of becoming infected. Workers can also be exposed when soil and dust is disrupted by seasonal and heavy winds that can carry Coccidioides spores through the air for extended periods.

1. Wear respiratory protection when required by your employer. A NIOSH-Approved Particulate Filtering Facepiece Respirator should be worn as part of a comprehensive respiratory protection program that includes medical exams, training, fit testing, and that meets the requirements of OSHA's Respiratory Protection standard (29 CFR 1910.134). If a worker is unable to wear a disposable particulate respirator because of facial hair or other fit limitations, wear respirators that do not require a face seal (e.g., positive pressure respirators of the hood and helmet type, or types that can be used with a continuous-flow, supplied-air respirator). Respirators may also be provided for voluntary use. See 2004 NIOSH Respirator Selection Logic for guidance on the protective capabilities of respirators. Participate in training offered by your employer on respiratory protection to prevent Valley Fever and other inhalation hazards in dusty environments.
2. Cover cuts and abrasions when working in endemic regions. Bandage any open sores or cuts and cover skin with clothing as comfort permits when working in dusty conditions.
3. Wash hands and exposed skin thoroughly with soap and water. Prevent transfer of and skin infection from Coccidioides spores by washing hands frequently and showering at the end of each shift (or as soon as possible).
4. Clean contaminated equipment and clothing. At the end of the workday or shift, wash or rinse vehicles and other equipment that have been exposed to blowing dust. Remove and bag clothing before entering your home to avoid transfer of Coccidioides spores to furniture and household surfaces and potential exposure to family members or pets.
5. Know your rights. Workers have the right to:
   • Work in conditions that do not pose a risk of serious harm.
   • Receive information and training (in a language and vocabulary the worker understands) about workplace hazards, methods to prevent them, and the OSHA standards that apply to their workplace.
   • Review records of work-related injuries and illnesses.
   • Confidentially file a complaint asking OSHA to inspect their workplace if they believe there is a serious hazard or that their employer is not following OSHA’s rules.
   • Exercise their rights under the law, including reporting an injury or raising health and safety concerns with their employer or OSHA, without facing retaliation. If a worker has been retaliated against for exercising their rights, they must file a complaint with OSHA within 30 days of the retaliation.