摘要：Employment, social, and economic factors have the potential to affect the magnitude of an influenza pandemic among farmworkers. Prevention efforts targeted toward livestock farmworkers, including increased access to seasonal influenza vaccine, risk reduction training, various forms of personal protection, and workplace sanitation, are needed. Crop and livestock farmworkers are at increased risk of exposure to influenza A viruses because of limited resources, substandard housing, immigration status, communication and cultural barriers, and discrimination. Recommendations were gathered from migrant clinicians, farmworker advocates, state and federal government agencies, industry stakeholders, and researchers to overcome these barriers, including surveillance of livestock farmworkers, inclusion of farmworker service organizations in planning efforts, and separation of immigration enforcement from emergency assistance. FARMWORKERS WHO WORK with livestock such as swine and poultry are potentially at risk for exposure to influenza A viruses that originate in birds, pigs, or other species; are novel to humans; and may pose a pandemic threat. 1 – 3 Whether working with livestock or crops, farmworkers may also be more vulnerable than the general population to human influenza pandemics as a result of living conditions, suboptimal access to health services, and potential communication barriers resulting from language and culture. 4 In 1990, the National Institute for Occupational Safety and Health (NIOSH) implemented a safety and health research agenda dedicated to agricultural workers. Recognizing that hired farmworkers have unique characteristics and exposures that might pose different risks than those faced by farm owners, NIOSH convened a work group of advocates, policy experts, farmworker health experts, government partners, and researchers to identify priorities for surveillance of and research involving hired farmworkers. 5 Although this agenda influenced the direction of research, not anticipated were needs related to emergency preparedness and pandemic influenza. Recognizing this gap, NIOSH, through a pair of efforts (one in 2007 and one in 2008), solicited input from a variety of stakeholders to identify issues and generate recommendations regarding pandemic influenza preparedness for farmworkers. In 2007, with input from industry, labor union, and public health stakeholders, NIOSH identified gaps and made recommendations to protect poultry workers, including farmworkers, from avian influenza. 6 In another effort in May 2008, NIOSH and Farmworker Justice, a not-for-profit advocacy and educational organization concerned about farmworker pandemic influenza preparedness, 7 gathered input on farmworkers from the Farmworker Health Committee at the National Farmworker Health Conference in San Juan, Puerto Rico, with e-mail follow-ups to committee members. The committee's 44 members included representatives of migrant health clinics and farmworker service organizations from 18 states and Puerto Rico. In addition, input was solicited from the planning committee for the Western Migrant Stream Forum organized by the Northwest Regional Primary Care Association; that committee consisted of national and regional farmworker advocates, clinicians, clinic administrators, and researchers. Members of the Farmworker Health Committee as well as the Western Migrant Stream Forum organizing committee offered input for the initial recommendations and then were provided with subsequent drafts for further comment. In this article, we summarize farmworkers' potential risk for exposure to animal influenza viruses with pandemic potential, the factors associated with a possible elevated impact of a human influenza pandemic among farmworkers (see the box on the next page), innovative approaches to reducing the burden of pandemic influenza among farmworkers, and recommendations to reduce the impact of a pandemic on farmworkers. The box on page S310 presents a summary of recommendations on avian influenza preparedness from the NIOSH report Protecting Poultry Workers from Avian Influenza. 6 The box on page S311 offers a summary of recommendations on pandemic influenza preparedness gathered in May 2008 from National Farmworker Health Conference participants and Western Migrant Stream Forum organizers. These recommendations are described in the final section of the article. Socioeconomic Factors Potentially Associated With Elevated Risk of a Human Influenza Pandemic Among Farmworkers Factors Affecting Exposure Language barriers/low literacy Fear of job loss Inability to prepare owing to lack of resources Crowded housing Lack of transportation/need for public transportation Limited access to television, radio, telephones, and the Internet Temporary employment, potential unfamiliarity with surroundings Factors Affecting Timeliness and Adequacy of Treatment Lack access to care (insurance status, lack of transportation, migratory practices) Cultural barriers Fear of authorities Discrimination and profiling Stakeholder Recommendations on Preparedness for Avian Influenza Outbreaks Among Farmworkers Occupational Factors That Affect Exposure Livestock and poultry farmworkers are exposed to respiratory secretions, blood, intestines, or droppings of livestock and poultry in which influenza outbreaks may occur. The extent to which personal protective equipment is available and used correctly is unknown. Stakeholder Recommendations Federal, state, and local public and animal health and agriculture authorities should collaborate with farm employers, farmworker health and social service organizations, agricultural extension agencies, and farmworker advocacy groups to protect poultry and other livestock workers from infection and disease in the event that influenza outbreaks occur in domestic animal populations. These protective measures include the following: Seasonal influenza vaccine (and linguistically/culturally appropriate educational materials on the vaccine) Training on reduction of the risk of infection from animal influenza viruses Sufficient personal protective equipment and training on its correct use (respirators, goggles, gloves, aprons) Sanitary facilities, including hand-washing facilities Surveillance and early detection of disease in workers as well as animals, including consideration of incorporating financial protections to encourage early reporting Stakeholder Recommendations on Pandemic Influenza Preparedness Among Farmworkers State and local authorities, in collaboration with farm owners and agricultural extension agents, should include farmworker service organizations such as migrant clinics, unions, and other sources trusted by farmworkers in planning for a pandemic influenza event. Such planning should include the following: Emergency warnings and public health messages disseminated via multiple media and taking culture, educational level, and language (Spanish and indigenous languages) into consideration Provision of food and supplies during emergencies Two-way information network (radio, telephone, or trusted messengers) to reach farmworkers in remote rural areas and camps Transportation during medical emergencies Alternative housing for those living in communal arrangements to prevent spread of infection Differentiation of public health and emergency response activities from those of immigration enforcement to promote cooperation of the farmworker community
