The potential risk for the introduction and establishment of Japanese encephalitis virus (JEV) within California is described based on the literature. JEV is a mosquito-borne arbovirus endemic to Asia that when transmitted to humans can lead to Japanese encephalitis (JE), a disease affecting mostly children with a fatality rate up to 30%. The geographical expansion of JEV in Asia along with the recent introduction and rapid spread of West Nile virus (WNV) across the United States, demonstrates the ability of arboviruses to rapidly extend their distributions. California is at particular risk for the introduction of JEV because it is a large state functioning as a hub for international travel and commerce with Asia, potentially allowing the introduction of mosquitoes infected with JEV. If JEV is introduced into California, the virus might become established due to the significant number of susceptible mosquito vectors and vertebrate hosts. Once introduced, the lack of active surveillance for JEV, the ambiguous clinical presentation of JE, the cross reactivity of serological testing between JEV and other flaviviruses, and the probability that clinicians and laboratories would not consider JE as a possible diagnosis would likely delay recognition. A significant delay in detection of JEV in California would make control and eradication of the virus very difficult and costly. Public health authorities should consider the need for future control efforts if JEV emerges in the United States.

Nine cases of idiopathic pulmonary fibrosis were identified among dental personnel treated at a tertiary care center in Virginia during 2000–2015.

Purpose of review: To examine respiratory and skin diseases that occur among workers exposed to metalworking fluids (MWFs) used during machining processes. Recent findings: Five cases of a severe and previously unrecognized lung disease characterized by B-cell bronchiolitis and alveolar ductitis with emphysema (BADE) were identified among workers at a machining facility that used MWFs, although MWF exposure could not be confirmed as the etiology. In the United Kingdom, MWF is now the predominant cause of occupational hypersensitivity pneumonitis (HP). Under continuous conditions associated with respiratory disease outbreaks, over a working lifetime of 45 years, workers exposed to MWF at 0.1 mg/m³ are estimated to have a 45.3% risk of acquiring HP or occupational asthma under outbreak conditions and a 3.0% risk assuming outbreak conditions exist in 5% of MWF environments. In addition to respiratory outcomes, skin diseases such as allergic and irritant contact dermatitis persist as frequent causes of occupational disease following MWF exposure. Summary: Healthcare providers need to consider MWF exposure as a potential cause for work-related respiratory and skin diseases. Additional work is necessary to more definitively characterize any potential association between MWF exposures and BADE. Medical surveillance should be implemented for workers regularly exposed to MWF.