Infectious diseases and Health and Safety in the South African mining industry

Safety is seen as a priority in the mining industry while the importance of workers’ health has not received such widespread attention. However infectious diseases have played an important role in mining since the days of the earliest occupational health records when the link between dust exposure and tuberculosis (TB) was postulated.     For over a century, researchers have been active in exploring occupational infectious diseases in the South African mining industry from sporotrichosis associated with wooden beam supports, to tuberculosis and, more recently, the effects of HIV on both health and safety. The National Institute for Occupational Health (NIOH) has played a pivotal role in determining the burden of occupational lung disease in the mining industry. As a result of unique compensation legislation, South Africa makes provision for the autopsy of deceased miners and former miners and there is now a database of over 100 000 autopsy records.     The NIOH pathology services have traced the epidemiology of TB infection since 1975; today, 25% of miners coming to autopsy have active tuberculosis. The highest global rates of tuberculosis occur in South African gold miners. Through collaborative research, NIOH has also traced the epidemiology of HIV through a cohort study of miners. The relationship of HIV to work-related injuries and fatalities and to the development of TB and other infectious diseases plus the inter-relationship of dust exposure and HIV will be presented.     In collaboration with the Mine Health and Safety Council the NIOH has developed programmes to improve clinical practice and these will be demonstrated.