**5.1 Non-pharmacologic strategies for prevention**

People with occupations or hobbies that involve outdoor activities associated with soil aerosolization and exposure to guano for birds or bats, agricultural and forestry workers, fishermen or hunters, and people employed in construction have a 5–10 times higher risk than from the general population [66].

To reduce the risk of illness in immunosuppressed patients living in areas endemic for histoplasmosis, the CDC recommends protective measures: avoid disturbing soil contaminated with chicken or bird guano or cleaning chicken coops, demolishing, remodeling, renovate or cleaning buildings, exploring caves, tunnels, or old archeological sites.

To minimize the risk of infection with *H. capsulatum* at the workplace, concrete measures are needed that can be identified by applying the control hierarchy framework used by health and safety at work specialists. Thus, the following measures are required:


The hierarchy of controls can also be used to prevent worker exposure to *H. capsulatum* in laboratory environments by: knowledge of the laboratory safety manual, training of laboratory personnel, medical supervision, through aseptic microbiological practices, handling of clinical and culture samples in a biosafety level (BSL)-3 laboratory and a laminar flow Biological Safety Cabinet (BSC) with wearing appropriate PPE, packing or taping closed culture plates, not performing slide cultures, and testing with molecular and proteomic approaches.

Including systematic collection of occupational information as part of histoplasmosis surveillance could facilitate the identification of future workplace-associated outbreaks and the identification of specific risk factors that require further evaluation [66].
