Poisoning Deaths in a Workshop for Ceremonial Papermaking - China, May 2025

On May 14, 2025, a county-level Chinese Center for Disease Control and Prevention (China CDC) in southwestern China received a report of the sudden death of four employees of a small workshop for ceremonial papermaking, which was operating without required safety and environmental approvals. The first person who died was a woman who lost consciousness while cleaning a wastewater tank. During the next 20 minutes, three of the woman's family members, also employees, entered the tank to attempt to rescue her. All four persons, including the workshop operator's wife, the workshop operator's son, the workshop operator, and the workshop operator's daughter, died. The county China CDC launched an immediate investigation, and the Intermediate Chinese Field Epidemiology Training Program and provincial and city China CDC staff members conducted a joint, on-site investigation that included identification of cases, analysis of the gas composition, and interviews of residents of the town and physicians to identify the cause of the apparent toxic exposure. Analyses revealed that levels of the highly toxic gases hydrogen sulfide, hydrogen fluoride, and phosphine were several times higher than the maximum allowable concentrations. Clinical signs among the decedents were consistent with poisoning by these gases. Lack of personal protective equipment in a confined space and the presence of toxic gases likely led to the multiple exposures and delayed response by rescue services. Although working in confined spaces with toxic gases is a known exposure risk, these exposures continue to be reported in China and have included deaths in the papermaking industry. These deaths highlight the importance of effective regulations for papermaking workshops and administrative controls, improved supervision, and education for workers.