Reply to Accelerated Silicosis-An Emerging Epidemic Associated with Engineered Stone. Comment on Leso, V. et al. Artificial Stone-Associated Silicosis: A Systematic Review. Int. J. Environ. Res. Public Health 2019, 16(4), 568, doi:10.3390/ijerph16040568.

Our systematic review on artificial stone (AS)-associated silicosis and the related comment by Edwards underline the urgency to define effective strategies to assess and manage the risk of exposure to silica in workers involved in AS job tasks. Case screening programs may be important to fully understand the extent of the silicosis epidemic associated with AS and point out critical issues in workplace settings/practices that, by contributing to higher respirable crystalline exposure, favor the disease manifestation. This information may guide the identification of the most appropriate preventive measures in workplaces, especially regarding the administration of updated training and information courses, the definition of good working practices, and the application of targeted health surveillance programs. However, considering the recent epidemiological data and the severity of AS-associated silicosis, it would be appropriate (according to the hierarchy of control strategy) to also consider the application of more stringent prevention measures, such as a safety-by-design approach to the chemical formulation of the AS. Overall, the implementation of the aforementioned preventive measures should ensure an effective control of the current silicosis epidemic and, at the same time, prevent the development of new disease cases in the near future.