Pulmonary function and airway inflammation among dairy parlor workers after exposure to inhalable aerosols

An algorithm for quantitatively estimating occupational endotoxin exposure in the Biomarkers of Exposure and Effect in Agriculture (BEEA) study: I. Development of task-specific exposure levels from published data

BACKGROUND/OBJECTIVE

Farmers conduct numerous tasks with potential for endotoxin exposure. As a first step to characterize endotoxin exposure for farmers in the Biomarkers of Exposure and Effect in Agriculture (BEEA) Study, we used published data to estimate task-specific endotoxin concentrations.

METHODS

We extracted published data on task-specific, personal, inhalable endotoxin concentrations for agricultural tasks queried in the study questionnaire. The data, usually abstracted as summary measures, were evaluated using meta-regression models that weighted each geometric mean (GM, natural-log transformed) by the inverse of its within-study variance to obtain task-specific predicted GMs.

RESULTS

We extracted 90 endotoxin summary statistics from 26 studies for 9 animal-related tasks, 30 summary statistics from 6 studies for 3 crop-related tasks, and 10 summary statistics from 5 studies for 4 stored grain-related tasks. Work in poultry and swine confinement facilities, grinding feed, veterinarian services, and cleaning grain bins had predicted GMs > 1000 EU/m3 . In contrast, harvesting or hauling grain and other crop-related tasks had predicted GMs below 100 EU/m3 .

SIGNIFICANCE

These task-specific endotoxin GMs demonstrated exposure variability across common agricultural tasks. These estimates will be used in conjunction with questionnaire responses on task duration to quantitatively estimate endotoxin exposure for study participants, described in a companion paper.

Lessons from Dairy Farmers for Occupational Allergy and Respiratory Disease

PURPOSE OF REVIEW

Exposure to bioaerosols at dairies has long been associated with allergy, respiratory disease, and decreases in lung function. Recent advancements in exposure assessments have aided our understanding on the size distribution and composition of these bioaerosols, but investigations focusing solely on exposures may overlook important intrinsic factors impacting worker's susceptibility to disease.

RECENT FINDINGS

In our review, we discuss the most recent studies examining the exposures and genetic factors that contribute to occupational disease in dairy work. We also review more recent concerns in livestock work associated with zoonotic pathogens, antimicrobial resistant genes, and the role of the human microbiome. The studies highlighted in this review demonstrate the need for further research to better understand bioaerosol exposure-response relationships in the context of extrinsic and intrinsic factors, antibiotic-resistant genes, viral pathogens, and the human microbiome to help inform effective interventions that improve respiratory health among dairy farmers.

Differences in gut metagenomes between dairy workers and community controls: a cross-sectional study

Background

As a nexus of routine antibiotic use and zoonotic pathogen presence, the livestock farming environment is a potential hotspot for the emergence of zoonotic diseases and antibiotic resistant bacteria. Livestock can further facilitate disease transmission by serving as intermediary hosts for pathogens as they undergo evolution prior to a spillover event. In light of this, we are interested in characterizing the microbiome and resistome of dairy workers, whose exposure to the livestock farming environment places them at risk for facilitating community transmission of antibiotic resistant genes and emerging zoonotic diseases.

Results

Using shotgun sequencing, we investigated differences in the taxonomy, diversity and gene presence of the human gut microbiome of 10 dairy farm workers and 6 community controls, supplementing these samples with additional publicly available gut metagenomes. We observed greater abundance of tetracycline resistance genes and prevalence of cephamycin resistance genes in dairy workers' metagenomes, and lower average gene diversity. We also found evidence of commensal organism association with plasmid-mediated tetracycline resistance genes in both dairy workers and community controls (including Faecalibacterium prausnitzii, Ligilactobacillus animalis, and Simiaoa sunii). However, we did not find significant differences in the prevalence of resistance genes or virulence factors overall, nor differences in the taxonomic composition of dairy worker and community control metagenomes.

Conclusions

This study presents the first metagenomics analysis of United States dairy workers, providing insights into potential risks of exposure to antibiotics and pathogens in animal farming environments. Previous metagenomic studies of livestock workers in China and Europe have reported increased abundance and carriage of antibiotic resistance genes in livestock workers. While our investigation found no strong evidence for differences in the abundance or carriage of antibiotic resistance genes and virulence factors between dairy worker and community control gut metagenomes, we did observe patterns in the abundance of tetracycline resistance genes and the prevalence of cephamycin resistance genes that is consistent with previous work.

Respiratory Findings in Herd Dairy Farmworkers from the Nile Delta Region

BACKGROUND

Dairy farmworkers are exposed to a variety of respiratory hazards, including organic and inorganic dust, allergens, disinfectants, and gases emitted by cows and their wastes resulting in a range of adverse health effects. In Egypt, large herd dairy farms (>1000 cattle) are growing in both size and number and thereby more workers are employed. However, there is a lack of studies on the respiratory health status of these workers. Accordingly, the present study aimed to determine the prevalence of respiratory problems, assess ventilatory functions, and highlight the predictors of abnormal spirometry patterns among Egyptian dairy farmworkers.

METHODS

A cross-sectional study was carried out on 282 male workers, of whom 141 were dairy farmworkers and the other 141, not involved in livestock handling, were enrolled as controls. Full history, clinical examination, and ventilatory function measurements were done for both groups.

RESULTS

Dairy farmworkers had a significantly higher prevalence of respiratory symptoms (throat irritation and/or sore throat, cough, sputum production, and difficulty breathing) than controls as well as bronchitis, wheezes on chest auscultation, and obstructive ventilatory patterns. Older age (>37 years), longer smoking duration (>10 years), and longer working duration (>4 years) were independent predictors of abnormal spirometry patterns, particularly obstructive patterns, in dairy farmworkers.

CONCLUSIONS

Large herd dairy farms, despite being open and naturally ventilated, are hazardous to workers' respiratory health. Hence, the provision of personal protective equipment, periodic spirometry examinations as well as mandatory breaks and days off, are highly urged.

Preliminary investigation of a hypertonic saline nasal rinse as a hygienic intervention in dairy workers

Livestock workers experience an increased burden of bioaerosol-induced respiratory disease including a high prevalence of rhinosinusitis. Dairy operations generate bioaerosols spanning the inhalable size fraction (0-100 μm) containing bacterial constituents such as endotoxin. Particles with an aerodynamic diameter between 10 and 100 μm are known to deposit in the nasopharyngeal region and likely affect the upper respiratory tract. We evaluated the effectiveness of a hypertonic saline nasal lavage in reducing inflammatory responses in dairy workers from a high-volume dairy operation. Inhalable personal breathing zone samples and pre-/post-shift nasal lavage samples from each participant over five consecutive days were collected. The treatment group (n = 5) received hypertonic saline while the control group (n = 5) received normotonic saline. Personal breathing zone samples were analyzed for particulate concentrations and endotoxin using gravimetric and enzymatic methods, respectively. Pro- and anti-inflammatory cytokines (i.e., IL-8, IL-10, and TNF-α) were measured from nasal lavage samples using a multiplex assay. Inhalable dust concentrations ranged from 0.15 to 1.9 mg/m3. Concentrations of both pro- and anti-inflammatory cytokines, specifically IL-6, IL-8, and IL-10, were significantly higher in the treatment group compared to the control group (p < 0.02, p < 0.04, and p < 0.01, respectively). Further analysis of IL-10 anti-inflammatory indicates a positive association between hypertonic saline administration and IL-10 production. This pilot study demonstrates that hypertonic saline nasal lavages were successful in upregulating anti-inflammatory cytokines to support larger interventional studies.

A Narrative Review of Occupational Air Pollution and Respiratory Health in Farmworkers

The agricultural crop sector in the United States depends on migrant, seasonal, and immigrant farmworkers. As an ethnic minority group in the U.S. with little access to health care and a high level of poverty, farmworkers face a combination of adverse living and workplace conditions, such as exposure to high levels of air pollution, that can place them at a higher risk for adverse health outcomes including respiratory infections. This narrative review summarizes peer-reviewed original epidemiology research articles (2000-2020) focused on respirable dust exposures in the workplace and respiratory illnesses among farmworkers. We found studies (n = 12) that assessed both air pollution and respiratory illnesses in farmworkers. Results showed that various air pollutants and respiratory illnesses have been assessed using appropriate methods (e.g., personal filter samplers and spirometry) and a consistent pattern of increased respiratory illness in relation to agricultural dust exposure. There were several gaps in the literature; most notably, no study coupled occupational air exposure and respiratory infection among migrant, seasonal and immigrant farmworkers in the United States. This review provides an important update to the literature regarding recent epidemiological findings on the links between occupational air pollution exposures and respiratory health among vulnerable farmworker populations.

Respiratory diseases and allergy in farmers working with livestock: a EAACI position paper

Farmers constitute a large professional group worldwide. In developed countries farms tend to become larger, with a concentration of farm operations. Animal farming has been associated with negative respiratory effects such as work-related asthma and rhinitis. However, being born and raised or working on a farm reduces the risk of atopic asthma and rhinitis later in life. A risk of chronic bronchitis and bronchial obstruction/COPD has been reported in confinement buildings and livestock farmers. This position paper reviews the literature linking exposure information to intensive animal farming and the risk of work-related respiratory diseases and focuses on prevention. Animal farming is associated with exposure to organic dust containing allergens and microbial matter including alive microorganisms and viruses, endotoxins and other factors like irritant gases such as ammonia and disinfectants. These exposures have been identified as specific agents/risk factors of asthma, rhinitis, chronic bronchitis, COPD and reduced FEV₁. Published studies on dust and endotoxin exposure in livestock farmers do not show a downward trend in exposure over the last 30 years, suggesting that the workforce in these industries is still overexposed and at risk of developing respiratory disease. In cases of occupational asthma and rhinitis, avoidance of further exposure to causal agents is recommended, but it may not be obtainable in agriculture, mainly due to socio-economic considerations. Hence, there is an urgent need for focus on farming exposure in order to protect farmers and others at work in these and related industries from developing respiratory diseases and allergy.

Household airborne endotoxin associated with asthma and allergy in elementary school-age children: a case-control study in Kaohsiung, Taiwan

To evaluate the association between the presence of asthma and allergy, and airborne endotoxin in homes of school-age children in Kaohsiung City, Taiwan, with a case-control study design by matching the age and class exposure. Data collection of home visits included an interviewer-administered questionnaire and air sampling of participants' homes for endotoxin, bacteria, and fungi, as well as temperature and relative humidity measurements. Endotoxin was detected in all air samples with a median value of 0.67 EU m^-3. In the adjusted logistic regression model, household airborne endotoxin was associated with higher prevalence of asthma and allergy; OR = 4.88 (95% CI 1.16-20.55) for Q3 (between 0.67 and 1.97 EU m ^-3) vs. Q1 (< 0.31 EU m ^-3), with statistical significance. Airborne fungi were associated with higher prevalence of asthma and allergy; OR = 4.47 (95% CI 1.13-17.69) for Q3 (between 314 and 699 CFU m ^-3) vs. Q1 (< 159 CFU m ^-3) in adjusted logistic regression models. Airborne endotoxin and fungi were significantly associated with children's asthma and allergy.

Personal exposure of dairy workers to dust, endotoxin, muramic acid, ergosterol, and ammonia on large-scale dairies in the high plains Western United States

Dairy workers experience a high degree of bioaerosol exposure, composed of an array of biological and chemical constituents, which have been tied to adverse health effects. A better understanding of the variation in the magnitude and composition of exposures by task is needed to inform worker protection strategies. To characterize the levels and types of exposures, 115 dairy workers grouped into three task categories on nine farms in the high plains Western United States underwent personal monitoring for inhalable dust, endotoxin, 3-hydroxy fatty acids (3-OHFA), muramic acid, ergosterol, and ammonia through one work shift. Eighty-nine percent of dairy workers were exposed to endotoxin at concentrations exceeding the recommended exposure guidelines (adjusted for a long work shift). The proportion of workers with exposures exceeding recommended guidelines was lower for inhalable dust (12%), and ammonia (1%). Ergosterol exposures were only measurable on 28% of samples, primarily among medical workers and feed handlers. Milking parlor workers were exposed to significantly higher inhalable dust, endotoxin, 3-OHFA, ammonia, and muramic acid concentrations compared to workers performing other tasks. Development of large modern dairies has successfully made progress in reducing worker exposures and lung disease prevalence. However, exposure to endotoxin, dust, and ammonia continues to present a significant risk to worker health on North American dairies, especially for workers in milking parlors. This study was among the first to concurrently evaluate occupational exposure to assayable endotoxin (lipid A), 3-hydroxy fatty acids or 3-OHFA (a chemical measure of cell bound and noncell-bound endotoxins), muramic acid, ergosterol, and ammonia among workers on Western U.S. dairies. There remains a need for cost-effective, culturally acceptable intervention strategies integrated in OHS Risk Management and production systems to further optimize worker health and farm productivity.

Size, Composition, and Source Profiles of Inhalable Bioaerosols from Colorado Dairies

Particulate matter emissions from agricultural livestock operations contain both chemical and biological constituents that represent a potential human health hazard. The size and composition of these dusts, however, have not been well described. We evaluated the full size distribution (from 0 to 100 μm in aerodynamic diameter) and chemical/biological composition of inhalable dusts inside several Colorado dairy parlors. Four aerodynamic size fractions (<3, 3-10, 10-30, and >30 μm) were collected and analyzed using a combination of physiochemical techniques to understand the structure of bacterial communities and chemical constituents. Airborne particulate mass followed a bimodal size distribution (one mode at 3 μm and a second above 30 μm), which also correlated with the relative concentrations of the following microbiological markers: bacterial endotoxin, 3-hydroxy fatty acids, and muramic acid. Sequencing of the 16S-rRNA components of this aerosol revealed a microbiome derived predominantly from animal sources. Bacterial genera included Staphlyococcus, Pseudomonas, and Streptococcus, all of which have proinflammatory and pathogenic capacity. Our results suggest that the size distribution of bioaerosols emitted by dairy operations extends well above 10 μm in diameter and contains a diverse mixture of potentially hazardous constituents and opportunistic pathogens. These findings should inform the development of more effective emissions control strategies.