Upper airway inflammation and respiratory symptoms in domestic waste collectors

Associations between bioaerosols, lung function work-shift changes and inflammatory markers: A study of recycling workers

OBJECTIVES

We investigated associations between bioaerosol exposures and work-shift changes in lung function and inflammatory markers among recycling workers.

METHODS

Inhalable dust was measured with personal samplers and analyzed for endotoxin, bacteria, and fungi (incubated at 25 °C and 37 °C) levels. Lung function (FEV1, FVC) was measured before and after work-shifts and serum concentrations of inflammatory markers (CRP, SAA, CC16, IL1B, IL2, IL4, IL5, IL6, IL8, IL10, IL13, and TNF) after the shift. Associations were explored by linear mixed-effects models.

RESULTS

We included 170 measurements from 88 production workers exposed to inhalable dust, endotoxin, bacteria, and fungi (25 °C and 37 °C) at geometric mean levels of 0.6 mg/m3, 10.7 EU/m3, 1.6×104 CFU/m3, 4.4×104 CFU/m3, and 103 CFU/m3, respectively, and 14 administrative workers exposed at 7-fold lower levels. No associations were observed between bioaerosol exposures and work-shift change in lung function. IL2, IL6, IL10, and TNF concentrations were positively associated with inhalable dust levels, SAA and IL6 with bacteria, CRP, SAA, IL8, and TNF with fungi (25 °C or 37 °C), with the latter being the only statistically significant finding (exp(β) 1.40, 95% confidence interval 1.01-1.96).

CONCLUSIONS

This study of recycling workers exposed to bioaerosol levels generally below those of farmers and compost workers and above background levels did not indicate any acute effect on lung function. Several inflammatory markers tended to increase with exposure, suggesting a systemic effect. Future research should combine data from bioaerosol-exposed workers to uncover health risks that may form the basis for health-based occupational exposure limits.

Assessment of waste workers occupational risk to microbial agents and cytotoxic effects of mixed contaminants present in the air of waste truck cabin and ventilation filters

Workers in the waste-processing industry are potentially exposed to high concentrations of biological contaminants, leading to respiratory and digestive problems and skin irritations. However, few data on the exposure of waste collection truck (WCT) drivers are available. The goal was to document the microbial risk of the waste collection truck (WCT) workers while in the vehicle cab. Long-period sampling using the truck air filters (CAF) and short time ambient air sampling in the cab were used. The potential release of microbial particles from CAFs was also investigated since it could contribute to the microbial load of the cabin air. A combination of analytical methods also helped assess the complex mixture of the biological agents. Aspergillus sections Fumigati and Flavi, E. coli, Enterobacter spp. and Legionella spp. were detected in the CAF of trucks collecting three types of waste. The highest levels of bacteria and fungi were found in the CAF from organic WCT. The highest endotoxin concentrations in CAF were 300 EU/cm2. Most of the CAF showed cytotoxic effects on both lung cells and hepatocytes. Only one mycotoxin was detected in a CAF. The maximal concentrations in the ambient WCT air varied according to the type of waste collected. The highest proportion (84%) of the air samples without cytotoxic effects on the lungs cells was for the recyclable material WCTs. The results revealed the potential microbial risk to workers from a complex mixture of bio-contaminants in the cabs of vehicles collecting all types of waste. The sustained cytotoxic effect indicates the potential adverse health-related impact of mixed contaminants (biological and non-biological) for the workers. Overall, this study highlights the benefits of using complementary sampling strategy and combined analytical methods for a the assessment of the microbial risk in work environments and the need to implement protective measures for the workers.Implications: Exposure to microbial agents is a well-known occupational hazard in the waste management sector. No previous study had evaluated the cytotoxicity of ambient air and ventilation filters to document worker exposure to a combination of contaminants during waste collection. This research confirms the usefulness of ventilation filters for long-term characterization of exposure to infectious agents, azole-resistant fungi, coliform bacteria and mycotoxin. Overall, this study highlights the importance of using several sampling and analysis methods for a comprehensive assessment of microbial risk in work environments, as well as the need to implement appropriate protective measures for collection workers.

Review of bioaerosols from different sources and their health impacts

The emission of bioaerosols in the ambient atmosphere from different sources is a cause of concern for human health and the environment. Bioaerosols are a combination of biotic matter like microbes and pollens. The present review emphasizes the understanding of various sources of bioaerosols (industries, municipal solid waste, and medical facilities), their components, and their impact on human health. The study of bioaerosols is of great importance as large numbers of people are estimated to be exposed on the global scale. Bioaerosols exposure in different work environments results in health issues such as infectious diseases, allergies, toxic effects, and respiratory problems. Hence, extensive research is urged to establish an effective assessment of bioaerosols exposure in the workplace, risks involved, distribution, and validation. The present review is intended to explore the relationship between bioaerosols exposure to the atmosphere and its impacts on human health. Some of the preliminary findings, based on our analysis of bioaerosols arising from municipal solid waste at a landfill site and a waste transfer station in Hyderabad, India, are also discussed herein.

Exposure levels of dust, endotoxin, and microorganisms in the Danish recycling industry

INTRODUCTION

Recycling of domestic waste and a number of employees in the recycling industry is expected to increase. This study aims to quantify current exposure levels of inhalable dust, endotoxin, and microorganisms and to identify determinants of exposure among recycling workers.

METHODS

This cross-sectional study included 170 full-shift measurements from 88 production workers and 14 administrative workers from 12 recycling companies in Denmark. The companies recycle domestic waste (sorting, shredding, and extracting materials from waste). We collected inhalable dust with personal samplers that were analysed for endotoxin (n = 170) and microorganisms (n = 101). Exposure levels of inhalable dust, endotoxin, and microorganisms and potential determinants of exposure were explored by mixed-effects models.

RESULTS

The production workers were 7-fold or higher exposed to inhalable dust, endotoxin, bacteria, and fungi than the administrative workers. Among production workers recycling domestic waste, the geometric mean exposure level was 0.6 mg/m3 for inhalable dust, 10.7 endotoxin unit (EU)/m3 for endotoxin, 1.6 × 104 colony forming units (CFU)/m³ of bacteria, 4.4 × 104 CFU/m³ of fungi (25 °C), and 1.0 × 103 CFU/m³ of fungi (37 °C). Workers handling paper or cardboard had higher exposure levels than workers handling other waste fractions. The temperature did not affect exposure levels, although there was a tendency toward increased exposure to bacteria and fungi with higher temperatures. For inhalable dust and endotoxin, exposure levels during outdoor work were low compared to indoor work. For bacteria and fungi, indoor ventilation decreased exposure. The work task, waste fraction, temperature, location, mechanical ventilation, and the company size explained around half of the variance of levels of inhalable dust, endotoxin, bacteria, and fungi.

CONCLUSION

The production workers of the Danish recycling industry participating in this study had higher exposure levels of inhalable dust, endotoxin, bacteria, and fungi than the administrative workers. Exposure levels of inhalable dust and endotoxin among recycling workers in Denmark were generally below established or suggested occupational exposure limits (OEL). However, 43% to 58% of the individual measurements of bacteria and fungi were above the suggested OEL. The waste fraction was the most influential determinant for exposure, and the highest exposure levels were seen during handling paper or cardboard. Future studies should examine the relationship between exposure levels and health effects among workers recycling domestic waste.

Levels of Clara cell secretory protein and surfactant protein A in municipal solid waste management workers in Ibadan, Southwest Nigeria

Toxic pneumonitis and related respiratory symptoms are common among waste management workers (WMWs). Products of different cellular responses following exposure to toxic components of wastes can lead to the production of a variety of biomolecules. There is a growing recognition of the importance of biomarkers in risk assessment and a strong advocacy for their determination and use as indicators of health and safety. This study assessed the prevalence of respiratory symptoms and the relevance of pulmonary surfactant protein A (SP-A) and Clara cell 16 protein (CC16) as indicators of occupational inhalation exposure to toxic substances and irritants in WMW. A total of 172 subjects consisting of 112 WMWs and 60 Non-WMWs were recruited by purposive sampling. Data on socio-economic and work-related symptoms were collected using structured questionnaire. CC16 and SP-A were determined by ELISA in serum samples. Clinical history reveals a slightly higher prevalence of respiratory symptoms in WMWs relative to control subjects. Increased permeability of the lung-blood barrier, characterized by significant elevation of serum SP-A and serum CC16, was associated with respiratory symptoms in WMWs. Steady increases in SP-A and CC16, respectively, in relation to occupational duration were observed in WMWs relative to control. Receiver operating characteristic curve and multivariate analyses revealed SP-A and CC16 as important lung biomarkers for assessing sub-clinical effects of occupational exposure. Our data suggest SP-A and CC16 may be relevant indicators for assessing occupational inhalation exposure to toxic substances and irritants among WMWs.

Divergent TLR2 and TLR4 Activation by Fungal Spores and Species Diversity in Dust from Waste Sorting Plants

This manuscript presents the results of an exploratory study on the relationships between NF-κB response through Toll-like receptor (TLR) activation by dust characterized by fungal spore concentrations and species diversity. Personal total dust samples were collected from Norwegian waste sorting plants and then characterized for fungal spores and fungal species diversity, as well as for other bioaerosol components, including endotoxins and actinobacteria. The ability of the dust to induce an NF-κB response by activating TLR2 and TLR4 in vitro was evaluated, as well as the relationship between such responses and quantifiable bioaerosol components. The average concentrations of bioaerosols were 7.23 mg total dust m^-3, 4.49 × 10⁵ fungal spores m^-3, 814 endotoxin units m^-3, and 0.6 × 10⁵ actinobacteria m^-3. The mean diversity measurements were 326, 0.59, and 3.39 for fungal richness, evenness, and Shannon index, respectively. Overall, fungal operational taxonomic units (OTUs) belonging to the Ascomycota phylum were most abundant (55%), followed by Basidiomycota (33%) and Mucoromycota (3%). All samples induced significant NF-κB responses through TLR2 and TLR4 activation. While fungal spore levels were positively associated with TLR2 and TLR4 activation, there was a trend that fungal species richness was negatively associated with the activation of these receptors. This observation supports the existence of divergent immunological response relationships between TLR activation and fungal spore levels on one hand and between TLR activation and fungal species diversity on the other. Such relationships seem to be described for the first time for dust from waste facilities. IMPORTANCE This manuscript presents results on multifactorial characterization of bioaerosol exposure in Norwegian waste sorting plants and the potential of such airborne dust to induce NF-κB reactions through TLR2 and TLR4 activations in an in vitro reporter cell model system. Our data revealed that increasing fungal spore levels in the dust is associated with increased activation of TLR2 and TLR4, whereas increasing fungal OTU richness is associated with decreasing activation of these receptors. The NF-κB-induced responses by the collected dust represent, therefore, effective measures of potential key immunological effects induced by a complex mixture of hazardous components, including characterized factors such as endotoxins, fungal spores, bacteria, and many other uncharacterized components. The key immunological events reported here are suggested as holistic alternatives to today's bioaerosol exposure characterization approaches for epidemiological studies in the future.

An assessment of occupational exposure to bioaerosols in automated versus manual waste sorting plants

Occupational exposure during waste sorting is associated with several health outcomes. This study obtained knowledge about the impact of work in fully automated waste sorting plants (AWSP; n = 3) vs manual waste sorting plants (MWSP; n = 3) on personal exposure (n = 71) to bioaerosols and exposure-related health effects. Personal full-shift air samples were collected using various filter-based active sampling devices that were placed in the workers' breathing zone. Personal exposure to inhalable and thoracic dust, endotoxin and microorganisms varied considerably between and within types of waste sorting plants (WSP). Workers at AWSP were on average exposed to 0.34 mg/m³ inhalable dust, 0.15 mg/m³ thoracic dust, and 51 EU/m³ endotoxins (geometric mean (GM) levels), whereas GM exposure levels at MWSP were 0.66 mg/m³ for inhalable dust, 0.44 mg/m³ for thoracic dust, and 32 EU/m³ for endotoxins. Exposure to submicronic fungal fragments did not differ between types of plants and ranged from levels below the detection limit (limit of detection, LOD) to levels in the order of 10⁶ fragments/m³. Higher levels of fungal fragments and fungal spores were found at AWSP compared to MWSP with a GM of 2.1 × 10⁵ spores/m³and with a GM of 1.2 × 10⁵ spores/m³, respectively. Actinobacterial spores were found in samples from AWSP only, with exposure levels ranging from 1.9 × 10⁴ to 1.1 × 10⁷ spores/m³. Exposure to microbial DNA varied within and between WSP and was on average in the order of 10⁴ copies/m³ for fungi and 10⁵ copies/m³ for bacteria. Health symptoms, such as sneezing, congested nose and runny nose were significantly more common among exposed workers compared to the unexposed control group.

Field Survey on Generation Patterns of Airborne Fungi in a Livestock Manure Composting Plant in South Korea

Airborne fungi emitted from livestock manure composting plants are one of the major harmful factors causing respiratory disease for workers and nearby residents. Their generation of emissions is relatively high compared to other workplaces. This study investigated the emission characteristics of airborne fungi generated in livestock manure composting plants and utilized them as basic data to prevent workers’ health. The livestock manure composting plants selected for the survey in this study were according to the fermentation mode, including screw type, rotary type and natural dry type. The field evaluation period was from September 2019 to August 2020 and was surveyed monthly. The equipment for collecting airborne fungi was a six-stage cascade impactor. An analysis of the quantification and qualification of airborne fungi was conducted through a culture method and identification technique, respectively. The mean levels of airborne fungi in livestock manure composting plants were 1143 (±106)CFU m−3 for screw type, 552 (±146)CFU m−3 for rotary type and 434 (±73)CFU m−3 for natural dry type, respectively. Based on the results obtained from this study, the livestock manure composting plant operated by screw type showed the highest concentration of airborne fungi, followed by the rotary type and natural dry type. The monthly concentration of airborne fungi was the highest in June and the lowest in February, regardless of the livestock manure composting plant type. The concentration range of airborne fungi corresponding to the respiratory particle diameter was 40 to 60% relative to the concentration of all airborne fungi. The correlation relationship between airborne fungi and environmental factors (temperature, relative humidity, particulate matter and odor) was not found to be significant in livestock manure composting plants. The predominant genera of airborne fungi identified were Aspergillus spp., Cladosporium spp. and Penicillium spp.

Microbial contamination and metabolite exposure assessment during waste and recyclable material collection

Waste workers are exposed to bioaerosols when handling, lifting and dumping garbage. Bioaerosol exposure has been linked to health problems such as asthma, airway irritant symptoms, infectious, gastrointestinal and skin diseases, and cancer. Our objective was to characterize the exposure of urban collectors and drivers to inhalable bioaerosols and to measured the cytotoxic effect of air samples in order to evaluate their health risk. Personal and ambient air sampling were conducted during the summer of 2019. Workers from 12 waste trucks collecting recyclables, organic waste or compost were evaluated. Bacteria and fungi were cultured, molecular biology methods were used to detect microbial indicators, cytotoxic assays were performed and endotoxins and mycotoxins were quantified. Domestic waste collectors were exposed to concentrations of bacteria and endotoxins above the recommended limits, and Aspergillus section Fumigati was detected at critical concentrations in their breathing zones. Cytotoxic effects were observed in many samples, demonstrating the potential health risk for these workers. This study establishes evidence that waste workers are exposed to microbial health risks during collection. It also demonstrates the relevance of cytotoxic assays in documenting the general toxic risk found in air samples. Our results also suggest that exposures differ depending on the type of waste, job title and discharge/unloading locations.

Review of biological risks associated with the collection of municipal wastes

In many countries, the management of household waste has recently changed with an increased focus upon waste sorting resulting in lower collection frequency for some waste fractions. A consequence of this is the potential for increased growth of microorganisms in the waste before collection, which can lead to an increased exposure via inhalation for waste collection workers. Through a review of the literature, we aimed to evaluate risks caused by waste collecting workers' exposure to bioaerosols and to illuminate potential measures to reduce the exposure. Across countries and waste types, median exposure to fungi, bacteria, and endotoxin were typically around 10⁴ colony forming units (cfu)/m³, 10⁴ cfu/m³, and 10 EU/m³, respectively. However, some studies found 10-20+ times higher or lower median exposure levels. It was not clear how different types of waste influence the occupational exposure levels. Factors such as high loading, ventilation in and cleaning of drivers' cabs, increased collection frequency, waste in sealed sacks, and use of hand sanitizer reduce exposure. Incidences of gastrointestinal problems, irritation of the eye and skin and symptoms of organic dust toxic syndrome have been reported in workers engaged in waste collection. Several studies reported a correlation between bioaerosol exposure level and reduced lung function as either a short or a long term effect; exposure to fungi and endotoxin is often associated with an inflammatory response in exposed workers. However, a better understanding of the effect of specific microbial species on health outcomes is needed to proceed to more reliable risk assessments. Due to the increasing recycling effort and to the effects of global warming, exposure to biological agents in this working sector is expected to increase. Therefore, it is important to look ahead and plan future measures as well as improve methods to prevent long and short-term health effects.

Respiratory Symptoms and Pulmonary Function of Workers in the Waste Management Industry

Introduction: Waste handling workers are exposed to air pollutants and toxic compounds produced during waste management and processing that can cause respiratory symptoms and lung function impairment. This study aimed to evaluate the respiratory health of exposed workers in a waste management plant in Attica, Greece.

Methods: 50 field workers exposed to outdoor pollutants (exposure group) and 32 office clerks with no exposure (control group) were evaluated. Upper and lower respiratory symptoms were documented and spirometry was performed.

Results: There was no statistically significant difference between the exposure and the control group in forced expiratory volume in one second (FEV1)%, forced vital capacity (FVC)%, FEV1/FVC% predicted values. Workers had lower maximal mid-expiratory flow (MMEF)% predicted values compared to controls (82% vs 94%, p=0.019). No difference was observed regarding the respiratory symptoms between the two groups.

Conclusion: Lower MMEF values were observed in the exposure group. Low MMEF can be indicative of small airway disease, thus smoking cessation, close follow-up, and the use of personal protective equipment are recommended.

A characterization of bioaerosols in biowaste pretreatment plants in relation to occupational health

Occupational exposure to microorganisms can be associated with adverse health outcomes. In this study, we assessed exposure to bioaerosols in two biowaste pretreatment plants in Denmark, which differed in location (city or countryside) and how they were built ('closed-off processes' or 'open processes'). Bioaerosol exposures were characterized by microbial concentrations in personal, stationary, sedimented dust, and hand samples, and their size distribution was assessed. Furthermore, species were identified by matrix-assisted laser desorption-ionisation time-of-flight mass spectrometry (MALDI-TOF MS), and inhalable dust, endotoxin, biofilm production, the total inflammatory potential, and fungicide resistance to four fungicides (amphotericin B, caspofungin acetate, itraconazole, voriconazole) were determined. Bacterial and fungal concentrations were on average (GM) in the order of 10⁴ cfu/m³, but ranged from 10² to 10⁸ cfu/m³. Several species which may cause health problems were identified. Personal endotoxin exposures were on average 28 EU/m³, but both personal and stationary samples ranged from 0.6 to 2035 EU/m³. Bioaerosols had the potential to form biofilms and to induce inflammation as measured in a human cell line. Exposures were higher in the plants that outdoor reference values. Higher exposures were found in the 'open process' plant, such as in microbial concentrations, species richness, endotoxin, biofilm production, and the total inflammatory potential. Six out of 28 tested Aspergillus fumigatus isolates were resistant to fungicides (amphotericin B and voriconazole). In conclusion, there is a high exposure to bioaerosols during work in biowaste pretreatment plants, however, results also suggests that how the plant is built and functions may affect the exposures.

Prevalence and associated factors of acute respiratory infection among street sweepers and door-to-door waste collectors in Dessie City, Ethiopia: A comparative cross-sectional study

Background

Acute respiratory infections are rising in developing countries including Ethiopia. Lack of evidence for the prevalence and associated factors of acute respiratory infection among street sweepers and door-to-door waste collectors in Dessie City, Ethiopia is a challenge for the implementation of appropriate measures to control acute respiratory infection. Thus, this study was designed to address the gaps.

Methods

A comparative cross-sectional study was conducted among 84 door-to-door waste collectors and 84 street sweepers from March to May 2018. A simple random sampling technique was used to select study participants. Data were collected by trained data collectors using a pretested structured questionnaire and on-the-spot direct observation checklist. Data were analyzed using three different binary logistic regression models at 95% confidence interval (CI): the first model (Model I) was used to identify factors associated with acute respiratory infection among street sweepers, whereas the second model (Model II) was used to identify factors associated with acute respiratory infection among door-to-door waste collectors, and the third model (Model III) was used for pooled analysis to identify factors associated with acute respiratory infection among both street sweepers and door-to-door waste collectors. From each model multivariable logistic regression, variables with a p-value <0.05 were taken as factors significantly associated with acute respiratory infection.

Results

The overall prevalence of acute respiratory infection among studied population was 42.85% with 95% CI (35.1, 50.0%). The prevalence of acute respiratory infection among street sweepers was 48.80% (95% CI: 37.3, 64.8%) and among door-to-door waste collectors was 36.90% (95% CI: 27.4, 46.4%). There was no statistically significant difference between the prevalence of acute respiratory infection among the two groups due to the overlapping of the 95% CI. Among the street sweepers, we found that factors significantly associated with acute respiratory infection were not cleaning personal protective equipment after use (adjusted odds ratio [AOR]: 2.40; 95% CI: 1.15, 5.51) and use of coal/wood for cooking (AOR: 3.95; 95% CI: 1.52, 7.89), whereas among door-to-door waste collectors, were not using a nose/mouth mask while on duty (AOR: 5.57; 95% CI: 1.39, 9.32) and not receiving health and safety training (AOR: 3.82; 95% CI: 1.14–7.03) were factors significantly associated with acute respiratory infection among door-to-door-waste collectors. From the pooled analysis, we found that not using a nose/mouth mask while on duty (AOR: 2.19; 95% CI: 1.16, 4.53) and using coal/wood for cooking (AOR: 2.74; 95% CI: 1.18, 6.95) were factors significantly associated with acute respiratory infection for both street sweepers and door-to-door waste collectors.

Conclusion

The prevalence of acute respiratory infection among street sweepers and door-to-door waste collectors has no statistically significant difference. For both groups, not using a nose/mouth mask while on duty and using coal/wood for cooking fuel factors associated with acute respiratory infection. The municipality should motivate and monitor workers use of personal protective equipment including masks and gloves. Workers should use a nose/mouth mask while on duty and should choose a clean energy source for cooking at home.

Immunopathological features of air pollution and its impact on inflammatory airway diseases (IAD)

Air pollution causes significant morbidity and mortality in patients with inflammatory airway diseases (IAD) such as allergic rhinitis (AR), chronic rhinosinusitis (CRS), asthma, and chronic obstructive pulmonary disease (COPD). Oxidative stress in patients with IAD can induce eosinophilic inflammation in the airways, augment atopic allergic sensitization, and increase susceptibility to infection. We reviewed emerging data depicting the involvement of oxidative stress in IAD patients. We evaluated biomarkers, outcome measures and immunopathological alterations across the airway mucosal barrier following exposure, particularly when accentuated by an infectious insult.

International expert consensus on the management of allergic rhinitis (AR) aggravated by air pollutants: Impact of air pollution on patients with AR: Current knowledge and future strategies

Allergic rhinitis affects the quality of life of millions of people worldwide. Air pollution not only causes morbidity, but nearly 3 million people per year die from unhealthy indoor air exposure. Furthermore, allergic rhinitis and air pollution interact. This report summarizes the discussion of an International Expert Consensus on the management of allergic rhinitis aggravated by air pollution. The report begins with a review of indoor and outdoor air pollutants followed by epidemiologic evidence showing the impact of air pollution and climate change on the upper airway and allergic rhinitis. Mechanisms, particularly oxidative stress, potentially explaining the interactions between air pollution and allergic rhinitis are discussed. Treatment for the management of allergic rhinitis aggravated by air pollution primarily involves treating allergic rhinitis by guidelines and reducing exposure to pollutants. Fexofenadine a non-sedating oral antihistamine improves AR symptoms aggravated by air pollution. However, more efficacy studies on other pharmacological therapy of coexisting AR and air pollution are currently lacking.

Respiratory Symptoms Among Domestic Waste Collectors

Objective

Increasing amount of waste concurrently increases the risk of exposure to hazardous materials among waste collectors. Vigorous exertion in the field intensifies the abundance of contaminated inspirable droplets. If left undetected and untreated, it may provoke significant pernicious health effects and redundant burdens to employees and employers. The purpose of this study is to determine the prevalence of respiratory symptoms and their associated factors among domestic waste collectors.

Method

A cross-sectional study was conducted in Kota Kinabalu, Sabah between January and April 2020. Data were collected using a validated questionnaire which encompasses details about sociodemographic, health status, environment, and employment characteristics.

Results

A total of 290 waste collectors with a mean age of 40 (±9) years old were participated in the study. Most of them were from Kadazan-Dusun-Murut ethnic origin with educational background till secondary school. The average monthly income of the workers was USD 298.45 (±171.9) per month, and they had been in service for 11 (±9.04) years. Respiratory symptoms were seen in 21% of the workers. The identified significant risk factors were determined as underlying chronic diseases (OR=2.34; 95% CI=1.054, 5.219) and contact with pets (OR=1.87; 95% CI=1.004, 3.288).

Conclusion

Respiratory symptoms are prevalent amidst domestic waste collectors and related to their health and field activities.

Effects of Occupational Exposures on the Lung Functions and Quality of Life of Garbage Collectors in the Urban Area

BACKGROUND

The present study was aimed to investigate the lung functions and health-related quality of life (HRQoL) of garbage collection workers of the urban cities in India.

STUDY SETTING

Urban city in India.

MATERIALS AND METHODS

The cross-sectional study encompassed 110 participants, 55 garbage collection workers in a garbage depot in the urban city of India and 55 age-matched control group volunteering to participate in the study. Assessment of the lung function was done by using computerized spirometry and HRQoL with the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire.

STATISTICAL ANALYSIS

Various statistical measures such as mean, standard deviations (SD), test of significance were utilized to analyze the data. Parametric data were analyzed by unpaired t-test and nonparametric data by Mann-Whitney U test.

RESULTS

A statistically significant difference was seen in the lung functions and quality of life in garbage collection workers except for the psychological component of WHOQoL-BREF questionnaire.

CONCLUSION

The study concludes that there is a greater impairment in the lung functions of garbage collection workers as compared to that of normal individuals. Moreover, the quality of life is lower in garbage workers than that of normal individuals considering the physical, social, and environmental aspects.

Adaptation to Occupational Exposure to Moderate Endotoxin Concentrations: A Study in Sewage Treatment Plants in Germany

Acute or chronic inhalation of endotoxin may lead to changes of lung function and inflammatory markers in the airways. Adaptation to workplace exposure may be possible. In this study, we investigated the possible difference in inflammatory markers assessed in nasal lavage fluid (NALF) in chronical exposure compared to voluntary subjects exposed acutely to endotoxin. We sought to define the variability of inflammatory markers in NALF and the dose-related changes after moderate exposure in naïve subjects. Endotoxin exposure (4-1039 EU/m³) resulted from routine work during one shift in sewage treatment plants. Subjects were matched to pairs (8 workers escorted by 10 students). Inflammatory markers were investigated before, directly after, and 16 h after the shift end. Additional NALF samples were collected in students without any specific exposure after 3 days. In NALF, total cell count, and interleukin (IL)-8 and IL-1β concentrations were significantly higher in workers than in students at all times pointing to workplace-related long-lasting exposure resulting in adaptation. However, concentration of inflammatory markers without specific exposure in students showed a great variability, covering the whole range of values recorded in the workers. The findings of this study make us to recommend a repeated assessment of inflammatory markers in healthy volunteers before the investigation of exposure-related changes and a sample size adequate for statistical analysis.

An Official American Thoracic Society Workshop Report: Presentations and Discussion of the Sixth Jack Pepys Workshop on Asthma in the Workplace

The Sixth Jack Pepys Workshop on Asthma in the Workplace focused on six key themes regarding the recognition and assessment of work-related asthma and airway diseases: (1) cleaning agents and disinfectants (including in swimming pools) as irritants and sensitizers: how to evaluate types of bronchial reactions and reduce risks; (2) population-based studies of occupational obstructive diseases: use of databanks, advantages and pitfalls, what strategies to deal with biases and confounding?; (3) damp environments, dilapidated buildings, recycling processes, and molds, an increasing problem: mechanisms, how to assess causality and diagnosis; (4) diagnosis of occupational asthma and rhinitis: how useful are recombinant allergens (component-resolved diagnosis), metabolomics, and other new tests?; (5) how does exposure to gas, dust, and fumes enhance sensitization and asthma?; and (6) how to determine probability of occupational causality in chronic obstructive pulmonary disease: epidemiological and clinical, confirmation, and compensation aspects. A summary of the presentations and discussion is provided in this proceedings document. Increased knowledge has been gained in each topic over the past few years, but there remain aspects of controversy and uncertainty requiring further research.

Respiratory health effects of exposure to low levels of airborne endotoxin - a systematic review

BACKGROUND

Elevated endotoxin levels have been measured in ambient air around livestock farms, which is a cause of concern for neighbouring residents. There is clear evidence that occupational exposure to high concentrations of airborne endotoxin causes respiratory inflammation, respiratory symptoms and lung function decline. However, health effects of exposure to low levels of endotoxin are less well described. The aim of this systematic review is to summarize published associations between exposure to relatively low levels of airborne endotoxin and respiratory health endpoints.

METHODS

Studies investigating respiratory effects of measured or modelled exposure to low levels of airborne endotoxin (average < 100 EU/m³) were eligible for inclusion. In total, 1362 articles were identified through a Pubmed database search, of which 31 articles were included in this review. Studies were included up to February 2017. Overview tables and forest plots were created, and study quality was assessed.

RESULTS

Twenty-two included studies had a cross-sectional design, others were designed as longitudinal observational (n = 7) or experimental (n = 2) studies. Most studies (n = 23) were conducted in an occupational setting, some involved domestic or experimental exposure. Several studies reported statistically significant effects of exposure to low levels of endotoxin on respiratory symptoms and lung function. However, considerable heterogeneity existed in the outcomes of the included studies and no overall estimate could be provided by meta-analysis to quantify the possible relationship. Instead, a best evidence synthesis was performed among studies examining the exposure-response relationship between endotoxin and respiratory outcomes. Significant exposure-response relationships between endotoxin and symptoms and FEV₁ were shown in several studies, with no conflicting findings in the studies included in the best evidence synthesis. Significantly different effects of endotoxin exposure were also seen in vulnerable subgroups (atopics and patients with broncho-obstructive disease) and smokers.

CONCLUSIONS

Respiratory health effects of exposure to low levels of airborne endotoxin (< 100 EU/m³) seem plausible. Future studies are needed to investigate ambient exposure to endotoxin and potential respiratory health effects, especially in vulnerable subgroups of the population.

Systematic Review: Occupational illness in the waste and recycling sector

BACKGROUND

The waste and recycling sector is a growing part of industry. Whether health surveillance is indicated and how it should be undertaken is unclear.

AIMS

To undertake a review of the literature to identify hazards to health, biological effects and occupational illnesses for workers in the sector.

METHODS

A systematic review of the published literature and two UK databases.

RESULTS

Rates of fatal, non-fatal injuries and self-reported work-related illness were found to be higher in the waste and recycling sector than in UK industry as a whole. There was an increased prevalence of respiratory, gastro-intestinal and skin complaints in workers exposed to compost relative to controls. They may also be at increased risk of extrinsic allergic alveolitis, allergic bronchopulmonary aspergillosis, occupational asthma and abnormalities of lung function. Workers involved with the recycling of batteries and cables may be at risk of lead poisoning and exposure to other heavy metals. There were case reports of mercury poisoning from the recycling of fluorescent lights. Cases of occupational asthma have been reported in association with wood and paper recycling. The recycling of e-waste may cause exposure to heavy metals and organic pollutants, such as polybrominated diphenyl ethers, dioxins and polyaromatic hydrocarbons, which have been associated with damage to DNA and adverse neonatal outcomes.

CONCLUSIONS

Ill-health and adverse biological effects have been described in waste and recycling workers, but their true prevalence has probably not been captured. Targeted health surveillance may be required to assess exposure and to identify occupational illness.

Comparative assessment of respiratory and other occupational health effects among elementary workers

Objective. This study was conducted to assess hazards faced by elementary workers. Methods. A questionnaire survey and a respiratory function test (spirometry) were carried out on 150 respondents. Results. Major hazards identified related to sharp objects, heavy weight lifting, thermally harsh conditions, working at height, whole body vibration, chemicals, pathogens, increased noise levels and confined space entry. Workers suffered from upper and lower respiratory disorder symptoms, digestive problems, optical and musculoskeletal issues, etc. Spirometric measurement showed obstructive lung disorders to be highest among construction workers (CW) (48%) followed by sanitation workers (SW) (32%) and solid waste pickers (SWP) (28%). Restrictive lung pattern was dominant among SW (56%) followed by SWP (46%) and CW (42%). The observed FEV₁/FVC in diseased SWP, SW and CW ranged from 51 to 96%, from 52 to 98% and from 31 to 99% respectively while observed mean FEV₁ was 2.15, 1.79 and 1.70 L, respectively. Conclusion. The study findings show that occupational exposure can significantly influence respiratory system impairment and contribute to other ailments among elementary workers. The study recommends use of appropriate protective equipment and regular medical examination for early recognition of any health risk so that timely interventions for effective management may be undertaken.

Air Pollution and Public Health: A PRISMA-Compliant Systematic Review

(1) Background: Particulate matter increases the risk of respiratory, allergic and oncological diseases in both exposed workers and the general population due to its toxic compounds (e.g., PAHs, gases, heavy metals, microorganisms). The aim of this review is to show the results obtained by our department regarding air pollution’s contributions to health damage in both occupationally and non-occupationally exposed people. (2) Methods: This review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching articles on PubMed, using eligibility criteria, extracting data independently from reports to reduce bias and considering the accuracy of the statistical analyses. (3) Results: Of fifteen papers, only three respected the abovementioned criteria. A total of 453 cases (174 occupationally exposed and 279 non-occupationally exposed individuals) were included in the review. Qualitative analysis showed that among workers, occupational exposure to air pollution increased the risk of allergic and pulmonary diseases, whereas environmental exposure to PM increased heavy metal intake, the last of which was characterized by well-known carcinogenic effects. 4) Conclusion: The use of personal protective equipment, a meticulous health surveillance program and specific environmental protection policies are needed to protect public health from damages due to air pollution.

A study of the potential release of bioaerosols from containers as a result of reduced frequency residual waste collections

Microorganisms have the potential to grow within waste containers if waste is stored for longer periods as a result of an extended residual waste collection cycle. Release of microorganisms as bioaerosols during waste collection and processing may be an occupational risk to workers within the industry. There may be many constituents of the bioaerosol that may be of concern, however, there are currently only workplace exposure limits proposed for endotoxin (90EUm^-3). A field-scale trial was established to determine the concentration of mesophilic bacteria, Gram-negative bacteria, Listeria monocytogenes, thermotolerant fungi, Aspergillus fumigatus, and endotoxin and (1→3)-β-d-glucan in air within bins containing either bagged or loose residual waste, in warm (23°C) or cold (7°C) conditions, to simulate an extended collection cycle. Fresh waste was added during the first four weeks, with an additional 'missed collection' phase of a further four weeks where no more waste was added. A second trial examined the microbiological components of bioaerosols associated with 'tipping' the bins, simulating the moment when bins are emptied into waste collection vehicles. The majority of mesophilic bacteria, fungi and A. fumigatus concentrations were recorded when fresh material was added to the bins, with only mesophilic bacteria recorded up to week 6 during the 'missed collection' phase. (1→3)-β-D-glucan concentrations were variable throughout the first trial, (geometric mean range 0.4-13.8ngm^-3). Perhaps the bioaerosol component of most interest was endotoxin (geometric mean range 0.52-1288EUm^-3). Elevated endotoxin concentrations were recorded during the 'missed collection' phase of the extended collection cycle and during 'tipping'. This data demonstrates significant concentrations of bioaerosols and particularly endotoxin can be generated during prolonged residual waste storage and collection. As endotoxin is a bioaerosol component of concern it can be concluded there is the potential for workplace exposure hence identifying key areas for risk assessment.

Bioaerosols, Noise, and Ultraviolet Radiation Exposures for Municipal Solid Waste Handlers

Few studies have investigated the occupational hazards of municipal solid waste workers, particularly in developing countries. Resultantly these workers are currently exposed to unknown and unabated occupational hazards that may endanger their health. We determined municipal solid waste workers' work related hazards and associated adverse health endpoints. A multifaceted approach was utilised comprising bioaerosols sampling, occupational noise, thermal conditions measurement, and field based waste compositional analysis. Results from our current study showed highest exposure concentrations for Gram-negative bacteria (6.8 × 103 cfu/m3) and fungi (12.8 × 103 cfu/m3), in the truck cabins. Significant proportions of toxic, infectious, and surgical waste were observed. Conclusively, municipal solid waste workers are exposed to diverse work related risks requiring urgent sound interventions. A framework for assessing occupational risks of these workers must prioritize performance of exposure assessment with regard to the physical, biological, and chemical hazards of the job.

Airway and Blood Inflammatory Markers in Waste Collectors

Waste collectors are exposed to a heterogeneous mixture of bioaerosols able to induce health effects. The study aim was to evaluate inflammatory processes in blood and in the respiratory tract via analysis of atopy and club cell secretory protein 16 (CC16) in serum, exhaled nitric oxide (FeNO), and cellular and soluble mediators in nasal lavage fluid (NALF) and induced sputum (IS). Sixty nine current waste collectors (48% smokers) and 28 former waste collectors (25% smokers) were included in the cross-sectional study. In both groups, 63 and 64% of workers reported complaints of the eyes, nose and/or upper airways. Thirty two percent of the current and 25% of the former workers were classified as atopics. More atopics suffered from rhinitis and conjunctivitis than non-atopics (64% vs. 40% in current workers; 71% vs. 40% in former workers). CC16 values of present non-smokers were significantly higher compared to smokers. In total, FeNO values of 31 participants were lower than 10 ppb, 94% of them were smokers and 85% had respiratory symptoms of lower airways. Most of the IS biomarkers were significantly higher in smokers than in non-smokers. Non-smoking workers with respiratory symptoms of lower airways had slightly elevated mediator IS concentrations compared to asymptomatic non-smokers. We conclude that inflammatory changes in waste collectors are detectable in the content of IS biomarkers, exhaled NO, and serum CC16, which all are influenced by the smoking habit. No significant differences in biomarkers are detectable between current and former waste collectors.

Inhalable dust, endotoxins and (1-3)-β-d-glucans as indicators of exposure in waste sorting plant environment

The aim of the study was to assess the levels of inhalable dust, endotoxins and (1-3)-β-d-glucans as agents harmful to the respiratory tract of workers of municipal waste sorting plants and interaction between these agents based on the measurements taken in two plants with different processing capacities. The study was conducted in summer season in two waste sorting plants (WSPs) differing in processing capacity. Samples of bioaerosol for inhalable dust (gravimetric method), endotoxins (LAL test in kinetic, chromogenic version) and (1-3)-β-d-glucans (Glucatell test in kinetic version) were collected from 42 sorting workers using individual aspirators with glass fiber filters during the work shift. Average geometric concentrations (geometric standard deviation; min-max) of inhalable dust, endotoxins and (1-3)-β-d-glucans were: WSP1: 1.7 mg m^-3 (2.2; 0.6-6.9 mg m^-3); 15.9 ng m^-3 (2.1; 5.4-78.9 ng m^-3), 55.1 ng m^-3 (1.8; 20.7-188.6 ng m^-3) and WSP2: 0.8 mg m^-3 (2.2; 0.2-3.8 mg m^-3), 9.8 ng m^-3 (2.4; 1.6-29.7 ng m^-3), 45.0 ng m^-3 (3.2, 5.7-212.9 ng m^-3), respectively. A significantly higher concentration of inhalable dust was recorded in WSP1 with bigger processing capacity compared to WSP2 (less processing capacity). Significant (p < 0.05) and very high correlations (Spearman rank R > 0.7) were found between the concentrations of all analyzed harmful agents. Processing capacity of waste sorting plants differentially affects the concentrations of inhalable dust, whereas concentrations of endotoxins and glucans are less clearly affected. This suggests that relative concentrations of endotoxin and glucan are depending on the waste sorting capacity.

Review: Endotoxin in the environment — exposure and effects

This review deals with endotoxin in the environment and its relation to disease among exposed persons. Data are presented on levels of endotoxin in different environments with maximum values of several μg/m3. The cellular reactions of importance for inhalation exposure effects are attachment to lipopolysaccharide binding protein, CD14 cell surface protein and TLR-4 receptors. The internalisation of endotoxin in macrophages and endothelial cells results in local production of inflammatory cytokines with subsequent migration of inflammatory cells into the lung and the penetration of cytokines into the blood. These events orchestrate clinical effects in terms of toxic pneumonitis, airways' inflammation and systemic symptoms. Inhalation challenges with pure endotoxin and field studies confirm the relation between these effects and exposure to dusts containing endotoxin. It is possible that polymorphism in genes determining endotoxin reactivity, particularly TLR-4, influences the risk for disease after environmental exposures. Some data suggest that the inflammation caused by inhaled endotoxin may decrease the risk for atopic sensitisation among children and lung cancer among workers exposed to organic dust. Additional research is needed to clarify the role of other environmental agents that are present in connection with endotoxin, particularly (1→3)-β-D-glucan from mold cell walls.

A systematic critical review of epidemiological studies on public health concerns of municipal solid waste handling

AIMS

The ultimate aim of this review was to summarise the epidemiological evidence on the association between municipal solid waste management operations and health risks to populations residing near landfills and incinerators, waste workers and recyclers. To accomplish this, the sub-aims of this review article were to (1) examine the health risks posed by municipal solid waste management activities, (2) determine the strengths and gaps of available literature on health risks from municipal waste management operations and (3) suggest possible research needs for future studies.

METHODS

The article reviewed epidemiological literature on public health concerns of municipal solid waste handling published in the period 1995-2014. The PubMed and MEDLINE computerised literature searches were employed to identify the relevant papers using the keywords solid waste, waste management, health risks, recycling, landfills and incinerators. Additionally, all references of potential papers were examined to determine more articles that met the inclusion criteria.

RESULTS

A total of 379 papers were identified, but after intensive screening only 72 met the inclusion criteria and were reviewed. Of these studies, 33 were on adverse health effects in communities living near waste dumpsites or incinerators, 24 on municipal solid waste workers and 15 on informal waste recyclers. Reviewed studies were unable to demonstrate a causal or non-causal relationship due to various limitations.

CONCLUSION

In light of the above findings, our review concludes that overall epidemiological evidence in reviewed articles is inadequate mainly due to methodological limitations and future research needs to develop tools capable of demonstrating causal or non-causal relationships between specific waste management operations and adverse health endpoints.

Respiratory Health in Waste Collection and Disposal Workers

Waste management, namely, collection, transport, sorting and processing, and disposal, is an issue of social concern owing to its environmental impact and effects on public health. In fact, waste management activities are carried out according to procedures that can have various negative effects on the environment and, potentially, on human health. The aim of our study was to assess the potential effects on respiratory health of this exposure in workers in the waste management and disposal field, as compared with a group of workers with no occupational exposure to outdoor pollutants. The sample consisted of a total of 124 subjects, 63 waste collectors, and 61 office clerks. Informed consent was obtained from all subjects before inclusion in the study. The entire study population underwent pulmonary function assessments with spirometry and completed two validated questionnaires for the diagnosis of rhinitis and chronic bronchitis. Statistical analyses were performed using STATA 13. Spirometry showed a statistically significant reduction in the mean Tiffenau Index values in the exposed workers, as compared with the controls, after adjusting for the confounding factors of age, BMI, and smoking habit. Similarly, the mean FEV1 values were lower in the exposed workers than in the controls, this difference being again statistically significant. The FVC differences measured in the two groups were not found to be statistically significant. We ran a cross-sectional study to investigate the respiratory health of a group of workers in the solid waste collection and disposal field as compared with a group of office workers. In agreement with most of the data in the literature, our findings support the existence of a prevalence of respiratory deficits in waste disposal workers. Our data suggest the importance of adopting preventive measures, such as wearing specific individual protection devices, to protect this particular category of workers from adverse effects on respiratory health.

Musculoskeletal disorders among municipal solid waste workers in India: A cross-sectional risk assessment

Background:

Waste management is a necessary activity around the world, but involves a variety of health hazards. In a developing country like India, municipal solid waste is collected manually requiring heavy physical activity. Among all occupational health issues, musculoskeletal problems are common among waste collectors in the form of nonfatal injuries because of the presence of such risk factors (lifting, carrying, pulling, and pushing). We have thus conducted this study to evaluate musculoskeletal disorders (MSDs) among municipal solid waste (MSW) workers.

Methodology:

A cross-sectional study using probability proportionate to size sampling, recruited 220 MSW workers from the Chennai Municipal Corporation, India for this study. A pretested validated questionnaire has been used to collect data on demographic and occupational history and information on musculoskeletal pain. Data analysis was performed using R software (3.0.1 version).

Results:

70% of the participants reported that they had been troubled with musculoskeletal pain in one or more of the 9 defined body regions during the last 12 months, whereas 91.8% had pain during the last 7 days. Higher prevalence of symptoms in knees, shoulders, and lower back was found to be 84.5%, 74.5%, and 50.9% respectively. Female illiterate workers with lower socioeconomic status were found to have higher odds for MSDs. Similarly, higher body mass index having no physical activity increases the chance of odds having MSDs.

Conclusion:

The higher percentage of musculoskeletal symptoms among MSW workers could be attributed to the long duration of employment, the low job control, and the nature of their job, which is physically demanding. A workplace of health promotion model integration can minimize the reported high prevalence, and a prospective cohort study could be recommended further.

Prevalence of work-related rhino-conjunctivitis and respiratory symptoms among domestic waste collectors

Waste collectors may suffer from acute and chronic health effects caused by organic dust (bioaerosols). Pathophysiological symptoms may originate either from allergic or irritative pathomechanisms, but an explicit distinction of the etiology is often complicated although crucial for proper risk assessment and workplace prevention. In this cross-sectional study, a total of 69 male waste collectors from the Ruhr area in Germany underwent a customized testing protocol including a modified questionnaire, basic clinical examination, spirometry, and immunologic parameters. Subjects were classified according to their work tasks into loaders (n=27), floaters (n=29), and drivers (n=13). We found that a high percentage of the workers had complaints (eyes 29.0%, nose 39.1%, and cough 34.8%) which were strongly work-related. Multiple logistic regression analyses indicated that duration of employment in waste collection (per 10 years) was associated with an increased prevalence of cough (OR=1.64, 95% CI 0.81; 3.35) and chronic bronchitis (OR=2.18, 95% CI 0.80; 5.92). An association between rhinitis and cough (OR=2.62, 95% CI 0.94; 7.27) was found, which supports the association between the prevalence of upper and lower airway disease. Furthermore, when adjusting for smoking status, atopic subjects suffered more frequently from irritation of the lower airways as indicated by cough (OR=2.71, 95% CI 0.91; 8.08). In conclusion, the study demonstrates associations between the prevalence of upper and lower airway disease in waste collectors. Notably, an underlying allergic disease in waste collectors could be suspected more commonly than previously reported.

Industrial hygiene, occupational safety and respiratory symptoms in the Pakistani cotton industry

OBJECTIVES

In the cotton industry of Pakistan, 15 million people are employed and exposed to cotton dust, toxic chemicals, noise and physical hazards. The aim of this study was to determine the prevalence of health symptoms, particularly respiratory symptoms, and to measure cotton dust and endotoxin levels in different textile factories of Faisalabad, Pakistan.

METHODS

A cross-sectional investigation was performed in a representative sample of 47 cotton factories in the Faisalabad region in Punjab, Pakistan. Respiratory symptoms of 800 workers were documented by questionnaire. Occupational safety in the factories was assessed by a trained expert following a checklist, and dust and endotoxin levels in different work areas were measured.

RESULTS

Prevalence of respiratory disease symptoms (fever, shortness of breath, chest tightness and cough) was generally high and highest in the weaving section of the cotton industry (20-40% depending on symptoms). This section also displayed the poorest occupational safety ratings and the highest levels of inhalable cotton dust (mean±SD 4.6±2.5 vs 0.95±0.65 mg/m(3) in compact units). In contrast, endotoxin levels were highest in the spinning section (median 1521 EU/m(3)), where high humidity is maintained.

CONCLUSIONS

There are still poor working conditions in the cotton industry in Pakistan where workers are exposed to different occupational hazards. More health symptoms were reported from small weaving factories (power looms). There is a dire need for improvements in occupational health and safety in this industrial sector with particular focus on power looms.

Respiratory disorders among municipal solid waste collectors in Mansoura, Egypt: a comparative study

ABSTRACT This research assessed the prevalence of respiratory complaints and the occupational risk factors among municipal solid waste (MSW) collectors. A comparative study was conducted upon MSW collectors in Western Municipality of Mansoura. Sociodemographic and occupational data were collected. Clinical examination and respiratory function measurements were performed. The prevalence of respiratory complaints during the past 12 months was higher among MSW collectors than the service worker group. Older age, cigarette smoking, and longer duration of employment were independently associated with impaired FEV1 (OR = 0.22, 7.2, 0.09, respectively). Older age group of collectors was independently associated with impaired FVC (OR = 0.34). Longer duration of employment was independently associated with impaired FEV1/ FVC (OR = 0.09). Respiratory complaints were prevalent among MSW collectors due to lack of engineering, medical and legislative measures.

Virus occupational exposure in solid waste processing facilities

It is well known that workers involved in the management of solid waste are at risk of exposure to bioaerosol, which is generally studied in relation to bacteria, fungi, and endotoxins. However, to date, there have been no reports on the incidence of work-related infectious diseases. To determine if occupational exposure to viruses occurs upon exposure to waste-related activities, monitoring was carried out in a landfill, a waste recycling plant, an incineration plant, and a waste collection vehicles. Air and surfaces were sampled and analyzed for torque teno virus (TTV), human adenovirus (HAdV), norovirus, rotavirus, and enterovirus using polymerase chain reaction (PCR)-based techniques. Positivity was confirmed by sequencing and quantification with real-time PCR; infectivity was also tested for culturable viruses. Samples were analyzed in parallel for mean total bacterial and fungi counts in both the summer and winter. In total, 30% (12/40) of air and 13.5% (5/37) of surface samples collected in plants were positive for HAdV and TTV. Among the eight HAdV-positive samples, six (75%), revealed in landfill and recycling plant air and in incinerator and waste vehicles surfaces, were able to replicate in cell culture and were subsequently confirmed as infective. The frequency of detection of virus-positive samples was similar in both seasons, but with evident differences in the type of virus detected: TTV and HAdV were more frequently detected in the summer and winter, respectively. The area of highest viral contamination was the paper selection landfill. Fungi and bacterial contamination did not correlate with viral presence or concentration. In conclusion, we evidence that working with solid and liquid waste can lead to infectious viruses, included in Group 2 of the European Directive 90/679/CEE pathogens list; thus, further investigation on the sources and routes of contamination is needed in order to assess the occupational risk.

Markers of upper airway inflammation associated with microbial exposure and symptoms in occupants of a water-damaged building

BACKGROUND

Water damage in buildings has been associated with reports of upper airway inflammation among occupants.

METHODS

This survey included a questionnaire, allergen skin testing, nasal nitric oxide, and nasal lavage on 153 participants. We conducted exposure assessments of 297 workstations and analyzed collected dust for fungi, endotoxin, and (1 → 3)-β-D-glucan to create floor-specific averages.

RESULTS

Males had higher levels of nasal inflammatory markers, and females reported more symptoms. ECP, IL-8, and MPO were significantly associated with nasal symptoms, flu-like achiness, or chills. Fungi and glucan were positively associated with blowing out thick mucus. Endotoxin was significantly associated with ECP in overall models, and with ECP, IL-8, MPO, and neutrophils among non-atopic females.

CONCLUSIONS

In this study, we documented an association between endotoxin and nasal inflammatory markers among office workers. The results of our study suggest that a non-allergic response may contribute to symptoms occurring among occupants in this water-damaged building.

Adenosine deaminase activity and immunoglobulin levels as potential systemic biomonitors of occupational hazards and health status in municipal solid waste management workers

Immune status of waste management workers (WMW) with underlying systemic inflammation was assessed to identify useful immune-related biomarkers of occupational health and safety. Clinical history of WMW revealed high prevalence of respiratory symptoms alongside gastrointestinal and musculoskeletal complaints relative to control. Systemic inflammation, characterized by significant (p<0.001) elevation of erythrocyte sedimentation rate and C-reactive protein, was associated with marked increase in concentration and prevalence of IgA (p<0.05), IgG (p<0.01) and adenosine deaminase activity (ADA) (p<0.01) in WMW. Haematological changes include significant (p<0.01) increase in lymphocytes, monocytes and total leukocytes. Eosinophils also increased significantly (p<0.001) while haemoglobin, packed cell volume and neutrophil decreased significantly (p<0.05). Receiver operating characteristic curve and multivariate analyses revealed ADA (p<0.002) and IgG (p<0.05) as important immune markers respectively for assessing sub-clinical effects of occupational exposure. Our data suggest ADA and IgG as useful immune health and safety indicators in WMW.

Serum total immunoglobin-E and health hazards in workers involved in land fill and compost areas of hazardous waste management plants

Background:

The exposures of bio-aerosols have reported higher occupational health hazards, the association between serum total IgE levels and job categories and occupational health hazards of waste disposal area was limited. The present study was undertaken to assess the relationship between occupational health hazards and Serum total IgE in waste disposal area.

Materials and Methods:

One hundred eighty subjects working in waste disposal areas in different parts of Bangalore at Karnataka, India were enrolled into the study in 2009. Using questionnaire the respiratory morbidity and other work related problems in HWW was carried. The levels of serum total IgE in study subjects were determined by using Enzyme–linked –immunosorbent assay kits (DRG International Inc, USA). The differences of serum total IgE levels between the groups were computed by using non-parametric Mann-Whitney U test. SPSS 10.0 for windows version of statistical software was used in the analysis.

Results:

The levels of serum total IgE was significantly increased in landfill area (P=0.027) compose plant workers (P=0.020). The morbidity conditions such as respiratory and musculoskeletal found significantly higher in waste disposal workers as compared to controls.

Conclusion:

The levels of serum total IgE was significantly increased in land fill area and compose plant workers but no significant relationship was found between the levels of serum total IgE and occurrence of health related symptoms or past respiratory disease.

[Solid urban waste: socio-environmental impacts and prospects for sustainable management with social inclusion]

Strategies to reconcile development with the protection of ecosystems will yet again be discussed at the forthcoming Rio +20 Summit. The management of solid urban waste is an issue which has barely been touched upon in such discussions. Given the institutionalization of the National Solid Waste Policy, this paper seeks to contribute to this debate and to single out alternatives to tackle this issue with an emphasis on social inclusion. For this purpose, specialized scientific literature was consulted as well as information on solid waste management. It is clearly seen that inadequate management of solid waste has immediate impacts on the environment and health, and contributes to climate change. Considering the limitations of the current options for waste disposal, it is essential to minimize the quantities produced by reducing, reusing and recycling. In this context, the role of independent waste gatherers who have been conducting work of great environmental importance is highlighted. Given the vulnerabilities of this population, it is necessary to devise public policies to ensure that waste gathering is a more respected and less risky activity that guarantees an income, so as to move towards more healthy, equitable and sustainable development.

Work-related health symptoms among compost facility workers: a cross-sectional study

Background

Industrial composting is a relatively new and expanding activity. Several studies indicate that compost workers are at risk to develop health symptoms. The aim of this study was to assess the prevalence of work-related health symptoms among compost workers compared with control subjects.

Methods

A questionnaire was distributed among 62 workers (31 exposed and 31 non-exposed workers). Data were analyzed using simple and multiple logistic regression analyses.

Results

Workers exposed to organic dust reported significantly more often respiratory, irritation (e.g., eyes, nose and throat), gastrointestinal, and skin symptoms than the non-exposed group. Moreover, all work-related symptoms were significantly more often reported by exposed than non-exposed workers. After adjustment for smoking status and age, the associations between exposure and respiratory, gastrointestinal, and skin symptoms remained statistically significant, in particular if these symptoms were work-related.

Conclusions

This study confirms that workers at compost facilities are at risk to develop occupational health problems, most likely related to organic dust exposure.

The levels of inflammatory markers and oxidative stress in individuals occupationally exposed to municipal solid waste in Ogun State, South West Nigeria

Airway inflammation and related respiratory complaints are common symptoms among waste management workers (WMWs). This study investigated the relationship between exposure to municipal solid waste (MSW) and the levels of inflammatory markers and oxidative stress among WMW of Ogun State, South West Nigeria. A total of 280 subjects consisting of 180 WMW and 100 controls were recruited. Ten millilitres of blood were collected from antecubital vein of the subjects for analysis. Results reveal that exposure to MSW is associated with systemic inflammation and oxidative stress. Significant ( p < 0.001) elevation of ceruloplasmin (Cp) and C-reactive protein was associated with marked decreases in superoxide dismutase ( p < 0.01), catalase ( p < 0.001), and glutathione ( p < 0.05) and significant ( p < 0.001) increases in malondialdehyde (MDA) and uric acid when compared with control. Haematological disorders include significant ( p < 0.05) decreases in haemoglobin, packed cell volume, and mean corpuscular volume and significant ( p < 0.01) increase in total leucocyte count. Apart from decreased albumin ( p < 0.05) and elevated aspartate aminotransferase ( p < 0.05) activity observed in WMW, other markers of hepatic (alanine aminotransferase, alkaline phosphatase, total cholesterol and triglycerides) and renal (urea and creatinine) functions did not change significantly ( p > 0.05) when compared with the control. A positive correlation between leucocytes ( r = 0.195, p < 0.01), Cp ( r = 0.210, p < 0.01) and job duration and between Cp and MDA ( r = 0.200, p < 0.01) and Cp and leucocytes ( r = 0.260, p < 0.001) were observed in WMW. Overall, exposure to MSW predisposes to systemic inflammation and oxidative stress and Cp may be a useful biomarker for monitoring health status of Nigerian WMWs.

Pre- and postshift levels of inflammatory biomarkers and DNA damage in non-bitumen-exposed construction workers-subpopulation of the German Human Bitumen Study

Circadian variations in immune defense and tissue repair may interfere with shift effects of occupational exposure when investigating biomarkers in cross-shift studies. This investigation compared biomarkers of inflammation and DNA damage in 59 nonsmoking and 59 smoking male construction workers pre- (6-10 a.m.) versus postshift (4-7 p.m.). Cellular compositions were analyzed in blood, induced sputum (IS), and nasal lavage fluid (NALF) and soluble inflammatory biomarkers were analyzed in IS and NALF. DNA damage was measured as 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo) adducts and DNA strand breaks (alkaline Comet assay) in white blood cells (WBC). Apoptosis was quantified as percent apoptotic cells by annexin V and 7-amino-actinomycin staining in blood lymphocytes using flow cytometry. In nonsmokers higher preshift than postshift levels of interleukin-8 (IL-8) in IS and more DNA strand breaks were detected. However, more DNA adducts were found postshift. Among smokers, the cellular composition of IS and NALF differed between pre- and postshift samples, in particular more neutrophils pre- than postshift. In contrast, more cells in early apoptosis were observed post shift in both smokers and nonsmokers. These results indicate a potential influence of circadian rhythms on several biomarkers used in epidemiological studies. Data suggest interference with shift-work effects of occupational exposure in cross-shift studies and also the need to consider smoking as a modifying variable.

Musculoskeletal disorders among municipal solid waste collectors in Mansoura, Egypt: a cross-sectional study

OBJECTIVE

To assess the percentage of musculoskeletal complaints and their possible risk factors among municipal solid waste (MSW) collectors.

DESIGN

A descriptive cross-sectional study with a comparison group.

SETTING

Primary level of care, at the Western Municipality of Mansoura City, Egypt.

PARTICIPANTS

A total of 160 male MSW collectors fulfilled the eligibility criteria and 120 of them participated in the study (response rate of 75%). The inclusion criteria were permanent or temporary solid waste collectors employed for 1 year or more. A comparison group of 110 male service workers at the Faculty of Medicine, Mansoura University, comparable to MSW collectors in most of the variables.

OUTCOME

The percentage of musculoskeletal disorders (MSDs) among collectors, their risk factors (socio-demographic, psychosocial, physical), and the independent risk factors for having the disorders.

RESULTS

The percentage of musculoskeletal complaints during the past 12 months was higher among MSW collectors (60.8%) than the comparison group (43.6%). Low back was the most frequently affected body region among MSW collectors. The differences in the distribution of musculoskeletal complaints between the two groups were statistically significant for the neck and hip/thigh regions. Logistic regression analysis revealed that the independent risk factors for musculoskeletal symptoms among MSW collectors were the longer duration of employment (OR=0.4, 95% CI=0.1 to 0.9); low decision latitude (OR=0.3, 95% CI=0.1 to 0.7); lifting, pulling; pushing/carrying loads >20 kg (OR=5.5, 95% CI=1.8 to 17.0) and walking for long periods of time (OR=2.6, 95% CI=1.1 to 6.6).

CONCLUSIONS

Musculoskeletal complaints are highly prevalent among MSW collectors which require engineering, medical and legislative measures. We suggest further research in the interventions that could reduce the high percentage among collectors.

Characterization and proinflammatory response of airborne biological particles from wastewater treatment plants

Wastewater contains a variety of microorganisms, and unit operations in the plants could release these biological components into the air environment. These airborne biological particles could have adverse health effects on plant workers and the downwind population. This study provides a first report on the concentration and characterization of the airborne biological particles in six wastewater treatment plants in Mumbai, India. The study indicates that 49% and 27% of the samples exceed, respectively, the exposure limit for airborne endotoxin and bacteria in occupational settings. Endotoxin was identified as the single most important component of the particulate matter responsible for induction of proinflammatory indicator (tumor necrosis factor-α) in in vitro assay. Identification of several clinically important bacterial species in the samples suggests that the workers at the treatment plant are exposed to opportunistic and infectious bacteria. Principal component analysis was used to identify the groups among the bacterial species which serves as the signature for transport study. Analysis also shows that the component related to spore-forming bacteria is present in all samples.

Workers' exposure to dust, endotoxin and β-(1-3) glucan at four large-scale composting facilities

OBJECTIVES

To characterise compost workers' exposure to dust, endotoxin and β-(1-3) glucan during various operational practices and investigate whether dust concentrations are a useful indicator of endotoxin exposure in compost workers.

METHODS

This study assessed inhalable dust fractions, bacterial endotoxin and β-(1-3) glucan in 117 personal samples and 88 ambient samples from four large-scale composting facilities.

RESULTS

Employees' exposures to inhalable dust, endotoxin and β-(1-3) glucan exhibited a large range. Inhalable dust was found to be generally low (GM 0.99 mg/m(3), GSD 2.99 mg/m(3)). Analysis of the biological component of the dust showed that employees' exposures to endotoxin were elevated (GM 35.10 EU/m(3), GSD 9.97 EU/m(3)). Employees' exposure to β-(1-3) glucan was low (GM 0.98 ng/m(3), GSD 13.39 ng/m(3)). Dust levels were elevated during manual sorting and screening of waste and high levels of endotoxin and β-(1-3) glucan were observed during all practices involving the movement of waste. A significant correlation was observed between the personal dust levels and personal endotoxin concentrations (r=0.783, p<0.05) and that personal inhalable dust concentration may be a valuable predictor for personal endotoxin concentration in the sites studied.

CONCLUSIONS

Workers at composting sites are exposed to high levels of bacterial endotoxin consistent with adverse respiratory outcomes even though in most cases, their personal dust exposure is below the suggested regulatory levels. Dose-response data for the biological components present in the dust encountered at composting sites are not well established at this time and site operators should adopt precautionary measures when assessing and managing these potential risks.

Health and safety in waste collection: Towards evidence-based worker health surveillance

BACKGROUND

Waste collectors around the world are at risk for work-related disorders and injuries. The aim of this study was to assess work demands, acute physiologic responses, illnesses, and injuries as a starting point for worker health surveillance (WHS).

METHODS

A systematic search was performed in PubMed and Embase on work demands, acute bodily responses, health, and injuries. A quality assessment and evidence synthesis was performed.

RESULTS

From a total of 379 retrieved studies, 50 studies fulfilled the inclusion criteria. Waste collecting varied from informal manual gathering to semi-automated systems. Most studies ("number of studies") on work demands and/or acute bodily responses addressed bioaerosols (14). Studies of health effects addressed respiratory complaints (8), and those on injuries addressed acute musculoskeletal disorders (3). Strong evidence is available that exposure to bioaerosols exceeds recommendations. Moderate evidence is available for an increased risk of respiratory complaints and musculoskeletal injuries, with significant odds ratios reported varying between 1.9-4.1 and 1.5-3.3, respectively. Limited evidence exists for gastrointestinal disorders and hearing loss.

CONCLUSIONS

WHS in waste collection is warranted for early detection of respiratory, gastrointestinal, and musculoskeletal disorders, and hearing loss.