Association between waste management and HBV among solid municipal waste workers: a systematic review and meta-analysis of observational studies

A Systematized Overview of Published Reviews on Biological Hazards, Occupational Health, and Safety

Introduction

The COVID-19 pandemic turned biological hazards in the working environment into a global concern. This systematized review of published reviews aimed to provide a comprehensive overview of the specific jobs and categories of workers exposed to biological hazards with the related prevention.

Methods

We extracted reviews published in English and French in PubMed, Embase, and Web of Science. Two authors, working independently, subsequently screened the potentially relevant titles and abstracts recovered (step 1) and then examined relevant full texts (step 2). Disagreements were resolved by consensus. We built tables summarizing populations of exposed workers, types of hazards, types of outcomes (types of health issues, means of prevention), and routes of transmission.

Results

Of 1426 studies initially identified, 79 studies by authors from every continent were selected, mostly published after 2010 (n = 63, 79.7%). About half of the reviews dealt with infectious hazards alone (n = 38, 48.1%). The industrial sectors identified involved healthcare alone (n = 16), laboratories (n = 10), agriculture (including the animal, vegetable, and grain sectors, n = 32), waste (n = 10), in addition of 11 studies without specific sectors. The results also highlighted a range of hazards (infectious and non-infectious agents, endotoxins, bioaerosols, organic dust, and emerging agents).

Conclusion

This systematized overview allowed to list the populations of workers exposed to biological hazards and underlined how prevention measures in the healthcare and laboratory sectors were usually well defined and controlled, although this was not the case in the agriculture and waste sectors. Further studies are necessary to quantify these risks and implement prevention measures that can be applied in every country.

Sero-prevalence of hepatitis viral infections among sanitary workers across worldwide: a systematic review and meta-analysis

BACKGROUND

Sanitation or sanitary workers are exposed to hepatitis virus infections because of filthy and dangerous working conditions. The current global systematic review and meta-analysis aimed to estimate the pooled sero-prevalence of occupationally associated hepatitis virus infection among them.

METHODS

Preferred Reporting Items for Systematic Reviews (PRISMA), and Population, Intervention, Comparison, Outcome and study design (PICOS) were used for flow diagram, and review questions, respectively. Four databases other methods were used published articles from 2000 to 2022. Boolean logic (AND, OR), MeSH, and keywords were used: (Occupation *OR Job *OR Work) AND (Hepatitis A *OR Hepatitis B virus *OR Hepatitis C virus *OR Hepatitis E virus) AND (Solid waste collectors [SWCs] *OR Street sweepers [SS] *OR Sewage workers [STWs] *OR health care facilities cleaners [HCFCs)) AND (Countries). Stata MP/17 software was used for pooled prevalence analysis, meta-regression analysis (Hedges) at a 95% confidence interval (CI:95%).

RESULTS

A total of 182 studies were identified studies, a total of 28 studies were included from twelve countries. Of these, from developed (n = 7) and developing countries (n = 5). From total a of 9049 sanitary workers, 5951(66%), 2280 (25%) and 818 (9%) were STWs, SWCs and SS, respectively. Globally, the pooled sero-prevalence of occupational-related hepatitis viral infections among sanitary workers was 38.06% (95% CI: 30-0.46.12). Of this, it was 42.96% (95% CI: 32.63-53.29) and 29.81% (95% CI: 17.59-42.02) for high-income and low-income countries, respectively. Meanwhile, by sub-analysis, the highest pooled sero-prevalence of hepatitis viral infections by categories, type and year were 47.66% (95%CI: 37.42-57.90), 48.45% (95% CI: 37.95-58.96), and 48.30% (95% CI: 36.13-60.47) for SWTs, HAV, and 2000 to 2010 year, respectively.

CONCLUSION

The consistency of the evidence suggests that sanitation workers, particularly sewage workers, are susceptible to occupationally acquired hepatitis regardless of their working conditions, necessitating significant changes to occupational health and safety regulations from governmental policies and other initiatives to reduce risks among sanitary workers.

Municipal solid waste, an overlooked route of transmission for the severe acute respiratory syndrome coronavirus 2: a review

Municipal solid waste could potentially transmit human pathogens during the collection, transport, handling, and disposal of waste. Workers and residents living in the vicinity of municipal solid waste collection or disposal sites are particularly susceptible, especially unprotected workers and waste pickers. Recent evidence suggests that municipal solid waste-mediated transmission can spread the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to humans. Such risks, however, have received little attention from public health authorities so far and may present an under-investigated transmission route for SARS-CoV-2 and other infectious agents during pandemics. In this review, we provide a retrospective analysis of the challenges, practices, and policies on municipal solid waste management during the current pandemic, and scrutinize the recent case reports on the municipal solid waste-mediated transmission of the coronavirus disease 2019 (COVID-19). We found abrupt changes in quantity and composition of municipal solid wastes during the COVID-19. We detail pathways of exposure to SARS-CoV-2 and other pathogens carried on municipal solid wastes. We disclose evidence of pathogenic transmission by municipal solid waste to humans and animals. Assessments of current policies, gaps, and voluntary actions taken on municipal solid waste handling and disposal in the current pandemic are presented. We propose risk mitigation strategies and research priorities to alleviate the risk for humans and vectors exposed to municipal solid wastes.

Dynamic assessment of economic and environmental performance index and generation, composition, environmental and human health risks of hospital solid waste in developing countries; A state of the art of review

Many studies have been conducted on hospital solid waste management (HSWM) throughout the world, especially developing countries. This interdisciplinary study aims to summarize the available knowledge on the health and environmental risks of hospital solid waste (HSW) and also, develop a dynamic associational assessment among hospital solid waste generation rate (HSWGR), hospital solid waste composition (HSWC), gross domestic product (GDP) per capita, and environmental performance index (EPI) in some developing countries for the first time. The results of this study showed that researchers from India, China, Pakistan, Brazil, and Iran had found more evidence about the health, economic, and environmental issues in HSW than the other developing countries. The literature showed that the highest and lowest reported HSWGR (in national average level) belonged to Ethiopia (6.03) and India (0.24) kg bed ^-1 day^-1, respectively. It has also been shown that all studied countries except Serbia, have higher levels of hazardous waste in their HSWC, based on the WHO's standard. Furthermore, the quantity and quality of HSW in developing countries depend on the service provided by the hospital, type of hospital, HSWM system, and the level of regional economic and culture. The association analysis showed that the EPI and GDP per capita of developing countries were significantly (p-value <0.05) associated with HSWGR, non-hazardous HSW, and hazardous HSW by the Spearman coefficients equal to 0.389, 0.118, -0.118, and 0.122, 0.216, and -0.346, respectively. However, it can be concluded that GDP per capita and EPI have a weak correlation with hazardous HSW and non-hazardous HSW. Moreover, HSW has many hazardous health and environmental risks such as dioxin and furan, that must be controlled and managed through implementing programs and policies based on sustainable development. As a final point, we believed that the present study can be considered to be a guide for future studies on HSWM in developing countries.

Continued Medical Waste Exposure of Recyclable Collectors Despite Dumpsite Closures in Brazil

BACKGROUND

Brasilia, the capital of Brazil, currently has the largest dumpsite of the Americas at Estrutural, with over 30 million tons of waste accumulated. Recyclable waste collectors are a group of workers who, in addition to having a low socioeconomic status and residing in vulnerable areas, work sorting garbage in inadequate and unsanitary areas. This profession puts individuals at risk, resulting in death, mutilation, and disease for workers.

OBJECTIVES

The aim of this study was to understand the effects of waste on recyclable collectors, along with their perceptions of associated risks.

METHODS

A qualitative study was conducted, using interviews with 34 participants at Estrutural.

RESULTS

Collectors were exposed to several hazards, including biological, physical, and more extreme hazards (e.g. being run over by waste trucks). Personal protective equipment was not adequately used, exposing recyclable collectors to injury. Accidents included cuts, burns, skin lesions, eyes lesions, and arm, leg, head, feet, and hand injuries and amputations. Often, homecare remedies and collected medical waste (e.g. pain killers) were used on these injuries instead of seeking out proper medical care.

CONCLUSIONS

Recyclable collectors were aware of occupational hazards, but lacked education on the risks and consequences associated with exposure to medical hazards. Moreover, Brazil recently formally closed all dumpsites, complicating this issue. The findings of the present study confirm the need to address these hazards to provide a safe working environment for waste pickers.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

This study was approved by the Research and Ethics Committee of the Health School of Brasília University under Opinion n. 1.517.670/2016.

COMPETING INTERESTS

The authors declare no competing financial interests.

Seroprevalence of HBV among Egyptian municipal solid waste workers

Background

Municipal solid waste workers (MSWWs) are potentially exposed to diverse hazards that are not merely a consequence of their occupation. Of particular concern are infectious diseases. The endemicity of hepatitis B virus (HBV) infection in Egypt suggests the possibility of disease transmission in MSWWs from improperly disposed hazardous materials found in the solid waste stream. To date, such transmission has not adequately been epidemiologically studied in Egypt.

Objective

To explore the seroprevalence of HBV among MSWWs in Egypt.

Methods

We conducted a descriptive cross-sectional study that included 1467 MSWWs recruited from the main municipality company in Alexandria, Egypt, in February 2018. The enrolled participants were categorized into two occupational groups (exposed; n = 1361 and non-exposed; n = 115) on the basis of their direct exposure to solid waste. The study procedure involved interviews using a predesigned questionnaire that covered general demographic information. Blood samples from all participants were tested for the hepatitis B surface antigen (HBsAg), a marker of active HBV infection, using a third-generation enzyme linked immunosorbent assay (ELISA).

Results

All MSWWs were male and had a mean age of 39.8 (±7.9) years. The majority were urban residents (72.8%) and engaged in solid waste collection (63.8%) or sorting (13.6%). The overall seroprevalence of active HBV infection was 1.5%. In total, 3.8% of the workers received the compulsory HBV vaccine during their infancy, meaning approximately 96.2% of the participants were at risk for HBV infection. Evaluating the availability and use of personal protective equipment revealed that most of the workers were provided with and wore overalls but not safety shoes, protective gloves, face masks, or helmets.

Conclusion

The present work suggests the possible transmission of HBV in workers exposed to municipal solid waste. This result necessitates the initiation of prophylactic HBV immunizations and the consideration of safer techniques for waste management.

Urban Waste Collectors in Belo Horizonte, Brazil: Their Perceptions of Occupational Health Risk

Frequent contact with hazardous materials makes waste collection a potentially unhealthy activity. This article assesses the perception of waste management workers regarding work-related accidents in domestic and health service contexts in Brazil. Six focus groups were performed between June 2014 and August 2015. The aims of this study were to apprehend different aspects of the participants' health, workers' experiences of work-related accidents and perception of risks. Cuts and puncture injuries were reported most frequently in the line of work and were often considered as irrelevant. Immunization against hepatitis B was not common among all workers, which increases the risk of infection for those individuals. Finally, it is considered urgent to consolidate an inclusive space in which workers can have discussions on their health.

Ineffective waste site closures in Brazil: A systematic review on continuing health conditions and occupational hazards of waste collectors

There are approximately 15 million people engaged in waste collection or recycling activities in the world. Some of these dump sites are informal and people work in environments that are labor-intensive, unregulated, unregistered, low-paid, unrecorded, and environmentally hazardous. A systematic review was conducted to assess consequential health conditions and occupational risks that affect waste collectors in Brazil. The search was limited to Brazil because although the government closed dump sites, open-air dumping-the worst type of waste disposal-still occurs in about half of the country; moreover, Brazil is the only country to systematically collect data on the occupation, with an estimated 229,568 recyclable collectors of all types country-wide, which offers relevant and pertinent data on the topic. The results of the search indicated that nearly every region has individuals that work as recyclable collectors. As expected, the sites are full of occupational hazards to the workers that can include: long working hours; exposures to physical, chemical, mechanical, biological, ergonomic and social agents; and frequent work accidents. Exposure to these risks can result both in physical and psychological illnesses. In view of these findings, public policies could be strengthened by supporting and providing incentives to municipalities, schools, universities, health professionals, and all others who will contribute to the closure of open-air waste or poor waste disposal systems. Moreover, an improved awareness should be provided to the general population about environmental education and correct disposal of garbage. The goal of healthy waste disposal conditions ultimately decreases environmental and public health effects, while improving the working conditions, quality of life, and health outcomes for recyclable collectors.

Seroprevalence of hepatitis B and C among domestic and healthcare waste handlers in Belo Horizonte, Brazil

Infection with the hepatitis B and C viruses may occur through contact with infected body fluids, including injury with infected sharps. Collectors of domestic or healthcare wastes are potentially exposed to these infections. The aim of this article is to investigate the risk factors associated with the prevalence of hepatitis B and C viruses (HBV and HCV) infection among domestic and healthcare waste workers in Belo Horizonte, Brazil. A cross-sectional study of hepatitis B and C infection was conducted from November 2014 to January 2015, through blood sample collection and interviews about socio-demographic factors with 61 workers exposed to healthcare waste ('exposed') and 461 exposed only to domestic wastes ('unexposed'). The prevalence of antibodies to HCV (Anti-HCV) antibodies was 3.3% in 'exposed' workers and 0.9% in 'unexposed', and of antibody to hepatitis B core antigen (Anti-HBc) was 9.8% and 5.6% in 'exposed' and 'unexposed' workers, respectively. Only 207 (44.9%) of those exposed to domestic waste and 45 (73.8%) of those handling healthcare waste were effectively immunised against hepatitis B virus (HBV). Exposures to domestic waste and to healthcare wastes were associated with similar risks of infection with HBV. The risk of hepatitis C virus (HCV) infection was marginally higher among healthcare waste workers compared with domestic waste workers, probably because of needlestick accidents owing to deficient sharps management systems. Immunisation against hepatitis B and screening tests to ensure the success of vaccination should be a condition for recruitment for both groups of waste workers.

Economic evaluation of HBV vaccination: A systematic review of recent publications (2000-2013)

AIM

To conduct a systematic review of the economic evaluations (EE) of HBV vaccination, taking also into account the studies published in the new millennium.

METHODS

An extensive scientific literature review was conducted using two electronic medical journal databases: Scopus and PubMed engines for published studies on EE of HBV vaccination.

RESULTS

22 articles were reviewed, 9, 5 and 8 cost-effectiveness, cost-benefit and cost-utility analysis, respectively. Studies were mainly concerning EE of universal vaccination (UV), mostly with regards to low or low-medium income countries. For high income countries, EE were focused on the possible implementation of HBV vaccination in particular settings, such as diabetic, renal and other chronic conditions care, as well as infectious diseasesUV has usually a very good cost-effectiveness ratio (80%), ranging from cost-saving (China) or few Euro per LY/QALY gained (in Thailand, and Vietnam) to 630.00$/QALY in USA (Asian and Pacific Islands) Moreover, EE of HBV vaccination are favorable in the infectious diseases field as well as for chronic conditions. In relation to diabetes the studies gave controversial results.

CONCLUSION

This systematic review highlighted the importance of introducing HBV vaccination not only for infant UV program but also for other settings in which patients are people affected by communicable and non-communicable diseases.

The Prevalence of Hepatitis B Virus Among Municipal Solid Waste Workers: Necessity for Immunization of At-Risk Groups

BACKGROUND

Hepatitis B virus (HBV) is likely to be more prevalent in certain populations and occupational groups, such as municipal solid waste workers (MSWWs).

OBJECTIVES

The current study aimed to estimate the prevalence of HBV and its risk factors among MSWWs compared to other municipal employees not exposed to waste.

PATIENTS AND METHODS

The current cross-sectional study included 654 municipal employees in Zahedan (south-eastern Iran). A sample of blood was taken from each participant and tested for HBsAg through the enzyme-linked immunosorbent assay (ELISA). Demographic and other data on high risk behaviors were also collected through in-depth interviews. Data were analyzed using chi-square test and multiple regression analysis by STATA.

RESULTS

The overall prevalence of HBV among municipal employees was 3.06% (95% CI: 1.70 - 4.30); however, it varied among the different employee subgroups as follows: 6.20% (95% CI: 2.70 - 9.70) in MSWWs, 3.3% (95% CI: 0.08 - 5.80) in drivers and 1% among staff who were not exposed to waste. Multiple regression analysis showed that exposure to waste [OR = 9.36; 95% CI = 2.01 - 43.7], lack of vaccination against HBV [OR = 3.83; 95% CI = 1.86 - 25.2], jaundice [OR = 6.91; 95% CI = 1.51 - 31.5], history of endoscopy [OR = 2.86; 95% CI = 1.08 - 7.62], and high risk behaviors [OR = 4.80; 95% CI = 1.96 - 27.2] were independently associated with HBV.

CONCLUSIONS

Greater encouragement for immunization against HBV as well as better education on HBV transmission routes and work safety precautions should be implemented to reduce the prevalence of HBV in MSWWs.

The reality of waste management in primary health care units in Brazil

A large number of users are serviced in primary health care units in Brazil, both in health facilities and in households. These services generate waste that must be managed safely, but there is no legislation that regulates this type of waste management in Brazil. The objective of this study was to analyse the production and management of waste in primary health care. A direct observation was performed of the stages in the handling and weighing of waste generated in primary health care units in the municipality of Goiânia (Brazil). The units generated infectious, chemical, and common waste, as well as sharp objects. The generation of waste ranged between 0.027 and 0.075 kg user-day. The generated waste was classified mostly as common and recyclable. Flaws were observed in the management of all types of waste. The critical point is segregation. Only 34.1% of the waste disposed of as infectious actually belonged to this group, the rest was ordinary waste. Flaws at this stage increase the volume of infectious waste, the occupational and environmental risks, and associated costs. Intervention to change this reality is needed and it requires the careful preparation of a waste management plan, corroborating structural changes to the implementation of this plan, and professional training and public policies to guide waste management in primary care, especially those generated in households.