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Heida A, Maal-Bared R, Veillette M, Duchaine C, Reynolds KA, Ashraf A, Ogunseye OO, Jung Y, Shulman L, Ikner L, Betancourt W, Hamilton KA, Wilson AM. Quantitative microbial risk assessment (QMRA) tool for modelling pathogen infection risk to wastewater treatment plant workers. WATER RESEARCH 2024; 260:121858. [PMID: 38936269 DOI: 10.1016/j.watres.2024.121858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
Wastewater treatment plants (WWTPs) provide vital services to the public by removing contaminants from wastewater prior to environmental discharge or reuse for beneficial purposes. WWTP workers occupationally exposed to wastewater can be at risk of respiratory or gastrointestinal diseases. The study objectives were to: (1) quantify pathogens and pathogen indicators in wastewater aerosols near different WWTP processes/unit operations, (2) develop a QMRA model for multi-pathogen and multi-exposure pathway risks, and (3) create a web-based application to perform and communicate risk calculations for wastewater workers. Case studies for seven different WWTP job tasks were performed investigating infection risk across nine different enteric and respiratory pathogens. It was observed that the ingestion risk among job tasks was highest for "walking the WWTP," which involved exposure from splashing, bioaerosols, and hand-to-mouth contact from touching contaminated surfaces. There was also a notable difference in exposure risk during peak (5:00am-9:00am) and non-peak hours (9:00am- 5:00am), with risks during the peak flow hours of the early morning assumed to be 5 times greater than non-peak hours. N95 respirator usage reduced median respiratory risks by 77 %. The developed tool performs multiple QMRA calculations to estimate WWTP workers' infection risks from accidental ingestion or inhalation of wastewater from multiple pathogens and exposure scenarios, which can inform risk management strategies to protect occupational health. However, more data are needed to reduce uncertainty in model estimates, including comparative data for pathogen concentrations in wastewater during peak and non-peak hours. QMRA tools will increase accessibility of risk models for utilization in decision-making.
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Affiliation(s)
- Ashley Heida
- School for Engineering of Matter, Transport and Energy, Arizona State University, 502 E Tyler Mall, Tempe, AZ 85287, USA; The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, Tempe, AZ 85281, USA
| | - Rasha Maal-Bared
- Bellevue Research and Testing Laboratory, CDM Smith, 14432 SE Eastgate Way Suite 100, Bellevue, WA 98007, USA
| | - Marc Veillette
- Department of biochemistry, microbiology and bioinformatics, Université Laval, Canada Research Chair on Bioaerosols, Quebec City, Canada
| | - Caroline Duchaine
- Department of biochemistry, microbiology and bioinformatics, Université Laval, Canada Research Chair on Bioaerosols, Quebec City, Canada
| | - Kelly A Reynolds
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Ahamed Ashraf
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Olusola O Ogunseye
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Yoonhee Jung
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Lester Shulman
- Central Virology Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Luisa Ikner
- Department of Environmental Science, College of Agricultre, Life & Environmental Sciences, University of Arizona, Tucson, AZ, USA
| | - Walter Betancourt
- Department of Environmental Science, College of Agricultre, Life & Environmental Sciences, University of Arizona, Tucson, AZ, USA
| | - Kerry A Hamilton
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, Tempe, AZ 85281, USA; School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ 85281, USA
| | - Amanda M Wilson
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
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Tolera ST, Temesgen S, Mulat Endalew S, Alamirew TS, Temesgen LM. Global systematic review of occupational health and safety outcomes among sanitation and hygiene workers. Front Public Health 2023; 11:1304977. [PMID: 38174086 PMCID: PMC10763668 DOI: 10.3389/fpubh.2023.1304977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Sanitary workers are exposed to a variety of occupational hazards in a variety of working environments, which can result in occupational-related outcomes. As a result, the goal of this review was to identify occupational health and safety outcomes among sanitary workers worldwide. Methods PRISMA was used as flow diagram and PICOS was used review questions. The studies published in English were searched from databases and others methods ranging from 2000 to 2022. Boolean logic (AND, OR), MeSH, and keywords used: (Occupation *OR Job *OR Work) AND (Occupational related respiratory Symptoms *OR Disease) AND [Solid waste collectors (SWCs) *OR Street sweepers (SS) *OR Sewage workers and waste treatment (STWs)] AND (Countries). Results A total of 228 studies were identified from 23 countries across the world. Studies were found via PubMed (n = 40), Medline (n = 25), Embase (n = 11) and Global Health (n = 66) and Google scholar (n = 63) and from previous (n = 23). From 8,962 of eligible sanitary workers, about 4,742 (54%), 1714 (19%) and 1,441 (16%) were sewage, sweepers and solid waste workers, respectively. A total study (n = 51) were eligible for occupational health and safety outcomes. Of these, respiratory problems accounted 27 (52%) and Gastroenteritis 14 (27%). Conclusion Despite a large number of studies to date provides sanitary employees all over the world face occupational-related risks, hence more research is needed to enhance and quantify illness burden among sanitary workers.
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Affiliation(s)
- Sina Temesgen Tolera
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Shibiru Temesgen
- Department of Statistics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Salie Mulat Endalew
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | | | - Liku Muche Temesgen
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
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Berglund F, Rodríguez-Molina D, Gradisteanu Pircalabioru G, Blaak H, Chifiriuc MC, Czobor Barbu I, Flach CF, Gheorghe-Barbu I, Măruțescu L, Popa M, de Roda Husman AM, Wengenroth L, Schmitt H, Larsson DGJ. The resistome and microbiome of wastewater treatment plant workers - The AWARE study. ENVIRONMENT INTERNATIONAL 2023; 180:108242. [PMID: 37816267 DOI: 10.1016/j.envint.2023.108242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023]
Abstract
Urban wastewater treatment plants harbor a large collection of antibiotic resistant enteric bacteria. It is therefore reasonable to hypothesize that workers at such plants would possess a more diverse set of resistant enteric bacteria, compared to the general population. To address this hypothesis, we have compared the fecal microbiome and resistome of 87 workers at wastewater treatment plants (WWTPs) from Romania and the Netherlands to those of 87 control individuals, using shotgun metagenomics. Controlling for potential confounders, neither the total antibiotic resistance gene (ARG) abundance, nor the overall bacterial composition were significantly different between the two groups. If anything, the ARG richness was slightly lower in WWTP workers, and in a stratified analysis the total ARG abundance was significantly lower in Dutch workers compared to Dutch control participants. We identified country of residence, together with recent antibiotic intake in the Dutch population, as the largest contributing factors to the total abundance of ARGs. A striking side-finding was that sex was associated with carriage of disinfectant resistance genes, with women in both Romania and the Netherlands having significantly higher abundance compared to men. A follow up investigation including an additional 313 publicly available samples from healthy individuals from three additional countries showed that the difference was significant for three genes conferring resistance to chemicals commonly used in cosmetics and cleaning products. We therefore hypothesize that the use of cosmetics and, possibly, cleaning products leads to higher abundance of disinfectant resistance genes in the microbiome of the users. Altogether, this study shows that working at a WWTP does not lead to a higher abundance or diversity of ARGs and no large shifts in the overall gut microbial composition in comparison to participants not working at a WWTP. Instead, other factors such as country of residence, recent antibiotic intake and sex seem to play a larger role.
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Affiliation(s)
- Fanny Berglund
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Daloha Rodríguez-Molina
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU (Ludwig-Maximilians-Universität) Munich, Munich, Germany
| | - Gratiela Gradisteanu Pircalabioru
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, Bucharest, Romania; Academy of Romanian Scientists, Bucharest, Romania
| | - Hetty Blaak
- Centre of Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Mariana-Carmen Chifiriuc
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, Bucharest, Romania; Academy of Romanian Scientists, Bucharest, Romania
| | - Ilda Czobor Barbu
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, Bucharest, Romania
| | - Carl-Fredrik Flach
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Irina Gheorghe-Barbu
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, Bucharest, Romania
| | - Luminița Măruțescu
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, Bucharest, Romania
| | - Marcela Popa
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, Bucharest, Romania
| | - Ana Maria de Roda Husman
- Centre of Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU (Ludwig-Maximilians-Universität) Munich, Munich, Germany
| | - Heike Schmitt
- Centre of Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - D G Joakim Larsson
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden.
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Madsen AM, Uhrbrand K, Kofoed VC, Fischer TK, Frederiksen MW. A cohort study of wastewater treatment plant workers: Association between levels of biomarkers of systemic inflammation and exposure to bacteria and fungi, and endotoxin as measured using two methods. WATER RESEARCH 2023; 231:119625. [PMID: 36680819 DOI: 10.1016/j.watres.2023.119625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/05/2022] [Accepted: 01/15/2023] [Indexed: 06/17/2023]
Abstract
Work in wastewater treatment plants (WWTPs) can be associated with exposure to airborne microorganisms and endotoxin from the working environment. The aim of this study was to obtain knowledge about whether serum levels of the markers of systemic inflammation, C-reactive protein (CRP) and serum amyloid A (SAA), are associated with personal exposure to endotoxin, measured using the Limulus (endotoxinLimulus) and the rFC (endotoxinrFC) assays, as well as bacteria and fungi in a cohort of WWTP workers. Exposure and blood samples were collected for 11 workers over one year. Exposure to endotoxinLimulus-day and endotoxinrFC-day correlated significantly (r = 0.80, p<0.0001, n = 104), but endotoxinLimulus-day was 4.4 (Geometric mean (GM) value) times higher than endotoxinrFC-day (p<0.0001). The endotoxinLimulus-day, endotoxinrFC-day, bacteria, and fungal exposure as well as serum levels of CRP-day (GM=1.4 mg/l) and SAA-day (GM=12 mg/l) differed between workers. Serum levels of SAAday correlated significantly with CRPday (r = 0.30, p = 0.0068). The serum levels of CRPday were associated significantly with exposure to endotoxinLimulus-day. Exposure, SAA and CRP data were also analyzed as av. of each season, and SAAseason was associated positively and significantly with endotoxinLimulus-season and endotoxinrFC-season and negatively with fungalseason exposure. In conclusion, CRPday was associated with the endotoxinLimulus-day and SAAseason with endotoxinLimulus-season and endotoxinrFC-season exposure. Thus, we hereby document that WWTP workers are exposed to airborne endotoxin which seems to have a negative impact on their health.
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Affiliation(s)
- Anne Mette Madsen
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark.
| | - Katrine Uhrbrand
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark
| | - Victor Carp Kofoed
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark
| | - Thea K Fischer
- Dept of Clinical Research, Nordsjaellands Hospital, Denmark; Dept of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Denmark
| | - Margit W Frederiksen
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark
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Mbareche H, Dion-Dupont V, Veillette M, Brisebois E, Lavoie J, Duchaine C. Influence of seasons and sites on bioaerosols in indoor wastewater treatment plants and proposal for air quality indicators. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2022; 72:1000-1011. [PMID: 35426760 DOI: 10.1080/10962247.2022.2066735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
During wastewater treatment, bioaerosols are generated and, can either remain in suspension for several hours or settle on surfaces and workers may be exposed. The presence of pathogens in the air could contribute to an increased frequency of gastrointestinal or respiratory illness amongst workers. Due to harsh winter conditions in Eastern Canada, many of the steps in the wastewater treatment process occur indoors, leading to a greater risk of significant occupational exposure especially if there is inadequate ventilation or a lack of personal protection. This work has used stationary sampling at various indoor wastewater treatment steps both in winter and summer. Bioaerosols were evaluated using both culture and molecular methods along with ventilation characterization. Endotoxins were quantified, as well as total cultivable and gram-negative bacteria and pathogen indicators using qPCR. This study highlights the presence of potential pathogens at all steps in the treatment process, which may represent a potential occupational hazard. Comparisons between summer and winter data suggest that water temperature is an important factor for microbial activity and suggest that increasing the rate of air changes per hour in summer would be beneficial to reduce the concentration of bioaerosols during this time of the year. The screening, grit/FOGs removal and biofiltration were the most bioaerosol-loaded sites. Based on strong correlations, we suggest the reconsideration of exposure limits in WWTPs. Workers should be encouraged to use personal respiratory protection to limit the risk of health problems, especially during long-term work.Implications: The work presented herein showcases significant correlations between concentrations of endotoxins, cultivable bacteria, gram-negative bacteria, and total bacteria by qPCR from air collected in indoor wastewater treatment plants. These correlations lead us to propose new limit of exposure values, revisited to fit the endotoxin exposure limits recommendations. The results can serve as guidelines for future proposals for air quality indicators.
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Affiliation(s)
- Hamza Mbareche
- Biological Platform, Sunnybrook Research Institute, Toronto, ON Canada
- Laboratory of Medicine and Pathobiology, University of Toronto, Toronto, ON, USA
| | - Vanessa Dion-Dupont
- Pavillon Alexandre Vachon, Université Laval, Québec, QC Canada
- Axe de pneumologie, CRIUCPQ, Québec, QC Canada
| | | | - Evelyne Brisebois
- Pavillon Alexandre Vachon, Université Laval, Québec, QC Canada
- Axe de pneumologie, CRIUCPQ, Québec, QC Canada
| | - Jacques Lavoie
- Prévention des risques chimiques et biologiques, IRSST, Montréal, QC Canada
| | - Caroline Duchaine
- Pavillon Alexandre Vachon, Université Laval, Québec, QC Canada
- Axe de pneumologie, CRIUCPQ, Québec, QC Canada
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Saad-Hussein A, Moubarz G, Mahdy-Abdallah H, Helmy MA. Impact of mannose-binding lectin gene polymorphism on lung functions among workers exposed to airborne Aspergillus in a wastewater treatment plant in Egypt. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:63193-63201. [PMID: 35449337 PMCID: PMC9477903 DOI: 10.1007/s11356-022-20234-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
In this study, the risk of Aspergillus (Asp.) positivity and its respiratory health impacts on wastewater treatment plant (WWTP) workers were studied. In addition, it identified the geno-susceptibility role of mannose-binding lectin 2 (MBL2) gene polymorphisms and the mannose-binding lectin (MBL) serum levels on the pulmonary functions of the Asp.-positive workers. Pulmonary function tests (PFTs) were performed for 89 workers from a selected WWTP, after exclusion of the smokers. Molecular identification of Asp. blood positivity was done by 18S rRNA sequencing. Determination of MBL2 gene polymorphism and estimation of MBL serum levels were done. PFTs revealed abnormalities in 49.2% of the workers. Asp. was positive in 42.5% of the workers with different species. Among the Asp.-positive workers, 6.5% of the workers were with obstructive PFTs, 12.9% with restriction, and 22.6% with combined PFT abnormalities. MBL2 genotyping showed that wild genotype AA was common (68.5%) among Asp.-positive workers compared to the other genotypes. This allele, whether homozygous or heterozygous, was significantly associated with decline in PFTs of the exposed workers. MBL serum levels were significantly lower in workers with obstructive, restrictive, and combined PFT abnormalities compared to those with normal PFTs, and in the workers with Asp.-positive species than the Asp.-negative workers. Moreover, it was significantly lower in workers with Asp. fumigatus compared to that in the workers with other Asp. species, and in the Asp.-positive workers with homozygous or heterozygous A allele compared to that in the Asp.-positive workers with homozygous B allele. Working in a WWTP can be associated with impaired PFTs due to exposure to airborne fungi. MBL2 genotyping showed that Asp.-positive workers with homozygous or heterozygous A allele were at risk to develop decline in their PFTs.
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Affiliation(s)
- Amal Saad-Hussein
- Environmental and Occupational Medicine Department, National Research Centre, Environment and Climate Change Research Institute, Cairo, Egypt
| | - Gehan Moubarz
- Environmental and Occupational Medicine Department, National Research Centre, Environment and Climate Change Research Institute, Cairo, Egypt
| | - Heba Mahdy-Abdallah
- Environmental and Occupational Medicine Department, National Research Centre, Environment and Climate Change Research Institute, Cairo, Egypt.
| | - Mona Adel Helmy
- Environmental and Occupational Medicine Department, National Research Centre, Environment and Climate Change Research Institute, Cairo, Egypt
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Characteristics and Determinants of the Presence of Respiratory Symptoms among Sewage Workers in Malaysia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:8567594. [PMID: 35321247 PMCID: PMC8938149 DOI: 10.1155/2022/8567594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/25/2021] [Accepted: 02/19/2022] [Indexed: 11/17/2022]
Abstract
Background The purpose of this study was to determine the relationships of PM 2.5 and H2S exposure with the presence of work-related respiratory symptoms among sewage workers. Methods A cross-sectional study was conducted in eleven sewage plants located in the central region of Peninsular Malaysia. One hundred ninety-one sewage workers were assessed using the British Medical Research Council (BMRC) questionnaire. Area air sampling was performed in three different sewage plants to measure the following parameters: physical air quality and concentration of PM 2.5 and H2S. Result Chronic cough (34.0%) was reported as the most common symptom, followed by chronic phlegm (26.2%), shortness of breath (7.9%), and chest tightness (3.7%). There were five significant determinants of the presence of respiratory symptoms among the sewage workers: shift work (AOR 23.50, 95% CI: 1.90–616.52), working at a sludge treatment facility (STF) (AOR 25.46, 95% CI: 2.06–314.29), a longer duration of working years (AOR 1,21, 95% CI: 1.01–1.44), individual cumulative exposure to PM 2.5 (AOR 9.01, 95% CI: 1.98–83.33), and individual cumulative exposure to H2S (AOR 1.04, 95% CI: 1.01–1.07). The majority of STF and non-STF workers had higher exposure to PM 2.5 and H2S concentrations in the air than office workers. Conclusion Sewage workers working at non-STFs or STFs reported a significantly higher prevalence of work-related respiratory symptoms and exposure to PM 2.5 and H2S compared with office workers. Exposure-response relationships were also found in sewage workers' cumulative exposure to PM 2.5 and H2S and the presence of respiratory symptoms.
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Oza HH, Lee MG, Boisson S, Pega F, Medlicott K, Clasen T. Occupational health outcomes among sanitation workers: A systematic review and meta-analysis. Int J Hyg Environ Health 2021; 240:113907. [PMID: 34942466 PMCID: PMC8837624 DOI: 10.1016/j.ijheh.2021.113907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/16/2021] [Accepted: 12/14/2021] [Indexed: 01/09/2023]
Abstract
Background Sanitation workers are essential to global public health and societal wellbeing. However, the health risks and outcomes associated with exposure to occupational risk factors among sanitation workers are neither well understood nor well quantified. We undertook a systematic review to (1) identify occupational risk factors among sanitation workers and (2) assess the effect of occupational exposure to human fecal sludge and wastewater on selected health outcomes among these workers. Methods We searched four databases (i.e., PubMED, MEDLINE, EMBASE, and LILACS) for eligible studies from inception through to January 01, 2020. The included population was workers ≥15 years engaged, formally or informally, in installing, operating, servicing, cleaning or emptying a sanitation technology at any step of the sanitation chain. The included comparator was workers in other occupations or the general population. Eligible outcomes were: mortality (any or all causes), gastroenteritis, occupational injuries, respiratory diseases, musculoskeletal disorders, and mental and social health conditions. Risk of bias was assessed separately on exposure assessment and health outcome using a modified Liverpool Quality Assessment Tool (LQAT). We pooled sufficiently homogenous studies using inverse variance meta-analysis with random effects. Results A total of 65 studies (9 cohort studies, 56 cross-sectional studies) met the inclusion criteria. One quarter of studies (n = 15) were from middle-income countries. Few studies assessed occupational risk factor exposures directly; most assigned exposure via proxy of occupation of sanitation worker. We judged nearly all studies to have “high risk of bias” in exposure and outcome assessment. Despite these limitations, the consistency of the overall evidence suggests that sanitation workers are at increased risk of gastroenteritis and respiratory conditions, and may be at increased risk of musculoskeletal disorders and mental/social health conditions. The pooled odds ratio for hepatitis A--the only outcome deemed suitable for meta-analysis--was 2.09 (95% Predicted Interval: 1.39–3.00, 12 studies). There was conflicting evidence from studies of increased risk of mortality; only one study reported on injuries. Conclusion Despite a large number of studies, there is limited evidence to date of the health risks faced by sanitation workers, particularly among groups that may be at particular risk-- women, informal workers and those living in low-income countries. Nevertheless, the research to date provides suggestive evidence of elevated occupational risk among sanitation workers across a range of health condition. More research is needed to improve the current bodies of evidence for all included health outcomes to be able to quantify disease burden among this occupational group.
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Affiliation(s)
- Hemali Harish Oza
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Madison Gabriella Lee
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sophie Boisson
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Frank Pega
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Kate Medlicott
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Rodríguez-Molina D, Berglund F, Blaak H, Flach CF, Kemper M, Marutescu L, Gradisteanu GP, Popa M, Spießberger B, Weinmann T, Wengenroth L, Chifiriuc MC, Larsson DGJ, Nowak D, Radon K, de Roda Husman AM, Wieser A, Schmitt H. Carriage of ESBL-producing Enterobacterales in wastewater treatment plant workers and surrounding residents - the AWARE Study. Eur J Clin Microbiol Infect Dis 2021:10.1007/s10096-021-04387-z. [PMID: 34902088 PMCID: PMC8667530 DOI: 10.1007/s10096-021-04387-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/29/2021] [Indexed: 12/19/2022]
Abstract
To investigate whether wastewater treatment plant (WWTP) workers and residents living in close proximity to a WWTP have elevated carriage rates of ESBL-producing Enterobacterales, as compared to the general population. From 2018 to 2020, we carried out a cross-sectional study in Germany, the Netherlands, and Romania among WWTP workers (N = 344), nearby residents (living ≤ 300 m away from WWTPs; N = 431) and distant residents (living ≥ 1000 m away = reference group; N = 1165). We collected information on potential confounders via questionnaire. Culture of participants' stool samples was performed with ChromID®-ESBL agar plates and species identification with MALDI-TOF-MS. We used logistic regression to estimate the odds ratio (OR) for carrying ESBL-producing E. coli (ESBL-EC). Sensitivity analyses included stratification by country and interaction models using country as secondary exposure. Prevalence of ESBL-EC was 11% (workers), 29% (nearby residents), and 7% (distant residents), and higher in Romania (28%) than in Germany (7%) and the Netherlands (6%). Models stratified by country showed that within the Romanian population, WWTP workers are about twice as likely (aOR = 2.34, 95% CI: 1.22-4.50) and nearby residents about three times as likely (aOR = 3.17, 95% CI: 1.80-5.59) to be ESBL-EC carriers, when compared with distant residents. In stratified analyses by country, we found an increased risk for carriage of ESBL-EC in Romanian workers and nearby residents. This effect was higher for nearby residents than for workers, which suggests that, for nearby residents, factors other than the local WWTP could contribute to the increased carriage.
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Affiliation(s)
- Daloha Rodríguez-Molina
- Occupational and Environmental Epidemiology and NetTeaching Unit, Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany.
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany.
- Pettenkofer School of Public Health, Munich, Germany.
| | - Fanny Berglund
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Hetty Blaak
- Centre of Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Carl-Fredrik Flach
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Merel Kemper
- Centre of Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Luminita Marutescu
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, Bucharest, Romania
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Gratiela Pircalabioru Gradisteanu
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, Bucharest, Romania
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Marcela Popa
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, Bucharest, Romania
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - Beate Spießberger
- German Centre for Infection Research (DZIF) Partner Site Munich, Munich, Germany
- Max Von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany
- Department of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
| | - Tobias Weinmann
- Occupational and Environmental Epidemiology and NetTeaching Unit, Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany
| | - Laura Wengenroth
- Occupational and Environmental Epidemiology and NetTeaching Unit, Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany
| | - Mariana Carmen Chifiriuc
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, Bucharest, Romania
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, Bucharest, Romania
| | - D G Joakim Larsson
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Dennis Nowak
- Occupational and Environmental Epidemiology and NetTeaching Unit, Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany
- German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Katja Radon
- Occupational and Environmental Epidemiology and NetTeaching Unit, Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany
| | - Ana Maria de Roda Husman
- Centre of Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Andreas Wieser
- German Centre for Infection Research (DZIF) Partner Site Munich, Munich, Germany
- Max Von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany
- Department of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
| | - Heike Schmitt
- Centre of Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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10
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Wengenroth L, Berglund F, Blaak H, Chifiriuc MC, Flach CF, Pircalabioru GG, Larsson DGJ, Marutescu L, van Passel MWJ, Popa M, Radon K, de Roda Husman AM, Rodríguez-Molina D, Weinmann T, Wieser A, Schmitt H. Antibiotic Resistance in Wastewater Treatment Plants and Transmission Risks for Employees and Residents: The Concept of the AWARE Study. Antibiotics (Basel) 2021; 10:antibiotics10050478. [PMID: 33919179 PMCID: PMC8143112 DOI: 10.3390/antibiotics10050478] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 11/18/2022] Open
Abstract
Antibiotic resistance has become a serious global health threat. Wastewater treatment plants may become unintentional collection points for bacteria resistant to antimicrobials. Little is known about the transmission of antibiotic resistance from wastewater treatment plants to humans, most importantly to wastewater treatment plant workers and residents living in the vicinity. We aim to deliver precise information about the methods used in the AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Wastewater Treatment Plants) study. Within the AWARE study, we gathered data on the prevalence of two antibiotic resistance phenotypes, ESBL-producing E. coli and carbapenemase-producing Enterobacteriaceae, as well as on their corresponding antibiotic resistance genes isolated from air, water, and sewage samples taken from inside and outside of different wastewater treatment plants in Germany, the Netherlands, and Romania. Additionally, we analysed stool samples of wastewater treatment plant workers, nearby residents, and members of a comparison group living ≥1000 m away from the closest WWTP. To our knowledge, this is the first study investigating the potential spread of ESBL-producing E. coli, carbapenemase-producing Enterobacteriaceae, and antibiotic resistance genes from WWTPs to workers, the environment, and nearby residents. Quantifying the contribution of different wastewater treatment processes to the removal efficiency of ESBL-producing E. coli, carbapenemase-producing Enterobacteriaceae, and antibiotic resistance genes will provide us with evidence-based support for possible mitigation strategies.
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Affiliation(s)
- Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU (Ludwig-Maximilians-Universität) Munich, 80336 Munich, Germany; (K.R.); (D.R.-M.); (T.W.)
- Correspondence:
| | - Fanny Berglund
- Centre for Antibiotic Resistance Research at University of Gothenburg, Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, 405 30 Gothenburg, Sweden; (F.B.); (C.-F.F.); (D.G.J.L.)
| | - Hetty Blaak
- Centre Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands; (H.B.); (M.W.J.v.P.); (A.M.d.R.H.); (H.S.)
| | - Mariana Carmen Chifiriuc
- Earth, Environment and Life Sciences Division, Research Institute, University of Bucharest, 050657 Bucharest, Romania; (M.C.C.); (G.G.P.); (L.M.); (M.P.)
| | - Carl-Fredrik Flach
- Centre for Antibiotic Resistance Research at University of Gothenburg, Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, 405 30 Gothenburg, Sweden; (F.B.); (C.-F.F.); (D.G.J.L.)
| | - Gratiela Gradisteanu Pircalabioru
- Earth, Environment and Life Sciences Division, Research Institute, University of Bucharest, 050657 Bucharest, Romania; (M.C.C.); (G.G.P.); (L.M.); (M.P.)
| | - D. G. Joakim Larsson
- Centre for Antibiotic Resistance Research at University of Gothenburg, Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, 405 30 Gothenburg, Sweden; (F.B.); (C.-F.F.); (D.G.J.L.)
| | - Luminita Marutescu
- Earth, Environment and Life Sciences Division, Research Institute, University of Bucharest, 050657 Bucharest, Romania; (M.C.C.); (G.G.P.); (L.M.); (M.P.)
| | - Mark W. J. van Passel
- Centre Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands; (H.B.); (M.W.J.v.P.); (A.M.d.R.H.); (H.S.)
- Directorate of International Affairs, Ministry of Health, Welfare and Sport, 2500 EJ The Hague, The Netherlands
| | - Marcela Popa
- Earth, Environment and Life Sciences Division, Research Institute, University of Bucharest, 050657 Bucharest, Romania; (M.C.C.); (G.G.P.); (L.M.); (M.P.)
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU (Ludwig-Maximilians-Universität) Munich, 80336 Munich, Germany; (K.R.); (D.R.-M.); (T.W.)
| | - Ana Maria de Roda Husman
- Centre Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands; (H.B.); (M.W.J.v.P.); (A.M.d.R.H.); (H.S.)
| | - Daloha Rodríguez-Molina
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU (Ludwig-Maximilians-Universität) Munich, 80336 Munich, Germany; (K.R.); (D.R.-M.); (T.W.)
- Institute for Medical Information Processing, Biometry, and Epidemiology—IBE, LMU (Ludwig-Maximilians-Universität) Munich, 81377 Munich, Germany
- Pettenkofer School of Public Health, 81377 Munich, Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU (Ludwig-Maximilians-Universität) Munich, 80336 Munich, Germany; (K.R.); (D.R.-M.); (T.W.)
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, LMU (Ludwig-Maximilians-Universität) University Hospital, 80802 Munich, Germany;
- Faculty of Medicine, Max von Pettenkofer Institute, LMU (Ludwig-Maximilians-Universität), 80336 Munich, Germany
| | - Heike Schmitt
- Centre Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands; (H.B.); (M.W.J.v.P.); (A.M.d.R.H.); (H.S.)
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11
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Madsen AM, White JK, Markouch A, Kadhim S, de Jonge N, Thilsing T, Hansen VM, Bælum J, Nielsen JL, Vogel U, Tendal K. A cohort study of cucumber greenhouse workers' exposure to microorganisms as measured using NGS and MALDI-TOF MS and biomarkers of systemic inflammation. ENVIRONMENTAL RESEARCH 2021; 192:110325. [PMID: 33068575 DOI: 10.1016/j.envres.2020.110325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/07/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
Work in greenhouses entails exposure to airborne fungi and bacteria. The aims of this study are to obtain knowledge about whether exposure to fungal and bacterial genera and species during work in a cucumber greenhouse is affected by work tasks, and whether a cohort of greenhouse workers' serum levels of serum amyloid A (SAA) and C-reactive protein (CRP), biomarkers of systemic inflammation, are associated with this. Data on personal exposure to airborne fungal and bacterial species measured over 4 years as well as serum levels of SAA and CRP sampled over two years were analyzed. For data analysis, the main work tasks were grouped into three different groups, called 'grouped work task'. Microorganisms were identified using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF MS) and next-generation sequencing (NGS). The 'daily exposure' of greenhouse workers' were as follows: 4.8 × 104 CFU bacteria/m3, 1.4 × 106 CFU fungi/m3, and 392 EU/m3 of endotoxin. Workers were exposed to many different microbial species including several species within the genera Acinetobacter, Bacillus, Microbacterium, Pseudomonas, Staphylococcus, and Streptomyces. The genera Ralstonia and Cladosporium were found in most samples. The exposure levels as well as the microbial composition were associated significantly with grouped work task and season with high exposures during tasks in close contact with mature and old plants and in the autumn. CRP and SAA levels were also associated with exposure level and grouped work tasks. The Shannon-Wiener indices were not different in the 3 'grouped work tasks'. Several specific species including e.g. Halomonas elongata, Stenotrophomonas maltophilia, Podosphaera fusca, and Wallemia spp. were found frequently or in high concentrations in the exposures associated with the highest levels of CRP and SAA. The microorganisms S. maltophilia, P. fusca, and Wallemia spp. were also found on the cucumber plant leaves. In conclusion, both exposure level and the species composition seem to have an effect on the serum levels of CRP and SAA of exposed workers. The greenhouse workers were exposed to only a few species characterized as human pathogens.
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Affiliation(s)
- Anne Mette Madsen
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark.
| | - John Kerr White
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark; Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, 9220, Aalborg Ø, Denmark.
| | - Amal Markouch
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark.
| | - Sarah Kadhim
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark.
| | - Nadieh de Jonge
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, 9220, Aalborg Ø, Denmark.
| | - Trine Thilsing
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9, DK-5000, Odense C, Denmark.
| | - Vinni M Hansen
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark.
| | - Jesper Bælum
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9, DK-5000, Odense C, Denmark.
| | - Jeppe Lund Nielsen
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, 9220, Aalborg Ø, Denmark.
| | - Ulla Vogel
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark.
| | - Kira Tendal
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark.
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12
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Zhang C, Tian F, Zhang M, Zhang Z, Bai M, Guo G, Zheng W, Wang Q, Shi Y, Wang L. Endotoxin contamination, a potentially important inflammation factor in water and wastewater: A review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 681:365-378. [PMID: 31108357 DOI: 10.1016/j.scitotenv.2019.05.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/28/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
Endotoxins, also referred to as lipopolysaccharides or pyrogens, are major components embedded in the outer cell wall membrane of most Gram-negative bacteria and some cyanobacteria. As common pyrogens and strong immune stimulators, health hazards associated with endotoxins in water and wastewater have been attracting attention in recent years. In this paper, the characteristics, existing forms, and detection assays of endotoxins in water and wastewater are reviewed. Cellular response and pathophysiological effects, and main exposure tracts of endotoxins in water and wastewater are discussed. Levels of endotoxin contamination in water, wastewater, and their aerosols are presented. The removal effects of different water and wastewater treatment processes are summarized. Hence, it is important to: (i) Improve investigations into endotoxin contamination in water and wastewater in order to identify their source, occurrence, and fate. (ii) Implement water and wastewater treatment processes capable of ensuring low levels of endotoxins. This review aims to identify efficient water and wastewater treatment processes capable of ensuring the production of WTPs and WWTPs effluents with a low level of endotoxin activity, and to guarantee the reduction of endotoxin exposure risks to the consumers of water and wastewater.
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Affiliation(s)
- Can Zhang
- Center for Disease Control and Prevention of Chinese PLA, Beijing 100071, China.
| | - Fang Tian
- School of Environmental Engineering, Nanjing Institute of Technology, Nanjing 211167, China
| | - Minglu Zhang
- Department of Environmental Science and Engineering, Beijing Technology and Business University, Beijing 100048, China
| | - Zhiqing Zhang
- Tianjin Institute of Environmental and Operational Medicine, Tianjin 300050, China
| | - Miao Bai
- Center for Disease Control and Prevention of Chinese PLA, Beijing 100071, China
| | - Guang Guo
- School of Environmental Engineering, Nanjing Institute of Technology, Nanjing 211167, China
| | - Wenjie Zheng
- Tianjin Key Laboratory of Animal and Plant Resistance, Tianjin Normal University, Tianjin, 300387, China
| | - Qiang Wang
- Center for Disease Control and Prevention of Chinese PLA, Beijing 100071, China
| | - Yun Shi
- Center for Disease Control and Prevention of Chinese PLA, Beijing 100071, China
| | - Lili Wang
- Center for Disease Control and Prevention of Chinese PLA, Beijing 100071, China
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13
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Heldal KK, Austigard ÅD, Svendsen KH, Einarsdottir E, Goffeng LO, Sikkeland LI, Nordby KC. Endotoxin and Hydrogen Sulphide Exposure and Effects on the Airways Among Waste Water Workers in Sewage Treatment Plants and Sewer Net System. Ann Work Expo Health 2019; 63:437-447. [DOI: 10.1093/annweh/wxz020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/04/2019] [Accepted: 02/20/2019] [Indexed: 01/27/2023] Open
Affiliation(s)
- Kari K Heldal
- Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
| | - Åse D Austigard
- Municipality of Trondheim, Working Environment Office, Trondheim, Norway
| | - Kristin H Svendsen
- Department of Industrial Economics and Technology Management, NTNU, Trondheim, Norway
| | - Elin Einarsdottir
- Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
| | - Lars Ole Goffeng
- Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
| | - Liv Ingun Sikkeland
- Department of Respiratory Medicine, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Karl-Christian Nordby
- Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
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14
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Xu G, Han Y, Li L, Liu J. Characterization and source analysis of indoor/outdoor culturable airborne bacteria in a municipal wastewater treatment plant. J Environ Sci (China) 2018; 74:71-78. [PMID: 30340676 DOI: 10.1016/j.jes.2018.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 05/14/2023]
Abstract
The potential health risks of airborne bacteria emission from a wastewater treatment process have been concerned. However, few studies have investigated the differences in community structure between indoor and outdoor bacteria. In this work, the characterization of airborne bacteria was studied in a municipal wastewater treatment plant in Beijing, China. Two indoor (i.e., fine screen room and sludge dewatering house) and two outdoor (i.e., aeration tank and control site) sampling sites were selected. An Andersen six-stage impactor was used for collecting culturable airborne bacteria in the air, and Illumina MiSeq sequencing was conducted to track the emission source of the culturable airborne bacteria. The results indicate that, compared with the outdoor aeration tank site, the concentrations of culturable airborne bacteria in the indoor fine screen room with poor ventilation were more than ten times higher and the particle size was about twice as large. The community structures of indoor and outdoor culturable airborne bacteria were obviously different. Enterobacteriaceae and opportunistic pathogens were detected in indoor culturable airborne bacteria, with wastewater and sludge dewatering machine identified as the primary sources. Conversely, Enterobacteriaceae and opportunistic pathogens were not detected in outdoor culturable airborne bacteria. Outdoor high wind speed might have resulted in rapid dilution and mixing of culturable airborne bacteria generated from the aeration tank with the ambient air. The results of the present research suggest that covering pollution sources, increasing ventilation rates, and using protective measures for personnel should be implemented to decrease the exposure risk to indoor culturable airborne bacteria.
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Affiliation(s)
- Guangsu Xu
- Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yunping Han
- Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Lin Li
- Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Junxin Liu
- Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China.
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15
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Austigard ÅD, Svendsen K, Heldal KK. Hydrogen sulphide exposure in waste water treatment. J Occup Med Toxicol 2018; 13:10. [PMID: 29507599 PMCID: PMC5831676 DOI: 10.1186/s12995-018-0191-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 02/22/2018] [Indexed: 11/21/2022] Open
Abstract
Background The aims of this study was to assess exposure to hydrogen sulphide (H2S) among waste water treatment workers (WWWs), and achieve a better measure of the risks of H2S exposure than only using the eight-hour average value and the ceiling value because the exposure pattern of H2S for WWWs is dominated by short-term peaks. Methods Ninety-three measurements of H2S from 56 WWWs in three cities and three rural areas were collected. All exposure measurements were carried out from the start of the day until lunch time (sampling time 4–5 h) when most of the practical work was performed. The type of tasks and extent of flushing were registered. H2S was measured using direct-reading instruments with logging: OdaLog L2/LL, Dräger X-am 5000 and Dräger Pac 7000 (0.1–200 ppm). Number and duration of peaks for different work tasks, seasons, places and extent of flushing were combined in an exposure index (IN), and evaluated in a mixed-model analysis, building a model aimed to predict exposure for different job tasks. Results Nine Percent (8 of 93) of all H2S measurements have peaks above 10 ppm; in addition, 15% (14 of 93) have peaks of 5–10 ppm, 35% (33 of 93) have peaks of 1–5 ppm and 65% (62 of 93) have peaks of 0.1–1 ppm. 29% of the measurements of hydrogen sulphide showed no registered level > 0.1 ppm. From the mixed-model analyses we see that exposure level, expressed as H2S index IN, varied between places, work type, season and degree of flushing. For the work in a plant in the capital, the exposure index varied from 0.02 for working in spring doing some flushing, to 0.7 for working at the same plant in winter doing flushing more than three times or more than 10 min. Collecting sewage from cesspools in city 2 in winter doing a lot of flushing gave a hydrogen sulphide index of 230. Conclusions The use of a H2S index, taking into consideration peak height, duration and number of peaks, could be a tool for exposure assessment for H2S.
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Affiliation(s)
| | - Kristin Svendsen
- 2Institute of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Alfred Getz vei 3, 7491 Trondheim, Norway
| | - Kari K Heldal
- 3The National Institute of Occupational Health, Oslo, Norway
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16
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Jäckel U, Martin E, Schäfer J. Heterogeneity in Cultivation-Based Monitoring of Airborne Bacterial Biodiversity in Animal Farms. Ann Work Expo Health 2017. [DOI: 10.1093/annweh/wxx039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Biomarkers of inflammation in workers exposed to compost and sewage dust. Int Arch Occup Environ Health 2015; 89:711-8. [DOI: 10.1007/s00420-015-1109-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/15/2015] [Indexed: 11/27/2022]
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18
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Basu R, Ram SS, Biswas A, Ray SS, Mukhopadhyay A, Chakraborty A, Mathummal S, Chakrabarti S. Investigation on the Trace Elemental Profile of Sewage Workers in Kolkata, an Indian Megacity. J Public Health Res 2015; 4:473. [PMID: 26425493 PMCID: PMC4568422 DOI: 10.4081/jphr.2015.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/18/2015] [Accepted: 03/24/2015] [Indexed: 11/23/2022] Open
Abstract
Background Environmental pollution has become a global health risk. Exposure to pollutants at the work place, i.e. occupational exposure, is one of the areas that need immediate attention. The civic drainage workers are exposed to pollutants present in the wastewater they handle and most of them are toxic heavy metals. Exposure to such pollutants may be a health hazard, since it can lead to the imbalance in nutrient elements status. Design and Methods In the present study, profiling of trace elements in the blood of drainage worker population from an Indian megacity, Kolkata, was carried out by energy dispersive x-ray fluorescence (EDXRF) and compared with the control group population of the same area. Results The elements detected by EDXRF spectrometry include P, S, Cl, K, Fe, Cu, Zn, Se, Br, and Rb. By using ANOVA with 5% significance level, we observed significant alterations in the trace elements status, iron over loading, selenium deficiency, and in Cu-Zn ratio. Gender specific variations within the same population were also observed. Conclusions The results indicate that the drainage workers have altered elemental profile in comparison to that of control population. Significance for public health Environmental pollution is a global health risk and awareness among sewage workers is growing very slowly in many developing countries. Due to this fact, workers are often exposed to different pollutants which are responsible for several health complications. Imbalances in the presence of trace elements in blood are a symptom of different health status and could also indicate new health perspectives for the future. In the present scenario, this paper is essential since this kind of analysis has not been done yet, especially regarding the health status of sewage workers. We hope this initial study will be a starting point for future investigations.
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Affiliation(s)
- Rajlaxmi Basu
- Institute of Haematology and Transfusion, Medicine Medical College , Kolkata, India
| | | | | | | | | | | | | | - Sila Chakrabarti
- Institute of Haematology and Transfusion, Medicine Medical College , Kolkata, India
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19
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Masclaux FG, Hotz P, Gashi D, Savova-Bianchi D, Oppliger A. Assessment of airborne virus contamination in wastewater treatment plants. ENVIRONMENTAL RESEARCH 2014; 133:260-5. [PMID: 24981824 DOI: 10.1016/j.envres.2014.06.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/20/2014] [Accepted: 06/04/2014] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Occupational exposure to bioaerosols in wastewater treatment plants (WWTP) and its consequence on workers' health are well documented. Most studies were devoted to enumerating and identifying cultivable bacteria and fungi, as well as measuring concentrations of airborne endotoxins, as these are the main health-related factors found in WWTP. Surprisingly, very few studies have investigated the presence and concentrations of airborne virus in WWTP. However, many enteric viruses are present in wastewater and, due to their small size, they should become aerosolized. Two in particular, the norovirus and the adenovirus, are extremely widespread and are the major causes of infectious gastrointestinal diseases reported around the world. The third one, hepatitis E virus, has an emerging status. GOAL AND METHODS This study׳s objectives were to detect and quantify the presence and concentrations of 3 different viruses (adenovirus, norovirus and the hepatitis E virus) in air samples from 31 WWTPs by using quantitative polymerase chain reaction (qPCR) during two different seasons and two consecutive years. RESULTS Adenovirus was present in 100% of summer WWTP samples and 97% of winter samples. The highest airborne concentration measured was 2.27 × 10(6) genome equivalent/m(3) and, on average, these were higher in summer than in winter. Norovirus was detected in only 3 of the 123 air samples, and the hepatitis E virus was not detected. CONCLUSIONS Concentrations of potentially pathogenic viral particles in WWTP air are non-negligible and could partly explain the work-related gastrointestinal symptoms often reported in employees in this sector.
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Affiliation(s)
- Frédéric G Masclaux
- Institute for Work and Health (IST), University of Lausanne and University of Geneva, Route de la Corniche 2, 1066 Epalinges-Lausanne, Switzerland.
| | - Philipp Hotz
- Occupational and Environmental Medicine Unit, Med. Poliklinik USZ, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Drita Gashi
- Occupational and Environmental Medicine Unit, Med. Poliklinik USZ, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Dessislava Savova-Bianchi
- Institute for Work and Health (IST), University of Lausanne and University of Geneva, Route de la Corniche 2, 1066 Epalinges-Lausanne, Switzerland
| | - Anne Oppliger
- Institute for Work and Health (IST), University of Lausanne and University of Geneva, Route de la Corniche 2, 1066 Epalinges-Lausanne, Switzerland.
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20
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Kouassi B, Horo K, Godé C, Ahui B, Kouassi MN, Achi V, Anon JC, Koffi N, N'Gom A, Aka-Danguy E, Koffi MO, Itchy M, Koné K, Manewa S. [Clinical manifestations in patients exposed to an environmental toxic accident (Abidjan, Ivory Coast 2006)]. Rev Mal Respir 2014; 32:38-47. [PMID: 25618203 DOI: 10.1016/j.rmr.2014.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In 2006, 528 tons of petroleum toxic waste have been released in Abidjan (Ivory Coast) during a major environmental accident. This study was aimed to describe the clinical manifestations provoked by these toxic waste. METHODS We have analysed the records of patients admitted to the university hospital of Cocody (Abidjan) following exposure to toxic waste. All the information were recorded on specific files or on notification files created by the physicians of the National Institute of Public Health, the authority charged with the supervision of this exercise. The files were completed by the physician in the course of the examination of the patient. RESULTS Over a period of 3-month-period, 10,598 patients were examined. The clinical manifestations affected all age groups. They were dominated by respiratory symptoms: pulmonary (74.5%) and upper respiratory (31.0%). Pulmonary symptoms included cough (48.8%), chest pain (37.9%), dyspnoea (9.5%) and a few cases of hemoptysis. Digestive symptoms mainly comprised abdominal pain (36.2%), diarrhea (23.0%), abdominal distension (19.9%) and vomiting (9.9%). The other symptoms were neurological, ophthalmic, cardiovascular and gynaecological. More than 96% of patients presented with at least two symptoms. The respiratory symptoms were significantly more frequent in patients over the age of 17 while diarrhea and vomiting were more often found in patients less than 17 years old. Chest pain was significantly more common in men while abdominal pain and vomiting predominated in women (P=0.001). CONCLUSION The clinical consequences of toxic waste exposure were varied and sometimes serious. A medium- and long-term evaluation of the subjects is required.
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Affiliation(s)
- B Kouassi
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire.
| | - K Horo
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire
| | - C Godé
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire
| | - B Ahui
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire
| | - M N Kouassi
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire
| | - V Achi
- Service de pneumologie, CHU de Bouaké, Bouaké, Côte d'Ivoire
| | - J-C Anon
- Service de pneumologie, CHU de Bouaké, Bouaké, Côte d'Ivoire
| | - N Koffi
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire
| | - A N'Gom
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire
| | - E Aka-Danguy
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire
| | - M O Koffi
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire
| | - M Itchy
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire
| | - K Koné
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire
| | - S Manewa
- Service de pneumologie, CHU de Cocody, BP V13, Abidjan, Côte d'Ivoire
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Duquenne P, Ambroise D, Görner P, Clerc F, Greff-Mirguet G. Exposure to airborne endotoxins among sewer workers: an exploratory study. ANNALS OF OCCUPATIONAL HYGIENE 2014; 58:283-93. [PMID: 24470536 DOI: 10.1093/annhyg/met085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Exploratory bioaerosol sampling was performed in order to assess exposure to airborne endotoxins during sewer work. Personal samples were collected in underground sewer pipes using 37-mm closed-face cassettes containing fibreglass filters (CFC-FG method) or polycarbonate filters (CFC-PC method). Endotoxins were quantified using the limulus amoebocyte lysate assay. Concentrations of airborne endotoxins at sewer workplaces (16-420 EU m(-3)) were higher than those measured outside the sewer network (0.6-122 EU m(-3)). Sewer worker exposure to airborne endotoxins depended on the workplace and on the tasks. Exposure levels were the highest for tasks involving agitation of water and matter, especially for 'chamber cleanup' and 'pipes cleanup' with a high-pressure water jet. Airborne endotoxin levels at the workplace tended to be higher when CFC-FG was used as the sampling method rather than CFC-PC. The adjusted mean of the measured concentrations for CFC-PC represents 57% of the mean observed with CFC-FG. The number of samples collected in the descriptive study was too low for drawing definitive conclusions and further exposure investigations are needed. Therefore, our exploratory study provides new exposure data for the insufficiently documented sewer working environment and it would be useful for designing larger exposures studies.
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Affiliation(s)
- Philippe Duquenne
- 1. Département Métrologie des Polluants, INRS, 1 rue du Morvan CS 60027, 54519 Vandœuvre-lès-Nancy Cedex, France
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22
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Heldal KK, Barregard L, Larsson P, Ellingsen DG. Pneumoproteins in sewage workers exposed to sewage dust. Int Arch Occup Environ Health 2012; 86:65-70. [PMID: 22350277 PMCID: PMC3535374 DOI: 10.1007/s00420-012-0747-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/01/2012] [Indexed: 11/30/2022]
Abstract
Purpose The association between exposure to bacteria and endotoxins in sewage dust and the serum concentrations of pneumoproteins in sewage treatment plant workers were studied. Methods Forty-four workers from eight sewage treatment plants and 38 reference workers participated in the study. Microbial aerosol was collected by personal inhalable samplers. The concentrations of bacteria and endotoxins were determined by fluorescence microscopy and the Limulus assay, respectively. Pneumoproteins (Clara cell protein: CC16, and Surfactant proteins A and D: SP-A, SP-D) were determined by ELISA in blood samples collected post-shift. Results The exposure to dust ranged from 0.02 to 9.3 (geometric mean (GM) 0.3 mg/m3, of bacteria from 0.3 to 4,900 × 103 (GM 27 × 103) cells/m3 and endotoxins from 1 to 3,160 (GM 28) EU/m3. The exposed workers had lower CC16 [arithmetic mean (AM) 4.9 ng/ml] compared to the referents (AM 6.4 ng/ml, p < 0.01). No significant difference was observed for SP-D and SP-A. Exposure to bacteria was positively associated with CC16 (p < 0.05) and SP-D (p < 0.05), adjusting for possible confounders. Conclusions This study showed that exposed workers had lower serum concentration of CC16 as compared to the referents, which may reflect a long-term effect on secretion of these pneumoproteins. The positive association between exposure to bacteria and the serum concentrations of CC16 and SP-D may be explained by a transient increased permeability of the lung–blood barrier.
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Affiliation(s)
- Kari Kulvik Heldal
- National Institute of Occupational Health, PO Box 8149 Dep, 0033 Oslo, Norway.
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Rinsoz T, Hilfiker S, Oppliger A. Quantification of thermotolerant Campylobacter in Swiss water treatment plants, by real-time quantitative polymerase chain reaction. WATER ENVIRONMENT RESEARCH : A RESEARCH PUBLICATION OF THE WATER ENVIRONMENT FEDERATION 2009; 81:929-933. [PMID: 19860149 DOI: 10.2175/106143009x407429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A total of 49 wastewater samples from 23 different wastewater treatment plants (WWTPs) were analyzed using real-time quantitative polymerase chain reaction for the presence and quantity of thermotolerant campylobacters. Thermotolerant campylobacters were detected in 87.5% (21/24) and 64% (16/25) of untreated and treated wastewater samples, respectively. Their concentration was sufficiently high to be quantified in 20.4% (10/49) of the samples. In these samples, the concentration ranged from 68,000 to 2,292,000 cells/L in untreated wastewater and from 10,800 to 28,000 cells/L in treated water. We conclude that thermotolerant campylobacters present a health hazard for workers at WWTPs in Switzerland.
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Affiliation(s)
- Thomas Rinsoz
- Institute for Work and Health, University of Lausanne and Geneva, Lausanne, Switzerland
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Trevisani M, Patacchini R, Nicoletti P, Gatti R, Gazzieri D, Lissi N, Zagli G, Creminon C, Geppetti P, Harrison S. Hydrogen sulfide causes vanilloid receptor 1-mediated neurogenic inflammation in the airways. Br J Pharmacol 2005; 145:1123-31. [PMID: 15937520 PMCID: PMC1576227 DOI: 10.1038/sj.bjp.0706277] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hydrogen sulfide (H(2)S) is described as a mediator of diverse biological effects, and is known to produce irritation and injury in the lung following inhalation. Recently, H(2)S has been found to cause contraction in the rat urinary bladder via a neurogenic mechanism. Here, we studied whether sodium hydrogen sulfide (NaHS), used as donor of H(2)S, produces responses mediated by sensory nerve activation in the guinea-pig airways. NaHS evoked an increase in neuropeptide release in the airways that was significantly attenuated by capsaicin desensitization and by the transient receptor potential vanilloid 1 (TRPV1) antagonist capsazepine. In addition, NaHS caused an atropine-resistant contraction of isolated airways, which was completely prevented by capsaicin desensitization. Furthermore, NaHS-induced contraction was reduced by TRPV1 antagonism (ruthenium red, capsazepine and SB366791), and was abolished by pretreatment with the combination of tachykinin NK(1) (SR140333) and NK(2) (SR48968) receptor antagonists. In anesthetized guinea-pigs, intratracheal instillation of NaHS increased the total lung resistance and airway plasma protein extravasation. These two effects were reduced by TRPV1 antagonism (capsazepine) and tachykinin receptors (SR140333 and SR48968) blockade. Our results provide the first pharmacological evidence that H(2)S provokes tachykinin-mediated neurogenic inflammatory responses in guinea-pig airways, and that this effect is mediated by stimulation of TRPV1 receptors on sensory nerves endings. This novel mechanism may contribute to the irritative action of H(2)S in the respiratory system.
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Affiliation(s)
- Marcello Trevisani
- Center of Excellence for the Study of Inflammation, University of Ferrara, Ferrara, Italy
| | | | - Paola Nicoletti
- Department of Critical Care Medicine & Surgery, University of Florence, Florence, Italy
| | - Raffaele Gatti
- Center of Excellence for the Study of Inflammation, University of Ferrara, Ferrara, Italy
| | - David Gazzieri
- Center of Excellence for the Study of Inflammation, University of Ferrara, Ferrara, Italy
| | - Nicola Lissi
- Center of Excellence for the Study of Inflammation, University of Ferrara, Ferrara, Italy
| | - Giovanni Zagli
- Department of Critical Care Medicine & Surgery, University of Florence, Florence, Italy
| | - Christophe Creminon
- CEA, Service de Pharmacologie et d'Immunologie, DRM, CEA-Saclay, Gif sur Yvette, France
| | - Pierangelo Geppetti
- Center of Excellence for the Study of Inflammation, University of Ferrara, Ferrara, Italy
- Department of Critical Care Medicine & Surgery, University of Florence, Florence, Italy
| | - Selena Harrison
- Department of Critical Care Medicine & Surgery, University of Florence, Florence, Italy
- Author for correspondence:
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