Respiratory Health in Waste Collection and Disposal Workers

Systematic review and meta-analysis of the potential threats to respiratory health from microbial Bioaerosol exposures

Infectious diseases are a part of everyday life, and acute respiratory diseases are the most common. Many agents carrying out respiratory infections are transmitted as bioaerosols through the air, usually, particulate matter containing living organisms. The purpose of the study is to conduct a systematic review and meta-analysis to assess the likelihood that people exposed to bioaerosols may experience severe respiratory diseases. Nine digital databases and bibliographies were assessed for papers conducted between January 1960 and April 2021. A total of 35 health and exposure studies were included from 825 studies for the systematic review, while only 17 contented the meta-inclusion analysis's criteria. This systematic review found higher bacterial bioaerosol concentrations in poultry farms, waste dumpsites, composting plants, and paper industries. The meta-analysis's Standard Mean Difference (SMD) measurement indicates a substantially positive association between bioaerosol exposure and respiratory disease outcomes in targeted populations. The value is 0.955 [95% CI, range 0.673-1.238; p < 0.001]. As per the Risk of Bias (ROB) findings, most of findings (30 out of 35 [85.71%]) were judged to have low ROB. From the random effect probit model, the total relative risk is 1.477 (95% CI, range 0.987-2.211), indicating a higher risk of respiratory diseases from bioaerosol exposure than the control groups. The total risk difference is 0.121 (95% CI, -0.0229 to 0.264), which means intervention groups may have a higher risk of respiratory diseases from continuous bioaerosol exposure than the control groups. The dose-response relationship revealed a strong positive linear coefficient correlation between bacterial & fungal bioaerosol exposure to respiratory health. Based on self-reported outcomes in those studies, The systematic review and meta-analysis stated that bioaerosol exposure had an effect on pulmonary health.

Bioaerosol-induced in vitro activation of toll-like receptors and inflammatory biomarker expression in waste workers

PURPOSE

Occupational exposure to bioaerosols during waste handling remains a health concern for exposed workers. However, exposure-related health effects and underlying immunological mechanisms are still poorly described.

METHODS

The present study assessed the inflammatory potential of work-air samples (n = 56) in vitro and investigated biomarker expression in exposed workers (n = 69) compared to unexposed controls (n = 25). These quantitative results were compared to self-reported health conditions.

RESULTS

Personal air samples provoked an activation of TLR2 and TLR4 HEK reporter cells in one-third of all samples, indicating that the work environment contained ligands capable of inducing an immune response in vitro. Monocyte levels, as well as plasma biomarker levels, such as IL-1Ra, IL-18 and TNFα were significantly higher in exposed workers, compared to the control group when confounding factors such as BMI, sex, age and smoking habits were accounted for. Furthermore, a significant exposure-related increase in midweek IL-8 levels was measured among exposed workers. Tendencies of increased prevalence of health effects of the respiratory tract were identified in exposed workers.

CONCLUSION

Inhalable dust provoked TLR activation in vitro, indicating that an exposure-related immune response may be expected in susceptible workers. However, despite significant differences in inflammatory plasma biomarker levels between exposed and unexposed workers, prevalence of self-reported health effects did not differ between the groups. This may be due to the healthy worker effect, or other factors such as adequate use of personal protective respiratory devices or adaptation to the work environment with reduced activation of the immune system.

Association between urban garbage exposure and allergic diseases among sanitation practitioners: A cross-sectional study

Background

The prevalence of allergic diseases has increased significantly in China over the last few decades, and there have been very few reports of allergic diseases in certain occupational specialties, with almost no reports among sanitation workers.

Objective

Our objective was to investigate the prevalence of allergic diseases and the prevalence of common allergen sensitization in the population engaged in sanitation, and to try to answer the connection between urban garbage waste exposure and the development of allergic diseases.

Methods

We conducted a cross-sectional survey of people working in sanitation-related jobs in Liwan District, Guangzhou, China. A total of 893 people completed the questionnaire for this study, and 500 of them were further screened and tested for allergens specific IgE and IgG4. Combining the questionnaire and test results, we investigated the incidence of allergy disorders and patterns of sensitization to allergens in this community, and evaluated the presence of occupational-related risk factors in this particular population.

Results

Of the 893 sanitation workers, 166 (18.59%) self-reported allergic diseases, predominantly suffering from allergic rhinitis (AR) (n = 98, 10.97%), followed by drug allergy (n = 31, 3.47%), atopic dermatitis (n = 27, 3.02%), food allergy (n = 21, 2.35%), and asthma (n = 9, 1.00%), in that order. In addition to dust mites (32.20%), which had the highest sensitization rate, the subject population had relatively high sensitization rates to ragweed (7.00%) and moulds mixture (8.20%) when compared with the rates of sensitization to moulds and ragweed in the general population; the top 3 sIgG4 positivity rates were egg (50.00%), milk (10.20%), and soybean (9.40%). The prevalence of self-reported AR was higher in office managers (the control group) than in cleaning staff (the exposed group), but there was no difference in sIgE positivity for serum allergens between the 2 groups. The chance of having AR may increase with management positions (crude OR 2.20, 95% CI 1.38-3.50), P = 0.001).

Conclusion

This is the first study to investigate the prevalence of allergy illnesses in the sanitation workforce in mainland China. We identified a community of real sanitation workers with high ragweed and mycobacterial sensitization rates. Urban cleaning may be protective factor against AR at the symptom level, but the serological results did not show this to be the case.

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

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

Screening for respiratory morbidities and obstructive lung function among municipal waste handlers in Puducherry: A community-based cross-sectional study

Background:

Waste management is a societal problem because of its environmental impact and public health implications. Solid waste handlers have a high incidence of occupational health issues, with respiratory morbidities being the most common. Aim: To assess the prevalence of respiratory morbidities, obstructive lung pattern and its associated factors among municipal solid waste management workers in Puducherry.

Materials and Methods:

This community-based cross-sectional study was carried out in May and June 2018 among 264 solid waste management workers selected by simple random sampling. They underwent a semi-structured interview schedule capturing their sociodemographic characteristics, work profile, presence of respiratory symptoms, and morbidities followed by lung function tests using a portable spirometer. The data was entered using Epidata entry client and analyzed using SPSS (v16).

Results:

The mean age of the workers was 47.1 (±8.87) years. The majority were females (85.6%), working as waste collectors (86%) on day duty (73.5%). More than two in five workers had either respiratory morbidity (42.8%) or obstructive lung pattern (44%). Higher age, occupation as waste collector, night shift duty, not using face mask on duty, and not receiving training on waste handling were the factors significantly associated with the respiratory morbidities and obstructive lung function.

Conclusion:

The prevalence of respiratory morbidities and obstructive lung disease were high among municipal solid waste handlers. Measures are needed to improve the work environment of waste handlers by ensuring the availability of protective gears and adequate training on work handling based on ergonomic principles.

Review of biological risks associated with the collection of municipal wastes

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

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

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

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

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

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

Challenges in Diagnosing Occupational Chronic Obstructive Pulmonary Disease

Occupational chronic obstructive pulmonary disease (oCOPD) represents 15–20% of the global burden of this disease. Even if industrial bronchitis has long been known, new occupational hazards continue to emerge and enlarge the number of people exposed to risk. This review discusses the challenges related to the early detection of oCOPD, in the context of new exposures and of limited usage of methods for an efficient disease occupational screening. It underlines that a better translation into clinical practice of the new methods for lung function impairment measurements, imaging techniques, or the use of serum or exhaled breath inflammation biomarkers could add significant value in the early detection of oCOPD. Such an approach would increase the chance to stop exposure at an earlier moment and to prevent or at least slow down the further deterioration of the lung function as a result of exposure to occupational (inhaled) hazards.

Increase in SARS-CoV-2 infected biomedical waste among low middle-income countries: environmental sustainability and impact with health implications

Studies have shown that severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) is a highly infectious disease, with global deaths rising to about 360,438 as of 28 May 2020. Different countries have used various approaches such as lockdown, social distancing, maintenance of personal hygiene, and increased establishment of testing and isolation centers to manage the pandemic. Poor biomedical waste (BMW) management, treatment, and disposal techniques, especially SARS-CoV-2 infected BMW, may threaten the environmental and public health in most developing countries and, by extension, impact the economic status of individuals and the nation at large. This may increase the potential for the transmission of air/blood body fluid-borne pathogens, increase the growth of microorganisms, risk of mutagenesis, and upsurge of more virulent strain. In contrast, uncontrolled substandard burning could increase the potential spread of nosocomial infection and environmental exposure to toxic organic compounds, heavy metals, radioactive, and genotoxic bio-aerosols which might be present in the gaseous, liquid, and solid by-products. The paucity of understanding of pathophysiology and management of the SARS-CoV-2 pandemic has also necessitated the need to put in place appropriate disposal techniques to cater for the sudden increase in the global demand for personal protective equipment (PPE) and pharmaceutical drugs to manage the pandemic and to reduce the risk of preventable infection by the waste. Therefore, there is a need for adequate sensitization, awareness, and environmental monitoring of the impacts of improper handling of SARS-CoV-2 infected BMWs. Hence, this review aimed to address the issues relating to the improper management of increased SARS-CoV-2 infected BMW in low middle-income countries (LMICs).

Health, Transport and the Environment: The Impacts of the COVID-19 Lockdown on Air Pollution

Lockdown measures were initiated in Italy on March 9th after the start of the SARS-CoV-2 epidemic to flatten the epidemic curve. The aim of the present study was to assess the impact of restrictive measures in the Apulia Region, southern Italy, on air quality from March to April 2020. We applied a dual-track approach. We assessed citizen mobility and vehicle traffic with mobility network data and information obtained from satellite tracking, and we evaluated and compared pollutant concentration data as measured by monitoring stations maintained by the Regional Agency for Environmental Protection and Prevention of Apulia (ARPA). The results showed a decrease in the weekly mean NO₂ concentration recorded by urban traffic stations during the lockdown period. In particular, in the city of Bari, the average NO₂ concentration decreased from 62.2 μg/m³ in March 2019 to 48.2 μg/m³ in March 2020. Regarding PM10 levels, the average concentrations at the individual traffic stations showed no particular variation compared to those in the same months of the previous year, except for Bari-Caldarola Station in March 2019/2020 (p-value < 0.001) and in April 2019/2020 (p-value = 0.04). In particular the average in March 2019 was ~26.9 μg/m³, while that in March 2020 was ~22.9 μg/m³. For April, the average concentration of PM10 in 2019 was 27.9 μg/m³, while in 2020, the average was ~22.4 μg/m³. This can be explained by the fact that PM10 levels are influenced by multiple variables such as weather and climate conditions and desert dust advections.

Potential Environmental and Human Health Risks Caused by Antibiotic-Resistant Bacteria (ARB), Antibiotic Resistance Genes (ARGs) and Emerging Contaminants (ECs) from Municipal Solid Waste (MSW) Landfill

The disposal of municipal solid waste (MSW) directly at landfills or open dump areas, without segregation and treatment, is a significant concern due to its hazardous contents of antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARGs), and metal resistance genes (MGEs). The released leachate from landfills greatly effects the soil physicochemical, biological, and groundwater properties associated with agricultural activity and human health. The abundance of ARB, ARGs, and MGEs have been reported worldwide, including MSW landfill sites, animal husbandry, wastewater, groundwater, soil, and aerosol. This review elucidates the occurrence and abundance of ARB, ARGs, and MRGs, which are regarded as emerging contaminants (ECs). Recently, ECs have received global attention because of their prevalence in leachate as a substantial threat to environmental and public health, including an economic burden for developing nations. The present review exclusively discusses the demands to develop a novel eco-friendly management strategy to combat these global issues. This review also gives an intrinsic discussion about the insights of different aspects of environmental and public health concerns caused due to massive leachate generation, the abundance of antibiotics resistance (AR), and the effects of released leachate on the various environmental reservoirs and human health. Furthermore, the current review throws light on the source and fate of different ECs of landfill leachate and their possible impact on the nearby environments (groundwater, surface water, and soil) affecting human health. The present review strongly suggests the demand for future research focuses on the advancement of the removal efficiency of contaminants with the improvement of relevant landfill management to reduce the potential effects of disposable waste. We propose the necessity of the identification and monitoring of potential environmental and human health risks associated with landfill leachate contaminants.

Covid-19 effects on municipal solid waste management: What can effectively be done in the Brazilian scenario?

The Covid-19 pandemic will leave a lasting impact on nearly every aspect of life in society and has also raised concerns on the contamination risks associated with waste management. This study presents a review on the main recommendations related to the management of municipal solid wastes during the pandemic. The recommendations were classified according to the target audience, and their applicability to the Brazilian reality is discussed. Results show that most analyzed recommendations are related to hygiene routines, use of personal protective equipment, and proper segregation, packing and final destination of potentially contaminated wastes. Brazilian organizations show a special concern about the exposure risks of waste pickers, advising for the temporary suspension of manual waste collection and sorting, hygiene protocols, social distancing and quarantine of recyclable materials. Overall, the recommendations are highly dependent on awareness and engagement of citizens and on planning and support of municipalities, which must invest in information campaigns and provide alternatives for the infectious waste produced in households. Furthermore, this study points out that the recommendations were issued in an emergency scenario, but as the pandemic is expected to last for an extended period of time, they must be revised as local contexts change, seeking to maintain and extend citizens engagement in selective collection and even in actions towards waste reduction.

Assessment of the microbial contamination of mechanical protection gloves used on waste sorting industry: A contribution for the risk characterization

In Portugal, mechanical protection gloves (MPG) are of mandatory use and during their use sweat is released and, consequently, the humidity of the material increases leading to conditions favorable to the growth of microorganisms. However, no studies have been conducted in MPG to assess the bioburden. This study intended to determine the bioburden present in MPG and their biological effects, and to discuss the possibility to use MPG as a passive method to assess occupational exposure to microbial contamination. Fungal burden was characterized through molecular tools for fungal toxigenic species, and antifungal resistance and mycotoxins profiles were determined. Cell viability was determined in swine kidney (SK) monolayer and hepatocellular carcinoma (Hep G2) cell lines. All MPG samples presented Gram-negative bacteria. The fungal contamination ranged from 0 CFU.m^-2 in both MEA and DG18, to 5.09 × 10⁶ and 2.75 × 10⁶ and the most commonly fungi found was Aspergillus spp. (50.46%). Azole resistant Aspergillus sections were found in azole supplemented media. Aspergillus sections (Circumdati, Flavi, Fumigati and Versicolores) were detected by molecular tools in 66 out of 67 samples. The most reported mycotoxin was mycophenolic acid (89.6%). HepG2 cells appear to be more sensitive to MPG contamination, with high cytotoxicity (IC50 < 0.05 mm2/ml) observed for 18 out of 57 gloves. MPG can be used in passive sampling to assess occupational exposure to bioburden in waste sorting industries and contribute for risk characterization. Some contaminants of MPG had cytotoxic potential and affected the biology of hepatic cells more than renal cells.

Assessment of airborne particles and bioaerosols concentrations in a waste recycling environment in Brazil

This study aims to assess the concentrations of size-fractioned particle mass (PM_1.0, PM_2.5, PM_4.0, PM₁₀) and number (PNC_0.3, PNC_0.5, PNC_1.0, PNC_2.5), bacteria, and fungi in a Materials Recycling Facility (MRF) in Brazil. The measurements were performed inside the waste processing shed (P1) and in the outdoor environment (P2) during working days in winter and spring of 2017, and summer of 2019. A total of 2,400 min of PM, 1,440 min of PNC, and 216 samples of bioaerosols were collected in the morning and afternoon. P1 has the strongest air contamination with mean values of 475.5 ± 563.7 µg m⁻³ for PM₁₀, 58.6 ± 36.0 cm⁻³ for PNC_0.3, 1,088.8 ± 825.2 colony-forming units per cubic meter (CFU m⁻³) for bacteria, and 2,738.3 ± 1,381.3 CFU m⁻³ for fungi. The indoor/outdoor ratios indicated the large influence of indoor sources due to the activities performed inside P1 that promote the generation and resuspension of pollutants. Gram-positive bacteria dominated with 58.6% of indoor samples. Overall, our results show a critical indoor air quality situation in a Brazilian MRF, which may cause several health risks for waste pickers. Finally, we call attention to the lack of occupational exposure limits for bioaerosols in industrial workplaces and mainly in MRFs.

An exploratory evaluation of the potential pulmonary, neurological and other health effects of chronic exposure to emissions from municipal solid waste fires at a large dumpsite in Olusosun, Lagos, Nigeria

Open municipal solid waste (MSW) combustion is a major emission source of particulate air pollution, polycyclic aromatic hydrocarbons, and more exotic hazardous organic pollutants including polychlorinated biphenyls and brominated flame retardants. However, the adverse impact of MSW combustion emission on health among the general population is unknown. Therefore, a cross-sectional study was conducted to explore the associations between potential exposure to MSW combustion-related air pollution and symptoms of adverse health effects among residents of a community adjacent to a large open landfill in Lagos, Nigeria. Using ordinal logistic regression and controlling for age, sex, and smoking, it was observed that residence for ≥ 11 years had increased odds (p < 0.05) of daily occurrence of tingling/numbness/whiteness of fingers (2.614), headaches (2.725), memory problems (2.869), tremor/cramps (2.748), and confusion (3.033) among other symptoms. These results indicate adverse health impacts of chronic exposure to MSW combustion emission.

Towards a risk evaluation of workers' exposure to handborne and airborne microbial species as exemplified with waste collection workers

Bioaerosol exposure is associated with health problems. The aim of this study is to evaluate whether it is possible to assess the risks posed by waste collection workers' exposure through identification and characterization of bacterial and fungal species, to which the workers are exposed. Using MALDI-TOF MS, microorganisms in waste collection workers' exposure through air, hand, and contact with the steering wheel were identified. Fungi found in high concentrations from the workers' exposure were characterized for the total inflammatory potential (TIP), cytotoxicity, and biofilm-forming capacity. In total, 180 different bacterial and 37 different fungal species in the workers' exposure samples were identified. Some of them belong to Risk Group 2, e.g. Escherichia coli, Klebsiella oxytoca, Staphylococcus aureus, and Aspergillus fumigatus, some have been associated with occupational health problems e.g. Penicillium citrinum and P. glabrum and some are described as emerging pathogens e.g. Aureobasidium pullulans. The TIP of fungal species was dose-dependent. High TIP values were found for Penicillium italicum, P. brevicompactum, P. citrinum, and P. glabrum. Several species were cytotoxic, e.g. A. niger and P. expansum, while some, e.g. P. chrysogenum, did not affect the cell viability. Based on waste workers' average inhalation rate, they inhaled up to 2.3 × 10⁴ cfu of A. niger, 7.4 × 10⁴ cfu of P. expansum, and 4.0 × 10⁶ cfu of P. italicum per work day. Some species e.g. A. niger and P. citrinum were able to form biofilm. In conclusion, the workers were exposed to several species of microorganisms of which some to varying degrees can be evaluated concerning risk. Thus, some microorganisms belong to Risk Group 2, and some are described as causing agents of occupational health problems, emerging pathogens, or intrinsically antibiotic resistant. For some other species very little is known. The TIP, cytotoxicity, and ability to form biofilm of the dominating fungi support and expand previous findings. These parameters depended on the species and the dose, thus highlighting the importance of species identification and exposure level in the risk assessment of exposure.

Health effects associated with proximity to waste collection points in Beitbridge Municipality, Zimbabwe

Population growth, urbanisation and economic development have led to the increasing generation of municipal solid waste while environmentally sustainable management remains a challenge the world over. This study sought to investigate health effects associated with proximity to waste collection points in Beitbridge Municipality, Zimbabwe. A cross-sectional study was undertaken to compare the occurrence of disease among the residents living within different distances from the waste collection points (50 m, 100 m, 150 m, 200 m, 250 m, 300 m and above 300 m). A handheld GPS device was used to collect coordinates of the location for the purposes of mapping. The Fishers Exact test and the Multiple Logistic Regression model conducted (on STATA V 13 SE) to determine the association between different variables and the occurrence of health effects. Questionnaires were administered to 700 stratified randomly selected respondents. Five refuse collection points and spatial distribution of health conditions were mapped at Dulibadzimu high-density suburb. The overall response rate was 98% and females constituted the majority of respondents (58%). Most of these respondents were aged between 26 and 35 years of age and were involved in informal trading (35%). Reported health conditions were diarrhoea, dyspnoea, dry cough, eye irritation and asthma. Distance, waste collection point, level of education, nature of occupation and sex were significant contributors to the prevalence of health effects associated with exposure to waste. Exposure to waste is a serious health concern in Beitbridge. Local authority is encouraged to abolish these waste collection points and invest more on conventional waste management systems in partnership with different stakeholders.

A case report of idiopathic environmental intolerance: A controversial and current issue

In this case of idiopathic environmental intolerance, a little known disease characterized by many symptoms of irritation due to exposure to several toxic compounds, genetic analysis could be helpful in case of differential diagnosis issue.

Measures to reduce the exposure of waste collection workers to handborne and airborne microorganisms and inflammogenic dust

Waste collection is associated with various health symptoms. The aims of this study were to obtain knowledge about exposure to bacteria, fungi, and endotoxin during waste collection, and to study whether it is possible to reduce the exposures and the total inflammatory potential (TIP) of those exposures through simple interventions. The study was performed with an initial baseline exposure assessment, a second assessment with intervention workers only, and a third with intervention and reference workers. The waste collection workers were exposed to 7.8 × 10³ cfu bacteria/m³, 1.4 × 10⁴ cfu fungi/m³, and 92 endotoxin units/m³ (geometric mean values). The potential exposures in the truck cabs were up to 23 times higher than outdoor reference concentrations. For the intervention trucks and workers, airborne fungi in the truck cab were reduced; fungi, bacteria, and yeasts on the steering wheels were reduced; and the concentration of fungi on the workers' hands was reduced. Exposures were typically highest during collection of mixed household waste, in the summer, and for collection using trucks with low loading height. The TIP was highest for the reference group sampling mixed household waste, using trucks with low loading height, in the summer. Endotoxin, bacteria, and fungi contributed to the TIP of 42 personal exposure assessments. CONCLUSION: Motivating workers to reduce exposure through simple interventions improved hand and truck cab hygiene, but only slightly reduced personal exposure to airborne bioaerosols. Exposure can be reduced by only using trucks with high loading height.

Respiratory Symptoms Among Domestic Waste Collectors

Objective

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

Method

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

Results

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

Conclusion

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

Health impact of exposure to asbestos in polluted area of Southern Italy

The three main sources of asbestos pollution in the city of Bari, Puglia, the former Fibronit asbestos factory, the Torre Quetta beach, the former Rossani barracks and the history of their reclamation are described. The results of cohort studies on factory workers and case-control studies on asbestos exposure to the resident population and the onset of mesothelioma are also reported. Finally, the data of the regional register of mesothelioma related to residents in the city of Bari and four new cases with environmental exposure due to the former Rossani barracks are presented.

Occupational Exposure to Endotoxin along a Municipal Scale Fecal Sludge Collection and Resource Recovery Process in Kigali, Rwanda

Background: Little is known about occupational exposures that occur along fecal sludge collection and resource recovery processes. This study characterizes inhaled endotoxin exposure to workers of a municipal scale fecal sludge-to-fuel processes in Kigali, Rwanda. Methods: Forty-two task-based air samples were collected from workers in five tasks along the fecal sludge collection and resource recovery process. Samples were processed for endotoxin using the limulus amebocyte lysate (LAL) test. To account for exposure variability and compare measured concentrations to established exposure limits, we used Monte Carlo modeling methods to construct distributions representing full eight-hour (8-h) exposures to endotoxin across eight exposure scenarios. Results: Geometric mean (GM) endotoxin concentrations in task-based samples ranged from 11–3700 EU/m³ with exposure concentrations increasing as the dryness of the fecal sludge increased through processing. The thermal dryer task had the highest endotoxin concentrations (GM = 3700 EU/m³) and the inlet task had the lowest (GM = 11 EU/m³). The geometric means (GM) of modeled 8-h exposure concentrations were between 6.7–960 EU/m³ and highest for scenarios which included the thermal dryer task in the exposure scenario. Conclusions: Our data suggest the importance of including worker exposure considerations in the design of nascent fecal sludge management processes. The methods used in this study combine workplace sampling with stochastic modeling and are useful for exposure assessment in resource constrained contexts.

Biochemical changes among municipal solid waste sorting workers: implications for personal protective equipment availability and use

Background. Solid waste management has emerged as one of the greatest challenges facing human and environmental health. Municipal solid waste workers are potentially exposed to a variety of occupational biohazards and safety risks in the workplace. Objective. This study aimed to evaluate the availability and use of personal protective equipment (PPE) and some biochemical changes among solid waste sorting workers. Methods. A group of solid waste sorting workers was interviewed and checked for availability, use and appropriateness of PPE using a structured questionnaire and checklist. Workers were tested for hepatic and renal function parameters and biomarkers of allergy and inflammation. Results. The level of high-sensitivity C-reactive protein (hsCRP) as a biomarker of inflammation was elevated in 12.9% while total serum immunoglobulin E was obviously high among most workers (79.2%). Workers with inadequately available, used or effective PPE were more likely to have morbidities and showed elevated serum levels of serum glutamic pyruvic transaminase, serum glutamic-oxaloacetic transaminase, urea, creatinine, hsCRP and total immunoglobulin E. Conclusions. Elevated biomarkers of allergy and inflammation herald preclinical disease risks that should be included in basic health surveillance. Use of PPE should be emphasized for workers involved in solid waste sorting to effectively protect their health.

Malignant mesothelioma in construction workers: the Apulia regional mesothelioma register, Southern Italy

Objective

Asbestos was widely used in construction in both a friable and a compact form until the 1990s, before its use was banned. Today, many of these materials are still in situ and represent a source of risk for construction workers. The objective of the study was to analyse the cases of mesothelioma arising among construction workers registered in the Apulia regional register of mesothelioma.

Results

For the period 1993–2018, there were 178 male cases, and 10.2% of the cases were present in the regional register. The average age at diagnosis was 64.7 years. The site was pleural in 96.06% of cases, with a diagnosis of certainty in 86.5% of the total cases and 61.8% of cases with epithelial histology. The average latency is 43.9 years. In 75.2% of cases, the exposure began between 1941 and 1970, with an average duration of 24.3 years. The age at the start of exposure in 68.5% of cases is between 8 and 20 years. The ORs were 2.5 (C.I. 95% 1.01–6.17) for the epithelioid histotype and the high duration of exposure. The data underline the need for prevention and information on all activities involving construction workers in which asbestos-containing materials are still used.

Epidemiology of Mesothelioma

Since 1973 the International Agency for Research on Cancer has classified asbestos as a certain carcinogen, but today it is still used in several countries. To date, mesothelioma risk is certainly linked not only to occupational exposures but also to environmental exposures. The incidence and mortality are increasing worldwide, especially in developing countries where asbestos is still often used without adequate measures for worker safety. The epidemiological surveillance systems of related asbestos diseases are instruments of public health adopted internationally. The experience and the operating methodology of the Italian mesothelioma registry and the data produced from 1996 to 2015 highlight how in countries where the asbestos ban has been active for over 20 years the risk of asbestos remains present, especially in the construction sector as well as for the environmental exposures of the resident population near companies that used asbestos in their production cycle. Worldwide, it is necessary to introduce the ban on the extraction, processing, and marketing of asbestos as claimed by the international scientific community.

Risk assessment of upper limbs repetitive movements in a fish industry

Objective

Work-related Musculoskeletal Disorders (WMSDs) have a multifactorial origin: work-related risk factors and individual factors (age, sex, anthropometric characteristics). The purpose of the current study was the risk assessment of upper limb-WMSDs of workers engaged in tasks of anchovies filleting and packaging in a fish industry considering the ergonomic evaluation and the painful symptomatology complained by employees of different age. The activities were analysed by the American Conference Governmental Industrial Hygienists (ACGIH) method, the Strain Index (SI) method, the Rapid Upper Limb Assessment (RULA) method as well as the Occupational Rapid Assessment (OCRA) checklist. Workers answered the Italian version of the Nordic Musculoskeletal Questionnaire (NMQ).

Results

The ACGIH method showed that packaging needs greater protection, while filleting requires ergonomic interventions. The SI showed a significant increasing risk for both tasks. The final score identified by RULA, for tasks of fish filleting and packaging, suggested a medium level of action, therefore were required additional observations. By OCRA checklist the final score for both tasks denoted a high risk.

Health and Environmental Risks of Residents Living Close to a Landfill: A Case Study of Thohoyandou Landfill, Limpopo Province, South Africa

The by-products of solid waste deposited in a landfill has adverse effects on the surrounding environment and humans living closer to landfill sites. This study sought to test the hypothesis that the deposition of waste on landfill has an impact on the surrounding environment and residents living closer to it. This was achieved by evaluating the perception of the respondents drawn from people living close (100-500 m) and far (1-2 km) from the landfill site, concerning environmental issues, health problems, and life satisfaction. Results from the study showed that 78% of participants living closer to the landfill site indicated serious contamination of air quality evident from bad odours linked to the landfill site. Illnesses such as flu, eye irritation and weakness of the body were frequently reported by participants living closer to the landfill than those living far from the landfill. More than half of the participants (56%) living closer to the landfill indicated fear of their health in the future. Thus, the participants living closer to the landfill site were less satisfied with the location of their community with respect to the landfill, than those living far from the landfill site. Therefore, the need for a landfill gas (LFG) utilisation system, proper daily covering of waste and odour diluting agents are necessary to reduce the problems of the residents living closer to the landfill site.

A Panel Study on Lung Function and Bronchial Inflammation among Children Exposed to Ambient SO₂ from an Oil Refinery

To determine the acute effects on respiratory function of children exposed to sulphur dioxide (SO₂), we conducted two population-based longitudinal investigations near a major oil refinery. We enrolled 233 children, age 8–14, in Sarroch (Italy). The first study entailed five monthly spirometric visits (Panel 5). In a subgroup, children positive for history of respiratory symptoms were tested weekly (20 times) with spirometry and fractional exhaled nitric oxide (FeNO) measurement (Panel 20). Baseline questionnaires and daily diaries were recorded. SO₂, NO₂, PM₁₀ and O₃ were measured by monitoring stations. Multiple regression models were fitted. Using a multipollutant model, we found that a 10 µg/m³ SO₂ increase at lag0–2 days determined a percent variation (PV) of −3.37 (90% confidence interval, CI: −5.39; −1.30) for forced expiratory volume after one second (FEV1) in Panel 5 and a PV = −3.51 (90% CI: −4.77; −2.23) in Panel 20. We found a strong dose-response relation: 1-h SO₂ peaks >200 µg/m³ at lag2 days = FEV1 PV −2.49. For FeNO, we found a PV = 38.12 (90% CI: 12.88; 69.01) for each 10 µg/m³ SO₂ increase at 8-h time lag and a strong dose-response relation. Exposure to SO₂ is strongly associated with reduction of lung function and an increase in airway inflammation. This new evidence of harmful effects of SO₂ peaks should induce regulatory intervention.

Quantitative Microbial Risk Assessment for Workers Exposed to Bioaerosol in Wastewater Treatment Plants Aimed at the Choice and Setup of Safety Measures

Biological risk assessment in occupational settings currently is based on either qualitative or semiquantitative analysis. In this study, a quantitative microbial risk assessment (QMRA) has been applied to estimate the human adenovirus (HAdV) health risk due to bioaerosol exposure in a wastewater treatment plant (WWTP). A stochastic QMRA model was developed considering HAdV as the index pathogen, using its concentrations in different areas and published dose–response relationship for inhalation. A sensitivity analysis was employed to examine the impact of input parameters on health risk. The QMRA estimated a higher average risk in sewage influent and biological oxidation tanks (15.64% and 12.73% for an exposure of 3 min). Sensitivity analysis indicated HAdV concentration as a predominant factor in the estimated risk. QMRA results were used to calculate the exposure limits considering four different risk levels (one illness case per 100, 1.000, 10.000, and 100.000 workers): for 3 min exposures, we obtained 565, 170, 54, and 6 GC/m³ of HAdV. We also calculated the maximum time of exposure for each level for different areas. Our findings can be useful to better define the effectiveness of control measures, which would thus reduce the virus concentration or the exposure time.

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

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