Occupational risk for hepatitis A: a literature-based analysis

Occupation and Industry Data Quality Among Select Notifiable Conditions in Washington State

CONTEXT

Occupation and industry are basic data elements that, when collected during public health investigations, can be key to understanding patterns of disease transmission and developing effective prevention measures.

OBJECTIVE

To assess the completeness and quality of occupation and industry data among select notifiable conditions in Washington and discuss potential improvements to current data collection efforts.

DESIGN

We evaluated occupation and industry data, collected by local health departments during routine case investigations, for 11 notifiable conditions, selected for inclusion based on an established or plausible link to occupational exposure.

SETTING AND PARTICIPANTS

Confirmed cases of select notifiable conditions among Washington residents aged 16 to 64 years, for years 2019-2021.

MAIN OUTCOME MEASURES

We calculated the percentage of cases among working-age adults reported as employed, the percentage with occupation and industry data collected, and the percentage assigned standard occupation and industry codes. We identified the most common responses for occupation and industry and challenges of assigning codes to those responses.

RESULTS

Among the 11 conditions evaluated, one-third of cases aged 16 to 64 years were reported as employed. Among the cases reported as employed, 91.5% reported occupation data and 30.5% reported industry data. "Self-employed" was among the top responses for occupation, a response that does not describe a specific job and could not be assigned an occupation code. In the absence of additional information, 4 of the most common responses for industry could not be coded: "health care," "technology," "tech," and "food."

CONCLUSION

Routine collection of informative occupation and industry data among working-age adults is largely absent from case investigations in Washington. Methods of data collection that improve quality while minimizing the burden of collection should be pursued. Suggestions for improving data quality are discussed.

Quantifying pathogen infection risks from household laundry practices

Aims

Contaminated laundry can spread infections. However, current directives for safe laundering are limited to healthcare settings and not reflective of domestic conditions. We aimed to use quantitative microbial risk assessment to evaluate household laundering practices (e.g., detergent selection, washing and drying temperatures, and sanitizer use) relative to log₁₀ reductions in pathogens and infection risks during the clothes sorting, washer/dryer loading, folding and storing steps.

Methods and Results

Using published data, we characterized laundry infection risks for respiratory and enteric pathogens relative to a single user contact scenario and a 1.0 × 10⁻⁶ acceptable risk threshold. For respiratory pathogens, risks following cold water wash temperatures (e.g. median 14.4℃) and standard detergents ranged from 2.2 × 10⁻⁵ to 2.2 × 10⁻⁷. Use of advanced, enzymatic detergents reduced risks to 8.6 × 10⁻⁸ and 2.2 × 10⁻¹¹ respectively. For enteric pathogens, however, hot water, advanced detergents, sanitizing agents and drying are needed to reach risk targets.

Significance and Impact of the Study

Conclusions provide guidance for household laundry practices to achieve targeted risk reductions, given a single user contact scenario. A key finding was that hand hygiene implemented at critical control points in the laundering process was the most significant driver of infection prevention, additionally reducing infection risks by up to 6 log₁₀.

Laundry Hygiene and Odor Control: State of the Science

Laundering of textiles—clothing, linens, and cleaning cloths—functionally removes dirt and bodily fluids, which prevents the transmission of and reexposure to pathogens as well as providing odor control. Thus, proper laundering is key to controlling microbes that cause illness and produce odors. The practice of laundering varies from region to region and is influenced by culture and resources. This review aims to define laundering as a series of steps that influence the exposure of the person processing the laundry to pathogens, with respect to the removal and control of pathogens and odor-causing bacteria, while taking into consideration the types of textiles. Defining laundering in this manner will help better educate the consumer and highlight areas where more research is needed and how to maximize products and resources. The control of microorganisms during laundering involves mechanical (agitation and soaking), chemical (detergent and bleach), and physical (detergent and temperature) processes. Temperature plays the most important role in terms of pathogen control, requiring temperatures exceeding 40°C to 60°C for proper inactivation, while detergents play a role in reducing the microbial load of laundering through the release of microbes attached to fabrics and the inactivation of microbes sensitive to detergents (e.g., enveloped viruses). The use of additives (enzymes) and bleach (chlorine and activated oxygen) becomes essential in washes with temperatures below 20°C, especially for certain enteric viruses and bacteria. A structured approach is needed that identifies all the steps in the laundering process and attempts to identify each step relative to its importance to infection risk and odor production.

A Bayesian Belief Network Model Assessing the Risk to Wastewater Workers of Contracting Ebola Virus Disease During an Outbreak

During an outbreak of Ebola virus disease (EVD), hospitals' connections to municipal wastewater systems may provide a path for patient waste bearing infectious viral particles to pass from the hospital into the wastewater treatment system, potentially posing risks to sewer and wastewater workers. To quantify these risks, we developed a Bayesian belief network model incorporating data on virus behavior and survival along with structural characteristics of hospitals and wastewater treatment systems. We applied the model to assess risks under several different scenarios of workers' exposure to wastewater for a wastewater system typical of a mid-sized U.S. city. The model calculates a median daily risk of developing EVD of approximately 6.1×10^-12 (90% confidence interval: 1.0×10^-12 to 5.4×10^-9 ; mean 1.8×10^-6 ) when no prior exposure conditions are specified. Under a worst-case scenario in which a worker stationed in the sewer adjacent to the hospital accidentally ingests several drops (0.35 mL) of wastewater, median risk is 5.8×10^-4 (90% CI: 8.8×10^-7 to 9.5×10^-2 ; mean 3.2×10^-2 ) . Disinfection of patient waste with peracetic acid for 15 minutes prior to flushing decreases the estimated median risk to 3.8×10^-7 (90% CI: 4.1×10^-9 to 8.6×10^-5 ; mean 2.9×10^-5 ). The results suggest that requiring hospitals to disinfect EVD patient waste prior to flushing may be advisable. The modeling framework can provide insight into managing patient waste during future outbreaks of highly virulent infectious pathogens.

Hepatitis A immunity and region-of-origin in a Swiss prison

Purpose - The environmental and demographic characteristics of closed institutions, particularly prisons, precipitate morbidity during hepatitis A virus (HAV) outbreaks. Given the high prevalence of chronic liver disease and other risk factors in the prison setting, the purpose of this paper is to examine HAV-immunity and its associated factors in this population. Design/methodology/approach - The cross-sectional study was conducted in 2009: a serology screening for HAV IgG was carried out among 116 inmates in Switzerland's largest pre-trial prison. Other participant characteristics were collected through a structured face-to-face questionnaire with a physician. Findings - In terms of significant demographics, Africa (53.5 percent) and the Balkans/Eastern Europe (36.2 percent) were the main regions of origin; a minority of inmates were from Western Europe (6.9 percent), Latin America (2.6 percent) or Asia (0.9 percent). The authors identified hepatitis A antibody-negative serology (lack of immunity) in five out of 116 prisoners (4.3 percent, 95 percent CI 1.4-9.7). Among participants of European origin alone, five out of 50 inmates were hepatitis A antibody-negative (10 percent, 95 percent CI 3.3-21.8), whereas the 66 inmates from other all continents were hepatitis A antibody-positive (immune) (p=0.026). Originality/value - In this prison population composed of mostly African migrants, hepatitis A immunity was high. This reaffirms that region of origin is highly associated with childhood immunity against HAV. HAV vaccination should take into account a patient's area of origin and his/her risk factors for systemic complications, if ever infected. This targeted strategy would offer herd immunity, and seek out the most vulnerable individuals who are potentially at risk of new exposure in this precarious setting.

Molecular characteristics of Staphylococcus aureus isolated from employees, children, and environmental surfaces in Iowa child daycare facilities

BACKGROUND

Infectious agents have the potential to thrive in child daycare facilities. Asymptomatic Staphylococcus aureus carriage is a risk factor for developing infection and contributes to transmission.

METHODS

We collected swabs from 110 employees, 111 unexposed adults, 81 children, and 214 environmental surfaces at 11 Iowa daycare facilities. S aureus isolates were characterized using antibiotic resistance profiles and Staphylococcal protein A typing. Staphylococcal protein A types were grouped into cluster complexes using the Based Upon Repeat Pattern algorithm.

RESULTS

All isolates (from 38 employees, 37 unexposed adults, 16 children, and 19 surfaces) were characterized. Daycare employees were more likely to carry erythromycin-resistant S aureus than unexposed adults (odds ratio, 3.7; 95% confidence interval, 1.1-12.7; P = .033). Isolates were genetically heterogeneous, although isolates from employees appeared more clonal than those from unexposed adults. Strains associated with ST8 were identified in 5 daycare facilities and 3 unexposed adults.

CONCLUSIONS

S aureus isolates collected from employees, children, and surfaces of daycare facilities are genetically heterogeneous, but contain strains associated with community-associated methicillin-resistant S aureus. This suggests that daycare facilities can serve as reservoirs for community-associated methicillin-resistant S aureus and facilitate genetic exchange. Employees may be at increased risk of carrying antibiotic-resistant strains, indicating more research is necessary into this occupational group.

HAV Immunity in Iranian Medical Students

BACKGROUND

Hepatitis A, a fecal-oral transmitted disease, which has been considered endemic in developing countries, seems to change its pattern in developing countries because of their improved socioeconomic status.

OBJECTIVES

In the present study, we aimed to determine the need of vaccination in 270 students at AJA University of Medical Sciences.

MATERIALS AND METHODS

The serum level of anti-HAV antibody was checked in 270 students of AJA University of medical students, and effect of different factors, including age, gender, pre-university entrance exam region, familial education, familial income, clean water availability, and previous history of jaundice were tested.

RESULTS

Of total 270 students, 30 were female. Their age ranged between 18 and 30 years old with the mean age of 20.58 years and just 34% of students had positive level of anti-HAV antibody. Age and sex had no role in positive serum level of anti-HAV antibody. According to analyzed data, lack of clean water availability, pre-university entrance exam region, lower family education, and poor health status estimation increased statistically the risk of HAV infection.

CONCLUSIONS

Because 66% of students were anti-HAV antibody negative and they will work as health care workers in future, our study suggest vaccinating all students accepted at AJA University of Medical Sciences.

Hospital textiles, are they a possible vehicle for healthcare-associated infections?

Textiles are a common material in healthcare facilities; therefore it is important that they do not pose as a vehicle for the transfer of pathogens to patients or hospital workers. During the course of use hospital textiles become contaminated and laundering is necessary. Laundering of healthcare textiles is most commonly adequate, but in some instances, due to inappropriate disinfection or subsequent recontamination, the textiles may become a contaminated inanimate surface with the possibility to transfer pathogens. In this review we searched the published literature in order to answer four review questions: (1) Are there any reports on the survival of microorganisms on hospital textiles after laundering? (2) Are there any reports that indicate the presence of microorganisms on hospital textiles during use? (3) Are there any reports that microorganisms on textiles are a possible source infection of patients? (4) Are there any reports that microorganisms on textiles are a possible source infection for healthcare workers?

Occupational health hazards in sewage and sanitary workers

An estimated 1.2 million scavengers in the country are involved in the sanitation of our surroundings. The working conditions of these sanitary workers have remained virtually unchanged for over a century. Apart from the social atrocities that these workers face, they are exposed to certain health problems by virtue of their occupation. These health hazards include exposure to harmful gases such as methane and hydrogen sulfide, cardiovascular degeneration, musculoskeletal disorders like osteoarthritic changes and intervertebral disc herniation, infections like hepatitis, leptospirosis and helicobacter, skin problems, respiratory system problems and altered pulmonary function parameters. This can be prevented through engineering, medical and legislative measures. While the engineering measures will help in protecting against exposures, the medical measures will help in early detection of the effects of these exposures. This can be partly achieved by developing an effective occupational health service for this group of workers. Also, regular awareness programs should be conducted to impart education regarding safer work procedures and use of personal protective devices.

Seroprevalence of anti-HAV among patients with chronic viral liver disease

AIM: To investigate the current seroprevalence of hepatitis A virus (HAV) antibodies in patients with chronic viral liver disease in Korea. We also tried to identify the factors affecting the prevalence of HAV antibodies.

METHODS: We performed an analysis of the clinical records of 986 patients (mean age: 49 ± 9 years, 714 males/272 females) with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection who had undergone HAV antibody testing between January 2008 and December 2009.

RESULTS: The overall prevalence of IgG anti-HAV was 86.61% (854/986) in patients with chronic liver disease and was 88.13% (869/986) in age- and gender-matched patients from the Center for Health Promotion. The anti-HAV prevalence was 80.04% (405/506) in patients with chronic hepatitis B, 86.96% (20/23) in patients with chronic hepatitis C, 93.78% (422/450) in patients with HBV related liver cirrhosis, and 100% (7/7) in patients with HCV related liver cirrhosis. The anti-HAV prevalence according to the decade of age was as follows: 20s (6.67%), 30s (50.86%), 40s (92.29%), 50s (97.77%), and 60s (100%). The anti-HAV prevalence was significantly higher in patients older than 40 years compared with that in patients younger than 40 years of age. Multivariable analysis showed that age ≥ 40 years, female gender and metropolitan cities as the place of residence were independent risk factors for IgG anti-HAV seropositivity.

CONCLUSION: Most Korean patients with chronic liver disease and who are above 40 years of age have already been exposed to hepatitis A virus.

Rotaviral RNA found on various surfaces in a hospital laundry

The aim of this investigative study was to determine the presence of rotaviral RNA at various control points (CP) of a hospital laundry. One of the possible sources of hospital infections is inappropriately laundered and disinfected hospital textiles. RT-PCR and nested PCR for gene amplification using specific primers following RNA isolation were used to determine the presence of rotaviral RNA on swabs. In addition, rotavirus suspensions were inoculated on marked surfaces as positive controls for different surfaces (cotton textiles, folding table and industrial dryer). Rotaviral RNA was found on various laundry surfaces: technical equipment, storage shelves, transport vehicles, personnel's hands, damp textiles, and folded laundry. Rotaviral RNA was also detected at all positive controls on tested surfaces after 24h. Based on the results, it is very important to take into consideration the proper handling of textiles after washing as one of the precautions against hospital-acquired infections. This paper reports the presence of rotaviral RNA for the first time on surfaces in laundries and equipment, as well as textiles.

Prevalence of hepatitis A virus infection among municipal solid-waste workers

A study was conducted among 151 municipal workers (72 solid-waste workers, and 79 workers not exposed to waste). Total antibodies against Hepatitis A virus (HAV) were measured, and socio-demographic information was collected using a self-administered questionnaire. Univariate analysis has shown that occupational exposure to waste, age, duration of employment and educational status were significantly associated with the prevalence of anti-HAV(+). Municipal Solid Waste Workers had a higher prevalence of anti-HAV(+) in comparison with municipal workers not exposed to waste. Duration of employment was significantly associated anti-HAV(+). Multivariate analysis revealed an independent association of anti-HAV(+) with occupational exposure to waste and ageing. Our results suggest a potential causal role of occupational exposure to waste, in the development of HAV infection.

Susceptibility to hepatitis A in patients with chronic liver disease due to hepatitis C virus infection: missed opportunities for vaccination

Hepatitis A virus (HAV) superinfection is associated with a high risk of liver failure and death in patients with underlying chronic liver disease. Although HAV vaccination is recommended for all patients with chronic hepatitis C virus (HCV) infection, little is known about adherence to these recommendations in clinical practice. The aims of this study were to determine the frequency of HAV testing and vaccination among patients with chronic HCV infection. We conducted a retrospective cohort study of 1,193 patients diagnosed with chronic HCV infection over a 1-year period. During 1,646 person-years of follow-up, patients were seen by their primary care provider a median of 10.0 times (interquartile range, 4.0-20.0). HAV antibody testing was performed in 640 subjects (53.6%), and 317 (49.5%) of those tested were susceptible (HAV antibody negative). Only 94 of the 1,193 patients (7.9%) received the HAV vaccine, including 26.8% of the 317 susceptible patients, 0.9% of the 323 patients who were already immune to HAV, and 1.1% of the 553 subjects who were never tested. Among the 94 vaccinated patients, 45 received only one dose of the vaccine. Three of the unvaccinated patients developed acute HAV infection during follow-up, and 1 of them died of acute liver failure. In conclusion, despite published recommendations to vaccinate against HAV in patients with chronic HCV infection, we found that HAV testing and vaccination rates were low in clinical practice. Public health programs to increase awareness about HAV vaccination in patients with chronic liver disease are needed.