Dear Sam Hadeed of the Water Environment Federation -- (WEF is the spokesperson for the sludge producers and sludge spreaders )...... regarding your recent editorial opining against "false" accusations that sewage workers get sick from their expsoure to this toxic/pathogenic waste .... just as neighbors of sludge sites have been getting sick for years ........the following represents a cursory Internet/document search on this isue -- which clearly indicates these people DO GET SICK .... and quotes from some of your favorite people -- Dr. Charles Gerba and Dr. Ian Pepper .... which CONFIRM sewage workers DO GET SICK:

"

The Researchers describe symptoms experienced by sludge workers:

"Clinically, these illnesses were usually manifested as undue tiredness and headaches that were evident after work. Additionally, other symptoms such as respiratory problems, nonspecific bowel dysfunction, irregular heartbeat, nausea, vomiting and diarrhea were also common complaints."

NEIGHBORS OF SLUDGE SITES HAVE BEEN REPORTING THESE SYMPTOMS FOR YEARS"

On February 2, 2000, Ned Beecher, head of the "New England Biosolids and
Residuals Association" -- and local stooge for Al Rubin, et al .....
wrote an 8-page letter to a State Representative and a State Senator
extolling the virtues of biosolids. Dr. Caroline Snyder and I will be
rebutting this letter.

I did want to share with you one section of Beecher's letter:

"Surely, if they (biosolids) are dangerous, we would be able to point to
clear and convincing cases of illness and death amongst those most
exposed -- wastewater treatment workers, managers of biosolids programs,
farmers and domestic livestock. While there are many stories and myths
out there, the ones I have examined closely all contain impossible
connections or assumptions and are not scientifically credible."

THE FOLLOWING are a SMALL SAMPLE of the information available re
occupational health hazards of sewage treatment workers:

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http://216.32.180.250/cgi-bin/linkrd?_lang=EN&lah=8d87dad55b5876042bd98d0c643bf1b1&lat=999012221&hm___action=http%3a%2f%2fwww%2ecdc%2egov%2fniosh%2f01822519%2ehtml

Waste Water Treatment Health Hazard Evaluation

LITTLE BLUE VALLEY SEWER DISTRICT

INDEPENDENCE, MISSOURI

HETA 94-0182-2519

August 1995

Summary

In March 1994 the National Institute for Occupational Safety and Health
(NIOSH) received a request to conduct a
health hazard evaluation (HHE) at the Little Blue Valley Sewer District
wastewater treatment plant in
Independence, Missouri. The employees reported gastrointestinal
disturbances, sore throats, fatigue, headaches,
eye irritation, and unexplained coughing accompanied by hoarseness while

working in the belt press room.

Based on the personal breathing zone air sample results, workers in the
belt press room were exposed to hydrogen
sulfide (H2S) concentrations which exceeded the 10-minute NIOSH ceiling
limit of 10 ppm and the 10-minute
OSHA PEL of 20 ppm. Recommendations were made to provide continuous H2S
monitors for employees working
in or around the belt press room and to implement engineering controls
to reduce H2S concentrations. Respiratory
protection is recommended in the interim until work practices and
engineering controls can effectively reduce H2S
exposures below recommended levels.



An initial site visit, walk-through evaluation, and employee interviews
were made at the sewage treatment plant on May 17-18,
1994. On August 2-4, 1994, a return site visit was made to collect
personal breathing zone (PBZ) air samples, general area air
samples, and bulk sewage sludge and incinerator ash samples. Maximum
10-minute hydrogen sulfide (H2S) PBZ
concentrations ranged from 0.1 parts per million (ppm) to 95 ppm; 8 of
the 13 PBZ exceeded the NIOSH 10-minute ceiling
recommended exposure limit (REL) of 10 ppm, and 3 of these exceeded the
Occupational Safety and Health Administration
(OSHA) 10-minute ceiling permissible exposure limit (PEL) of 20 ppm.
Maximum 10-minute H2S concentrations in general
area air samples obtained in the belt press room ranged from 46 to 69
ppm. Outside the belt press room, the maximum
10-minute H2S general area air concentrations ranged from non-detectable

to 0.1 ppm.

PBZ air sample results for total particulate and endotoxin ranged from
0.03 to 0.28 milligrams per cubic meter of air (mg/m3),
and 2.59 to 6.82 endotoxin units per cubic meter of air (EU/m3),
respectively. While no evaluation criteria has been established
for endotoxin, the levels detected were all below the calculated zero
pulmonary function effects level for endotoxin of 90
EU/m3 reported by Castellan, and the levels Rylander has reported
causing airway inflammation with increased airway
reactivity at 200 EU/m3. The general area air sample concentrations of
total particulate and endotoxin ranged from 0.03 to
0.19 mg/m3 and 2.03 to 54.7 EU/m3, respectively. The general area air
sample containing 54.7 EU/m3 endotoxin was
collected between two gravity concentrators.

Bulk samples of waste activated sewage sludge were collected and
analyzed qualitatively for headspace volatile organic
compounds (VOCs). The sludge samples containing 40% solids had the
highest concentrations and largest variety of VOCs
when compared to sludge samples containing 5% solids, which were higher
than sludge samples containing 1% solids. Major
VOCs identified included toluene, C10-C14 aliphatic hydrocarbons,
cyclopentanone, methyl ethyl ketone, and acetone. Other
VOCs detected included methanol, ethanol, butanol, C5-C11 aliphatic
ketones, furans, limonene, acetic acid, and a few fatty
acids.

Pairs of air samples were collected for VOCs in a given location. One
sample from each pair was analyzed qualitatively to
identify VOCs present. Similar to the results obtained from the sludge
headspace air sample results, toluene, limonene, and
various aliphatic hydrocarbons, mainly in the C10-C14 range, were the
major compounds identified. Traces of acetone,
isopropanol, methyl ethyl ketone, other ketones, furans, and
1,1,1-trichloroethane were also detected on some samples. Based
on the qualitative results, the other sample from each pair was analyzed

quantitatively for toluene, limonene, and total
hydrocarbons. Area air sample results for toluene, limonene, and total
hydrocarbons ranged from non-detectable (ND) to 0.39
ppm.

PBZ air sample results for toluene were all below 0.06 ppm, well below
the NIOSH REL of 100 ppm and the OSHA PEL
TWA of 200 ppm. PBZ air sample results for limonene and total
hydrocarbons were all below 0.05 ppm. No evaluation
criteria for limonene or total hydrocarbons have been established.

Bulk samples of waste activated sewage sludge and incinerator ash were
analyzed for elemental composition. Detectable
concentrations of 23 different elements were found. Concentrations of
the elements were highest in the incinerator ash samples,
followed by sludge samples containing 40% solids. The eight most
abundant elements present in the sludge samples were
aluminum (Al), calcium (Ca), iron (Fe), phosphorous (P), magnesium (Mg),

sodium (Na), barium (Ba), and copper (Cu). The
eight most abundant elements present in the ash samples were P, Al, Ca,
Fe, Mg, Na, zinc (Zn), and Ba.

General area air samples were collected and analyzed for the following
metals: lead; chromium (Cr); Al; silver; Zn; Cu; arsenic;
Be; cadmium; antimony; selenium (Se); and titanium. All results were ND
except for a trace concentration of Zn (between 0.9
and 3.0 micrograms per cubic meter of air) present in an air sample
collected between the ash and sludge conveyors on the
second day of sampling.

Bulk incinerator ash samples were also analyzed for silica (Si) content.

The concentrations ranged from 3.16 to 5.19% Si.
General area air samples were collected and analyzed for respirable
particulate and Si (quartz, and cristobalite). The respirable
particulate concentrations ranged from 0.01 to 0.08 mg/m3. None of the
sample results had detectable concentrations of
respirable quartz or cristobalite.



Keywords: SIC 4952 (Wastewater Treatment) waste activated sludge,
incineration, hydrogen sulfide, volatile organic
compounds, metals, silica, total particulate, endotoxin.



To request a full text copy of this HHE, contact NIOSH Publications at
1-800-35-NIOSH (1-800-356-4674).

Go back to the NIOSH Home Page or to the CDC Home Page
************************************************************
Studies on humans exposed to airborne sewage sludge.



Rylander R, Andersson K, Belin L, Berglund G, Bergstrom R, Hanson L,
Lundholm
M, Mattsby I

A clinical investigation was made among workers in a sewage treatment
plant
and age matched controls not exposed to sewage. Acute incidences of
fever and
eye symptoms were found in about 50% of the exposed population. Serum
immunoglobulins, white blood cells and thrombocytes were elevated in the

exposed group. A higher percentage of increased levels of C-reactive
protein
and fibrinogen degradation products was found in the exposed group.
Although
no definite cause-effect relationship can be established the responsible

agent in the environment could well be endotoxins.

PMID: 834990, UI: 77104585



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Towards an Occupational Exposure Limit for Endotoxins?

by Dick Heederik and Jeroen Douwes
http://lw2fd.hotmail.msn.com/cgi-bin/compose?curmbox=F000000001&a=f509b4bfbbc9774b088f41e624582f40&mailto=1&to=Dick%2eHeederik%2estaff%40eoh%2ewau%2enl&msg=MSG998874484.6&start=2049805&len=144010&src=&type=x
page 17-19

Abstract

Endotoxins are part of the outer membrane of Gram-negative bacteria and
are present ubiquitously in the environment. The
lipopolysaccharide (LPS) part of the molecule is responsible for its
toxic properties. Environmental monitoring is ususally
performed by sampling airborne dust and subsequent analysis of aqueous
extracts by using a LAL assay. The kinetic version of
htis assay can measure concentrations as low as in the pg/m(3) range. A
generally accepted protocol is not yet available.
Endotoxin levels are related to the occurrence of Gram-negative
bacteria. Animal faeces and bacteria contiminated plant
materials contribute most to organic dust related endotoxin exposure.
Endotoxin exposure is therefore most prevalent in
agricultural and related industries. Acute health effects are dry cough
and shortness of breath accompanied by a decrease in
lung function, fever reaction and malaise, and sometimes dyspnea and
headaches occurring a few hours after the start of the
endotoxin exposure. Epidemiological and experimental studies suggest
that chronic endotoxin exposure may lead to chronic
bronchitis and reduced lung function. Depending of the relevant health
effect, no effect levels range from 9 to 170ng/m(3). The
Dutch Expert Committee on Occupational Standards (DECOS) of the National
Health Council proposed a health based
redcommended limit value of 50 Endotoxin Units/m(3) (4.5ng/m(3)) over an
8 hour exposure period.
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Bacteria and Fungi in Organic Dust as Potential Health Hazard

by Jacek Dutkiewicz
http://lw2fd.hotmail.msn.com/cgi-bin/compose?curmbox=F000000001&a=f509b4bfbbc9774b088f41e624582f40&mailto=1&to=dutkiewi%40galen%2eimw%2elublin%2epl&msg=MSG998874484.6&start=2049805&len=144010&src=&type=x
page 11-16

Abstract

People engaged in agriculture, waste collection and other professions
are exposed to large quantities of bioaerosols associated
with organic dusts, ranging from 10(3)-10(10) cfu/m(3). These
bioaerosols are composed of Gram-negative rod-shaped
bacteria, Gram-positive, non-branching bacteria (corynebaccteria, cocci
and endospore-forming bacilli), antinomycetes and
fungi (moulds and yeasts). Endotoxin produced by Gram-negative bateria
causes non-specific, inflammatory reaction in the
lungs of exposed people, while thermophilic actinomycetes and moulds are
a common cause of allergy. So far only little is
known about health effects of Gram-positive bacteria, which in many
cases form a dominant fraction of dust-borne bioaerosols.

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1996-03-05 QUANTIFICATION OF AIR CONTAMINANTS AT A MUNICIPAL SEWAGE
SLUDGE
COMPOSTING FACILITY IN COLORADO
An estimated 50 million tons of compost are produced in the United
States annually. Between 1983 and 1993 the number of
commercial-sized composting facilities grew dramatically. The growth of
this industry coincides with a growing potential for
exposure of compost workers to air contaminants, including biologic
dusts, various gases, and airborne heavy metals. In 1993
approximately 4,000 employees were working at 321 municipal composting
facilities in 46 states.

In order to characterize the air contaminants inside a municipal
composting facility, researchers from the High Plains
Intermountain Center for Agricultural Health & Safety and the Department
of Environmental Health at Colorado State
University recently conducted a study at a composting facility in
Longmont, Colorado. During this study total dust
concentrations were measured as high as 173.79 mg/m3. The geometric mean
of total dust samples on days with screening and
sweeping operations were 23.05 mg/m3 and 35.19 mg/m3. The average mass
median aerodynamic diameter (MMAD) of the
aerosol was approximately 4.0 um. Endotoxin concentrations varied from
28.9 ng/m3 to 5,930.6 ng/m3. According to the
International Committee on Occupational Health, 21 percent of the
collected endotoxin concentrations exceeded levels which
may cause organic dust toxic syndrome (ODTS), 69 percent exceeded acute
bronchoconstriction levels, and 100 percent
exceeded the mucous membrane irritation level.

The results suggested a cause for serious concern about occupational
exposure of employees to endotoxins during sewage
sludge composting. Additionally, the high dust concentration coupled
with the small MMAD indicated a possible occupational
health risk from dust exposure at this municipal composting facility.
However, very low concentrations of silica, gases and
airborne heavy metals were measured during this study at this facility.

For more information on this study, please contact:
Alex Darragh or Del Sandfort
Occupational Health and Safety Section
Colorado State University
Fort Collins, CO 80523
(970)491-6151
Alex Darragh http://lw2fd.hotmail.msn.com/cgi-bin/compose?curmbox=F000000001&a=f509b4bfbbc9774b088f41e624582f40&mailto=1&to=adarragh%40lamar%2ecolostate%2eedu&msg=MSG998874484.6&start=2049805&len=144010&src=&type=x
Del Sandfort http://lw2fd.hotmail.msn.com/cgi-bin/compose?curmbox=F000000001&a=f509b4bfbbc9774b088f41e624582f40&mailto=1&to=dsand%40lamar%2ecolostate%2eedu&msg=MSG998874484.6&start=2049805&len=144010&src=&type=x

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Record 1 from database:
MEDLINE
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Title
Intestinal parasite carriage in workers exposed
to sewage.
Author
Schlosser O; Grall D; Laurenceau MN
Address
GÆenÆerale des Eaux, Occupational Health
Department, Paris, France.
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Source
Eur J Epidemiol, 1999 Mar, 15:3, 261-5
Abstract
The presence of protozoan cysts and helminth
eggs in sewage and the very low minimal infective
doses of parasites suggest an occupational risk
for workers exposed to sewage. The objective of
this study was to assess this risk in a group of
raw sewage-exposed workers. The relationship
between sewage exposure and intestinal parasite
carriage was estimated by a multiple
cross-sectional survey comparing yearly
prevalence rates in 126 employees working in sewers in
Paris, France, with the prevalence rate in 363
food-handlers employed between 1988 and 1993.
The incidence of intestinal parasitic
infestation was estimated among sewage-exposed workers.
Four parasite species were identified among
sewage-exposed workers: whipworm, Giardia lamblia,
Entamoeba coli and Endolimax nanus. The
prevalence mean of intestinal parasite carriage was
11.8% (57/480), related to the presence of
protozoa in 91% of samples. G. lamblia was present in
3.5% (17/480) of samples. The incidence of
positive parasitological stool examination was 5.9/100
person-years. The incidence of G. lamblia in
stool examinations was 1.7/100 person-years.
Age-adjusted odds ratios were significantly
higher in exposed workers in 1988 (OR: 6.5; 95% CI:
2.0-14.5), 1990 (OR: 4.4; 95% CI: 1.2-10.1) and
1991 (OR: 3.4; 95% CI: 1.0-8.2), but not during
the other three years. The results of this study
emphasize an occupational risk of intestinal
protozoan infestation in workers exposed to
sewage. The decrease of adjusted OR with time
reflects the efficacy of compliance with rules
of hygiene.
Language of Publication
English
Unique Identifier
99320979

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MeSH Heading (Major)
Intestinal Diseases, Parasitic|*EP/TM;
Occupational Diseases|*EP; Occupational
Expo

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"The relative risk of alterations in respiratory function (both
instrumental and clinical findings) was
increased among the water treatment workers."



NLM database Document



Record 1 from database:
MEDLINE
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Title
[An epidemiological study of a group of workers
employed in the maintenance of a sewer network
and of urban waste water treatment plants]
Author
Salano R; Copello F
Address
Servizio di Medicina del Lavoro AMGA (Azienda
Mediterranea Gas e Acqua), Genova.
Source
Med Lav, 1998 Sep, 89:5, 393-403
Abstract
The paper reports the results of a study on
occupational risks of a group of sewage workers of the
city of Genoa vs. a control group of nonexposed
subjects; the first group was divided into three
subgroups according to the job characteristics.
After bibliographical research on the topic, a
specific questionnaire was used to analyse
individual symptoms. Clinical examinations, blood and
respiratory tests were also performed. The
statistical analysis was performed by evaluating F test
for differences between parametric measures and
the relative risk for non-parametric findings. The
relative risk of alterations in respiratory
function (both instrumental and clinical findings) was
increased among the water treatment workers. The
average platelets count in the exposed
workers appeared to be significantly reduced
compared to non-exposed subjects although both
were within the normal limits. There was non
evidence of an increased prevalence of positive A
hepatitis markers in the exposed workers.
Language of Publication
Italian
Unique Identifier
99164338

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MeSH Heading (Major)
Occupational Diseases|DI/*EP/ET; Sanitary
Engineering|*MA/SN; Urban Population|*/SN; Water
Purification|*/SN
MeSH Heading
Chi-Square Distribution; Comparative Study;
Confidence Intervals; English Abstract; Human;
Incidence; Italy|EP; Occupational
Exposure|AE/SN; Risk; Sewage|AE/SN
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itle
Occupational hepatitis B virus infection in
sewage workers.
Author
Arvanitidou M; Constantinidis TC; Doutsos J;
Mandraveli K; Katsouyannopoulos V
Address
Laboratory of Hygiene and Epidemiology, Medical
School, Aristoteles University of Thessaloniki,
Greece.
Source
Med Lav, 1998 Sep, 89:5, 437-44
Abstract
In a cross-sectional study the employees of a
Sewage Company were tested for hepatitis B virus
(HBV) markers--HBsAg, anti-HBs, anti-HBc--to
determine the prevalence of HBV infection and
assess the risk of exposed sewage workers
becoming infected, so as to evaluate the necessity
for appropriate vaccination. The overall
prevalence of HBV markers was 43.9% and 6.6% of the
employees were HBsAg carriers. In the univariate
analysis the prevalence of past and current
infection was significantly associated with
exposure to sewage (p < 0.001), age (p < 0.001) and
with educational level (p < 0.001). However, the
logistic regression analysis confirmed that only
exposure to sewage was independently associated
with positivity for HBV infection (p < 0.001).
Workers exposed to sewage should therefore be
considered for vaccination against hepatitis B
virus.
Language of Publication
English
Unique Identifier
99164342
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LEGIONAIRES DISEASE

Title
Pontiac fever at a sewage treatment plant in the
food industry.
Author
Gregersen P; Grunnet K; Uldum SA; Andersen BH;
Madsen H
Address
Department of Occupational Medicine, K?ge
Hospital, Denmark.
Source
Scand J Work Environ Health, 1999 Jun, 25:3,
291-5
Abstract
BACKGROUND AND OBJECTIVES: During a hot and
humid summer period workers became ill
with fever and flu-like symptoms after repairing
a decanter for sludge concentration at a sewage
treatment plant. The work took place over a
period of 10 days in a small closed room, while
another decanter was in operation and was
consequently emitting aerosol to the environment, to
which the workers were exposed. The aim of this
study was to determine the cause of this
outbreak of febrile illness so that additional
cases could be prevented. METHODS: All 5 patients
were seen and examined in the Department of
Occupational Medicine. Furthermore 2 of the
workers had recurrent illness and were examined
during hospitalization. As Pontiac fever
(nonpneumonic legionellosis) was suspected,
antibodies to legionellae were measured in blood
samples. After positive antibody titers to
Legionella pneumophila were found, samples of the
sludge were collected for legionellae culture.
RESULTS AND CONCLUSIONS: The clinical picture
agreed with that described for Pontiac fever,
and positive antibody titers to L. pneumophila
serogroup 1 were found in blood from all 5
patients. L. pneumophila serogroup 1 was cultured in
high amounts from sludge from the decanter. It
was concluded that the fever was caused by L.
pneumophila emitted to the environment by the
uncovered decanter. Procedures for preventing new
cases were established.
Language of Publication
English
Unique Identifier
99377991

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MeSH Heading (Major)
Food Industry|*; Legionnaires' Disease|*ET;
Occupational Diseases|*ET; Sewage|*; Waste
Management|*
MeSH Heading
Aerosols; Human; Recurrence



Publication Type
JOURNAL ARTICLE
ISSN
0355-3140
Country of Publication
FINLAND
************************************************************************




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USE OF WASTEWATER FOR IRRIGATION - SALMONELLA

Title
Salmonella infection in children from the
wastewater-spreading zone of Marrakesh city (Morocco).
Author
Aiat Melloul A; Hassani L
Address
Laboratoire de Microbiologie, UniversitÆe Cadi
Ayyad, Marrakesh, Morocco.
Source
J Appl Microbiol, 1999 Oct, 87:4, 536-9
Abstract
The available circumstantial evidence gained
from epidemiological and microbiological
investigations suggests that the use of
untreated wastewater causes an excess of Salmonella
infection among children living in El Azzouzia
(the wastewater-spreading area of Marrakesh city,
Morocco) compared with those from a control area
that does not practice sewage irrigation (Sidi
Moussa). The prevalence in the exposed group
(32.56%) was significantly (P < 0. 001) higher than
for the control group (1.14%). Serogroups B and
C were the most commonly isolated. Boys were
at greater risk (37.61%) of contracting
Salmonella infection than girls (26.66%). Age-specified
rates showed that children of less than 10 years
old were infected at a higher rate than older
children in the area (exposed group), with
40.32% and 19.72% rates of infection, respectively.
Crop irrigation with untreated wastewater caused
a significantly higher rate of infection with
Salmonella in the children of agricultural
workers (39.33%) than in the children of non-agriculturists
(24.58%).
Language of Publication
English
Unique Identifier
20051443

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MeSH Heading (Major)
Feces|*MI; Salmonella Infections|*EP;
Sewage|*MI; Water Microbiology|*; Water Pollution|*
MeSH Heading
Adolescence; Age Factors; Child; Child,
Preschool; Data Interpretation, Statistical; Female;
Human; Male; Morocco|EP; Prevalence; Sex
Factors; Socioeconomic Factors; Support, Non-U.S.
Gov't; Water Supply
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HEPATITIS A

tle
Risk of hepatitis A infection in sewage workers.

Author
Brugha R; Heptonstall J; Farrington P; Andren S;
Perry K; Parry J
Address
Immunisation Division, Public Health Laboratory
Service, Communicable Disease Surveillance
Centre, London, UK.
Source
Occup Environ Med, 1998 Aug, 55:8, 567-9
Abstract
OBJECTIVE: To evaluate the risk of hepatitis A
virus (HAV) infection among sewage workers from
occupational exposure to raw sewage. METHODS: An
analytical cross sectional study of 241
company employees with possible occupational
exposure to sewage in a large water and
sewerage company was carried out. Previous
exposure to hepatitis A virus infection was
assessed, as were its associations with possible
risk factors. RESULTS: Frequent occupational
exposure to raw sewage was a significant risk
factor for HAV infection, independently of other
known risk factors (odds ratio 3.73, 95%
confidence interval 1.48 to 9.37). Of 50 employees who
reported occupational exposure to raw sewage
most of the time, 30 (60%) had had HAV infection.
CONCLUSION: Employees who are likely to be at
risk of frequent exposure should have their
immunity ensured. The salivary assay for IgG
anti-HAV used in the study was highly specific and
would be suitable for prevaccination testing of
older employees, who are more likely to be immune.
Language of Publication
English
Unique Identifier
99066407
******************************************************************************

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HEPATITIS C

Title
Sewer workers: occupational risk for hepatitis
C--report of two cases and review of literature.
Author
Brautbar N; Navizadeh N
Address
Department of Medicine, University of Southern
California, School of Medicine, Los Angeles, USA.
Source
Arch Environ Health, 1999 Sep, 54:5, 328-30
Abstract
Two sewer workers contracted hepatitis C. The
epidemiological literature in which
sewer-contaminated water is described as a known
vector for outbreaks of hepatitis C, as well as
the specific occupational history of the two
patients described here, suggest that sewer workers
may be at increased risk of contracting
hepatitis C.
Language of Publication
English
Unique Identifier
99429256

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MeSH Heading (Major)
Hepatitis C|*ET; Occupational Diseases|*ET;
Occupational Exposure|*AE; Sewage|*; Water
Pollution|*

**********************************************************************

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"The relative risk of alterations in respiratory function (both
instrumental and clinical findings) was
increased among the water treatment workers. The
average platelets count in the exposed
workers appeared to be significantly reduced
compared to non-exposed subjects although both
were within the normal limits."

[An epidemiological study of a group of workers
employed in the maintenance of a sewer network
and of urban waste water treatment plants]
Author
Salano R; Copello F
Address
Servizio di Medicina del Lavoro AMGA (Azienda
Mediterranea Gas e Acqua), Genova.
Source
Med Lav, 1998 Sep, 89:5, 393-403
Abstract
The paper reports the results of a study on
occupational risks of a group of sewage workers of the
city of Genoa vs. a control group of nonexposed
subjects; the first group was divided into three
subgroups according to the job characteristics.
After bibliographical research on the topic, a
specific questionnaire was used to analyse
individual symptoms. Clinical examinations, blood and
respiratory tests were also performed. The
statistical analysis was performed by evaluating F test
for differences between parametric measures and
the relative risk for non-parametric findings. The
relative risk of alterations in respiratory
function (both instrumental and clinical findings) was
increased among the water treatment workers. The
average platelets count in the exposed
workers appeared to be significantly reduced
compared to non-exposed subjects although both
were within the normal limits. There was non
evidence of an increased prevalence of positive A
hepatitis markers in the exposed workers.
Language of Publication
Italian
Unique Identifier
99164338

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MeSH Heading (Major)
Occupational Diseases|DI/*EP/ET; Sanitary
Engineering|*MA/SN; Urban Population|*/SN; Water
Purification|*/SN
MeSH Heading
Chi-Square Distribution; Comparative Study;
Confidence Intervals; English Abstract; Human;
Incidence; Italy|EP; Occupational
Exposure|AE/SN; Risk; Sewage|AE/SN



Publication Type
JOURNAL ARTICLE
ISSN
0025-7818
Country of Publication
ITALY

*********************************************************************************

Regul Toxicol Pharmacol 1984 Sep;4(3):305-21




Toxicologic studies associated with the agricultural use of municipal
sewage
sludge and health effects among sewage treatment plant workers.



Babish JG, Stoewsand GS, Kranz JM, Boyd JN, Ahrens VD, Lisk DJ

The proposed use of municipal sewage sludges as soil amendments on
agricultural land involves potential health risks. Sludges may contain
toxic
heavy metals, synthetic organics, and pathogens. Studies of animals
inhabiting sludge-amended soils, or foraging on crops grown on such
soils,
have shown an increased deposition of cadmium and polychlorinated
biphenyls
in animal tissues, hepatic microsomal enzyme induction, altered blood
profiles, appearance of mutagens in blood and excreta, and lowered feed
intake, feed efficiency, and milk production. Epidemiologic evidence of
possible adverse health effects among sewage plant workers exposed to
aerosolized pathogens or synthetic organic vapors during wastewater
treatment
or land spreading of sludge is still inconclusive. Other possible
deleterious
environmental effects include pollution of groundwater and toxicity to
birds
consuming worms or insects inhabiting sludge-treated soils.

PMID: 6494501, UI: 85039448

************************************************************************

JAMA 1979 May 18;241(20):2177-9




Occupational exposure to hexachlorocyclopentadiene. How safe is sewage?



Morse DL, Kominsky JR, Wisseman CL 3d, Landrigan PJ

In March 1977, a large volume of the industrial chemical
hexachlorocyclopentadiene (HCCPD) was dumped into a municipal sewage
system
in Kentucky. We evaluated the health effects of exposure to HCCPD in 145

sewage treatment plant workers. We found that 85 (59%) had noted eye
irritation, 65 (45%) had headaches, and 39 (27%) had throat irritation.
Symptoms occurred throughout the plant; however, highest attack rates
occurred in primary sewage treatment areas. Medical examination of 41
employees three days after the plant was closed showed proteinuria and
elevation of serum lactic dehydrogenase levels; these findings were not
present three weeks later. This episode demonstrates the toxicity of
HCCPD
and emphasizes the vulnerability of sewage workers to chemical toxins in

wastewater systems.

PMID: 430818, UI: 79154502

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Am J Ind Med 1993 May;23(5):751-61

Respiratory function in sewage workers.



Zuskin E, Mustajbegovic J, Schachter EN

Andrija Stampar School of Public Health, Zagreb, Croatia.

Respiratory symptoms and ventilatory capacity were studied in a group of
74
sewage workers employed in cleaning the city sewage system of Zagreb,
Croatia. Workers were studied by their work stations: closed channels (N
=
26), drainage (N = 31), and other sewage workers (N = 17). The
prevalence of
chronic respiratory symptoms was higher in closed channel and drainage
workers than in controls, particularly for chronic cough (range:
41.9-46.2%
vs. 14.3%), chronic phlegm (range: 38.7-46.2% vs. 14.3%), chronic
bronchitis
(range: 32.3-42.3% vs. 8.6%), and chest tightness (range: 29.0-53.8% vs.
0%).
In the first two groups of sewage workers there was a high prevalence of

acute symptoms which developed during the work shift, being particularly

pronounced for eye irritation (range: 16.1-26.9%), dyspnea (16.1-23.1%),

dizziness (range: 6.5-23.1%), throat burning (9.7-19.2%), and skin
irritation
(range: 22.6-26.9%). Baseline ventilatory capacity was significantly
decreased compared to predicted values in sewage workers; in particular,

values for FEF50 and FEF25 were reduced, suggesting obstructive changes
in
smaller airways. Our data indicate that sewage workers experience
frequent
acute and chronic respiratory symptoms and exhibit objective evidence of

respiratory dysfunction.

PMID: 8506853, UI: 93282397

****************************************************************************************

Schweiz Med Wochenschr 1977 Feb 12;107(6):182-4




Studies on humans exposed to airborne sewage sludge.



Rylander R, Andersson K, Belin L, Berglund G, Bergstrom R, Hanson L,
Lundholm
M, Mattsby I

A clinical investigation was made among workers in a sewage treatment
plant
and age matched controls not exposed to sewage. Acute incidences of
fever and
eye symptoms were found in about 50% of the exposed population. Serum
immunoglobulins, white blood cells and thrombocytes were elevated in the

exposed group. A higher percentage of increased levels of C-reactive
protein
and fibrinogen degradation products was found in the exposed group.
Although
no definite cause-effect relationship can be established the responsible

agent in the environment could well be endotoxins.

PMID: 834990, UI: 77104585

******************************************************************

SEWAGE WORKER DIES

http://216.32.180.250/cgi-bin/linkrd?_lang=EN&lah=3767644cb9a0e6992a65c679b351f163&lat=999012221&hm___action=http%3a%2f%2fwww%2ecdc%2egov%2fepo%2fmmwr%2fpreview%2fmmwrhtml%2f00000783%2ehtm - WORKER DIED

OCCUPATIONAL FATALITY

August 22, 1986 / 35(33);533-5

Epidemiologic Notes and Reports Occupational Fatality
Following Exposure to Hydrogen Sulfide -- Nebraska

Hydrogen sulfide (H((2))S) is a potential hazard for workers in
wastewater-treatment plants. Investigation of an occupational
fatality resulting from exposure to H((2))S in such a plant illustrates
the hazards associated with this agent.

On September 3, 1983, a worker at a wastewater-treatment plant in Omaha,

Nebraska, was found unconscious after he had
gone to collect samples in the building where wastewater enters the
plant. He died later that day from acute respiratory distress
syndrome. A review of hospital records and the autopsy report showed the

pattern of his fatal illness was compatible with
exposure to H((2))S.

On September 6, engineers of the City of Omaha requested that the
National Institute for Occupational Safety and Health
(NIOSH) evaluate working conditions and help develop a health and safety

plan for the plant (1). NIOSH investigators
collected 40 personal-breathing-zone* and 26 long-term area air samples
for H((2))S in all areas of the plant. Concentrations
of H((2))S in the personal air samples ranged from none detected to 2.2
parts per million (ppm); results from the long-term
area air samples ranged from none detected to 56.0 ppm. The highest
concentrations were found in the area near where the
worker was apparently fatally overcome. Instantaneous area air samples
for H((2))S were also collected in this area. These
concentrations ranged from 50 ppm to 200 ppm (the maximum reading on the

instrument used) when one of the supply fans in
the building malfunctioned.

During the week of October 17, 54 (83%) of the 65 workers in the plant
responded to a self-administered questionnaire.
Forty-one (76%) respondents indicated that, during the previous 2 weeks,

they had experienced at least three of the symptoms
known to be associated with H((2))S exposure, most commonly cough (61%),

eye irritation (57%), and nose irritation (54%).
However, no clear association between frequency of symptoms and
estimated exposure was found.

The exact circumstances resulting in the worker's death may never be
known. NIOSH investigators concluded that the factors
contributing to the death included: (1) the summer temperature and the
long transit time of the sewage entering the plant
(resulting in high concentrations of dissolved H((2))S); (2)
inappropriate design of the ventilation system; and (3) inadequate
safety procedures for workers entering potentially dangerous areas.
Based on these factors, NIOSH investigators provided
recommendations to prevent any future fatal incidents. Reported by NIOSH

Region VII, Hazard Evaluations and Technical
Assistance Br, Div of Surveillance, Hazard Evaluations, and Field
Studies, National Institute for Occupational Safety and
Health, CDC.

Editorial Note

Editorial Note: At room temperature, H((2))S is a colorless gas and has
a characteristic rotten-egg odor. Although it has a
rather low odor threshold (0.13 ppm), it can cause olfactory fatigue at
100 ppm in 2-15 minutes. It is a rapid-acting systemic
poison that causes respiratory paralysis with consequent asphyxia at
high concentrations (1,000-2,000 ppm). Inhalation of high
concentrations may cause coma after a single breath and may be rapidly
fatal. Prolonged exposure to 250 ppm H((2))S may
cause pulmonary edema. Exposure to concentrations above 50 ppm for 1
hour may produce acute conjunctivitis with pain,
lacrimation, and photophobia; in severe form, this may progress to
keratoconjunctivitis and vesiculation of the corneal
epithelium. Prolonged exposure to concentrations as low as 50 ppm
H((2))S may cause rhinitis, pharyngitis, bronchitis, and
pneumonitis. In low concentrations, H((2))S may cause headache, fatigue,

irritability, insomnia, eye and respiratory irritation,
and gastrointestinal disturbances; in somewhat higher concentrations, it

affects the central nervous system, causing excitement
and dizziness (2,3).

The Occupational Safety and Health Administration (OSHA) has established

a one-time, 10-minute exposure limit of 50 ppm
during a work shift (4). NIOSH recommends that the concentration for a
10-minute sample not exceed 10 ppm and also that
the area be evacuated if the concentration of H((2))S exceeds 50 ppm
(2).

The recommendations resulting from the Nebraska investigation provided a

basis for preventing recurrence of the problem. The
nature of the sewage (i.e., high concentration of H((2))S) entering the
plant probably contributed to the death of this worker.
The NIOSH investigators recommended the plant retain a consulting firm
to evaluate adding an aeration system or chemicals
along the sewage-transit line to prevent the growth of bacteria that
cause the production of H((2))S. The average flow time
through more than 25 miles of sewer pipe to the plant is approximately 8

hours. At all times, but especially during times of low
flow and warmer water temperatures, the sewage becomes anaerobic,
facilitating the production of H((2))S by certain bacteria.
The presence of H((2))S had been a recurring problem at this plant.
During the last stages of plant construction, a worker died
in the main sewer that enters the plant; sewer gas was listed as the
probable cause of death.

A second factor was the ventilation system in the mezzanine, bar screen,

and wet-well areas. This system was designed to keep
the entire area under positive pressure so the exhausted air could be
filtered to avoid community odor problems. When the
ventilation system failed during a power outage, an H((2))S level of 200

ppm was measured at the doorway to the mezzanine
area before the ventilation system was turned back on. Based on this
figure, NIOSH investigators estimated the level of
H((2))S to be in the 1,000-2,000 ppm range in the area where the
incident occurred. This is considerably above the value of
300 ppm that NIOSH considers immediately dangerous (5). As an
experiment, NIOSH investigators and plant maintenance
personnel reversed the fan in an effort to correct the airflow to the
wet-well area; the H((2))S concentration dropped from 125
ppm to 7 ppm in 2 hours. The NIOSH investigators recommended that all
ventilation systems throughout the plant be evaluated
and deficiencies be corrected.

A third probable contribution to the death was the lack of specific
procedures to ensure safe entry into areas containing
potentially hazardous gases. The implementation of carefully written and

enforced procedures can help prevent the same
potentially hazardous conditions that existed for this fatality.

References

1.National Institute for Occupational Safety and Health. Health
hazard evaluation report no. HETA 83-440-1537.
Cincinnati, Ohio: National Institute for Occupational Safety and
Health, 1984.

2.National Institute for Occupational Safety and Health. Criteria for

a recommended standard.....occupational exposure to
hydrogen sulfide. Cincinnati, Ohio: National Institute for
Occupational Safety and Health, 1977. DHEW publication no.
(NIOSH) 77-158.

3.International Labour Office. Encyclopaedia of occupational health
and safety. Vol I/a-k. Geneva: International Labour
Office, 1983.

4.Occupational Safety and Health Administration. OSHA safety and
health standards. 29 CFR 1910.1000. Occupational
Safety and Health Administration, U.S. Department of Labor, revised

1983.

5.National Institute for Occupational Safety and Health. NIOSH/OSHA
pocket guide to chemical hazards. Cincinnati,
Ohio: National Institute for Occupational Safety and Health, 1985.
DHHS (NIOSH) publication no. 78-210. *Personal
air samples are collected in the worker's breathing zone. Long-term

area air samples are collected in the work area over
an entire work shift. Instantaneous air samples are measured by a
direct reading instrument.



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