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. 2023 Oct 21;14(4):347–357. doi: 10.1016/j.shaw.2023.10.008

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

Alexis Descatha 1,2,∗, Halim Hamzaoui 3, Jukka Takala 4, Anne Oppliger 5
PMCID: PMC10770102  PMID: 38187198

Abstract

Introduction

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

Methods

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

Results

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

Conclusion

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

Keywords: Biological risk, Biosafety, Endotoxins, Exposure, Occupational setting

1. Introduction

Biological hazards, both infectious and non-infectious, constitute significant threats to health in numerous industrial sectors and workplaces around the world, often leading to occupational and work-related diseases [[1], [2], [3], [4]]. During the COVID-19 pandemic, controlling biological risks in working environments became a global priority and revealed the urgent need to develop standards and guidelines for managing them [5]. In the context of drafting technical guidelines on biological hazards for the International Labor Organization, the importance of having a global vision has been stressed, and in particular, the need of a systematic view of the occurrence of biological risk in the workplace, with an inventory of the jobs and categories of workers exposed to it and related prevention measures. We, therefore, aimed to perform a systematized overview of the scientific literature in this domain to identify the specific jobs and categories of workers exposed to biological hazards.

2. Methods

Our review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement [6]. We searched the PubMed, EMBASE, Web of Science, and academic electronic databases without date limits until August 2022. Our search strategy was designed by the researchers and specialist librarians to optimize the string (see Appendix 1).

Because our review was to focus on review articles about biological hazards and occupational health, our research sought selected keywords in article titles and abstracts. The term ‘review’ was considered a keyword rather than a filter to increase the search's sensitivity since we did not only include systematic reviews. We did not exclude any languages in the first selection so as to quantify the total number of reviews and their languages, though only articles in French and English were included in the next stage. Study selection was made using Covidence software (https://www.covidence.org/). All the study records identified in the search were downloaded, and duplicates were identified and deleted. Next, two review authors, working independently (AO, AD), screened the titles and abstracts of potentially relevant articles (step 1) and then examined their full texts (step 2). In step 1, we excluded irrelevant studies (i.e., do not fit inclusion criteria, including wrong study design, population, or setting). Disagreements on which articles should be included were resolved by consensus between the two authors.

In addition to the first author's name, the year of publication, nationality of the first author author's, and the review's design, we also extracted the article's PECO criteria (Population, Exposure, Comparison, Outcome). We also recorded the populations of exposed workers, types of hazards, types of outcomes (types of health issue, means of prevention), and routes of transmission. The review's protocol was registered in PROSPERO as CRD42022351533.

3. Results

We found 1,426 studies corresponding to our inclusion criteria in the three databases. After eliminating the duplicates (n = 567), 859 studies remained at this first selection step, and 79 of these were included in the final round (Fig. 1, [3,4,[13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89]]).

Fig. 1.

Fig. 1

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Flow diagram of study selection.

Most of the studies were published after 2010 (n = 63, 79.7%), and they concerned a broad diversity of countries and every continent (Europe, n = 40; the Americas, n = 22; Asia, n = 10; Africa, n = 4; and Oceania, n = 3). Systematic reviews represented less than 40% of the published reviews (2 scoping reviews, 29 systematic reviews), and the others were non-systematic reviews (n = 48). About half of the reviews dealt with infectious hazards only (n = 38, 48.1%), 24 focused on non-infectious hazards only (30.4%) and 17 included both infectious and non-infectious hazards (21.5%).

Summaries of the sectors of economic activity identified in the review process are presented in Table 1, Table 2, Table 3, Table 4, Table 5: all sectors (n = 11, with some focus or exclusion, Table 1), healthcare workers only (n = 16, Table 2), laboratories (n = 10, Table 3), agriculture (including animal, vegetable and grain sectors, n = 32, Table 4), and waste (n = 10, Table 5). Table 1, Table 2, Table 3, Table 4, Table 5 are notable because of the large number of different hazards considered (infectious and non-infectious agents, endotoxins, bioaerosols, and organic dust). The most frequently reported health outcomes were infections and respiratory symptoms. Some papers discussed transmission routes and preventive measures.

Table 1.

Studies looking at all sectors

Study_ID Nationality of the first author Review type Infectious/Non-infectious Activity sectors/populations Hazards Modes of transmission Health outcomes Prevention guidelines (yes/no)
Acke_2022 The Netherlands Systematic Infectious All except healthcare occupations All pathogenic agents Aerosols, direct contact, percutaneous Infection No
Douwes_2003 The Netherlands (with USA) Non-systematic Infectious and non-infectious All except healthcare occupations Bioaerosols Aerosols Respiratory symptoms, infections, allergy Yes (minor)
Dutkiewicz_1988 USA (with Poland) Non-systematic Infectious and non-infectious All Biohazards Aerosols and direct contact Infections, respiratory symptoms, allergy No
Farokhi_2018 The Netherlands Systematic Non-infectious All Endotoxins Aerosols Respiratory symptoms No
Franco_2020 Brazil (with Pakistan) Systematic Non-infectious All Toxigenic fungi and mycotoxins Aerosols, direct contact Respiratory symptoms and toxic effects No
Haagsma_2012 The Netherlands Systematic Infectious All All pathogens (Tables 1+3) All (Tables 2+3) Not specified No
Liebers_2006 Germany Non-systematic Non-infectious All with a focus on agriculture, textile industry, wood processing industry, waste collection Endotoxins Aerosols Respiratory symptoms, organic dust toxic syndrome No
Liebers_2020 Germany Systematic Non-infectious All Endotoxins Aerosols Respiratory symptoms, organic dust toxic syndrome No
Montano_2014 Germany Non-systematic Infectious All 50 pathogens (, appendix) Not detailed All No
Payton_2000 UK Non-systematic Infectious All/focus on healthcare workers Hepatitis B/C and HIV Percutaneous Infection No
Rim_2014 Republic of Korea Non-systematic Infectious All All pathogenic agents Aerosol, direct contact/percutaneous Infection Yes (engineering, management, training, PPE)
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Table 2.

Studies focused on healthcare workers

Study ID Nationality of the first author Review type Infectious/Non-infectious Activity sectors/populations Hazards Modes of transmission Health outcomes Prevention guidelines (yes/no)
Andrion_1994 Italy Non-systematic Infectious Healthcare workers All (TB, Hepatitis, HIV, …) Not specified Infection Yes (organization, education, occupational health)
Barchitta_2019 Italy Non-systematic Infectious Healthcare workers Vaccine-preventable diseases Not specified Infection/vaccination Yes (vaccination)
Brewczyńska_2015 Poland Non-systematic Infectious Healthcare workers (emergency medical personnel) Infectious (mostly), but allergens mentioned Aerosols, direct contact, percutaneous (bloodborne infections, airborne infection, direct and indirect contact infection mostly) Infection (mostly), but immunity disorders (asthma) mentioned No
Dearaujo_2022 Brazil Systematic Infectious Healthcare workers Respiratory biological agents (SARS, influenza) Aerosol Infection (potential) Yes (effectiveness of masks)
Díaz-Guio_2020 Columbia (with Germany) Non-systematic Infectious Healthcare workers (intensive care) SARS CoV-2 Aerosols/droplets, direct- indirect contact Infection Yes (PPE, procedure, skills/knowledge)
Fyumagwa_2011 Tanzania Non-systematic Infectious Healthcare workers and livestock workers if epidemic Phlebovirus Percutaneous Rift Valley Fever Yes (in case of epidemic = health message, PPE, surveillance)
Leggat_2007 Australia (Thailand and Japan) Non-systematic Infectious Healthcare workers (Dentists) Infectious Aerosols, direct contact, percutaneous Infection Yes (sterilisation/PPE)
Low_2005 Singapore Non-systematic Infectious Healthcare workers Respiratory hazards Aerosols/droplets Respiratory infection (influenza, pertussis, tuberculosis, SARS) Yes (early identification and precautions, education, vaccination, research)
Monteiro_2022 Portugal Systematic Infectious Healthcare workers Bacteria (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus spp., Staphylococcus aureus and Micrococcus luteus) Aerosols, direct contact Infection No
Pedrosa_2011 Brazil Systematic Infectious Healthcare workers and laboratory workers Virus Aerosol, direct contact/percutaneous Infection Yes (biosafety procedures)
Rai_2021 Australia (with Bhutan) Scoping Infectious Healthcare workers Bloodborne pathogens and tuberculosis Percutaneous and respiratory HIV, hepatitis and tuberculosis No
Ridge_2019 USA Systematic Infectious Healthcare workers (Nurse) Bloodborne pathogens Percutaneous Not detailed Yes (training, PPE mostly)
Szymanska_2012 Poland Non-systematic Infectious Healthcare workers (Dentist) Bacterial hazards Aerosols, direct contact, percutaneous Bacterial infection No
Tan_1991 Malaysia Non-systematic Infectious Healthcare workers (Nurse) Biological hazards (Hepatitis B/C, HIV, tuberculosis, CMV, herpes, clostridium difficile) Aerosols, direct contact, percutaneous Infection No
Trevisan_2015 Italy Non-systematic Infectious Healthcare workers Hepatitis B Percutaneous Hepatitis B Yes (vaccination)
Zemouri_2017 The Netherlands Scoping Infectious Healthcare workers (hospital and dental environment) Biological hazards via bioaerosols Bioaerosols Infection No
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Table 3.

Studies focused on laboratories

Study_ID Nationality of the first author Review type Infectious/Non-infectious Activity sectors/population Hazards Modes of transmission Health outcomes Prevention guidelines (yes/no)
Andrup_1990 Denmark Non-systematic Both infectious and not infectious Laboratory/Industries with use of recombinant DNA Microbiological/endo-exotoxin contamination Aerosols, direct contact Not detailed Yes (containment, medical surveillance, regulation)
Artika_2017 Indonesia Non-systematic Infectious Laboratory (with emerging virus) Emerging virus in 2017 (table 1) Not specified Infection Yes (biosafety with containment, procedures, protection, biosecurity)
Coelho_2015 Portugal Non-systematic Infectious Laboratory All (Brucella, mycobacterium tuber, Neisseria, parasites and viruses) Aerosols, direct contact Infection Yes (regulation, biosafety biosecurity, organization, training)
Collins_2017 USA Non-systematic Infectious Laboratory animal research Viral vectors Direct contact, Percutaneous (with biological fluids, bite, scratch) Not specified Yes (regulation, risk assessment, procedures)
Ghosh_2020 USA Non-systematic Infectious Laboratory (using viral vectors systems for gene therapy) Viral vectors Not specified Not specified Yes (biosafety rules validation Table 1 and Figure 1)
Gomez-Tatay_2019 Spain Non-systematic Infectious Laboratory (Synthetic Biology) Synthetic Biology Not specified Not specified Yes (biosafety Table 1, biosecurity, regulation)
Hankenson_2003 USA Non-systematic Infectious Laboratory animal research Zoonotic agents Aerosols, direct contact, percutaneous Zoonosis Yes
Pastorino_2017 France Non-systematic Infectious Laboratory Infectious (CL-3, infectious agents or toxins that may be transmitted through the air and cause potentially lethal infections) Aerosol, direct contact/percutaneous Infection Yes (biosafety with material/technical, PPE, waste management, disinfection and regulation)
Peng_2018 China (with Mexico collaboration) Non-systematic Infectious Laboratory Microorganism Aerosols, direct contact, percutaneous Injuries Yes(lessons learned)
Schlimgen_2016 USA Non-systematic Not infectious Laboratory (lentiviral vector facilities) Lentiviral vector exposures Not detailed Oncogenic Yes (antiretroviral drugs, regulation)
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Table 4.

Studies focused on agriculture/animal, vegetable workers

Study_ID Nationality of the first author Review types Infectious/Non-infectious Activity sectors/populations Hazards Modes of transmission Health outcomes Prevention guidelines (yes/no)
Agunos_2016 Canada Systematic Infectious and non-infectious Poultry exposed occupations All pathogens (including all HxNx viruses, Erysipelothrix sp bacteria, MRSA, Aspergillus sp fungi and allergens) Aerosols, direct contact Infection, allergic response, MRSA carriage Yes (list of preventive measures)
Basinas_2015 Denmark (with The Netherlands) Non-systematic Non-infectious Livestock farmers Organic dust, endotoxins Aerosols Not investigated No
Chamba_2016 Mozambique Non-systematic Non-infectious Wood processing industry Wood dust Aerosols Asthma, respiratory symptoms Yes, some information on potential preventive measures
Cole_2000 USA Non-systematic Infectious and non-infectious Pig industry Zoonotic pathogens and antibiotic-resistant bacteria carriage and endotoxins, dust, airborne bacteria Aerosols, direct contact Infection and respiratory symptoms No
Dadar_2022 Iran Systematic Infectious Workers in contact with livestock, wildlife and pets Brucella sp Aerosols and direct contact Brucellosis No
Davidson_2018 Australia Non-systematic Non-infectious Cannabis production and handling Organic dust, bioaerosols, pollen, plant allergens Aerosol, direct contact Respiratory symptoms, allergy, byssinosis Yes, Australian OEL
Déléry_2009 France Non-systematic Non-infectious Agriculture, wood and waste industries Endotoxins Aerosols Respiratory symptoms Yes, report on current recommendations (OEL) from different countries
Dias_2022 Portugal Systematic Non-infectious Sawmills Wood dust, bioaerosols Aerosols Allergy, respiratory symptoms No
Dignard_2019 USA Non-systematic Infectious and non-infectious Animal workers Zoonotic pathogens, antibiotic-resistant bacteria carriage Aerosols, direct contact Infection No
Donham_1985 USA Non-systematic Infectious Agriculture Zoonotic agents Aerosols, direct contact Zoonoses, respiratory symptoms No
Dutkiewicz_2011 Poland Non-systematic Infectious and non-infectious Mainly outdoor workers (agriculture, forestry) Zoonotic agents, bioaerosols Aerosols, direct contact Zoonoses, respiratory symptoms No
Fontana_2017 Italy Systematic Non-infectious Agriculture Organic dust, endotoxins Aerosols COPD No
Gessain_2008 France Non-systematic Infectious Animal workers: Hunters, laboratory workers, zoo, veterinarians Simian foamy virus Direct contact, percutaneous Infection No
Lebouquin_2011 France Non-systematic Infectious and non-infectious Poultry industry Zoonotic agents and organic dust, bioaerosols, endotoxins Aerosols and direct contact Zoonoses, respiratory symptoms Yes
Magri_2021 Brazil Systematic Infectious and non-infectious Poultry industry Zoonotic pathogens, organic dust Aerosols, direct contact Infections and respiratory symptoms No
May_2012 USA Non-systematic Non-infectious Large animal farms Bioaerosol, organic dust Aerosols Respiratory symptoms No
Omland_2002 Denmark Non-systematic Non-infectious Livestock farmers Bioaerosols, organic dust, endotoxins Aerosols Respiratory symptoms, allergy, asthma No
Pereira_2020 Brazil Systematic Infectious Rural, abattoir (butchers), veterinarians, laboratory workers and hunters Brucella sp Direct contact with infected animals or contaminated material Brucellosis No
Reynolds_2013 USA (with Australia, Denmark, Sweden) Systematic Non-infectious Dairy workers Bioaerosols, organic dust Aerosols Respiratory symptoms, No
Ricco_2021 Italy Systematic Infectious Agriculture and forestry workers Hantavirus Aerosols Infection No
Richard_2015 Switzerland Non-systematic Infectious Forestry workers Borrelia sp, Francisella tulerensis, Leptospira interrogans Aerosols, vector-borne, direct contact Lyme disease, tularemia and leptospirosis Yes (biosafety)
Samadi_2013 The Netherlands (with Iran) Non-systematic Infectious and non-infectious Veterinarians Zoonotic agents, bioaerosols and allergens Aerosols, direct contact, percutaneous Zoonosis, respiratory symptoms, allergy No
Sigsgaard_2020 Denmark (with Germany, The Netherlands) Non-systematic Non-infectious Livestock farmers Bioaerosols, organic dust Aerosols Respiratory symptoms, asthma, rhinitis Yes, citing literature reporting engineering and production parameters affecting farmers' exposure to bioaerosols
Tsapko_2011 Ukraine (with Poland) Non-systematic Non-infectious Agriculture Bioaerosols, organic dust Aerosols Not mentioned No
Wangia_2019 USA Non-systematic Non-infectious Farming, grain milling, animal husbandry and textile production Aflatoxin Aerosols, direct contact Cancer No
Wilhelm_2011 Canada Systematic Infectious Workers in contact with pigs Hepatitis E virus Percutaneous Hepatitis No
Youssef_2021 UK Systematic Infectious Livestock farmers Zoonotic agents Not detailed Zoonosis No
Burdzik_2012 South Africa Non-systematic Non-infectious Food and seafood processing workers Allergic proteins, irritant proteins Direct contact with food Contact dermatitis No
Jeebhay_2010 South Africa (with Canada) Non-systematic Non-infectious Seafood industry Respiratory symptoms, asthma Aerosols Respiratory symptoms, asthma Yes
Lai_2013 USA Non-systematic Non-infectious Textile workers Dust, endotoxins Aerosols Asthma and COPD No
Nafees_2016 Pakistan Systematic Non-infectious Textile workers Cotton dust, endotoxins Aerosols Byssinosis Yes (effectiveness of prevention)
Nafees_2022 Pakistan (with UK, Italy) Systematic Non-infectious Textile workers Cotton dust, endotoxins Aerosols Byssinosis No
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Table 5.

Studies focused on waste sectors

Study_ID Nationality of the first author Review type Infectious/Non-infectious Activity sectors/populations Hazards Health outcomes Prevention guidelines (yes/no) Modes of transmission
Anzivino-Viricel_2012 France Systematic Infectious and non-infectious Waste Mainly non-infectious hazards Irritation, respiratory symptoms, gastrointestinal symptoms No Aerosols, direct contact
Corrao_2013 Italy Systematic Infectious Waste Hepatitis B virus Hepatitis No Percutaneous exposure to body fluids
Han_2021 China Non-systematic Infectious and non-infectious Waste Bioaerosols, antimicrobial-resistant gene Infections, respiratory symptoms, skin symptoms No Aerosols, direct contact
Madsen_2021 Europe Non-systematic Infectious and non-infectious Waste Biological hazards Infection, respiratory symptoms, toxic effects, gastrointestinal effects Yes (Table 3, appendix) Aerosols, direct contact
Muzaini_2021 Malaysia Systematic Not infectious Waste Bioaerosols, organic dust, endotoxins Respiratory symptoms No Aerosols
Oza_2022 USA (with Switzerland) Systematic Infectious and non-infectious Waste Infectious agents Bacterial and parasitological infections, respiratory symptoms, No Aerosols, direct contact
Poole_2017 UK Systematic Infectious and non-infectious Waste Infectious agents and bioaerosols Infections, respiratory and skin symptoms No Aerosols, direct contact, percutaneous
Van_Kampen_2020 Germany Systematic Infectious and non-infectious Waste Infectious agents and dust (bioaerosols) Infection, respiratory symptoms No Aerosols, direct contact, percutaneous
Pearson_2015 UK Systematic Infectious and non-infectious Composting facilities Bioaerosols, organic dust, Aspergillus fumigatus Respiratory symptoms, infection, allergy No Aerosols, direct contact
Robertson_2019 UK Systematic Not infectious Waste Bioaerosols, organic dust Respiratory symptoms, gastrointestinal symptoms No Aerosols
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Reviews involving healthcare workers described many professions, from nurses to dentists, including different specialties (e.g., emergency, intensive care, and pathology) to illustrate the diversity of potential exposures in the healthcare sector (Table 2). Reviews involving laboratory workers detailed laboratory-acquired infections and injuries, such as needle sticks, cut, and scrapes, and provided information on prevention procedures or biosafety guidelines (Table 3). Agricultural sector reviews included animal farmers, animal food industry workers, veterinarians, abattoir workers, grain industry workers, cannabis industry workers and, by extension, professions working with trees (e.g., forestry, sawmill industries) and plant-based textiles (e.g., cotton, other non-synthetic textiles) (Table 4). Reviews involving waste industries included wastewater treatment plant workers, composting workers, and solid-waste handlers (in collecting, sorting, and treatment) (Table 5).

4. Discussion

This systematized overview provides a comprehensive description of the published academic works describing populations of workers exposed to biological hazards, including information on preventive and safety measures implemented for them.

In the healthcare and laboratory sectors, the importance of emerging hazards (new pathogens and new technologies) was stressed long before the COVID-19 pandemic, with a focus on anticipating potential risks at 15, 25, 26, 38, 56, 67, 73, 90. At the same time, workers in these sectors are also exposed to known biological hazards, such that basic precautions and preventive measures should already be applied continuously (e.g., safety procedures, vaccination), not only in industrialized countries but worldwide.

In the agriculture and waste sectors, workers are mainly exposed to organic dust and bioaerosols. A bioaerosol is an airborne collection of biological material. They can be composed of bacterial cells and cellular fragments (endotoxins), fungal spores and fungal hyphae, viruses, and the by-products of microbial metabolism. Pollen grains and other biological material can also be airborne as bioaerosols [1]. Of the various biological substances present in bioaerosols, only endotoxins (lipopolysaccharides of the walls of gram-negative bacteria) have an OEL of 90 EU/m3 for an 8-hours work exposure, proposed by Dutch Expert Committee on Occupational Standards. In animal farming (pig, dairy, horse and poultry farming), the average levels of personal exposure to endotoxins vary from 220 to 9,609 EU/m3, with a maximum of 374,000 EU/m3 measured in pig farming [17]. In the grain sector, average concentration of 1,115 EU/m3 is observed, while it reached 1,800 EU/m3 in the seed processing sector, with medians of 56,000 and 160,000 EU/m3 for grain storage and dried grass processing, respectively. In the cotton sector, the averages were from 20 to 4,850 EU/m3, with maximum of 30,450 EU/m3, and in the forestry sector, the maximum averages were 7,070 EU/m3. The most frequent health effects associated with occupational exposure to organic dust are respiratory symptoms. However, the dose–response relationship between levels of exposure and health outcomes is difficult to establish since exposure characterization suffers from a lack of standard protocols for bioaerosol sampling and analysis. Thus, there are no occupational exposure limits available to ensure workplace safety. Several countries provide recommendations, but there is no international consensus. Only the Netherlands has proposed an occupational exposure limit for endotoxins, although without defining a methodology for sampling and analysis. Forestry workers and hunters are potentially exposed to zoonotic agents from wild animals, whereas animal farmers, workers in the animal food industry, veterinarians, and abattoirs workers are exposed not only to zoonotic agents from livestock but also the risk of being colonized by antimicrobial-resistant bacteria transmitted from animals. This last issue is a rather ‘new’ investigative research area and has, therefore, not yet been fully taken into account in review papers. In the waste sectors, in addition to exposure to non-infectious agents, there is a great risk of workers coming into contact with human pathogens [13,64,67,70,74].

Different limits should be mentioned. First, it is not a systematic review but a systematized review, since our goal was to provide an overview of populations and risks, without answering any single precise question [7]. Second, relevant original studies, could not be included, if they were not referenced as review papers or guidelines not focusing on biological risk. Furthermore, the low proportion of systematic reviews, with very different focuses (from the effectiveness of prevention methods to the jobs exposed), did not enable us to assess the quality of their evidence, their effect size and did not allow to perform sensitivity analyses. Therefore, to avoid confusion, the term ‘umbrella review’ was not used. For instance, exposures to the many different biological hazards described were measured using diverse, non-comparable methods (sampling and analysis). Moreover, descriptions of the methods used to collect and/or quantify viruses or protein allergens were very scarce, as these methods were only in the development stage. Finally, dose–response relationship between exposure to biological hazards and their associated health effects (dose-response curve) were rarely investigated.

Furthermore, our investigation focused on published reviews on biological hazards. Publication bias is probable since we only chose reviews pertinent to the overview's aim. Indeed, many worthwhile original studies were not included. As we focused our attention on review papers alone, we may have missed new or emerging issues that have not yet been targeted by reviews of the literature. It is probable that some relevant studies on very specific aspects of biological hazards have been missed due to their novelty: for instance, as we mentioned earlier, healthcare workers' fitness to work [8], states of the arts without reviews [90] or with no relationship with health issues [91], the proportion of workers exposed to COVID-19 and job-exposure matrices [9,10], exposure to antimicrobial-resistant bacteria, exposure to some biological risks and effects on mental health [11], and reviews or guidelines on general preventive, health, and safety issues that included biological hazards were not included in this overview [12]. We also focused only on publications in English and French, but we found articles concerning a great diversity of countries and covering a long period.

In conclusion, the biological hazards present in working environments are very significant in many occupational activities, involving different modes of exposure and different health outcomes. Further studies are necessary to quantify these risks and thus establish occupational exposure limits, to help implement prevention measures that can be applied to all workplaces and to combat all hazards to human health, including new emerging ones.

Conflicts of interest

The authors declare no conflicts of interest.

Disclamer

The views expressed in this paper are those of the authors and do not necessarily reflect the views of the aforementioned institutions.

Acknowledgments

All the authors are paid by their home institutions. AD is Editor in Chief of Archives des maladies professionnelles et de l'environnement. AD and JT are members of the board of the International Commission on Occupational Health. No direct funding.

Footnotes

Appendix A

Supplementary data to this article can be found online at https://doi.org/10.1016/j.shaw.2023.10.008.

Appendix A. Supplementary data

The following is the Supplementary data to this article:

Multimedia component 1
mmc1.docx (14.8KB, docx)

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