Abstract
Aims: To assess the risk for work related symptoms among sewage workers in Sweden using a postal questionnaire.
Methods: All municipalities in Sweden were contacted and asked to provide addresses of sewage workers and controls. Controls were recruited among other municipal workers not exposed to sewage, such as workers in drinking water plants and gardeners. A questionnaire was sent to the subjects and after two reminders, the response rate was 74% among sewage workers and 59% among controls.
Results: Significantly increased risks for airway symptoms, chronic bronchitis, and toxic pneumonitis, as well as central nervous system symptoms such as headache, unusual tiredness, and concentration difficulties were found among the sewage workers compared with controls. Furthermore, an increased risk for non-specific work related gastrointestinal symptoms was found among the sewage workers; an increased risk for joint pains, related to pains in more than four joints but not with loading, was also found.
Conclusions: The results of this questionnaire survey show an increased risk for airway, gastrointestinal, and general symptoms such as joint pains and central nervous system symptoms among sewage workers. Clinical investigations are needed to determine the cause of the reported symptoms among sewage workers, and further field studies are required to assess the causal agents.
Full Text
The Full Text of this article is available as a PDF (140.1 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Brugha R., Heptonstall J., Farrington P., Andren S., Perry K., Parry J. Risk of hepatitis A infection in sewage workers. Occup Environ Med. 1998 Aug;55(8):567–569. doi: 10.1136/oem.55.8.567. [DOI] [PMC free article] [PubMed] [Google Scholar]
- De Serres G., Levesque B., Higgins R., Major M., Laliberté D., Boulianne N., Duval B. Need for vaccination of sewer workers against leptospirosis and hepatitis A. Occup Environ Med. 1995 Aug;52(8):505–507. doi: 10.1136/oem.52.8.505. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Friis L., Agréus L., Edling C. Abdominal symptoms among sewage workers. Occup Med (Lond) 1998 May;48(4):251–253. doi: 10.1093/occmed/48.4.251. [DOI] [PubMed] [Google Scholar]
- Goldsmith JR, Merkin L, Quastel MR, Poljak S, Kordysh EA, Wishkerman V, V, Emerit I., I Evaluation of the Radiation Exposures of Chernobyl "Liquidators": Exploratory Studies of a Sample of Immigrants to Israel. Int J Occup Environ Health. 1997 Jan;3(1):51–59. doi: 10.1179/oeh.1997.3.1.51. [DOI] [PubMed] [Google Scholar]
- Gregersen P., Grunnet K., Uldum S. A., Andersen B. H., Madsen H. Pontiac fever at a sewage treatment plant in the food industry. Scand J Work Environ Health. 1999 Jun;25(3):291–295. doi: 10.5271/sjweh.437. [DOI] [PubMed] [Google Scholar]
- Heng B. H., Goh K. T., Doraisingham S., Quek G. H. Prevalence of hepatitis A virus infection among sewage workers in Singapore. Epidemiol Infect. 1994 Aug;113(1):121–128. doi: 10.1017/s0950268800051530. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Herbert A., Carvalheiro M., Rubenowitz E., Bake B., Rylander R. Reduction of alveolar-capillary diffusion after inhalation of endotoxin in normal subjects. Chest. 1992 Oct;102(4):1095–1098. doi: 10.1378/chest.102.4.1095. [DOI] [PubMed] [Google Scholar]
- Khuder S. A., Arthur T., Bisesi M. S., Schaub E. A. Prevalence of infectious diseases and associated symptoms in wastewater treatment workers. Am J Ind Med. 1998 Jun;33(6):571–577. doi: 10.1002/(sici)1097-0274(199806)33:6<571::aid-ajim8>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
- Kraut A., Lilis R., Marcus M., Valciukas J. A., Wolff M. S., Landrigan P. J. Neurotoxic effects of solvent exposure on sewage treatment workers. Arch Environ Health. 1988 Jul-Aug;43(4):263–268. doi: 10.1080/00039896.1988.10545947. [DOI] [PubMed] [Google Scholar]
- Lundholm M., Rylander R. Work related symptoms among sewage workers. Br J Ind Med. 1983 Aug;40(3):325–329. doi: 10.1136/oem.40.3.325. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mattsby I., Rylander R. Clinical and immunological findings in workers exposed to sewage dust. J Occup Med. 1978 Oct;20(10):690–692. [PubMed] [Google Scholar]
- Melbostad E., Eduard W., Skogstad A., Sandven P., Lassen J., Søstrand P., Heldal K. Exposure to bacterial aerosols and work-related symptoms in sewage workers. Am J Ind Med. 1994 Jan;25(1):59–63. doi: 10.1002/ajim.4700250116. [DOI] [PubMed] [Google Scholar]
- Michel O., Duchateau J., Plat G., Cantinieaux B., Hotimsky A., Gerain J., Sergysels R. Blood inflammatory response to inhaled endotoxin in normal subjects. Clin Exp Allergy. 1995 Jan;25(1):73–79. doi: 10.1111/j.1365-2222.1995.tb01005.x. [DOI] [PubMed] [Google Scholar]
- Michel O., Nagy A. M., Schroeven M., Duchateau J., Nève J., Fondu P., Sergysels R. Dose-response relationship to inhaled endotoxin in normal subjects. Am J Respir Crit Care Med. 1997 Oct;156(4 Pt 1):1157–1164. doi: 10.1164/ajrccm.156.4.97-02002. [DOI] [PubMed] [Google Scholar]
- Mulloy K. B. Sewage workers: toxic hazards and health effects. Occup Med. 2001 Jan-Mar;16(1):23–38. [PubMed] [Google Scholar]
- Nethercott J. R., Holness D. L. Health status of a group of sewage treatment workers in Toronto, Canada. Am Ind Hyg Assoc J. 1988 Jul;49(7):346–350. doi: 10.1080/15298668891379873. [DOI] [PubMed] [Google Scholar]
- Richardson D. B. Respiratory effects of chronic hydrogen sulfide exposure. Am J Ind Med. 1995 Jul;28(1):99–108. doi: 10.1002/ajim.4700280109. [DOI] [PubMed] [Google Scholar]
- Rylander R., Bake B., Fischer J. J., Helander I. M. Pulmonary function and symptoms after inhalation of endotoxin. Am Rev Respir Dis. 1989 Oct;140(4):981–986. doi: 10.1164/ajrccm/140.4.981. [DOI] [PubMed] [Google Scholar]
- Rylander R. Health effects among workers in sewage treatment plants. Occup Environ Med. 1999 May;56(5):354–357. doi: 10.1136/oem.56.5.354. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rylander R., Thorn J., Attefors R. Airways inflammation among workers in a paper industry. Eur Respir J. 1999 May;13(5):1151–1157. doi: 10.1034/j.1399-3003.1999.13e35.x. [DOI] [PubMed] [Google Scholar]
- Scarlett-Kranz J. M., Babish J. G., Strickland D., Lisk D. J. Health among municipal sewage and water treatment workers. Toxicol Ind Health. 1987 Sep;3(3):311–319. doi: 10.1177/074823378700300303. [DOI] [PubMed] [Google Scholar]
- Sehgal R., Mahajan R. C. Occupational risks in sewage work. Lancet. 1991 Nov 30;338(8779):1404–1405. doi: 10.1016/0140-6736(91)92288-d. [DOI] [PubMed] [Google Scholar]
- Shakespeare A., Poole J. Sewage workers and hepatitis A. Occup Health (Lond) 1993 Nov;45(11):364–366. [PubMed] [Google Scholar]
- Skinhøj P., Hollinger F. B., Hovind-Hougen K., Lous P. Infectious liver diseases in three groups of Copenhagen workers: correlation of hepatitis A infection to sewage exposure. Arch Environ Health. 1981 May-Jun;36(3):139–143. doi: 10.1080/00039896.1981.10667618. [DOI] [PubMed] [Google Scholar]
- Thorn J., Kerekes E. Health effects among employees in sewage treatment plants: A literature survey. Am J Ind Med. 2001 Aug;40(2):170–179. doi: 10.1002/ajim.1085. [DOI] [PubMed] [Google Scholar]
- Thorn J., Rylander R. Inflammatory response after inhalation of bacterial endotoxin assessed by the induced sputum technique. Thorax. 1998 Dec;53(12):1047–1052. doi: 10.1136/thx.53.12.1047. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zuskin E., Mustajbegovic J., Schachter E. N. Respiratory function in sewage workers. Am J Ind Med. 1993 May;23(5):751–761. doi: 10.1002/ajim.4700230509. [DOI] [PubMed] [Google Scholar]