Infectious Liver Dieases in Three Groups of Copenhangen Workers: Correlation of Hepatitis A Infection to Sewage Exposure

Abstract

Three groups of Copenhagen municipality male employees-77 sewer workers, 81 gardeners, and 79 clerks-matched for age and duration of employment, were studied for clinical and serological evidence of infection with viral hepatitis types A and B and pathogenic leptospires. "Antibody against hepatitis A virus" (anti-HAV) was found significantly more often among sewer workers (80.5%), than among gardeners (60.5%) or clerks (48.1%). The anti-HAV prevalence rates correlated with age rather than duration of employment. Of all the 11 cases of jaundice reported, only 3 cases (sewer workers) occurred while employed for the city. One case of the 11 resulted from leptospirosis. Anti-HAV was detected in the other 10 subjects and was assumed to be of etiological importance. Hepatitis B serological markers were similar in each group. It is concluded that exposure to metropolitan sewage provides a limited risk of enteric infections, such as hepatitis A, while the hepatitis B virus apparently is not successfully transmitted by this route.

The epidemiology of hepatitis A in Rio de Janeiro: environmental and domestic risk factors

“…Studies of hepatitis A antibodies in municipal workers exposed to raw sewage have found differing results [19]. Skinhoj et al [20] found a significantly higher prevalence than in a control group in Copenhagen, but De Serres et al [21] found no such association in their study in Quebec, Canada. The difference in the present study is that it relates to children, who are not only immunologically naı$ ve but also likely to have more intimate contact than adults with the wastewater, through play and other activity.…”

Prevalence of hepatitis A virus infection among sewage workers in Georgia

“…There is often direct contact with sewage while working, and in circumstances that allow neither complete personal protective equipment nor prompt washing [Weldon et al, 2000]. In the early 1980's, evidence of a possible risk of hepatitis A in this group was indicated by an outbreak in England [Timothy and Mephan, 1984] and a small observational study in Copenhagen [Skinhøj et al, 1981]. Since that time, additional cross-sectional studies have been conducted in Europe, North America, Israel, and Singapore, with inconsistent results.…”

Clinical question

“…There were nine original epidemiologic studies on the risk of acquiring hepatitis A through occupational exposure to sewage due to work in a sewage plant (13)(14)(15)(16)(17)(18)(19)(20)(21). Cohort studies would have provided the best evidence, but we found only cross-sectional studies.…”