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Infectious disease risk in asbestos abatement workers

BMC Public Health volume 12, Article number: 665 (2012) Cite this article

Abstract

Background

The current literature reports increased infectious disease occurrence in various construction occupations, as an important contributor to morbidity and mortality arising from employment.

These observations should be expanded to asbestos abatement workers, as the abatement can create an environment favorable for bacterial, viral and fungal infections.

Discussion

Asbestos abatement work employs activities resulting in cuts, blisters and abrasions to the skin, work in a dirty environment and exposure to dust, mists and fumes.

Furthermore, this population exhibits a high smoking rate which increases the risk of chronic obstructive pulmonary disease and respiratory infections.

In addition, these workers also commonly employ respirators, which can accumulate dirt and debris magnifying exposure to microbes. Use of respirators and related types of personal protective equipment, especially if shared and in the close environment experienced by workers, may enhance communicability of these agents, including viruses.

Summary

Abatement workers need to be provided with information on hazards and targeted by appropriate health education to reduce the infection risk. Epidemiological studies to investigate this risk in asbestos removers are recommended.

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Background

Several studies [1–5] have reported on increased infectious disease occurrence in various construction occupations, with these agents constituting an important contributor to morbidity and mortality arising from employment.

We believe these observations need to be expanded to asbestos abatement workers, especially since infectious diseases appear to be associated with certain industrial occupations, most notably those in the construction industry.

Respiratory diseases are commonly discussed as a hazard for those employed in the asbestos abatement industry, although focus is on cancer and asbestosis. Recently there has even been a suggestion of exposure to asbestos contributing to cardiovascular disease [6] with this agent causing disease states in locations other than the lungs and those traditionally identified, especially at high exposure levels [7]. For this group of workers there are periodically discussions of other non-asbestos hazards (e.g. confined conditions, heat disorders, etc.), with the literature rarely mentioning infectious diseases [8, 9].

Discussion

One study [1] reported exposure to inorganic dust, which includes asbestos, for construction workers resulted in a high rate of mortality from infectious pneumonia (relative risk for inorganic dust =1.87, with 95% confidence interval: 1.22-2.89). Since asbestos abatement workers are exposed to both inorganic/mineral dusts and chemicals, it would appear a risk from infectious disease exists and include various forms of infections (e.g. skin) beside mortality from pneumonia as indicated by Thoren [1] for inorganic dust.

A PubMed search of “asbestos abatement and infectious disease”, “asbestos abatement and infections”, “asbestos workers and infectious disease” or “asbestos workers and infections” produced no actual citations; although, one existed as related to fungal exposure during abatement [10]. Today, mold (fungal) exposure during abatement is recognized as a hazard for this type of industry [11, 12].

Overall, abatement can create an environment favorable for bacterial and fungal infections [13]. For construction workers, most reports discuss infections related to bacterial or fungal diseases [3, 13, 14], but have not clearly illustrated how this hazard extends to asbestos-related work. This report may be the first in the open literature expressing the concept of infectious disease risk directly linked to asbestos abatement workers.

Asbestos abatement work employs activities resulting in cuts, blisters and abrasions to the skin, work in a dirty environment and exposure to dust, mists and fumes (i.e. inorganic and mineral dusts). Exposures and operations of this nature place this group (abatement workers in general) at risk for skin and mucous membrane, uro-genital tract, respiratory, gastro-intestinal tract, cutaneous, direct contact, animal reservoirs-related and inanimate grouped infections as classified by Haagsma [2]. Infection risk in construction as well as in asbestos abatement work should probably be considered similar to other industries’ that a lay person may consider riskier in terms of communicable diseases (e.g. underground mining [15–17], agriculture [18, 19], cattle farming [20], sewerage work [21–24], infantry in military [25], etc.).

Furthermore, asbestos abatement workers exhibit a high smoking rate (e.g. 70%) [26], which increases the risk of chronic obstructive pulmonary disease (COPD) and respiratory infections. It has also been observed that even non-smokers exposed to inorganic dust have an increased mortality rate for COPD [27], enhancing the potential of infection.

In addition, these workers also commonly employ respirators, which can accumulate dirt and debris magnifying exposure to microbes. Use of respirators and related types of personal protective equipment, especially if shared and in the close environment experienced by workers, may enhance communicability of these agents, including viruses. Moreover dermatitis from various causes (e.g. chemical and infectious agents) is a concern [28].

With these findings, type of work performed by abatement workers and their high rate of smoking, it appears this occupational group is at increased risk for various types of infectious disease, including those associated with the pulmonary system.

This hazard may be of even greater importance for asbestos abatement workers in terms of health consequences (e.g. emerging as an important risk factor) since current exposure to asbestos has been shown to be low and there is now little risk of asbestos-related disease for this population (asbestos abatement workers – in the western world) [29, 30].

When discussing non-asbestos disease hazards for this occupational population, infectious (microbial) agents should be included along with hygiene practices related to prevention. Abatement workers need to be provided with information on hazards and prevention of infectious disease and dermatitis; the Internet can be a very helpful resource in this complex and changing field if used efficiently [31]. Personnel also need to be targeted by health education aimed at reducing the infection risk [32]. Decontamination and hand washing would appear to be of great importance, but is not the only form of protection/prevention available (e.g. disinfection agents), especially for dermatological and gastro-intestinal risks/hazards. Abatement workers have routine physical examinations primarily focusing on the pulmonary system and the ability to use a respirator. However, in many cases this has become a bureaucratic paper process acting as a work permit and not functioning as a true evaluation of health [33]. Regardless, it may be prudent during this evaluation also to check these workers for their current level of vaccination (e.g. against Pneumococcus, Haemophilus influenza type b and tetanus toxoid), and according to the type and location of work other vaccines could be considered, where appropriate and feasible [34]. In many ways, this is a forgotten aspect of occupational medicine, especially for those undertaking various forms of abatement. A major role can be played by general practitioners and occupational physicians in terms of health education. These preventive measures can be applied to the construction-related industries in general.

Summary

The underestimation of the infectious risk among asbestos removers is likely due to the limited number of epidemiological studies on asbestos abatement workers as compared to asbestos workers.

Indeed, as they are exposed to both inorganic/mineral dusts and chemicals, these workers would appear at risk from various forms of infections and communicable diseases. Therefore an evaluation of this population regarding infectious disease occurrence seems to be recommended to determine the extent of this hazard as suggested more broadly by Haagsma [2]. Lastly, abatement workers need to be provided with information on hazards and targeted by appropriate health education to reduce the infection risk.

References

  1. Torén K, Qvarfordt I, Bergdahl IA, Järvholm B: Increased mortality from infectious pneumonia after occupational exposure to inorganic dust, metal fumes and chemicals. Thorax. 2011, 66: 992-996. 10.1136/thoraxjnl-2011-200707.

    Article  PubMed  Google Scholar 

  2. Haagsma JA, Tariq L, Heederik DJ, Havelaar AH: Infectious disease risks associated with occupational exposure: a systematic review of the literature. Occup Environ Med. 2011, Online First (10.1136/oemed-2011-100068)

    Google Scholar 

  3. Cummings KC, McDowell A, Wheeler C, McNary J, Das R, Vugia DJ, Mohle-Boetani JC: Point-source outbreak of coccidioidomycosis in construction workers. Epidemiol Infect. 2010, 138: 507-511. 10.1017/S0950268809990999.

    CAS  Article  PubMed  Google Scholar 

  4. Tüchsen F, Hannerz H, Spangenberg S: Mortality and morbidity among bridge and tunnel construction workers who worked long hours and long days constructing the Great Belt Fixed Link. Scand J Work Environ Health. 2005, 31 (Suppl 2): 22-26.

    PubMed  Google Scholar 

  5. Brenner H, Ahern W: Sickness absence and early retirement on health grounds in the construction industry in Ireland. Occup Environ Med. 2000, 57 (9): 615-620. 10.1136/oem.57.9.615.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. Harding AH, Darnton A, Osman J: Cardiovascular disease mortality among British asbestos workers (1971–2005). Occup Environ Med. 2012, 69: 417-421. 10.1136/oemed-2011-100313.

    Article  PubMed  Google Scholar 

  7. Chen M, Tse LA, Au RK, Yu IT, Wang XR, Lao XQ, Au JS: Mesothelioma and lung cancer mortality: A historical cohort study among asbestosis workers in Hong Kong. Lung Cancer. 2011, epub

    Google Scholar 

  8. Williams PR, Phelka AD, Paustenbach DJ: A review of historical exposures to asbestos among skilled craftsmen (1940–2006). J Toxicol Environ Health B Crit Rev. 2007, 10: 319-377. 10.1080/10937400601034191.

    CAS  Article  PubMed  Google Scholar 

  9. Turpin-Legendre E, Meyer JP: Comparison of physiological and subjective strain in workers wearing two different protective coveralls for asbestos abatement tasks. Appl Ergon. 2003, 34: 551-556. 10.1016/S0003-6870(03)00081-4.

    CAS  Article  PubMed  Google Scholar 

  10. Cormack WJ: Infection control during construction. Health Estate. 2005, 59: 41-43.

    PubMed  Google Scholar 

  11. Rautiala S, Torvinen E, Torkko P, Suomalainen S, Nevalainen A, Kalliokoski P, Katila ML: Potentially pathogenic, slow-growing mycobacteria released into workplace air during the remediation of buildings. J Occup Environ Hyg. 2004, 1: 1-6.

    Article  PubMed  Google Scholar 

  12. Cheng SM, Streifel AJ: Infection control considerations during construction activities: land excavation and demolition. Am J Infect Control. 2001, 29: 321-328. 10.1067/mic.2001.118410.

    CAS  Article  PubMed  Google Scholar 

  13. Smith CA: Skin infections in Kaimai Rail Tunnel construction workers. N Z Med J. 1977, 85: 514-517.

    CAS  PubMed  Google Scholar 

  14. Kuruvila M, Dubey S, Gahalaut P: Pattern of skin diseases among migrant construction workers in Mangalore. Indian J Dermatol Venereol Leprol. 2006, 72: 129-132. 10.4103/0378-6323.25638.

    Article  PubMed  Google Scholar 

  15. Corbett EL, Churchyard GJ, Clayton T, Herselman P, Williams B, Hayes R, Mulder D, De Cock KM: Risk factors for pulmonary mycobacterial disease in South African gold miners. A case–control study. Am J Respir Crit Care Med. 1999, 159 (1): 94-99.

    CAS  Article  PubMed  Google Scholar 

  16. Godfrey-Faussett P, Sonnenberg P, Shearer SC, Bruce MC, Mee C, Morris L, Murray J: Tuberculosis control and molecular epidemiology in a South African gold-mining community. Lancet. 2000, 356 (9235): 1066-1071. 10.1016/S0140-6736(00)02730-6.

    CAS  Article  PubMed  Google Scholar 

  17. Sonnenberg P, Glynn JR, Fielding K, Murray J, Godfrey-Faussett P, Shearer S: HIV and pulmonary tuberculosis: the impact goes beyond those infected with HIV. AIDS. 2004, 18 (4): 657-662. 10.1097/00002030-200403050-00010.

    Article  PubMed  Google Scholar 

  18. Tangkanakul W, Tharmaphornpil P, Plikaytis BD, Bragg S, Poonsuksombat D, Choomkasien P, Kingnate D, Ashford DA: Risk Factors Associated With Leptospirosis In Northeastern Thailand, 1998. AmJTrop Med Hyg. 2000, 63 (3,4): 204-208.

    CAS  Google Scholar 

  19. Katzenelson E, Buium I, Shuval HI: Risk of communicable disease infection associated with wastewater irrigation in agricultural settlements. Science. 1976, 194 (4268): 944-946. 10.1126/science.982051.

    CAS  Article  PubMed  Google Scholar 

  20. Archer BN, Weyer J, Paweska J, Nkosi D, Leman P, Tint KS, Blumberg L: Outbreak of Rift Valley fever affecting veterinarians and farmers in South Africa, 2008. S Afr Med J. 2011, 101 (4): 263-266.

    Article  PubMed  Google Scholar 

  21. Thorn J, Beijer L, Rylander R: Work related symptoms among sewage workers: a nationwide survey in Sweden. Occup Environ Med. 2002, 59: 562-566. 10.1136/oem.59.8.562.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. De S, 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, 52: 505-507. 10.1136/oem.52.8.505.

    Article  Google Scholar 

  23. Arvanitidou M, Constantinidis TC, Doutsos J, Mandraveli K, Katsouyannopoulos V: Occupational hepatitis B virus infection in sewage workers. Med Lav. 1998, 89 (5): 437-444.

    CAS  PubMed  Google Scholar 

  24. Franco E, Giambi C, Ialacci R, Coppola RC, Zanetti AR: Risk groups for hepatitis A virus infection. Vaccine. 2003, 21: 2224-2233. 10.1016/S0264-410X(03)00137-3.

    Article  PubMed  Google Scholar 

  25. O’Shea MK: Acinetobacter in modern warfare. Int J Antimicrob Agents. 2012, 39: 363-377. 10.1016/j.ijantimicag.2012.01.018.

    Article  PubMed  Google Scholar 

  26. Lange JH, Mastrangelo G, Buja A: Smoking and alcohol use in asbestos abatement workers. Bull Environ Contam Toxicol. 2006, 77: 338-342. 10.1007/s00128-006-1071-2.

    CAS  Article  PubMed  Google Scholar 

  27. Bergdahl IA, Toren K, Eriksson K, Hedlund U, Nissin T, Flodin R, Jarvholm B: Increased mortality in COPD among construction workers exposed to inorganic dust. Eur Respir J. 2004, 23: 402-406. 10.1183/09031936.04.00034304.

    CAS  Article  PubMed  Google Scholar 

  28. Skogstad M, Levy F: Occupational irritant contact dermatitis and fungal infection in construction workers. Contact Dermatitis. 1994, 31: 28-30. 10.1111/j.1600-0536.1994.tb01901.x.

    CAS  Article  PubMed  Google Scholar 

  29. Lange JH, Mastrangelo G, Cegolon L: A proposed threshold exposure for airborne asbestos. Occup Environ Med. 2011, 10.1136/oemed-2011-100225.

    Google Scholar 

  30. Lange JH, Mastrangelo G, Cegolon L: Asbestos abatement workers versus asbestos workers: exposure and health-effects differ. Int J Occup Med Environ Health. 2011, 24: 1-2. 10.2478/s13382-011-0009-z.

    Article  Google Scholar 

  31. Johnson LE, Reyes K, Servos MJ: Resources for Infection Prevention and Control on the World Wide Web. Clin Infect Dis. 2009, 48 (11): 1585-1595. 10.1086/598974.

    Article  PubMed  Google Scholar 

  32. Ohtsu M, Miyamoto H, Yoshioka S, Kajiki S, Ishimatsu S, Ogawa M, Mori K, Taniguchi H: Construction of a tool for risk assessment of infectious diseases in a workplace–as a primary precaution. J UOEH. 2008, 30 (4): 461-470.

    PubMed  Google Scholar 

  33. Lange JH: A questionnaire survey during asbestos abatement refresher training for frequency of respirator use, respirator fit testing and medical surveillance. J Occup Med Toxicol. 1993, 2: 65-74.

    Google Scholar 

  34. Dos Santos PR, Noronha NH, Mattos UA, da Silva D: Nursing and healthcare for workers: the experience of the immunization action at Fiocruz/Manguinhos. Cien Saude Colet. 2011, 16 (2): 553-565. 10.1590/S1413-81232011000200019.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Envirosafe Training and Consultants, Pittsburgh, PA, USA

    John H Lange

  2. Department of Molecular Medicine, Padua University, Padua, Italy

    Giuseppe Mastrangelo & Luca Cegolon

  3. Imperial College London, School of Public Health, St. Mary's Campus, London, UK

    Luca Cegolon

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  1. John H Lange
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Correspondence to Luca Cegolon.

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The authors declare that they have no competing interests.

Authors’ contributions

JHL conceived the idea and drafted the paper; GM contributed to the drafting of the paper; LC drafted the paper and had general responsibility of the work. All authors read and approved the final manuscript.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Lange, J.H., Mastrangelo, G. & Cegolon, L. Infectious disease risk in asbestos abatement workers. BMC Public Health 12, 665 (2012). https://doi.org/10.1186/1471-2458-12-665

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Keywords

  • Chronic Obstructive Pulmonary Disease
  • Infection Risk
  • Personal Protective Equipment
  • Asbestosis
  • High Smoking Rate

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