Review: Extracts from the public and OH literature

New UK immunisation programme

Howell-Jones R, Jilt H and Beddows S (2008). “What will HPV immunisation do for health protection in the UK”. Health Protection Matters 11, 16-19. Published by the Health Protection Agency, web:

Human papillomavirus (HPV) infection is a necessary, although not sufficient, cause of cervical cancer. Although the link between cervical cancer and sexual activity has long been recognised, it was not until the 1950s that HPV was isolated from cervical cancer tissue. Later it was identified as the causal sexually transmitted carcinogen. Since its discovery, more than 100 types of HPV have been identified, including 40 that infect the anogenital tract. Relatively few types (around 12) are causally associated with cancer and hence termed high-risk (HR) types. Low-risk (LR) types are not associated with cancer but cause warts (genital and other). The vast majority of HPV infections, including HR HPV infections, resolve without any consequences. However, some infections persist and can cause changes to the cells of the uterine cervix that may lead to cancer. Two HR types, HPV 16 and HPV 18, are of particular importance as they are associated with about 70% of all cervical cancers. There are currently around 2,700 cases and 1,000 deaths from invasive cervical cancer in the UK each year. Cervical cancer is the twelfth most common cancer in women in the UK and accounts for 2% of all female cancers. Following the identification of HPV and its association with cancer, vaccines have been developed and an HPV immunisation programme will start in the UK in September 2008 with the aim of protecting girls against future risk of cervical cancer, routine vaccination being initially targeted at 12- to -13-year-old girls. The government recently announced that GlaxoSmithKline have been awarded the contract to provide their HPV vaccine, Cervarix, for the programme. The UK will be the first country to use the bivalent vaccine, the choice having been made by the Department of Health, following a procurement exercise in which the vaccines were examined against predefined criteria including scientific qualities and cost-effectiveness.

Dutch Q fever outbreak

Schimmer B, Morroy G, Dijkstra F et al (2008). “Large ongoing Q fever outbreak in the south of the Netherlands”. Eurosurveillance 13(31), article 2. Published by the European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden, web:

Q fever is a worldwide zoonosis caused by the bacterium Coxiella burnetii, which is common in a wide range of wild and domestic animals. Cattle and small ruminants, in particular sheep and goats, have been associated with large human outbreaks. Humans become infected primarily by inhaling aerosols that are contaminated by C. burnetii. Most infections remain asymptomatic but in about 40% lead to a febrile disease, pneumonia and/or hepatitis. Chronic infections, mainly endocarditis, are observed in 3% to 5% of cases, with an increased risk for pregnant women and persons with heart-valve disorders or impaired immunity. Following an outbreak in 2007 in the Netherlands, the disease has become an important public health problem in that country, where it is now a notifiable disease (in humans). Since 2007, veterinary and the public health sectors have exchanged information about farms with newly diagnosed animal cases of Q fever to allow for adequate response and control. This article describes the 2008 Dutch outbreak affecting more that 650 people, the largest community outbreak ever reported in the literature, and the measures taken in response. The outbreak led to public health questions about the need for screening of pregnant women for Q fever and exclusion of blood donations from individuals in affected regions. Other European countries such as Denmark and Germany have also reported a changing epidemiology of Q fever and an increase in cases in 2008, but not to the same extent as in the Netherlands.

Ticks as disease vectors in the UK

Mortimer PP and Moore P (2008). “A questionable fever”. Health Protection Matters 11, 25. Published by the Health Protection Agency, web:

Coxiella burnetii, which causes so-called Q fever, is a pathogen mainly infecting animals but also occasionally humans. This article explains that because it may be disseminated atmospherically, a few recognised acute cases in a community may be signalling “an iceberg of submerged infection”, often mainly urban rather than rural, because those who work in the country with livestock may have long since acquired immunity to Q fever, whereas town dwellers are likely to be more susceptible. Significant Q fever outbreaks in the UK were in south Birmingham in 1989, when about 150 clinical cases were recognised more recently in Scotland, associated with a meat-packing plant in South Wales, caused by dispersal of organisms from contaminated strawboard and a cluster of urban cases in south-west England. Selective vaccination may have a place as a community protection measure where there is occupational exposure – when seasonal contract labour is involved, for example – but Q fever is too rarely serious to warrant widespread vaccination.

Ticks and lyme disease in the UK

Jameson L (2008). “Tick recording”. Health Protection Matters 11, 10-12. Published by the Health Protection Agency, web:

Ticks carrying lyme disease are a growing problem, increasingly reported across Europe. In the UK, the number of people infected annually has risen from 292 reported cases in 2003 to an estimated 684 in 2006. This article describes some of the 22 species of the blood-feeding ectoparasites (closely related to mites and more distantly related to spiders and scorpions) that are found in the UK. Globally, ticks are one of the most important disease vectors, second only to mosquitoes, in terms of the number of pathogens vectored. After feeding on an infected host, a tick can become infected and consequently transmit this infection to any subsequent hosts that it may feed on. In Britain, lxodes ricinus is the most commonly encountered tick species, often found in woodland, particularly deciduous or mixed woodland, rough upland or moorland pastures and grasslands. The significantly increased reports are partly the result of improved surveillance and detection methods but also changes in human lifestyles that have increased exposure to ticks in their natural environment. A scheme managed by a microbial risk assessment group within the Health Protection Agency’s Centre for Emergency Preparedness and Response at Porton Down, Wiltshire, aims to provide evidence-based risk assessment advice to public authorities on emerging infectious disease threats, including lyme disease. In collaboration with the Biological Records Centre, this group has established a tick recording scheme to gather data and made available electronic digital maps indicating the relative likelihood of the presence of lxodes ricinus in different parts of Great Britain. These are freely accessible, via the National Biodiversity Network (NBN) gateway, for research and public use at

Work-related injuries among immigrants compared to native-born workers

Smith PM and Mustard C (2008). “Comparing the risk of work-related injuries between immigrants to Canada, and Canadian-born labour market participants”. Occupational and Environmental Medicine Online First, 9 July 2008. DOI:10.1136/oem.2007.038646.

This study examined the burden of work-related injuries among immigrants to Canada compared to Canadian-born labour force participants. Immigrant men in their first five years in Canada reported lower rates of activity-limiting injuries compared to Canadian-born respondents. The percentage of injuries that required medical attention was much higher among recent immigrants compared to Canadian‑born respondents, resulting in an increased risk of activity‑limiting injuries requiring medical attention among immigrant men, compared to Canadian-born labour force participants. No excess risk was found among female immigrants compared to Canadian-born female labour market participants.

Work-related sickness absences and mandatory occupational health surveillance

Mortelmans AK, Donceel P, Lahaye D et al (2008). “Work-related sickness absences and mandatory occupational health surveillance”. Occupational Medicine Advance Access published on 30 July 2008. DOI:10.1093/occmed/kqn089.

To prevent work-related ill health, selection of workers for mandatory occupational health surveillance should be based on the actual risk of work-related disease. The aims of this study were: (i) to determine the proportion of sick-listed workers with self-reported work-related health problems not under mandatory occupational health surveillance and (ii) to determine whether self-reported work-related sickness absences occur more frequently among workers under mandatory occupational health surveillance or among workers not under mandatory surveillance. There were 1,564 participants. Thirty-seven per cent of workers with self‑reported work-related sickness absences were not under mandatory occupational health surveillance. Work-related sickness absences occurred as frequently among workers under mandatory occupational surveillance as among those not under mandatory occupational health surveillance. To prevent work-related illnesses and sickness absences, a revision of the mandatory occupational health surveillance system is indicated.

Injury rates and employment category in healthcare workers

Alamgir H, Yu S, Chavoshi N et al (2008). “Occupational injury among full-time, part-time and casual health care workers.” Occupational Medicine 58(5), 348-354.1

This study investigated whether work-related injury rates differ by employment category (part time, full time or casual) for registered nurses (RNs) in acute care and care aides (CAs) in long-term facilities. In multivariate models, having adjusted for age, gender, facility and health region, full-time RNs had significantly higher risk of sustaining injuries compared to part-time and casual workers. For CAs, full-time workers had significantly higher risk of sustaining injuries compared to casual workers. Full-time direct patient care occupations have greater risk of injury compared to part-time and casual workers within the healthcare sector.

Infection risk after needlestick injury in hospital workers

Wicker S, Cinatl J, Berger A et al (2008). “Determination of risk of infection with blood-borne pathogens following a needlestick injury in hospital workers”. Annals of Occupational Hygiene Advance Access, published 29 July 2008. DOI 10.1093/annhyg/men044.

This paper measures the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in patients at the University Hospital of Frankfurt/Main, and correlates the prevalence with risk factors for exposure to and infection of healthcare workers (HCWs). Individual risk assessments were calculated for exposed HCWs. The results indicated that the prevalence of blood-borne infections in patients was about nine times higher for HBV, 15 times higher for HCV and 82 times higher for HIV than in the overall German population. While accidental needlestick injuries were most frequent in surgery, the nominal risk of blood-borne virus infection was greatest in the field of internal medicine. The study underlines the importance of HBV vaccinations and access to HIV post-exposure prophylaxis for HCWs as well as the use of anti-needlestick devices.

Treating addicted doctors

Marshall EJ (2008). “Doctors’ health and fitness to practise: treating addicted doctors”. Occupational Medicine 58(5), 334-340.1

Figures from North America indicate that the prevalence of alcohol problems in doctors may be no higher than in the population as a whole, whereas high rates of prescription drug use have been identified. This practice of self-treatment with controlled drugs is a “unique concern” for doctors. Anxiety and depression, personality problems, stress at work, family stress, bereavement, an injury or accident at work, pain and a non-specific drift into drinking have been implicated. Medical schools and continuing medical education programmes must give greater emphasis to addiction and substance misuse in doctors with a view to reducing the incidence of “impaired physicians” and promoting and encouraging early treatment and rehabilitation. The relationship between the addiction psychiatrist and the occupational physician is key, given that these problems occur at the interface between occupational health and regulatory systems.

Performance problems in doctors and cognitive impairments

Pitkanen M, Hurn J and Kopelman MD (2008). “Doctors’ health and fitness to practise: performance problems in doctors and cognitive impairments.” Occupational Medicine 58(5), 328-333.1

This paper briefly reviewed the common neurocognitive causes for performance problems in doctors and provided an updated account of the current literature. Neuropsychiatric and neuropsychological assessment is increasingly accepted as an accurate evaluation tool to clarify the performance problems in doctors. Further, it seems that neurocognitive difficulties are commonly found to be the cause for such problems. The performance problems in doctors need to be acknowledged “better too soon than too late”. Neuropsychiatric and neuropsychological assessment helps to create an accurate treatment and rehabilitation plan for the specific functional tasks of the particular doctor’s duties.

HIV post-exposure prophylaxis among police

Merchant RC, Nettleton JE, Mayer KH et al (2008). “HIV post-exposure prophylaxis among police and corrections officers”. Occupational Medicine Advance Access, published 14 July 2008. DOI:10.1093/occmed/kqn083.

This study sought to estimate the incidence rate (IR) of emergency department (ED) visits for blood or body fluid exposures sustained by police and corrections officers in an entire state and to quantify the utilisation of HIV post-exposure prophylaxis (PEP) in response to these exposures. The average annual incidence of ED visits for blood or body fluid exposures over the study period was 4.41 exposures per 1,000 police and corrections personnel. Only 15% of officers sustained percutaneous injuries or blood-to-mucous membrane exposures. Sixteen officers were offered HIV PEP and 10 accepted it. Offering of HIV PEP was 3.3-fold greater for officers sustaining percutaneous and blood-to-mucous membrane exposures than for other body fluid exposures. The incidence of ED visits for blood or body fluid exposures by police and corrections officers was low and most exposures did not have the potential for HIV transmission. HIV PEP was infrequently used for these exposures.

Return to work by breast cancer patients

Villaverde RM, Batlle JF, Yllan AV et al (2008). “Employment in a cohort of breast cancer patients”. Occupational Medicine Advance Access, published 30 July 2008. DOI:10.1093/occmed/kqn092.

The authors investigated employment- and work-related disability in a cohort of breast cancer patients to identify possible discrimination and other obstacles to remaining in work. The study included 96 patients with breast cancer, of which 80% were unable to work after diagnosis, but 56% returned to work at the end of treatment. The sequelae of the disease or its treatment and the stage of disease were independently associated with the ability to work after the end of treatment. Only one patient did not tell his/her employers and co-workers about his/her disease. In total, 29% noticed changes in their relation with co-workers and managers, usually in the sense that they tried to be helpful. None reported job discrimination.

DNA damage and repair in lymphocytes of petrol attendants

Keretetse GS, Laubscher PJ, Du Plessis JL et al (2008). “DNA damage and repair detected by the comet assay in lymphocytes of African petrol attendants: a pilot study”. Annals of Occupational Hygiene Advance Access, published 29 July 2008. DOI 10.1093/annhyg/men047.

The aim of this study was to evaluate the level of exposure of petrol attendants to petrol volatile organic compounds (VOCs) and also to determine their effect on DNA damage and repair in lymphocytes of African petrol attendants. The comet assay was used to investigate the basal DNA damage and repair capacity in isolated lymphocytes of petrol attendants and unexposed subjects. The petrol attendants were found to be exposed to levels of petrol VOCs lower than the South African occupational exposure limit for constituent chemicals. A significant relationship was found between the volume of petrol sold during the shift and the average concentrations of benzene, toluene and the total VOCs measured. Significantly higher basal DNA damage was observed with the exposed group compared to the unexposed group. The period of exposure influenced the level of DNA damage and the calculated repair capacity. DNA repair capacity was delayed in smokers of both exposed and unexposed group.

Bioaerosols exposure among poultry house workers

Oppliger A, Charrière N, Droz P-O et al (2008). “Exposure to bioaerosols in poultry houses at different stages of fattening use of real-time PCR for airborne bacterial quantification.” Annals of Occupational Hygiene 52(5), 405-412.2

To evaluate the evolution of bioaerosol concentration during the fattening period, bioaerosol parameters (inhalable dust, endotoxin and bacteria) were measured in 12 poultry confinement buildings in Switzerland, at three different stages of the birds’ growth. Bioaerosol levels increased significantly during the fattening period of the chickens. During the task of catching mature birds, the mean inhalable dust concentration for a worker was more than six-fold higher than the Swiss occupational recommended value. The mean exposure level of bird catchers to total bacteria and Staphylococcus species was also very high. It was concluded that, in the absence of wearing protective breathing apparatus, chicken catchers in Switzerland risk exposure beyond recommended limits for all measured bioaerosol parameters. Moreover, the use of Q-PCR to estimate total and specific numbers of airborne bacteria is a promising tool for evaluating any modifications intended to improve the safety of current working practices.

Female exposure to solvents associated with reduced fertility

Sallmén M, Neto M and Mayan ON (2008). “Reduced fertility among shoe manufacturing workers”. Occupational and Environmental Medicine 65(8), 518-524.3

This paper investigated whether fertility is reduced among female shoe manufacturing workers exposed to organic solvents. A retrospective study was conducted on time to pregnancy (TTP) among 250 Portuguese shoe manufacturing workers exposed to solvents and 250 unexposed women working in stores of food units and storehouses. Female exposure to solvents was associated with reduced fertility. A slightly stronger association was found among women with regular menstrual cycles. There was an interaction between solvent exposure and female smoking or use of coffee, the exposed women who smoke or use coffee being highly fecund. The findings provide further evidence that exposure to organic solvents is hazardous for female reproduction. The observed association may be related to any of the following solvents commonly used in shoe manufacturing: n-hexane and hexane isomers, toluene, methyl ethyl ketone, acetone, ethyl acetate and dichloromethane.

Exposure to metalworking fluid aerosols

Lillienberg L, Burdorf A, Mathiasson L et al (2008). “Exposure to metalworking fluid aerosols and determinants of exposure”. Annals of Occupational Hygiene Advance Access, published 29 July 2008. DOI 10.1093/annhyg/men043.

The aims of this study were to describe exposure to inhalable MWF aerosols and volatile compounds in machine shops, to estimate the influence of important determinants of exposure and to compare different sampling techniques for MWF aerosols. On average, the extracted fraction of MWF aerosol was 67% of the inhalable aerosol concentration. The exposure levels of triethanolamine, formaldehyde and volatile compounds were generally low. In 21 workers with continuous aerosol measurements, short-term peak exposures during 6% of the work time contributed to 25% of the average concentration of inhalable MWF aerosol. Inhalable MWF aerosol concentration measured with the PAS-6 sampler was twice as high as the concentrations derived from the open-faced sampler. These findings suggest that control measures, such as full enclosure of machines and the elimination of the use of compressed air as cleaning technique, are required to reduce the exposure to MWF aerosols to levels below the expected threshold for adverse respiratory health effects.

Occupational exposure to styrene in the plastics industry

Rooij V, Kasper A, Triebig G et al (2008). “Trends in occupational exposure to styrene in the European glass fibre-reinforced plastics industry”. Annals of Occupational Hygiene 52(5), 337-349.2

This study presented temporal trends of styrene exposure for workers in the European glass fibre-reinforced plastics (GRP) industry during the period 1966-2002. Trend analyses of the available styrene exposure data showed that the average styrene concentration in the breathing zone of open-mould workers in the European GRP industry has decreased on average by 5.3% per year during the period 1966-1990 and by only 0.4% annually in the period after 1990. The highest exposures were measured in southern Europe and the lowest exposures in northern Europe, with central Europe in between. Biological indicators of styrene (mandelic acid in post-shift urine) showed a somewhat steeper decline, most likely because urine samples were collected in companies that showed a stronger decrease of styrene exposure in air than GRP companies where no biological measurements were carried out.

Assessing the Stoffenmanager exposure model

Tielemans E, Noy D, Schinkel J et al (2008). “Stoffenmanager exposure model: development of a quantitative algorithm”. Annals of Occupational Hygiene Advance Access, published 10 July 2008. DOI 10.1093/annhyg/men033.

In the Netherlands, the web-based tool called “Stoffenmanager” was initially developed to assist small- and medium-sized enterprises to prioritise and control risks of handling chemical products in their workplaces. The aim of the present study was to explore the accuracy of the Stoffenmanager exposure algorithm. This was done by comparing its semi-quantitative exposure rankings for specific substances with exposure measurements collected from several occupational settings to derive a quantitative exposure algorithm. The mixed-effect regression models with natural log-transformed Stoffenmanager scores as independent parameter explained a substantial part of the total exposure variability. The overall performance increased the authors’ confidence in the use of the Stoffenmanager as a generic tool for risk assessment. The mixed-effect regression models presented in this paper may be used for assessment of so-called reasonable worst-case exposures. This evaluation is considered as an ongoing process and when more good quality data become available, the analyses described in this paper will be expanded. Based on these analyses, the algorithm will be refined in the near future.

Mortality of asbestos miners and millers

Musk AW, de Klerk NH, Reid A at al (2008). “Mortality of former crocidolite (blue asbestos) miners and millers at Wittenoom”. Occupational and Environmental Medicine 65(8), 541-543. 3

Nearly 7,000 male workers who worked at the Wittenoom mine and mill were followed up using death and cancer registries throughout Australia and Italy to the end of 2000. There have been 190 cases of pleural and 32 cases of peritoneal mesothelioma in this cohort of former workers at Wittenoom. Mortality from lung cancer, pneumoconiosis, respiratory diseases, tuberculosis, digestive diseases, alcoholism and symptoms, signs and ill-defined conditions were greater in this cohort compared to the Western Australian male population. Asbestos-related diseases, particularly malignant mesothelioma, lung cancer and pneumoconiosis, continue to be the main causes of excess mortality in the former blue asbestos miners and millers of Wittenoom.

Occupational exposure to wood dust

Scarselli A, Binazzi A, Ferrante P et al (2008). “Occupational exposure levels to wood dust in Italy, 1996-2006”. Occupational and Environmental Medicine 65(8), 567-574.3

Wood dust has been classified as carcinogenic to humans and the association with nasal cancer risk has been observed in a large number of epidemiological studies. The authors sought to summarise data about occupational exposure levels to wood dust in Italy and to examine some exposure determinants. The study confirmed the previous findings about occupational exposure to wood dust (mainly in wood industry and among woodworking machine operators) and suggested further investigations on other risk sectors (building and repairing of ships and boats). The potential of the occupational exposure database as a source of data for exposure assessment and surveillance was also confirmed.


  1. Oxford University Press for the Society of Occupational Medicine, 6 St Andrew’s Place, London NW1 4LB, tel: 020 7486 2641, fax: 020 7486 0028, email:, web:

  2. Oxford University Press for the British Occupational Hygiene Society, web:

  3. BMJ Publishing Group, BMA House, Tavistock Square, London WC1H 9JR, tel: 020 7387 4499, fax: 020 7383 6661, web:

From Occupational Health Review, September 2008

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