Ramin Tabibi

Emerging Zoonoses: the "One Health Approach"

Zoonoses represent a public health risk recently pointed out by the spreading of previously unknown human infectious diseases emerging from animal reservoirs such as severe acute respiratory syndrome and avian influenza caused by H5N1-virus. These outbreaks have shown that animal breeding activities can pose a significant public health risk. Until now, the risk of zoonoses has probably been underestimated, particularly in occupational settings. The emergence or re-emergence of bacterial (Mycobacterium bovis and Brucella spp) or viral (hepatitis E virus) infections shows that zoonoses should be considered as emerging risks in agricultural and animal breeding and should be addressed by specific preventive interventions. Close cooperation and interaction between veterinarians, occupational health physicians and public health operators is necessary, for a worldwide strategy to expand interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. This is what the One Health Approach was intended to be.

Hepatitis E virus infection: an emerging occupational risk?

BACKGROUND Hepatitis E virus (HEV) infection is endemic in many developing countries, causing substantial morbidity. Transmission is primarily faeco-oral and is associated with both sporadic infections and epidemics in areas where poor sanitation and weak public health infrastructures exist. Recently, it has become clear that HEV is also an endemic disease in industrialized countries. Moreover, a porcine reservoir and growing evidence of zoonotic transmission have been reported in these countries, suggesting the possibility of occupational transmission to man. AIMS To summarize the current knowledge on the epidemiology and prevention of transmission of HEV infection in occupational settings. METHODS The following key words were used to explore PubMed: hepatitis E, disease, epidemiology, profession(al), occupation(al). RESULTS After screening of the results, 107 publications were retained. In non-endemic regions, seroprevalence varied from a few per cent (2-7.8%) in Europe, Japan and South America to 18.2-20.6% in the USA, Russia, UK, southern France and Asia. A meta-analysis of 12 cross-sectional studies evaluating HEV immunoglobulin G (IgG) seroprevalence in individuals occupationally exposed to swine showed greater odds of seropositivity in the exposed group but also a high degree of heterogeneity. A funnel plot suggested publication bias. CONCLUSIONS There was a significant association between occupational exposure to swine and HEV IgG seroprevalence, but the level of prevalence detected depended also on the type of HEV IgG kits used. Further research, including on mechanisms and risk factors for infection, as well as the development of better serological tests for identification of infection, is required.

Occupational Health in Mountainous Kyrgyzstan

BACKGROUND In the period of transition from a centralized economy to the market economy, occupational health services in Kyrgyzstan have survived through dramatic, detrimental changes. It is common for occupational health regulations to be ignored and for basic occupational health services across many industrial enterprises and farms to be neglected. OBJECTIVE The aim of this study was to demonstrate the present situation and challenges facing occupational health services in Kyrgyzstan. FINDINGS The transition from centralized to the market economy in Kyrgyzstan has led to increased layoffs of workers and unemployment. These threats are followed by increased workload, and the health and safety of workers becomes of little concern. Private employers ignore occupational health and safety; consequently, there is under-reporting of occupational diseases and accidents. The majority of enterprises, especially those of small or medium size, are unsanitary, and the health status of workers remains largely unknown. The low official rates of occupational diseases are the result of data being deliberately hidden; lack of coverage of working personnel by medical checkups; incompetent management; and the poor quality of staff, facilities, and equipment. Because Kyrgyzstan is a mountainous country, the main environmental and occupational factor of enterprises is hypoxia. Occupational health specialists have greatly contributed to the development of occupational medicine in the mountains through science and practice. CONCLUSIONS The enforcement of existing strong occupational health legislation and increased financing of occupational health services are needed. The maintenance of credible health monitoring and effective health services for workers, re-establishment of medical services and sanitary-hygienic laboratories in industrial enterprises, and support for scientific investigations on occupational risk assessment will increase the role of occupational health services in improving the health of the working population.

1360 Differences between peritoneal and pleural mesothelioma in lombardy, italy

Introduction Asbestos is the main risk factor for development of both peritoneal (PEM) and pleural (PLM) mesothelioma, but characteristics of this two diseases and their association with asbestos show some differences. We examined characteristics of PEM and PLM in Lombardy, Italy, the most populated (currently, 10 million residents) and industrialised Italian region. Methods The RML, established in 2000, is a population-based registry which records all cases of mesothelioma among Lombardy residents. It is part of a national network of mesothelioma registries (ReNaM). Notification of mesothelioma cases is compulsory by law. Additional sources of mesothelioma cases include hospital admission, mortality, occupational diseases, and pathology databases. Verified mesothelioma cases are interviewed about past asbestos exposure using a standardised questionnaire. For this study, from the RML database we selected PEM and PLM cases diagnosed in 2000–2014. We investigated asbestos exposure, presence of asbestosis or pleural plaques, and past employment in economical sectors. Results We identified 300 PEM and 5,011 PLM cases. Incidence rates (per 1.000.000 person-years, world standardised) of PEM were 2.4 (men) and 1.7 (women), compared with 52.4 and 19.9 for PLM. Asbestosis (both genders) and pleural plaques (men) were more frequent among PEM cases. Occupational asbestos exposure was similar in PEM and PLM cases. We found higher proportions of PEM employed in the asbestos cement production. Conclusion The higher frequency of pleural plaques in PEM cases and the similar frequency of past occupational asbestos exposure confirm the association between asbestos exposure and peritoneal mesothelioma. The higher proportions of asbestosis and of past employment in the asbestos-cement sector among PEM cases suggest a possible role of high exposures to asbestos in the peritoneal mesothelioma genesis.

Basic Occupational Health Services for Agricultural Workers in the South of Iran

The agricultural sector has by far the world’s largest labour force, there are more than one billion workers in this industry worldwide, which contains half of the total world labour force. On the other hand, agriculture is one of the most hazardous occupations, and many workers suffer occupational accidents and ill health each year. Farming and animal breeding are associated with exposure to a wide variety of risk factors, including zoonotic agents, dust, elements of the thermal environment, noise, vibration and chemicals. Although half of the world’s population are economically active and spend at least one third of their time in the workplace, only 15% of the workers have access to basic occupational health services. According to a WHO report, Iran has a well-structured health care system through which basic health care services are available to the entire population, and health indicators in Iran have consistently improved. The agricultural health program in Iran is being carried out in the cities and rural areas, and occupational health services are mainly integrated into the health network. This paper aims to describe the health care system and basic occupational health services (BOHs) available to 5,300 agricultural enterprises with 8,380 employees in the cities of Abadan, Khorramshahr and Shadegan in the Abadan region (Abadan, Khoramshahr and Shadegan districts), in the south of Iran.

Estimation of Short-term Mortality and Morbidity Attributed to Fine Particulate Matter in the Ambient Air of Eight Iranian Cities

Amongst the various pollutants in the air, particulate matters (PM) have significant adverse effects on human health. The current research is based on existing epidemiological literature for quantitative estimation of the current health impacts related to particulate matters in some selected principal Iranian megacities. In order to find the influence of air pollution on human health, we used the AirQ software tool presented by the World Health Organization (WHO) European Centre for Environment and Health (ECEH), Bilthoven Division. The adverse health outcomes used in the study consist of mortality (all causes excluding accidental causes), due to cardiovascular (CVD) and respiratory (RES) diseases, and morbidity (hospital admissions for CVD and RES causes). For this purpose, hourly PM10 data were taken from the monitoring stations in eight study cities during 2011 and 2012. Results showed annual average concentrations of PM10 and PM2.5 in all megacities exceeded national and international air quality standards and even reached levels nearly ten times higher than WHO guidelines in some cities. Considering the short-term effects, PM2.5 had the maximum effects on the health of the 19,048,000 residents of the eight Iranian cities, causing total mortality of 5,670 out of 87,907 during a one-year time-period. Hence, reducing concentrations and controlling air pollution, particularly the presence of particles, is urgent in these metropolises.

The State of Higher Education in Occupational Health and Safety in Central Asian Countries

A healthy workforce is vital for the sustainable social and economic development of any country. Assuring occupational health and safety (OHS) depends not only on the passing of quality working legislation and inspection of workplaces, but also on preparation of qualified specialists on OHS. Aimed at assessing of relevance of the content of training at Central Asian universities to the needs in prevention of risks of accidents and injuries and promotion of a preventive culture in the workplace, and finding out how they are compliant with the recommendations of the Mainstreaming occupational safety and health into the education (2010), we examined curricula of 20 medical and non-medical universities across Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. The analysis of training programs showed that education in OHS and preparation of qualified specialists in Central Asiana countries is up-to-date and tailored to local needs for prevention of risks of accidents and injuries and promotes the notion of a preventive culture in the workplace.

Differences between peritoneal and pleural mesothelioma in Lombardy, Italy

BACKGROUND We examined characteristics of peritoneal (PEM) and pleural (PLM) mesothelioma in Lombardy, Italy. METHODS From the Lombardy Mesothelioma Registry we selected PEM (N=300) and PLM (N=5011) cases diagnosed in 2000-2014. We investigated asbestos exposure and presence of asbestosis or pleural plaques. RESULTS Incidence rates (per 1,000,000 person-years, world standardized) of PEM were 1.2 (men) and 0.9 (women), compared with 22.6 and 8.4 for PLM. Asbestosis (both genders) and pleural plaques (men) were more frequent among PEM cases. Occupational asbestos exposure was similar in PEM and PLM cases. We found higher proportions of PEMs employed in the asbestos cement production. CONCLUSION The higher frequency of pleural plaques in PEM cases confirm the association between asbestos and peritoneal mesothelioma. The higher proportions of asbestosis and of past employment in the asbestos-cement sector among PEM cases suggest a possible role of high exposures to asbestos in the peritoneal mesothelioma genesis.

O16-2 Hepatitis E virus infection: an emerging occupational risk in pig handlers?

Introduction Hepatitis E virus (HEV) infection is endemic in many developing countries, causing substantial morbidity. Transmission is primarily faeco-oral and is associated with both sporadic infections and epidemics in areas without drinkable water. In industrialised countries, HEV infection was thought to occur only in individuals infected in endemic areas. However, sporadic cases have been reported in persons from industrialised regions with no history of recent travel. Such reports and the availability of more comprehensive molecular and serological data have changed HEV epidemiology, accepting that autochthonous HEV is a problem and an endemic disease in industrialised countries. Moreover, a porcine reservoir and growing evidence of zoonotic transmission have been reported in these countries, suggesting the possibility of occupational transmission to man. This review summarises the current knowledge on the epidemiology and prevention of transmission of HEV infection in occupational settings. Methods The following keywords were used to explore PubMed: hepatitis E, disease, epidemiology, profession(al), occupation(al). The results were further screened and 107 publications were retained. Results In nonendemic regions, seroprevalence varies from a few percent (2–7.8%) in Europe, Japan and South America to several percent (18.2–20.6%) in the USA, Russia, UK, southern France and Asia. A meta-analysis of 12 cross-sectional studies evaluating potential association between HEV IgG seroprevalence in individuals occupationally exposed to swine showed greater odds of seroposivity in the exposed group but also a high degree of heterogeneity. The funnel plot suggests publication bias. Conclusions There is a significant association between occupational exposure to swine and HEV IgG seroprevalence, but the level of prevalence detected depends also on the type of HEV IgG kits used. Further research, including on mechanisms and risk factors for infection, as well as the development of better serological tests for identification of infection, are required.