Non-malignant occupational respiratory diseases and climate change.

BACKGROUND: Respiratory diseases of infectious, allergic, neoplastic or degenerative origin are due to the interaction of environmental and occupational risk factors, individual susceptibility and other co-factors and comorbidities. Asthma and other respiratory pathologies can be worsened by climate change and exposure to other agents in occupational environments.METHODS: PubMed and Scopus, and several websites on public and occupational health were queried to find publications and documents on work-related respiratory diseases, asthma, rhinitis, chronic obstructive pulmonary disease (COPD), pneumoconiosis and allergic alveolitis in association with climate change.RESULTS: Most of the retrieved articles concerned asthma (75 in Scopus), while the other topics were less frequently covered in the scientific literature, with a maximum of 29 papers for rhinitis and 23 for COPD. The most important terms highlighted by the word clouds were 'health', 'air', 'pollution', and, only for asthma and rhinitis, 'pollen' and 'allergic/allergy'. Website data on public and occupational health, and climate change were reported.CONCLUSIONS: Assessment and management of respiratory diseases that recognise occupational exposures should be improved, and more research into integrated approaches should be favoured. Health surveillance practices for workers exposed to agents that cause respiratory diseases should be implemented. The development of biomarkers of exposure, effect and susceptibility needs further study.

Hepatitis E virus infection in North Italy: high seroprevalence in swine herds and increased risk for swine workers.

We determined the hepatitis E virus (HEV) seroprevalence and detection rate in commercial swine herds in Italy's utmost pig-rich area, and assessed HEV seropositivity risk in humans as a function of occupational exposure to pigs, diet, foreign travel, medical history and hunting activities. During 2011-2014, 2700 sera from 300 swine herds were tested for anti-HEV IgG. HEV RNA was searched in 959 faecal pools from HEV-seropositive herds and in liver/bile/muscle samples from 179 pigs from HEV-positive herds. A cohort study of HEV seropositivity in swine workers (n = 149) was also performed using two comparison groups of people unexposed to swine: omnivores (n = 121) and vegetarians/vegans (n = 115). Herd-level seroprevalence was 75·6% and was highest in farrow-to-feeder herds (81·6%). Twenty-six out of 105 (24·8%) herds had HEV-positive faecal samples (25 HEV-3, one HEV-4). Only one bile sample tested positive. HEV seropositivity was 12·3% in swine workers, 0·9% in omnivores and 3·0% in vegetarians/vegans. Factors significantly associated with HEV seropositivity were occupational exposure to pigs, travel to Africa and increased swine workers' age. We concluded that HEV is widespread in Italian swine herds and HEV-4 circulation is alarming given its pathogenicity, with those occupationally exposed to pigs being at increased risk of HEV seropositivity.

Serosurvey against H5 and H7 avian influenza viruses in Italian poultry workers.

Highly pathogenic (HP) and low pathogenic (LP) avian influenza viruses (AIVs) belonging to H5 and H7 subtypes have been found to be associated with human infection as the result of direct transmission from infected poultry. Human infections by AIVs can cause mild or subclinical disease, and serosurveys are believed to represent an important tool to identify risk of zoonotic transmission. Therefore, we sought to examine Italian poultry workers exposed during LPAI and HPAI outbreaks with the aim of assessing serologic evidence of infection with H5 and H7 AIVs. From December 2008 to June 2010 serum samples were collected from 188 poultry workers and 379 nonexposed controls in Northern Italy. The hemagglutination inhibition (HI) assay using horse red blood cells (RBCs) and a microneutralization (MN)-enzyme-linked immunosorbent assay test were used to analyze human sera for antibodies against the following H5 and H7 LPAI viruses: A/Dk/It/4445/07(H5N2); A/Ty/It/2369/09(H5N7); A/Ty/It/218-193/ 10; A/Ck/It/3775/99(H7N1); A/Ty/It/214845/03(H7N3); and A/Dk/It/332145/09(H7N3). Since previous studies identified low antibody titer to AIVs in people exposed to infected poultry, a cutoff titer of > or = 1:10 was chosen for both serologic assays. Only HI-positive results confirmed by MN assay were considered positive for presence of specific antibodies. The Fisher exact test was used to analyze differences in seroprevalence between poultry workers and control groups, with the significance level set at P < 0.05. MN results showed a proportion of H7-seropositive poultry workers (6/188, i.e., 3.2%), significantly higher than that of controls (0/379), whereas no MN-positive result was obtained against three H5 LPAI subtypes recently identified in Italy. In conclusion, the survey indicated that assessing seroprevalence can be an important tool in risk assessment and health,surveillance of poultry workers.

Risk of acquiring tick-borne infections in forestry workers from Lazio, Italy.

The seroprevalence of antibodies to Borrelia burgdorferi and tick-borne encephalitis (TBE) virus was evaluated in a group of forestry rangers in the Lazio region of Italy. One hundred and forty-five forestry rangers and 282 blood donors were examined by two-tiered serological tests for B. burgdorferi and TBE virus. Information on occupation, residence, tick bites, outdoor leisure activities and other risk factors was obtained. The prevalence of IgG/IgM antibodies to B. burgdorferi showed no statistical difference between the two groups, but there was a higher occurrence of IgM antibodies. There were significant differences between indoor and outdoor, urban and rural workplaces among the 145 exposed workers (χ² test: p < 0.001), and a higher risk for outdoor rural than urban tasks was detected among the ten Western blot-tested forestry rangers positive to B. burgdorferi (χ² test: p < 0.1). No seropositivity was observed for the TBE virus. Forestry rangers from the Lazio region did not have a higher risk of Borrelia infection than the blood donors, though an increase in the risk for outdoor tasks in a rural environment was observed.

[Contribution of ISPESL (National Institute for Occupational Safety and Prevention) for protecting workers from exposure to avian influenza]. / Il contributo dell'ISPESL per la protezione di lavoratori esposti a virus dell'influenza aviaria.

Influenza virus A/H5N1 occurs mainly in birds, in which is highly contagious and deadly, and does not usually infect people. Most of the cases occurred in humans resulted from people having direct or close contact with H5N1 infected poultry or contaminated surfaces. The circulation of influenza viruses in birds, humans and other hosts represents a public and animal health threat, with important economic consequences. Controlling avian influenza in poultry, in particular with biosecurity measures, is the primary method to reduce human risk from infection. Enhanced surveillance both in poultry and in wild birds proved effective for the early detection of the infection. Worldwide most countries developed strategic plans, guidelines and recommendations for effective disease prevention and control. Moreover documents were specifically prepared to keep specific categories of workers adequately informed on how to avoid or minimize exposure to the viruses. In accordance with the Italian Decree 626/94, recently amended by the Decree 81/08, regarding the protection of workers from risks related to exposure to biological agents at work, the Department of Occupational Medicine of ISPESL prepared one booklet directed to people working with poultry and, together with Corpo Nazionale Vigili del Fuoco, two booklets addressed to fire brigade who could be at various levels involved in outbreak disease control and eradication activities. In fact information and training are essential aspects of a global preventive and protective strategy.

Detection of different Borrelia burgdorferi genospecies in serum of people with different occupational risks: short report.

This study is aimed at applying a previously described PCR-based method to detect B. burgdorferi sensu lato and different Borrelia genospecies in total DNA preparations of serum samples collected from people with different occupational risks for tick bite and with serological evidence of borreliosis. Among the seropositive samples, the PCR for B. burgdorferi confirmed the positivity in 65 percent of the forestry workers and in 60 percent of the subjects living in the same area. None of the seronegative subjects belonging to the control group showed the presence of B. burgdorferi sensu lato DNA. Results on genospecies distribution show that B. afzelii was the predominant species, followed by B. garinii and finally by B. valaisiana.

[HCV genotyping in health professionals: controversies and perspectives]. / Genotipizzazione dell'HCV in operatori sanitari: controversie e prospettive.

Healthcare workers (HCW) are at risk of acquiring blood-borne infections, including HCV Although current evidence does not suggest an increased prevalence of HCV infection among HCW, transmission of infection following occupational exposure has been demonstrated. Moreover, HCV can establish a persistent, chronic infection contributing to progressive liver disease, and post-exposure prophylaxis against HCV infection is not currently available. Problems still arise in the health surveillance of healthcare workers HCV infected. The use of virologic assays has become essential in the management of hepatitis C virus (HCV) infection, in order to improve the diagnosis of the infection, to guide the treatment decisions, and to assess the virologic response to antiviral therapy. Although several studies have specifically evaluated the role of HCV genotypes, many questions have not been answered. It is thought that HCV genotypes are important epidemiological markers, but more investigations are needed to elucidate their role regarding the progression and the pathogenesis of liver disease. The clinical implication of HCV genome heterogeneity, the different genotyping methods and the possible role of HCV genotypes as a parameter that could help health surveillance of infected HCW are described in this paper.

[Emerging infectious diseases among swine workers]. / Patologie infettive emergenti per gli addetti ad allevamenti suinicoli.

In the last years emerging infections represent an important problem of public health and occupational medicine. Biological agents and their hosts exist in a precariously balanced and continuously evolving relationship, influenced by their environment. RNA viruses are responsible for most of the emerging diseases. Epidemics that recently affected the world of work are zoonoses, such as cases of SARS in healthcare staff Dutch poultry workers infected with the avian virus A/H7N7 in 2003, the current threat of avian flu A/H5N1 to poultry workers. Workers at risk include those who are in contact with live or dead infected animals, with aerosols, dust or surfaces contaminated by animal secretions, persons engaged in animal breeding and trade, veterinaries, and others. Pigs are at risk of acquiring many viral and bacterial diseases and, consequently, could be able to transmit some of these infections to occupationally exposed subjects. The aim of our study is to set out some emerging zoonosis that could affect swine workers, an occupational sector where a proper assessment of biological risks is difficult to perform.

[Virus C hepatitis: successful therapy in a health care worker]. / Epatite C: la vittoria della terapia sul virus in un operatore sanitario.

Hepatitis C viral is a problem of population health. The World Health Organization considers Hepatitis C an epidemic, a "silent" epidemic because a patient living with Hepatitis C can be infected for decades before being discovered. Recent data show an estimated number of 170 million patients infected with hepatitis C virus in the world. Number of new infections per year has declined from an average of 240,000 in the 1980s to about 26,000 in 2004. The incidence of HCV infected patients is estimated to 500-600 new cases in a year in Italy. Chronic infection is present in 55%-85% of infected persons. Approximately one third of the patients develop cirrhosis over a number of years, which can lead to liver failure and other serious complications. There is no vaccine and no completely effective treatment. Recent data show PEG-IFN-RBV combination therapy is most effective. We describe one HCV infected individual case report with HCV genotype 1b who received combination therapy for 4 weeks. Levels of HCV RNA became undetectable after an mouth of treatment.

[QuantiFERON-TB Gold test in homeless shelter staff: preliminary results]. / Test QuantiFERON-TB Gold in addetti all'assistenza: risultati preliminari.

Tuberculosis (TB) continues to be a major cause of disability and death and it has become a real problem in industrialized countries. The spread of HIV, the increasing immigration rate of people from countries with endemic TB and the growth of drug-resistant Mycobacterium tuberculosis strains extend its impact. Since the spread of the infection occurs early, health care workers are particularly exposed to the risk of contracting and/or transmitting the mycobacterium. In health care settings, policies and procedures for TB control should be developed, including health surveillance. Until recently the tuberculin skin test was the only available method for diagnosing tuberculosis, however it suffers several methodological weaknesses: high rate of false positive results in vaccinated populations, the subjectivity of the evaluation and the booster effect. Recently, the introduction of new in vitro serological tests, as the Quantiferon TB-Gold in tube (QFT-TB), may overcome these problems. The QFT-TB is based on the quantification of interferon-gamma released from sensitized lymphocytes in whole blood incubated overnight with PPD from M. tuberculosis and control antigens. The present study was performed on 27 nuns (homeless shelter staff) who were at risk for contracting tuberculosis. The prevalence of positive tests was 15 out 27 (55.5%).

[Use of the comet test in occupational medicine and industrial toxicology: considerations and prospects]. / Impiego del comet test in medicina del lavoro e tossicologia industriale: considerazioni e prospettive.

The comet test (Single Cell Gel Electrophoresis or SCGE) is an easy to perform, rapid and highly sensitive genotoxicity assay; it requires small amounts of biological substrate and is applicable in vivo and in vitro to a wide variety of cells and tissues. Modified versions of the comet test able to detect oxidative damage or the effects of agents inducing DNA-DNA or DNA-protein crosslinks are available. Similarly to other genotoxicity assays, the comet test is not predictive far individual cancer risk. Limitations and critical features presently linked to comet test applications, with particular regard to the biomonitoring of individuals exposed to genotoxic agents, include: lack of sensitivity with respect to aneugens (agents inducing numerical chromosomal aberrations), possible underestimation of genotoxic potency of agents with mixed action mechanisms, sensitivity depending on the genotoxic agent itself, dependence an biological substrate with regard to the influence of cytotoxicity on the assay results, influence of age, tobacco smoke, alcohol and drug consumption, diet, kinetics of DNA adducts and DNA repair mechanisms. Consequently, a routine use of the comet test in biological monitoring of individuals that are occupationally and environmentally exposed to genotoxic agents is submitted to its validation by multicentric studies on large population samples with different exposure patterns, with a suitable characterisation of the role played by the above mentioned factors. Human studies should also be increasingly focused on the direct cellular targets of exposure to genotoxicants (e.g. epithelial cells of oral cavity and airways).

[Biosafety in laboratories concerning exposure to biological agents]. / La biosicurezza nei laboratori per gli esposti ad agenti biologici.

Laboratory workers are exposed to a variety of potential occupational health hazards including those deriving from infectious materials and cultures, radiations, toxic and flammable chemicals, as well as mechanical and electrical hazard. Although all of them are significant, this paper will focus on biological hazards present in clinical and research laboratories. In fact, in spite of numerous publications, guidelines and regulations, laboratory workers are still subject to infections acquired in the course of their researches. This paper describes some aspects that include good microbiological practices (GMPs), appropriate containment equipment, practices and operational procedures to minimize workers' risk of injury or illness.

Prevalence and incidence of antibodies to Borrelia burgdorferi and to tick-borne encephalitis virus in agricultural and forestry workers from Tuscany, Italy.

The ticks Ixodes persulcatus and Ixodes ricinus are the main vectors of both Borrelia burgdorferi sensu lato and tick-borne encephalitis (TBE) virus in Eurasia. Borrelia burgdorferi is the cause of Lyme borreliosis, and TBE is a biphasic meningoencephalitis induced by an arbovirus belonging to the flavivirus family. The principal aims of the current investigation were (i) to determine the frequency of serological evidence of Borrelia burgdorferi sensu lato and TBE infections in healthy agricultural and forestry workers, (ii) to determine the incidence of seroconversion for antibodies against Borrelia burgdorferi sensu lato and TBE virus in Tuscan workers during a 1-year survey; and (iii) to assess the occupational risk for agricultural and forestry activities in a defined area (Tuscany, Italy). A total of 412 blood samples were taken from agricultural and forestry workers, and information on age, duration of employment, and history of tick bites was collected in a questionnaire to establish the risk factors for the diseases. Three hundred sixty-five blood donors from the same region served as controls. To estimate the rate of seroconversion, 176 of the agricultural and forestry workers were tested 1 year later. IgG and IgM antibodies against Borrelia burgdorferi sensu lato and TBE virus were detected in serum by an enzyme-linked immunosorbent assay and confirmed by Western blot analysis for Borrelia burgdorferi and by a test for inhibition of hemagglutination for TBE. Antibodies against Borrelia burgdorferi were more frequent among the workers than in the control group (7.8% vs. 4.9% in the IgG-IgM enzyme-linked immunosorbent assay and 7.03% vs. 3.56% in the confirmatory test). No seropositivity was observed for TBE virus. Eighteen of 176 subjects who underwent a second blood test developed specific antibodies against Borrelia burgdorferi within 1 year.

[SARS and occupational risk]. / SARS e rischio occupazionale.

SARS is an infectious disease caused by a previously unrecognized human coronavirus, called SARS-associated coronavirus (SARS-CoV). Current information indicates that most transmission is via respiratory droplets coming from a person who is symptomatic with SARS ("close contact"). The aim of our study is to evidence the critical role of the family physician, the first health-care worker who cares with suspected/probable SARS patients, underlying the importance of the correct use and management of the personal protective equipment.

[Vaccine prophylaxis: contribution for the control of biologic risk in exposed workers]. / La profilassi vaccinale: contributo per il controllo del rischio biologico nei lavoratori esposti.

Working activities with exposure to biological agents have become a matter of discussion especially after the introduction in Italy of the Law 626/94, in conformity with the EU directive 90/679/EEC. There are many important biological agents that can have infectious, allergic, toxic or carcinogenic effects on the working population. Large occupational groups are exposed to these biohazards, both in agriculture and industry. Vaccination is one of the most beneficial medical practices, which has led to the eradication of such a devastating human disease as smallpox and the almost total elimination of poliomyelitis. Vaccination is also one of the most cost effective prevention measures applicable in this respect. This paper describes the possible vaccinations that employers should make available to employees exposed to biological risk, according to article 86 of Law 626/94.

[Prevention, safety and prophylactic measures in occupational HIV infection in Italy, the European Union and the USA]. / Misure di prevenzione, sicurezza e profilassi nell'infezione occupazionale da HIV in Italia, Unione Europea e USA.

Numerous guidelines have been issued by Public Health institutions and related authorities in the last few years for the prevention of HIV infection among occupationally exposed workers. Our study was aimed at comparing the regulations and guidelines on this topic that have recently been adopted by Western countries, also taking into account the impact of the problem in current scientific literature. Health-care workers are the category with the highest risk for occupational exposure to HIV principally associated with accidental needlesticks, skin lesions and percutaneous injuries. In preventive and occupational medicine, Italy, the European Union and the USA have founded their recommendations on universal and specific precautions issued by the Center for Disease Control. Moreover, as long ago as 1990 the Italian Ministry of Health issued official guidelines for the prevention of occupational exposure to bloodborne pathogens. Post-exposure management is crucial for the protection of workers at risk. As a consequence of the failure of some monotherapeutic zidovudine treatments, different countries revised their guidelines and recommended the use of a combination of chemotherapeutic drugs for the post-exposure regimen. However, most of the currently available data are derived from efficacy studies of combined therapy on HIV-infected patients. Therefore, further experimental investigations are needed aimed at evaluating the short- and long-term effects of these treatments in the post-exposure protection of workers at risk for HIV infection.

Antiviral effect of hyperthermic treatment in rhinovirus infection.

Human rhinoviruses (HRV) are recognized as the major etiologic agents for the common cold. Starting from the observation that local hyperthermic treatment is beneficial in patients with natural and experimental common colds, we have studied the effect of brief hyperthermic treatment (HT) on HRV replication in HeLa cells. We report that a 20-min HT at 45 degrees C is effective in suppressing HRV multiplication by more than 90% when applied at specific stages of the virus replication cycle. Synthesis of virus proteins is not affected by HT, indicating that the target for treatment is a posttranslational event. The antiviral effect is a transient cell-mediated event and is associated with the synthesis of the 70-kDa heat shock protein hsp70. Unlike poliovirus, rhinovirus infection does not inhibit the expression of hsp70 induced by heat. The possibility that hsp70 could play a role in the control of rhinovirus replication is suggested by the fact that a different class of HSP inducers, the cyclopentenone prostaglandins PGA1 and delta 12-PGJ2, were also effective in inhibiting HRV replication in HeLa cells. Inhibition of hsp70 expression by actinomycin D prevented the antiviral activity of prostaglandins in HRV-infected cells. These results indicate that the beneficial effect of respiratory hyperthermia may be mediated by the induction of a cytoprotective heat shock response in rhinovirus-infected cells.

Inhibition of poliovirus replication by prostaglandins A and J in human cells.

Cyclopentenone prostaglandins (PGs) inhibit the replication of a wide variety of enveloped DNA and RNA viruses. The antiviral activity is associated with alterations in the synthesis, maturation, and intracellular translocation of viral proteins. In the present report, we describe the effects of cyclopentenone PGs PGA1 and delta 12-PGJ2 on poliovirus (PV) replication in HeLa cells. Both PGs were found to inhibit PV replication dose dependently. Virus yield was significantly reduced at nontoxic concentrations, which did not suppress RNA or protein synthesis in uninfected or PV-infected cells. Both the pattern of PV proteins synthesized and the kinetics of viral protein synthesis and degradation appeared to be similar in PGA1-treated cells and control cells. Antiviral PGs have been shown to selectively inhibit virus protein synthesis during the replication of several viruses, including vesicular stomatitis virus (VSV), and this effect has been recently associated with the induction of a 70-kDa heat shock protein (HSP70). PGA1 and delta 12-PGJ2 were found to induce HSP70 synthesis in uninfected or VSV-infected HeLa cells. PV infection was found to inhibit PG-induced HSP70 synthesis in these cells, suggesting that the lack of ability of cyclopentenone PGs to block PV protein synthesis could be related to an impaired heat shock response in PV-infected cells. The finding that PV protein synthesis was not inhibited by PGs suggests that cyclopentenone PGs could interfere with a late event in the virus replication cycle, such as protein assembly and maturation of PV virions.

In vitro activity of commercially manufactured disinfectants against Pseudomonas aeruginosa.

The in vitro activity of 17 commercially manufactured disinfectants routinely used in a large teaching hospital was tested against 128 strains of Pseudomonas aeruginosa isolated from hospitalized patients and the hospital environment. Except for quaternary ammonium salts, all the disinfectants at dilutions higher or equalling those recommended by the manufacturer were adequate to suppress P. aeruginosa. Chlorhexidine-, povidone-iodine- and glutaraldehyde-based disinfectants at dilutions 4 to 8-fold lower than the normal use dilution had a marked bactericidal effect ( > 3 log10 reduction of viable cells) within a short time (10 to 120 min). Similar formulations produced by different manufacturers exhibited comparable activity against P. aeruginosa.