OCCUPATIONAL INFECTIONS MUDr. Markéta Petrovová KPL FN USA a LF MU Brno xAids 300px-TB_in_sputum upravatbc Definition •Occupational infections are those human •diseases caused by work-associated exposure to •microbial agens, including – bacteria – viruses – funghi – parasites (protozoa, helmints) – •What distinguishes an infection as occupational is •some aspect of the work that involves contact with •a biologically active organism. Infections may be transmitted •when people work or live in groups (daycare centers, barracks) •when people work with ill people or with human secretions (healthcare and laboratory workers) •when people travel (bussines travel, military campaigns) •when people work with animals (farms, zoos, laboratories) •when the spores occure (farming, constructions) •when the water aerosol occures (factories, treatment plants) Kinds of occupational infections 1.Infections due to exposure to infected human or their tissues 2. 2.Zoonoses – infections transmitted from animals to humans 3. 3.Travel associated infectious diseases 1. Infections with interhumans transmission • •Healthcare and clinical laboratory workers are at increased risk of infection by organisms whose natural hosts are humans, as in the case of viral hepatitis A,B,C, HIV, scabies, rubella, measles, mumps, varicella zoster, EB virus, epidemic keratoconjunctivitis, TBC… • •Teachers, policemans, social workers: rubella, measles, mumps, influenza, tuberculosis 1203680822_ockovani-hepatitida Occupational infections, Czech Republic, 1976-2006 Occupational infections, Czech Republic, 1976-2006 Occup. hepatitis, Czech Republic, 1976-2006 Occup. tuberculosis, Czech republic,1976 - 2006 Ocup. scabies, Czech republic, 1976-2006 2. Zoonoses •are defined as diseases, that infect both humans and animals. • •Occupations involving –contact with infected animals, their infected secretions or tissues –or contact with arthropod vectors from infected animals can result in occupational zoonotic disease Bacterial zoonoses • •Anthrax (Bacillus anthracis) may cause a cutaneous or pulmonary infection. It is a disease of animal handlers, imported leather • •Brucellosis (Brucella abortus, B.suis, B. recurrens, B.canis) endangers slaughterhouse employees, livestock producers, veterinarians, hunters) • •Tularemia (Francisella tularensis) – hunters, forestly workers, farmers, veterinarians • •Leptospirosis (L. icterohaemorrhagiae, L.grippothypohosa, L. canicola, L.pomona) field agricultural workers, abbatoir workers, farmers, sewer and canal workers, veterinarians, miners, fishermen •Tetanus (Clostridium tetani)– gardeners, horse breeders, farmers • •Lyme disease (Borrelia burgdorferi) forestly workers, lumberjacks • •Ornithosis –psitacosis is caused by Chlamydia psittaci and may be confused with hypersensitivity pneumonitis, for example, pigeon or parrot breeders, zoo attendants, poultry workers • •Q fever is caused by Coxiella burneti. Exposures: farmers, ranchers, veterinariens, slaughterhousemen, laboratory workers, wool processors • •Plaque Yersinia pestis and Pasteurella multocida are additional bacterial zoonoses Viral zoonoses •Include •Tick-born encephalitis (flavivirus) – forestly workers • •Rabies (lyssa virus) – laboratory workers, veterinarians, trappers, hunters, persons who handle wild or unidentified animals) • •Hantavirus - farmers, geodesists Rabies in Czech Republic • Rabies is a viral disease of the central nervous system transmitable from infected animals to humans • •Human rabies occur very rarely in CR. • Only 3 cases were diagnosed during last 40 years. Source of exposure: fox, dog in India, unknown in Vietnam • •Domestic animals • Preventive vaccination of domestic carnivors is the principal method for protecting • Rabies in Czech Republic •Wild animals • In 2001, 35 animals cases were reported, and only 3 cases of fox rabies in 2002. Those were the last known cases of rabies in the CR. • •oral vaccination of foxes •25 millions vaccine baits were used during the period 1989 - 2004. The vaccination program was exceptionally effective and resulted in the total elimination of rabies. •2002: due to absence of rabies for over 2 years, the CR qualifies as a rabies free country. image Protozoal zoonoses •Toxoplasmosis (Toxoplasma gondi) – laboratory workers, veterinarians, cat handlers •Toxocarosis (Toxocara canis) veterinarians • •Fungal zoonoses •Coccidiomycosis (Coccidioides immitis) – farm workers, archeologists, excavation workers, construction workers • • occured to Czechs working abroad (2000-2008) 3.Occupational tropical and subtropical infectious and parasite diseases year 2000 2001 2002 2003 2004 2005 2006 2007 2008 celkem Malaria 7 5 3 5 11 8 5 2 5 51 Lambliosis 0 0 0 1 2 4 3 13 0 23 Amebosis 1 2 2 2 11 4 2 1 1 26 Diseases caused by worms 1 0 1 1 0 2 0 1 0 6 salmonelosis 0 1 2 0 0 0 0 1 0 4 other inf. diarrheas 0 0 1 1 2 3 3 4 0 14 arbovirosis 0 1 0 1 0 6 2 2 2 14 others 0 0 0 2 2 0 0 0 0 4 total 9 9 9 13 28 27 15 24 8 142 Travel medicine •Travel forms an important part of the occupational activities of many people these days, be they engineers, executives or manual workers. •It is, therefore, possible to subsume almost any tropical infectious disease under the heading of occupationally relates disorders. •Occupational physicians need to be aware of the problems encoutered both by workers based here who travel overseas, and by workers who enter this country to work, either on a temporary or permanent basis. 162649 Travel – asicoated infectious diseases •All travelers should have routin immunisations updated • •Additional preventive measures may be required for persons travelling to developing countries, thoses who will be working outside of urban locations and those, who many be in contact with animals. • •Educational programs for health and safety should include information on common sense prevention, specific immunisations or chemoprofylaxis, source of medical care, and medical clearence based on particular hazards that may be present in the destination country as well as availability of appropriate healt care. Preventive measures •Passive imunisation - prompt, but short-term effect •HBIG (Hepatect) – VHB, hyperimun. globulin- lyssa, tetanus • •Active immunisation • •Chemoprophylaxis • as with malaria profylaxis, or following exposure • as with ATB following meningococcal exposure • INH following tuberculosis bacilli exposure • AZT following HIV exposure Vaccination •3 databases available worldwide: •CDC - Centers for Disease Control and Prevention •IAMAT – Int. Association for Medical Assistance to Travellers •CRM - Centrum für Reisemedizin • •Compulsory or urgent recommended vaccinations •Other recommended vaccinations in specific circumstances •Antimalarial prophylaxis •Other infection risk The recommended procedure for choices of vaccination •Check the status of current vaccinations - particularly against tetanus, diphtheria, measles and polio • §Assess the planned stay in the destination: §the nature of residence (work, study, humanitarian assistance, recreation, sports, adventure) §the length of stay (short term = 2-4 weeks, medium =1-3 months, long term = more than 3 months), §the method of travel ( local transport: bus, train, boat) Appropriate time for vaccination • –the optimal time (1 month before departure) –the minimum time (7-14 days before departure) –refrain from vaccination, less than 3 days (7 more days) before departure – •Category vaccination • •Cat. I (high mortality disease): vaccination against • yellow fever and rabies •Cat. II (easily portable, alimentary or faecal oral • disease) vaccination against viral hepatitis A, typhoid fever • and cholera •Cat. III (severe, but specifically transmitted diseases): vaccination • against meningococcal diseases, Japanese encephalitis, • tick-borne encephalitis and viral hepatitis B. • Legionelosis •Travellers who visit developed settings (e.g., hotels, even in developing countries) are exposed to aerosolized, warm water are at risk for infection. • Despite the presence of Legionella bacteria in many aquatic environments, the risk of developing legionellosis for most individuals is low. Elderly and immunocompromised travellers are at higher risk. •Exposures can occur during activities such as recreation in or near a whirlpool spa, while showering in a hotel, or touring in cities with buildings that have cooling towers. •The largest outbreak (449 cases) ever reported was traced to a cooling tower on the roof of a city hospital in Murcia, Spain, in 2001. Malaria in the world Map of malaria endemic areas in the world Viral hepatitis A in the world hepaa_mapa Geographic distribution of Hepatitis B prevalence, 2005 Map 4-5. Geographic distribution of Hepatitis B prevalence, 2005 Tuberculosis in the world Image:TB incidence.png Tuberculosis in Europe Tuberculosis in the world Image:Tuberculosis reported cases 2006.PNG Incidence: červená = >300, oranžová = 200-300; žlutá = 100-200; zelená 50-100; modrá = <50 Recommendation •VHB immunisation and meningococcus immunisation are useful for travellers to endemic areas, particularly if long residence is planned. • •Vaccine for rabies and for Japanese encephalitis B may be needed for persons with animal contact in endemic areas. • •Other general protective measures include insect repellents where insect vector may transmit disease (malaria, yellow fever, dengue, filariasis, leishmaniasis, trypanosomiasis and hemorrhagic fevers). Recommendation •Use of light colored and protectiv clothingh, mosqiuto netting, and avoidance of scented cosmetics may be helpful. • •The traveler should také care not eat or drink contaminated food or water and should avoid uncooked foods. • •Commonly encountered travel-related diseases include travelers diarrhea, hepatitis A, yellow fever, typhoid fever, cholera, malaria. • Thank You for Attention poust