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agree, but this conclusion should not be extended to include hepatitis C virus (HCV). We have reported 10 patients with EMC (6 type IIand 4 type III) presenting with a serological pattern of HCV infection (ELISA second generation and RIBA tests, Abbott).1 9 patients had a we
pronounced increase in serum aminotransferases. Liver biopsy, done in 3 patients, showed persistent or active hepatitis. Since that report, we have investigated all our patients with EMC. Of 30 patients, 21 were seropositive for HCV (ELISA second generation and RIBA tests, Abbott). In contrast to Dr Cassato’s fmdings (April 27, p 104), we did not find any serological evidence of HBV
However, when hygiene and protection regulations are not followed then sewage workers may well put themselves
Department of Public Health Medicine, Norwich Health Authority, Norwich NR7 0SS, UK
BRYAN JEFFERSON HEAP
Unity Medical Services, Norwich
MARY L. BETON MCCULLOCH
Doby JM, Duval JM, Beaucournu JC. Amoebiasis, an occupational disease of sewer workers? Nouv Presse Med 1980; 9: 532-33 2. Knobloch J, Bialek R, Hasemann J. Intestinal protozoal infestation in persons with occupational sewage contact. Dtsch Med Wochenschr 1983; 108: 57-60. 3. Clark CS, Cleary EJ, Schiff GM, Linnemann CC, Phair JP, Briggs TM. Disease risks of occupational exposure to sewage. J Environ Engrg Am Soc Civil Engineers 1976; 1.
JR, Disdier P, Durand JM, et al. Mixed cryoglobulinemia in hepatitis C virus infection: ten cases. Presse Med 1991; 20: 1233. 2. Alter MJ, Sampliner R. Hepatitis C: and miles to go before we sleep. N Engl J Med 1989; 321: 1538-39.
Giardiasis and occupational risk in sewage workers SIR,-In the 6 months between March and August, 1991, cases of giardiasis have been confirmed in Norwich health district. 10 of these patients had a history compatible with infection being acquired abroad. 3 of the remaining 14 were sewage workers who had no other risk factors or history of exposure. This raised the question, is giardiasis an occupational risk in sewage workers? Patient 1 worked with high pressure water hoses to unblock drains and sewers. Although correct protective clothing and washing facilities were available to him he admitted that he often disregarded these precautions and was frequently contaminated by raw sewage. Patient 2 worked at a sewage treatment plant and she obtained sewage samples for chemical analysis at various stages in the sewage process. She often did not wear protective clothing and gloves and frequently contaminated her hands with sewage. Patient 3 was a pump engineer who, although he did not usually work with sewers, had considerable exposure to sewage over a few weeks when working on a sewage pumping project. All patients presented to their general practitioners with symptoms compatible with giardiasis. Cysts and trophozoites of Giardia intestinalis (formerly G lamblia) were identified in their stools. Workers in sewers and in treatment plants who have intimate and prolonged exposure to contaminated waters might be at greater risk of infectious and parasitic disease transmission than the general public. Few studies of health of wastewater industry workers have been published. European workers have reported an increase of parasitic infections among workers exposed to wastewater. Doby et al,l in a study of 54 French sewer workers and 300 control subjects, detected giardia in 16-5% of sewer workers but in only 2-5% of In a survey of 614 employees of control subjects (p
agree, but this conclusion should not be extended to include hepatitis C virus (HCV). We have reported 10 patients with EMC (6 type IIand 4 type III) presenting with a serological pattern of HCV infection (ELISA second generation and RIBA tests, Abbott).1 9 patients had a we
pronounced increase in serum aminotransferases. Liver biopsy, done in 3 patients, showed persistent or active hepatitis. Since that report, we have investigated all our patients with EMC. Of 30 patients, 21 were seropositive for HCV (ELISA second generation and RIBA tests, Abbott). In contrast to Dr Cassato’s fmdings (April 27, p 104), we did not find any serological evidence of HBV
However, when hygiene and protection regulations are not followed then sewage workers may well put themselves
Department of Public Health Medicine, Norwich Health Authority, Norwich NR7 0SS, UK
BRYAN JEFFERSON HEAP
Unity Medical Services, Norwich
MARY L. BETON MCCULLOCH
Doby JM, Duval JM, Beaucournu JC. Amoebiasis, an occupational disease of sewer workers? Nouv Presse Med 1980; 9: 532-33 2. Knobloch J, Bialek R, Hasemann J. Intestinal protozoal infestation in persons with occupational sewage contact. Dtsch Med Wochenschr 1983; 108: 57-60. 3. Clark CS, Cleary EJ, Schiff GM, Linnemann CC, Phair JP, Briggs TM. Disease risks of occupational exposure to sewage. J Environ Engrg Am Soc Civil Engineers 1976; 1.
JR, Disdier P, Durand JM, et al. Mixed cryoglobulinemia in hepatitis C virus infection: ten cases. Presse Med 1991; 20: 1233. 2. Alter MJ, Sampliner R. Hepatitis C: and miles to go before we sleep. N Engl J Med 1989; 321: 1538-39.
Giardiasis and occupational risk in sewage workers SIR,-In the 6 months between March and August, 1991, cases of giardiasis have been confirmed in Norwich health district. 10 of these patients had a history compatible with infection being acquired abroad. 3 of the remaining 14 were sewage workers who had no other risk factors or history of exposure. This raised the question, is giardiasis an occupational risk in sewage workers? Patient 1 worked with high pressure water hoses to unblock drains and sewers. Although correct protective clothing and washing facilities were available to him he admitted that he often disregarded these precautions and was frequently contaminated by raw sewage. Patient 2 worked at a sewage treatment plant and she obtained sewage samples for chemical analysis at various stages in the sewage process. She often did not wear protective clothing and gloves and frequently contaminated her hands with sewage. Patient 3 was a pump engineer who, although he did not usually work with sewers, had considerable exposure to sewage over a few weeks when working on a sewage pumping project. All patients presented to their general practitioners with symptoms compatible with giardiasis. Cysts and trophozoites of Giardia intestinalis (formerly G lamblia) were identified in their stools. Workers in sewers and in treatment plants who have intimate and prolonged exposure to contaminated waters might be at greater risk of infectious and parasitic disease transmission than the general public. Few studies of health of wastewater industry workers have been published. European workers have reported an increase of parasitic infections among workers exposed to wastewater. Doby et al,l in a study of 54 French sewer workers and 300 control subjects, detected giardia in 16-5% of sewer workers but in only 2-5% of In a survey of 614 employees of control subjects (p
