Transcript Document

Current Impact of Occupational Zoonoses in the UK
Conference on “Occupational Zoonoses”
Thursday 9th July 2009, Leahurst, University of Liverpool,
Neston CH64 7TE
Prof Raymond Agius & Dr Melanie Carder
Occupational & Environmental Health Research Group
The University of Manchester
http://www.medicine.manchester.ac.uk/oeh/
Objectives & Structure
• To outline the national health surveillance methods in
The Health and Occupation Reporting Network
(THOR) used for collecting information on
occupational disease and work-related ill health
(including occupational zoonoses).
• To present data on physician reported cases of
occupational zoonoses in the UK.
• To discuss the above.
The Health and Occupation Reporting
Network (THOR)
• A research and surveillance programme, fulfilling a medical
observatory function, for occupational disease, work related ill
health and sickness absence
• Started in UK with 1st scheme in 1989: SWORD
• >2000 doctors participate
• Reporting new cases of occupational /work-related disease
seen in the previous month
• Reports from clinical ‘system’ specialists account for an
estimated 11,000 new UK cases of work-related ill-health per
annum.
• Reports from OPs and GPs account for a further estimated
12,000 UK cases per year
• THOR Ireland started in 2005
http://www.medicine.manchester.ac.uk/ceh/thor
The work-related ill health
Surveillance Pyramid
THOR
specialist
THOR
cases
Not reported
by specialist
Seen by a general practitioner (GP)
No medical consultation
THOR-GP
SWI
General Practitioner
Occupational Physician
Clinical Specialist
Cases reported to THOR
specialists
Cases reported to THOR-GP
The Health and Occupation
Reporting (THOR) network
SWORD
EPIDERM
Surveillance of Work-related
and Occupational Respiratory Disease
Occupational Skin Surveillance
Chest Physicians
Dermatologists
OPRA
Occupational Physicians
Reporting Activity
MOSS
Musculoskeletal Occupational
Surveillance Scheme
SIDAW
Occupational Physicians
THOR-GP
Rheumatologists
Surveillance of Infectious
Diseases At Work
Consultants in Communicable
Disease Control
THOR in General Practice
General Practitioners
THOR-EXTRA
SOSMI
Special reports outside the
Incidence Sampling Frame, &
from minor specialties e.g.
ENT & Audiological Physicians
Surveillance of Occupational
Stress and Mental-illness
Psychiatrists
THOR-GP
Reporters
As at June 2006
Network trained to
Diploma level in
Occupational Medicine
Mainly Manchester alumni
•Interest & motivation
•Competence
•Affinity
Report electronically
every month
on-line web form
N=318
Denominators for calculating incidence :
Numerator source
Denominator source
Info besides numbers,
& gender includes
Clin. Specialists*
(National) Labour
Age, industry, occupation
Force Survey*
Gen. practitioners
Practice data
Age, residence postcode+
Occup. Physns.
3 yearly survey
Industry sector
+ social and occupational parameters can be derived
** with adjustments for specialist participation rate
SIDAW – Surveillance of
Infectious Diseases at Work
• SIDAW commenced October 1996
• Occupationally acquired infectious disease in the UK
1996-7.Ross et al. (1998) Comm Dis & Pub Health;
Vol 1; 98-102
– 116 SIDAW participants (CCDC) but since ↓
– 1037 cases reported
– 78% nil returns
SIDAW Report Card
Details of all reported cases (A-H)
G ro u p
R e f e re n c e
N um be r
Ge nde r
Age
NOVEMBER 2004
P o s tc o de
( f irs t h a lf )
e .g . S W3
O c c u p a t io n
Wo rk p la c e
Surveillance Of Infectious Disease At Work
A const it uent of T he Healt h and Occupat ion Report ing net work (T HOR)
SIDAW
Number of NEW cases of OCCUPATIONALLY ACQUIRED infectious diseases seen or reported to you in November 2004
A
Brucellosis
H
B
Hepatitis
1._________________________
C
Legionellosis
2. _________________________
D
Leptospirosis
E
Ornithosis
1. Single sporadic cases
F
Pulmonary tuberculosis
2. Outbreaks (>=2 associated cases)*
G
Q Fever
___________________________
X
Other e.g. scabies infestation (please specify)
Diarrhoeal disease
___________________________
Please record details overleaf for groups A-X1
Tick here if no case/s to report
*P le a s e s um m a ris e a va ila ble da ta o n a ge , s e x, o c c upa tio n
a nd s us pe c te d a ge nt
Date…………………
Initials……………………..
THOR, Centre f or Occupational & Environmental Health, Faculty of Medicine & Human Sciences, University of Manchester, Block C, 4th Floor,
Humanities Devas Street, Oxf ord Road, Manchester, M13 9PL Tel:0161 275 8491 Fax: 0161 275 5506 w w w .coeh.man.ac.uk
A g e n t ( if k n o wn ) P le a s e s p e c if y
b a s is f o r d ia g n o s is e .g .s e ro lo g y,
is o la t io n , c lin ic a l
Results
• Larger set, as per abstract, from 1996- 2008 inclusive.
Communicable disease specialists - SIDAW:
907
(907)
Occupational physicians - OPRA:
64
(240)
Dermatologists – EPIDERM:
13
(35)
Chest physicians – SWORD:
10
(10)
Total
984
(1182)
(Numbers in parentheses are estimates based on the reporters’
sampling ratio, but the data presented here are based on the
actual reported numbers not this estimate)
• Since SIDAW started in October 1996, part of the data (where
specified) is limited to 1997-2008.
Actual cases of Campylobacter by industry, 1997-2008
N = 498
1% 2% 2%
5%
Agriculture, hunting and forestry
14%
Mfr of food products and beverages
1%
Construction
8%
Retail trade
2%
Hotels and restuarants
Other buisness activities
Public administration and defence
13%
Education
Health and social care
43%
8%
1%
Sewage and refuse disposal
Recreational, sporting and cultural
Other
Actual cases of Campylobacter reported to SIDAW and
OPRA, 1997-2008
Campylobacter
Number of cases
120
100
80
60
40
20
0
1997
1998
1999
2000
2001
2002
2003
Year
2004
2005
2006
2007
2008
Actual cases of Salmonella by industry, 1997-2008
N = 186
5%
Agriculture, hunting and forestry
17%
9%
Mfr of food products and beverages
Retail trade
14%
10%
Hotels and restuarants
Public administration and defence
4%
3%
4%
Education
Health and social care
Recreational, sporting and cultural
34%
Other
Actual cases of Salmonella reported to SIDAW and OPRA,
1997-2008
Salmonella
Number of cases
120
100
80
60
40
20
0
1997
1998
1999
2000
2001
2002
2003
Year
2004
2005
2006
2007
2008
Actual cases of Campylobacter and Salmonella reported to
SIDAW and OPRA, 1997-2008
120
Number of cases
100
Campylobacter
Salmonella
80
60
40
20
0
1997
1998
1999
2000
2001
2002
2003
Year
2004
2005
2006
2007
2008
Actual cases of Ornithosis by industry, 1997-2008
N = 50
8%
2%
12%
Agriculture, hunting and forestry
2%
Mfr of food products and beverages
Electrcity, gas, water supply
18%
Retail trade
Public administration and defence
2%
Health and social care
56%
Private households
Actual cases (50) of Ornithosis by industry, 1996-2008
SIDAW:
6/34 (18%) : agriculture (turkey plucker, aviary worker, pheasant breeder)
12/34 (35%) : manufacture of food products and beverages (poultry
processing, meat inspector)
1/34 (3%) : electricity, gas, water supply (maintenance engineer: ‘pigeon alley’)
7/34 (21%) : retail trade (pet shop workers)
4/34 (12%) : health and social care (vets)
1/34 (3%) : private households (estate manager)
OPRA:
8 cases in mfr. of food
1 case in public administration and defence
SWORD:
All 8 cases in mfr. of food (poultry workers)
Actual cases of Leptospirosis by industry, 1997-2008
N = 42
5%
Agriculture, hunting and forestry
7%
Fishing
7%
35%
Mfr of food products and beverages
Electrcity, gas, water supply
Construction
19%
Health and social care
Sewage and refuse disposal
12%
10%
5%
Recreational, sporting and cultural
Actual cases (42) of Leptospirosis by industry, 1996-2008
SIDAW:
10/29 (34%) : agriculture (farmers, dairyman, compost maker, herdsman)
1/29 (3%) : forestry (wood cutter)
5/29 (17%) : fishing (fish farmers)
2/29 (7%) : manufr. of food products & beverages (fish filleter, slaughterman)
1/29 (3%) : collection, purification and distribution of water (water worker)
2/29 (7%) : construction (builder, labourer)
1/29 (3%) : public administration and defence (sewage worker)
2/29 (7%) : health and social care (animal welfare worker)
7/29 (7%) : sewage and refuse disposal (refuse collector)
2/29 (7%) : recreational, cultural and sporting activities (zoo worker)
OPRA:
4/17 (24%) : agriculture (farmers),
1 case : mfr of motor vehicles,
1 case : electricity, gas and water
5 cases : construction,
2 cases : public admin and defence
1 case : health and socia
1 case : sewage and refuse disposal
Actual cases of Brucellosis by industry, 1997-2008
N = 41
2% 2%
Agriculture, hunting and forestry
7%
Mfr of food products and beverages
52%
Health and social care
37%
Sewage and refuse disposal
Recreational, sporting and cultural
Actual cases (41) of Brucellosis by industry, 1996-2008
SIDAW:
16/25 (64%) : agriculture (all farmers)
4/25 (16%) : manufacture of food products and beverages (workers in
abattoirs and one meat classification officer)
3/25 (12%) : health and social care (all vets)
1/25 (4%) : Sewage and refuse disposal (sewage worker)
1/25 (4%) : recreational, cultural and sporting activities (organiser of fox
hunts)
OPRA:
5/16 (31%) : in agriculture (farmers)
11/16 (69%) : mfr. of food products and beverages (abattoir workers)
Actual cases of rarer conditions, 1996-2008
Examples of other conditions :
•Q fever:
16 cases
• {‘Rickettsia’
3 cases}
•Orf:
9 cases
•Lyme disease:
4 cases
Actual cases of rarer conditions, 1996-2008
From occupational exposure overseas or from material
imported from abroad or from laboratory work:
•Anthrax
hide & skin collector
•Cholera
travel agent
•Dengue fever
media editor
•Schistosomiasis
university laboratory technician
underwater cameraman
More specific information available on request…
Reserve slides
Database …
[email protected]
Discussion …
possibilities
Incidence and Trends
Dermatitis - Most frequently reported industries
Estimated cases of contact dermatitis reported by
dermatologists in 2006 (‘Epiderm’: University of Manchester)
0
50
100
150
200
250
300
Healthcare & social
work
400
450
421
Hotel & catering
238
Hairdressing & beauty
304
Construction
Retail
350
146
123
Incidence rates of contact dermatitis reported to EPIDERM (2006) by most
frequently reported industries per 100,000 employed per year
related to population denominator from the Labour Force Survey 2005 data
0
20
Healthcare & social
work
80
100
120
19.69
Hairdressing & beauty
Retail
60
12.15
Hotels & catering
Construction
40
132.79
6.54
2.87
140
Cases of occupational asthma attributed to latex
(SWORD 1991-2007)
60
Estimated
50
Actual
40
30
20
10
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Trends in contact dermatitis
OPRA, all reporters
OPRA
EPIDERM
100
100
80
% increase in reported cases
% increase in reported cases
80
60
40
20
0
-20
-40
-60
40
20
0
-20
-40
-60
-80
-80
-100
60
1996 1997
1998
1999
2000 2001
2002
2003 2004 2005 2006
Year
Estimated annual change (1996-2006):
-3.1% (95% CI: -4.0%, -2.2%)
-100
Year
Estimated annual change (1996-2006):
-7.9% (95% CI: -10.6%, -5.1%)
Trends in total stress and mental
ill health
200
180
160
140
120
100
80
60
40
20
0
-20
-40
-60
-80
-100
SOSMI, all reporters
% increase in reported cases
% increase in reported cases
OPRA, all reporters
1996
1997
1998
1999
2000 2001 2002
2003
2004
2005
2006
Year
Estimated annual change (1999-2006):
+9.7% (95% CI: +6.9%, +12.6%)
200
180
160
140
120
100
80
60
40
20
0
-20
-40
-60
-80
-100
1996
1997
1998
1999
2000 2001 2002
2003
2004
2005
2006
Year
Estimated annual change (1999-2006):
-3.3% (95% CI: -6.0%, -0.5%)
Industries reported by diagnostic category THOR-GP 2006 to 2007
Hair & beauty
Agriculture
Land transport
Financial
Metal manufacture
Food Manufacture
Other business
Catering
Education
Retail
Public admin & defence
Construction
Health & social care
All cases
0%
25%
Musculoskeletal
Mental ill health
50%
Skin
75%
Respiratory
Audiological
100%
Other
Conclusions
• THOR undertakes a national observatory function providing
medically certified measurements of incidence of occupational
disease and work related illness
• THOR can identify determinants of work related ill health such
as occupational zoonoses and thus help inform preventive / risk
reduction policy
• The commonest reported cases were caused by Campylobacter
and Salmonella. Although numbers reported are large enough to
monitor trends, there may be substantial bias resulting in underreporting.
• Ornithosis, Leptospirosis and Brucellosis were the next
commonly reported.
• Data on less common zoonoses have also been generated.
Acknowledgements
Funded partly by the UK Health & Safety Executive,
also Dept of Health, charities etc
Thanks are due to all participating physicians
Other members of the THOR team
Dr Roseanne McNamee
Dr Susan Turner
Dr Kevan Thorley
Dr Melanie Carder
Miss Louise Hussey
Dr Annemarie Money
Ms Rachel Robinson
Ms Susan Taylor
et al
Reserve Slides
SIDAW
OPRA*
EPIDERM*
SWORD*
TOTAL
No.
of
case
s
%
mal
e
Me
an
age
Age
ran
ge
No. of
cases
%
mal
e
Me
an
age
Age
ran
ge
No
.
of
ca
se
s
% Mean
m age
a
l
e
Age
range
No.
of
case
s
%
mal
e
Mea
n
age
Age
ran
ge
Brucellosis
25
92
40
1664
16
(16)
100
36
1959
-
-
-
-
-
-
-
41 (41)
Leptospirosis
29
100
37
1757
17
(61)
100
43
2655
-
-
1 (1)
100
43
-
47 (91)
Q fever
11
100
41
2560
4 (26)
100
41
2560
-
-
-
-
1 (1)
0
55
-
16 (38)
Ornithosis
34
63
44
2065
9 (9)
44
42
2662
-
-
-
-
8 (8)
38
40
3157
51 (51)
Orf
2
100
41
2852
3 (25)
100
40
2755
4
(2
6)
-
-
9 (53)
Ringworm
1
100
20
-
-
-
-
-
9
(9)
-
-
10 (10)
Anthrax
1
100
55
-
-
-
-
-
-
-
-
-
-
-
1 (1)
Cryptosporidiosis
26
55%
34
1676
2 (13)
100
36
3041
-
-
-
-
-
-
28 (39)
Salmonella
210
56
34
1673
4 (48)
0
36
3144
-
-
-
-
-
-
214
(258)
Schistosomiasis
-
-
-
-
2 (13)
50
44
3255
-
-
-
-
-
-
2 (13)
Lyme disease
3
100
49
3563
1 (1)
100
50
-
-
-
-
-
-
-
4 (4)
-
-
-
-
-
-
-
SIDAW Reporters 1999-2003
YEAR
NO. OF REPORTERS
1999
116
2000
114
2001
109
2002
99
2003
101
YEAR
NUMBER OF
CASES
1996*
1997
1998
1999
2000
2001
2002
2003
2004
242
1025
1192
634
575
721
2240
1030
*OCTOBER - DECEMBER 1996
Survey
• February 2004
– SIDAW reporters (n=101) contacted by
phone
• 75 / 101 willing to continue reporting
• March 2004
– 75 reporters sent a postal survey
– Single mail shot (no reminders)
– 30/75 (40%) response rate
Q1. How easy is the report card to
use?
very easy
quite easy
adequate
quite difficult
very difficult
no response
0
10
20
30
40
% of survey responders
50
60
Q1. Comments
• 2 main causes (scabies / noroviruses) –
difficult to collect data on other causes
• Larger section for diarrhoeal disease
• Is age / gender information essential?
• We can’t tell whether or not an infection
is work related, therefore it’s easy to
send in a “nil” return!
Q2. How useful are the instructions?
clear
adequate
misleading
no response
0
10
20
30
40
% of survey responders
50
60
Q2. Comments
• Clearer definitions would help
• Do you want info on all D&V cases that
may be occupationally acquired that are
proven/suspected norovirus infection?
• Use a follow up letter to those reporting
norovirus / scabies about 1/12 after
initial reporting to collect further data
Q3. Improvements for gathering data on
outbreaks
• Provide daily card “aide memoire”
• Request outbreak summaries
• Minimise data to be returned
– numbers affected, agent, occupation/workplace
• Reformat card / clearer instructions
• Electronic reporting
• Links with other data sources
– community / hospital outbreak questionnaires
Q4. What would make SIDAW more
useful?
•
•
•
•
•
Have information on line
Others to collect data (nursing colleagues?)
Provide summaries of outbreaks
List regular reporters to SIDAW
Exclude noroviruses / scabies & collect data
on other causes
• No use to me – my role does not distinguish
between infection acquired at work / home /
play
Q5. How interesting are the
reports?
very
quite
not very
no response
0
10
20
30
40
50
% of survey responders
60
70
Q5. Comments
• Under-reporting means that figures
have little validity (e.g. for scabies,
diarrhoea)
• Present other information
– Trends over time
– Anecdotal reports
• Proportions of occupationally acquired
cases would be interesting
• Link with other data sources
Q6. Do you have direct patient
contact?
never
occasionally
sometimes
regularly
no response
0
10
20
30
% of survey responders
40
50
Q6. If no direct patient contact, suggest
more effective ways of reporting to
SIDAW
• Give details of HSE involvement
• Make presentations at meetings
• Involve other groups in reporting
– GPs / PCTs / Acute Trusts / EHOs / OHDs
– ? Patient reporting
• CCDCs should be happy to report!
• Departments are understaffed & additional
reporting might not be welcomed
Discussion
• Most frequently reported categories
(scabies noroviruses, diarrhoeal
disease)
• Production of outbreak reports
• Involvement of other groups in SIDAW
• Publicising SIDAW more widely
• An Advisory Committee for SIDAW?