Current Impact of Occupational Zoonoses in the UK Conference on

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Current Impact of Occupational Zoonoses in the
UKConference on Occupational
ZoonosesThursday 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/

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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.

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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
• gt2000 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

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The work-related ill health Surveillance Pyramid
THOR cases
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General Practitioner
Occupational Physician
Clinical Specialist
Cases reported to THOR specialists
Cases reported to THOR-GP
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The Health and Occupation Reporting (THOR)
network
EPIDERM Occupational Skin Surveillance
Dermatologists
SWORD Surveillance of Work-related and
Occupational Respiratory Disease Chest
Physicians
OPRA Occupational Physicians Reporting
Activity Occupational Physicians
MOSS Musculoskeletal Occupational Surveillance
Scheme Rheumatologists
SIDAW Surveillance of Infectious Diseases At
Work Consultants in Communicable Disease
Control
THOR-GP THOR in General Practice General
Practitioners
THOR-EXTRA Special reports outside the Incidence
Sampling Frame, from minor specialties e.g.
ENT Audiological Physicians
SOSMI Surveillance of Occupational Stress and
Mental-illness Psychiatrists
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• 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

N318
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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
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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

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SIDAW Report Card
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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.

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Actual cases of Campylobacter by industry,
1997-2008
N 498
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Actual cases of Campylobacter reported to SIDAW
and OPRA, 1997-2008
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Actual cases of Salmonella by industry, 1997-2008
N 186
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Actual cases of Salmonella reported to SIDAW and
OPRA, 1997-2008
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Actual cases of Campylobacter and Salmonella
reported to SIDAW and OPRA, 1997-2008
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Actual cases of Ornithosis by industry, 1997-2008
N 50
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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)
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Actual cases of Leptospirosis by industry,
1997-2008
N 42
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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
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Actual cases of Brucellosis by industry, 1997-2008
N 41
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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)
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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

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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

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More specific information available on request
Reserve slides Database raymond.agius_at_manchester
.ac.uk
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Discussion possibilities
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Incidence and Trends
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Dermatitis - Most frequently reported industries
Estimated cases of contact dermatitis reported
by dermatologists in 2006 (Epiderm University
of Manchester)
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Incidence rates of contact dermatitis reported to
EPIDERM (2006) by most frequently reported
industries per 100,000 employed per yearrelated
to population denominator from the Labour Force
Survey 2005 data
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Cases of occupational asthma attributed to latex
(SWORD 1991-2007)
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Trends in contact dermatitis
OPRA
1996 1997 1998 1999 2000 2001
2002 2003 2004 2005 2006
Estimated annual change (1996-2006) -3.1 (95
CI -4.0, -2.2)
Estimated annual change (1996-2006) -7.9 (95
CI -10.6, -5.1)
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Trends in total stress and mental ill health
1996 1997 1998 1999 2000 2001
2002 2003 2004 2005 2006
1996 1997 1998 1999 2000 2001
2002 2003 2004 2005 2006
Estimated annual change (1999-2006) 9.7 (95
CI 6.9, 12.6)
Estimated annual change (1999-2006) -3.3 (95
CI -6.0, -0.5)
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Industries reported by diagnostic category
THOR-GP 2006 to 2007
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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
  under-reporting.
• Ornithosis, Leptospirosis and Brucellosis were
  the next commonly reported.
• Data on less common zoonoses have also been
  generated.

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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
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Reserve Slides
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SIDAW SIDAW SIDAW SIDAW OPRA OPRA OPRA OPRA OPRA EPIDERM EPIDERM EPIDERM EPIDERM SWORD SWORD SWORD SWORD TOTAL
No. of cases male Mean age Age range No. of cases male Mean age Age range No. of cases No. of cases male Mean age Age range No. of cases male Mean age Age range
Brucellosis 25 92 40 16-64 16 (16) 100 36 19-59 - - - - - - - - - 41 (41)
Leptospirosis 29 100 37 17-57 17 (61) 100 43 26-55 - - - 1 (1) 100 43 - 47 (91)
Q fever 11 100 41 25-60 4 (26) 100 41 25-60 - - - - - 1 (1) 0 55 - 16 (38)
Ornithosis 34 63 44 20-65 9 (9) 44 42 26-62 - - - - - 8 (8) 38 40 31-57 51 (51)
Orf 2 100 41 28-52 3 (25) 100 40 27-55 4 (26) 4 (26) - - 9 (53)
Ringworm 1 100 20 - - - - - 9 (9) 9 (9) - - - - 10 (10)
Anthrax 1 100 55 - - - - - - - - - - - - 1 (1)
Cryptosporidiosis 26 55 34 16-76 2 (13) 100 36 30-41 - - - - - - - - - 28 (39)
Salmonella 210 56 34 16-73 4 (48) 0 36 31-44 - - - - - - - 214 (258)
Schistosomiasis - - - - 2 (13) 50 44 32-55 - - - - - - - - - 2 (13)
Lyme disease 3 100 49 35-63 1 (1) 100 50 - - - - - - - - 4 (4)
Campylobacteriosis 542 74 34 16-81 1 (1) 100 18 - - - - - - - - - - 543 (543)
Cholera 1 0 64 - - - - - - - - - - - - 1 (1)
Dengue fever - - - - 1 (1) 100 42 - - - - - - - - - - 1 (1)
Giardia 21 75 39 26-60 1 (1) 100 29 - - - - - - - - 22 (22)
Trichinosis 1 0 47 - - - - - - - - - - - - - - 1 (1)
Rickettsia - - - - 3 (25) 100 54 43-67 - - - - - - - 3 (25)

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SIDAW Reporters 1999-2003
YEAR NO. OF REPORTERS
1999 116
2000 114
2001 109
2002 99
2003 101
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YEAR NUMBER OF CASES
1996 242
1997 1025
1998 1192
1999 634
2000 575
2001 721
2002 2240
2003 1030
2004
OCTOBER - DECEMBER 1996
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Survey

• February 2004
• SIDAW reporters (n101) 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

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Q1. How easy is the report card to use?
of survey responders
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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 cant tell whether or not an infection is work
  related, therefore its easy to send in a nil
  return!

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Q2. How useful are the instructions?
of survey responders
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Q2. Comments

• Clearer definitions would help
• Do you want info on all DV 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

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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

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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

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Q5. How interesting are the reports?
of survey responders
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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

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Q6. Do you have direct patient contact?
of survey responders
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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

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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?