From the Guidelines
Sewage workers are not at increased risk of contracting hepatitis A due to occupational exposure, but they are at risk of contracting leptospirosis. According to the study by 1, hepatitis A vaccine is not recommended for sewage workers solely based on occupational exposure, as they have not been demonstrated to be at increased risk for hepatitis A virus infection. However, the study by 1 highlights the presence of various pathogen microorganisms, including Leptospira bacteria, in wastewater, posing a risk to sewage workers. The risk of leptospirosis can be mitigated through the use of personal protective equipment, including waterproof gloves, boots, face shields, and coveralls, as well as strict hygiene measures such as:
- Thorough handwashing with soap and water
- Avoiding eating or drinking in work areas
- Showering after shifts
- Promptly cleaning and covering any cuts or abrasions Early recognition of symptoms is crucial, as leptospirosis presents with flu-like symptoms, muscle pain, and sometimes jaundice or kidney failure. Prompt medical attention should be sought if symptoms develop, as early antibiotic treatment for leptospirosis (typically doxycycline or penicillin) can reduce severity and duration of illness.
From the Research
Risk of Hepatitis A and Leptospirosis among Sewage Workers
- Sewage workers are at risk of contracting hepatitis A, as evidenced by a case report describing the occurrence of hepatitis A in three workers at a waste water treatment plant during a small community outbreak 2.
- A study found that antibodies against hepatitis A virus were detected in 65.7% of wastewater treatment plant workers, which was significantly higher than in the control group, suggesting that hepatitis A is an occupational hazard for sewage workers 3.
- However, another study found that the prevalence of antibodies to HAV was not significantly more prevalent among sewer workers than among controls, and that hepatitis A is apparently no longer a risk for sewer workers due to the generalized decrease in incidence of hepatitis A in the past three decades 4.
- Regarding leptospirosis, sewer workers are at a potential risk of infection due to exposure to contaminated sewage, as rodents that abound in underground sewers are carriers of leptospira 5.
- A sero surveillance study found that the prevalence of leptospirosis among sewer workers was 16.6%, with evidence of leptospiral infection found to be maximum in areas infested with rodents and stray animals 5.
- The risk of hepatitis A virus infection among sewage workers may vary depending on the location, with a study in Israel finding that exposure to sewage is not a risk factor for hepatitis A infection 6.
- In contrast, a study in Greece found that wastewater treatment plant workers had a higher prevalence of anti-HAV antibodies than the control group, suggesting that hepatitis A is an occupational hazard for sewage workers in that region 3.