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Current Impact of Occupational Zoonoses in the UK Conference on “Occupational Zoonoses” Thursday 9th July 2009, Leahurst, University of Liverpool, Neston.

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Presentation on theme: "Current Impact of Occupational Zoonoses in the UK Conference on “Occupational Zoonoses” Thursday 9th July 2009, Leahurst, University of Liverpool, Neston."— Presentation transcript:

1 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

2 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.

3 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 1 st 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

4 Not reported by specialist Seen by a general practitioner (GP) No medical consultation SWITHOR-GPTHOR specialist The work-related ill health Surveillance Pyramid THOR cases

5 General Practitioner Clinical Specialist Occupational Physician Cases reported to THOR specialists Cases reported to THOR-GP

6 OPRA Occupational Physicians Reporting Activity Occupational Physicians MOSS Musculoskeletal Occupational Surveillance Scheme Rheumatologists THOR-EXTRA Special reports outside the Incidence Sampling Frame, & from minor specialties e.g. ENT & Audiological Physicians SIDAW Surveillance of Infectious Diseases At Work Consultants in Communicable Disease Control EPIDERM Occupational Skin Surveillance Dermatologists SWORD Surveillance of Work-related and Occupational Respiratory Disease Chest Physicians SOSMI Surveillance of Occupational Stress and Mental-illness Psychiatrists The Health and Occupation Reporting (THOR) network THOR-GP THOR in General Practice General Practitioners

7 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

8 Denominators for calculating incidence : Numerator sourceDenominator sourceInfo besides numbers, & gender includes Clin. Specialists*(National) LabourAge, industry, occupation Force Survey* Gen. practitionersPractice dataAge, residence postcode+ Occup. Physns.3 yearly surveyIndustry sector + social and occupational parameters can be derived ** with adjustments for specialist participation rate

9 SIDAW – Surveillance of Infectious Diseases at Work SIDAW commenced October 1996 Occupationally acquired infectious disease in the UK Ross et al. (1998) Comm Dis & Pub Health; Vol 1; –116 SIDAW participants (CCDC) but since ↓ –1037 cases reported –78% nil returns

10 SIDAW Report Card

11 Results Larger set, as per abstract, from inclusive. Communicable disease specialists - SIDAW:907(907) Occupational physicians - OPRA:64 (240) Dermatologists – EPIDERM:13 (35) Chest physicians – SWORD:10 (10) Total984 (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

12 Actual cases of Campylobacter by industry, N = 498

13 Actual cases of Campylobacter reported to SIDAW and OPRA,

14 Actual cases of Salmonella by industry, N = 186

15 Actual cases of Salmonella reported to SIDAW and OPRA,

16 Actual cases of Campylobacter and Salmonella reported to SIDAW and OPRA,

17 Actual cases of Ornithosis by industry, N = 50

18 Actual cases (50) of Ornithosis by industry, 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)

19 Actual cases of Leptospirosis by industry, N = 42

20 Actual cases (42) of Leptospirosis by industry, 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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22 Actual cases of Brucellosis by industry, N = 41

23 Actual cases (41) of Brucellosis by industry, 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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25 Actual cases of rarer conditions, Examples of other conditions : Q fever:16 cases {‘Rickettsia’3 cases} Orf:9 cases Lyme disease:4 cases

26

27 Actual cases of rarer conditions, From occupational exposure overseas or from material imported from abroad or from laboratory work: Anthraxhide & skin collector Cholera travel agent Dengue fevermedia editor Schistosomiasisuniversity laboratory technician underwater cameraman

28 More specific information available on request… Reserve slides Database …

29 Discussion … possibilities

30 Incidence and Trends

31 Dermatitis - Most frequently reported industries Estimated cases of contact dermatitis reported by dermatologists in 2006 (‘Epiderm’: University of Manchester)

32 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

33 Cases of occupational asthma attributed to latex (SWORD )

34 Trends in contact dermatitis Estimated annual change ( ): -3.1% (95% CI: -4.0%, -2.2%) Estimated annual change ( ): -7.9% (95% CI: -10.6%, -5.1%) OPRA

35 Trends in total stress and mental ill health Estimated annual change ( ): +9.7% (95% CI: +6.9%, +12.6%) Estimated annual change ( ): -3.3% (95% CI: -6.0%, -0.5%)

36 Industries reported by diagnostic category THOR-GP 2006 to 2007

37 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.

38 Acknowledgements 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 Funded partly by the UK Health & Safety Executive, also Dept of Health, charities etc

39 Reserve Slides

40 SIDAWOPRA*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 % male% male Mean age Age range No. of case s % mal e Mea n age Age ran ge Brucellosis (16) (41) Leptospirosis (61) (1) (91) Q fever (26) (1) (38) Ornithosis (9) (8) (51) Orf (25) (2 6) --9 (53) Ringworm (9) (10) Anthrax (1) Cryptosporidiosis2655% (13) (39) Salmonella (48) (258) Schistosomiasis----2 (13) (13) Lyme disease (1) (4) Campylobacterios is (1) (543) Cholera (1) Dengue fever----1 (1) (1) Giardia (1) (22) Trichinosis (1) Rickettsia----3 (25) (25)

41

42 SIDAW Reporters YEARNO. OF REPORTERS

43 YEARNUMBER OF CASES 1996* *OCTOBER - DECEMBER 1996

44 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

45 Q1. How easy is the report card to use? % of survey responders

46 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!

47 Q2. How useful are the instructions? % of survey responders

48 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

49 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

50 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

51 Q5. How interesting are the reports? % of survey responders

52 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

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

54 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

55 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?


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