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Prof Raymond Agius & Dr Melanie Carder Occupational & Environmental Health Research Group The University of Manc

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

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Prof Raymond Agius & Dr Melanie Carder Occupational & Environmental Health Research Group The University of Manc

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  1. Current Impact of Occupational Zoonoses in the UKConference 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/

  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 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

  4. THOR specialist THOR-GP SWI The work-related ill health Surveillance Pyramid THOR cases

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

  6. The Health and Occupation Reporting (THOR) network SWORD Surveillance of Work-related and Occupational Respiratory Disease Chest Physicians EPIDERM Occupational Skin Surveillance Dermatologists 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

  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 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

  9. 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

  10. SIDAW Report Card

  11. 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.

  12. Actual cases of Campylobacter by industry, 1997-2008 N = 498

  13. Actual cases of Campylobacter reported to SIDAW and OPRA, 1997-2008

  14. Actual cases of Salmonella by industry, 1997-2008 N = 186

  15. Actual cases of Salmonella reported to SIDAW and OPRA, 1997-2008

  16. Actual cases of Campylobacter and Salmonella reported to SIDAW and OPRA, 1997-2008

  17. Actual cases of Ornithosis by industry, 1997-2008 N = 50

  18. 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)

  19. Actual cases of Leptospirosis by industry, 1997-2008 N = 42

  20. 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

  21. Actual cases of Brucellosis by industry, 1997-2008 N = 41

  22. 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)

  23. 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

  24. 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

  25. More specific information available on request… Reserve slides Database … raymond.agius@manchester.ac.uk

  26. Discussion …possibilities

  27. Incidence and Trends

  28. Dermatitis - Most frequently reported industries Estimatedcases of contact dermatitis reported by dermatologists in 2006 (‘Epiderm’: University of Manchester)

  29. 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

  30. Cases of occupational asthma attributed to latex (SWORD 1991-2007)

  31. 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%)

  32. 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%)

  33. Industries reported by diagnostic category THOR-GP 2006 to 2007

  34. 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.

  35. 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

  36. Reserve Slides

  37. SIDAW Reporters 1999-2003

  38. *OCTOBER - DECEMBER 1996

  39. 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

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

  41. 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!

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

  43. 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

  44. 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

  45. 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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