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Liver diseases - 277 entries found

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CIS 12-0181 Cave M., Falkner K.C., Henry L., Costello B., Gregory B., McClain C.J
Serum cytokeratin 18 and cytokine elevations suggest a high prevalence of occupational liver disease in highly exposed elastomer/polymer workers
Cytokeratin 18 (CK18) is a novel serologic biomarker for occupational liver disease. The purpose of this study was to determine the prevalence of CK18 elevation in elastomer/polymer workers exposed to acrylonitrile, 1,3-butadiene, and styrene. A total of 82 chemical workers were evaluated. Cytokeratin 18 was determined by enzyme-linked immunosorbent assay and proinflammatory cytokines were measured by multi-analyte chemiluminescent detection. Thirty-nine percent (32 of 82) had elevated CK18 levels. The pattern of CK18 elevation was consistent with toxicant-associated steatohepatitis (TASH) in the majority of cases (78%). Tumor necrosis factor α, interleukin-6, interleukin-8, monocyte chemotactic protein-1, and plasminogen activator inhibitor-1 were increased in these workers compared with those with normal CK18 levels. These results suggest a high prevalence of occupational liver disease and TASH in elastomer/polymer workers with elevated proinflammatory cytokines.
Journal of Occupational and Environmental Medicine, Oct. 2011, Vol.53, No.10, p.1128-1133. 42 ref.
Serum_cytokeratin_18_[BUY_THIS_ARTICLE] [in English]

CIS 11-0371 Fedeli U., Mastrangelo G.
Vinyl chloride industry in the courtroom and corporate influences on the scientific literature
Pressure from the vinyl chloride (VC) industry on researchers involved in industry-sponsored studies and on regulatory agencies has been documented since the 1970s. This commentary describes the influence of a lawsuit pursued by workers of an Italian VC plant on the recent scientific debate on VC exposure and risk of hepatocellular carcinoma (HCC). Original studies carried out by consultants of the public prosecutors and by independent researchers supported the above association. VC-industry consultants published two reviews during the lawsuit, claiming that liver angiosarcoma was the only VC-related cancer. The judges concluded that the evidence of the association between HCC and VC was still not convincing. After the trial, the risk of HCC was confirmed by a re-assessment of VC carcinogenicity from the International Agency for Research on Cancer, but other subsequent industry-funded reviews criticized the new evidence. Industry-funded authors cited each other, and rarely disclosed conflicts of interest. Based on a network of collaborating researchers, industrial interests can shape the literature enhancing the background noise surrounding the scientific evidence.
American Journal of Industrial Medicine, 2011, Vol.54, p.470-473. 27 ref.

CIS 11-0057 Oyunbileg S., Sumberzul N., Oyuntogos L., Javzmaa J., Wang J.D.
Analysis of incidence rates of occupational diseases in Mongolia, 1986-2006
The purpose of this study was to determine incidence rates and time trends of major occupational diseases in Mongolia. Information about all 4598 patients from 1986 to 2006 who were diagnosed and registered with occupational diseases by the National Center of Workplace Conditions and Occupational Diseases was retrieved. There was an increasing trend in the incidence rates of reported occupational respiratory diseases, musculoskeletal disorders, cardiovascular diseases, skin diseases, toxic hepatitis and noise-induced hearing loss. Such a trend may result from both rapid industrialization in Mongolia and increased recognition of occupational disease. Implications of these findings are discussed.
International Journal of Occupational and Environmental Health, 1st quarter 2011, Vol. 17, No.1, p.31-37. 26 ref.


CIS 10-0548 He J., Wang P., Zhu J.Q., Wu G., Ji J.M., Xue Y.
Role of urinary biomarkers of N,N-dimethylformamide in the early detection of hepatic injury among occupational exposed workers
The objective of this study was to identify sensitive and convenient biomarkers for the early detection of hepatic injury in N,N-dimethylformamide (DMF) exposed workers. Seventy-nine workers at a synthetic leather factory were investigated by means of a questionnaire survey. Air, urine and blood samples were collected at the specific time point. Airborne DMF and the urine metabolites of DMF were measured by gas chromatography (GC), high-performance liquid chromatography (HPLC), and gas chromatography-mass spectrometry (GC-MS). Traditional liver function tests and hepatic fibrosis parameters were performed by auto-chemistry analyzer and ELISA methods. It was found that workers exposed to DMF with higher N-acetyl-S-(N-methylcarbamoyl)-cysteine levels were more likely to develop liver diseases. In addition, serum bile acid and hyaluronidase have the potential to act as early indicators of toxic hepatic fibrosis activities for occupational health surveillance.
International Archives of Occupational and Environmental Health, Apr. 2010, Vol.83, No.4, p.399-406. 26 ref.


CIS 09-1159 Connor B.A., Patron D.J.
Use of an accelerated immunization schedule for combined hepatitis A and B protection in the corporate traveler
Increased international business travel to moderate or high endemic areas of hepatitis A and B may leave many business travellers at risk for infection if not vaccinated. Often, the decision to travel to these regions is taken less than two months before departure. Because many areas endemic for hepatitis A are also endemic for hepatitis B, accelerated administration of the combined vaccine can offer protection for international business travellers destined for these countries, and should be part of corporate travel immunization programmes.
Journal of Occupational and Environmental Medicine, Aug 2008, Vol.50, No.8, p.945-950. Illus. 44 ref.

CIS 09-1158 Bunn W.B.
Risk and burden associated with the acquisition of viral hepatitis A and B in the corporate traveler
As the number of international business travellers continues to grow, so does the list of destinations, many of which are endemic for hepatitis A and B. For employers, infected employees can result in increased health care costs and reduced productivity. Safe and efficacious vaccines are available. Well-designed immunization plans organized within the enterprise health system can prevent hepatitis A and B when employees are abroad on business. This article discusses the risks, costs and prevention of hepatitis A and B for international business travellers.
Journal of Occupational and Environmental Medicine, Aug 2008, Vol.50, No.8, p.935-944. Illus. 74 ref.

CIS 09-713 Luckhaupt S.E., Calvert G.M.
Deaths due to bloodborne infections and their sequelae among health care workers
Using data from the National Occupational Mortality Surveillance (NOMS) system in the United States, a matched case-control design was employed to examine the relationship between health-care employment and death from HIV, hepatitis B (HBV), hepatitis C (HCV), liver cancer and cirrhosis from 1984 to 2004. Employment in the health-care industry was associated with increased risk of death from HIV (odds ratio OR 2.27), HBV (OR 1.98) and cirrhosis (OR 1.09) among males, and death from HCV among both males (OR 1.46) and females (OR 1.22). Nursing was the occupation with the highest risk among males for HIV and HBV, but female nurses were at decreased risk of dying from HIV (OR 0.69).
American Journal of Industrial Medicine, Nov. 2008, Vol.51, No.11, p.812-824. 41 ref.

CIS 08-1459 FitzSimons D., François G., De Carli G., Shouval D., Prüss-Üstün A., Puro V., Williams I., Lavanchy D., De Schryver A,, Kopka A., Ncube F., Ippolito G., Van Damme P.
Hepatitis B virus, hepatitis C virus and other blood-borne pathogens in healthcare workers: Guidelines for prevention and management in industrialized countries
The Viral Hepatitis Prevention Board (VHPB) convened a meeting of international experts from the public and private sectors in order to review and evaluate the epidemiology of blood-borne infections in healthcare workers, to evaluate the transmission of hepatitis B and C viruses as an occupational risk, to discuss primary and secondary prevention measures and to review recommendations for infected healthcare workers. This meeting outlined a number of recommendations for the prevention and control of viral hepatitis, including the training of personnel, application of standard precautions and hepatitis B vaccination. Other topics addressed included ethical and legal issues, the assessment of risk and costs, and the role of the VHPB. Participants also identified a number of terms that need harmonisation or standardisation in order to facilitate communication between experts.
Occupational and Environmental Medicine, July 2008, Vol.65, No.7, p.446-451. 29 ref.

CIS 08-1210 Rybacki M., Michowicz A.
Exposure to viruses at the workplace, with the example of viral hepatitis
Zagrożenia wirusowe w miejscu pracy na przykładzie wirusowego zapalenia wątroby [in Polish]
The characteristics of hepatitis B and C viruses are presented, together with their infection mechanisms. The occupational groups most exposed to infection hazards from these viruses are mentioned, together with the methods of prevention and treatment.
Praca i Zdrowie, 2008, No.1, p.10-16. Illus.


CIS 08-534 Let art be your legacy
NIOSH researchers worked with professional tattoo artists to figure out how they can be exposed to blood and blood-borne pathogens. Based on visits to piercing and tattooing shops and interviews with practicing artists, various communication materials were developed to better inform artists of these diseases, explain how artists can be exposed and reinforce safe practices to reduce the chances of exposure. This information card explains how contamination by hepatitis B occurs; it suggests that body artists be vaccinated against hepatitis B and that they attend yearly blood-borne pathogen training. See also CIS 08-532/533.
Publications Dissemination, National Institute for Occupational Safety and Health (NIOSH), 4676 Columbia Parkway, Cincinnati, OH 45226-2001, USA, Nov. 2007. 2p. Illus. [in English]


CIS 08-1457 Bloodborne facts - Protect yourself when handling sharps
A needlestick or a cut from a contaminated scalpel can lead to infection from hepatitis B virus or human immunodeficiency virus which causes AIDS. Although few cases of AIDS have been documented from occupational exposure, approximately 8700 health care workers each year contract hepatitis B. About 200 will die as a result. Aimed at health care personnel, this information sheet explains how to avoid the risk of cut and stick injuries (disposing of sharps in puncture-resistant containers, handling of sharps containers).
U.S. Department of Labor, Occupational Safety and Health Administration, 200 Constitution Avenue, Washington, D.C. 20210, USA, [2006]. 1p. [in English]

CIS 08-70 Lee C.Y., Jung S.L., Kim S.A., Park K.S., Ha B.G.
Incidence of dimethylacetamide induced hepatic injury among new employees in a cohort of elastane fibre workers
The objective of this cohort was to investigate the incidence of N,N-dimethylacetamide (DMA)-induced hepatic injury among new elastane fibre workers and to explore risk factors relating to this injury. A total of 440 new workers employed from 1 January 2002 to 31 July 2004 were included as study subjects. DMA exposure estimates were based on urinary N-methylacetamide (NMA) concentrations. There were 28 cases of DMA-induced hepatic injury. The overall incidence of DMA induced hepatic injury among new elastane fibre workers was 0.089/person-year. Incidence rates were seven to ten times higher in high exposure groups than in low exposure groups. Results suggest the existence of a dose-dependent DMA-induced hepatic injury. The inverse relation between the incidence of DMA-induced hepatic injury and duration of employment may reflect a type of healthy worker effect or an acquired tolerance to DMA-induced hepatic injury.
Occupational and Environmental Medicine, Oct. 2006, Vol.63, No.10, p.688-693. Illus. 16 ref.

CIS 06-1400 Maroni M., Fanetti A.C.
Liver function assessment in workers exposed to vinyl chloride
A medical examination including liver function tests (LFTs) and liver ultrasonography was carried out in a group of 757 workers with long-standing service in the production of vinyl chloride monomer (VCM) and polyvinyl chloride (PVC) in four production plants in Italy. Cumulative and maximum VCM exposures were calculated. Possible histories of viral hepatitis and alcohol intake habits of subjects were carefully investigated. Regression analysis explored the association between abnormal LFTs and a group of possible determinants. Results indicate that liver function assessment only (including LFTs) is not able to detect VCM-induced liver damage, but reveals alterations due to non-occupational factors, such as dietary and/or metabolic dysfunctions. The LFTs are however of importance in detecting conditions that indicate the need to avoid VCM exposure.
International Archives of Occupational and Environmental Health, Jan. 2006, Vol.79, No.1, p.57-65. 17 ref. [in English]


CIS 07-721 Dounias G., Kypraiou E., Rachiotis G., Tsovili E., Kostopoulos S.
Prevalence of hepatitis B virus markers in municipal solid waste workers in Keratsini (Greece)
The objective of this cross-sectional study was to evaluate the prevalence of hepatitis B virus (HBV) markers among municipal solid waste workers. Participants consisted of 166 workers in Keratsini, Greece. Evaluations included the prevalence of biological markers of HBV infection (HbsAg, anti-Hbc, anti-Hbs) and their association with exposure to waste and various socio-demographic factors. There was a significant difference in the prevalence of anti-Hbc positivity between exposed and non-exposed employees to waste. Older employees had a significantly higher prevalence of anti-Hbc positivity. Logistic regression analysis showed that the exposure to waste and age were independently associated with the anti-Hbc positivity. It is concluded that occupational exposure to waste is possibly associated with the acquisition of HBV infection. Immunization of these workers should be considered to reduce the risk of HBV infection.
Occupational Medicine, Jan. 2005, Vol.55, No.1, p.60-63. 22 ref.

CIS 06-713 Lot F., Miguéres B., Abiteboul D.
Occupational seroconversions through HIV and HCV among health care professionals in France, as of 31 December 2004
Séroconversions professionnelles par le VIH et le VHC chez le personnel de santé en France. Situation au 31 décembre 2004 [in French]
This article provides the results of a survey of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) contamination in occupational settings carried out by the French Health Monitoring Institute (Institut de veille sanitaire) and the results of a study by GERES (study group on health care workers' exposure to infectious agents) on occupational HCV contamination risk factors. No new cases of occupational HIV contamination were reported among health care personnel between 1997 and 2004 (a total of 13 HIV seroconversions were reported up to 1997). Between 1991 and 2004, 54 cases of hepatitis C conversions were reported among health care personnel. Results of the studies suggest that close to half of the HIV or HCV seroconversions occurring in occupational settings could have been avoided had standard precautions been observed.
Documents pour le médecin du travail, Sep. 2005, No.103, p.335-346. Illus. 7 ref.$File/TF143.pdf [in French]


CIS 06-450 Jarke J.
Health service personnel with chronic HBV, HCV and HIV infections - Guidelines for work versus exclusion from the profession
Chronisch HBV-, HCV-, HIV-infiziertes Personal im Gesundheitsdienst - Regelungen zur Berufsausübung versus Berufsverbote [in German]
Patients at health care centres should be effectively protected against viral infections (hepatitis, HIV) transmitted by infected health care personnel. While the occupational physician is responsible for health and safety at work rather than for protecting the patient, they must act with regard to the well-being of the patient. In Germany, no guidelines have been issued for the protection of patients which could serve as a guide to occupational physicians, infected health care workers and employers. Nevertheless, recommendations published by scientific institutions provide sufficient guidance for rational measures to be drawn up to allow infected workers to continue in their occupation and to enable employers to carry out their duties in accordance with labour laws. Unfortunately, those in charge often make decisions on an irrational or emotional basis, leading to discrimination and injustice for health care workers. It is argued that a legal directive is urgently needed.
Arbeitsmedizin - Sozialmedizin - Umweltmedizin, 2004, No.8, p. 428-434. 12 ref.

CIS 05-64 Hsiao T.J., Wang J.D., Yang P.M., Yang P.C., Cheng T.J.
Liver fibrosis in asymptomatic polyvinyl chloride workers
This study was designed to determine whether vinyl chloride monomer (VCM) exposure is associated with liver fibrosis. 347 workers with occupational exposure to VCM were systemically examined using liver ultrasonography and routine liver function tests. Vinyl chloride monomer cumulative dose (ppm-month) was estimated by summing the products of air VCM concentration levels and months of employment. Liver fibrosis was defined in subjects with precirrhosis and cirrhosis of the liver diagnosed using ultrasonography. Significantly increased risks of developing liver fibrosis were found in workers who had a history of high exposure jobs (odds ratio 5.5) when compared with workers without such a history. It is concluded that there is an increased risk of developing liver fibrosis in PVC workers with high exposures to VCM.
Journal of Occupational and Environmental Medicine, Sep. 2004, Vol.46, No.9, p.962-966. 20 ref.

CIS 05-227 Insausti Macarrón D., Caso Pita C., Rodríguez de la Pinta M.D., Gómez Parra I.R., Lucas J.C., Cruzet Fernández F.R.
Hepatitis C virus infection among health care personnel following accidents involving biological material
Infección por virus de hepatitis C en profesionales sanitarios tras accidente con material biológico [in Spanish]
The objective of this study was to analyse cases of hepatitis C virus (HCV) infections that occurred following accidents involving biological material reported between 1991 and 2002 among the health care personnel of a Spanish hospital. Data were collected by means of a questionnaire. 554 needlestick injuries with potential HCV contamination were reported during the study period. Five workers were infected, corresponding to an overall risk of 0.9%. Unexpected situations being difficult to avoid, it is advised that health care personnel be provided with safe equipment and that accident cases be followed so as to allow the early detection and efficient treatment of cases.
Medicina y seguridad del trabajo, June 2004, Vol.L, No.195, p.31-38. 25 ref.

CIS 05-226 Caso Pita C., Insausti Macarrón D., Rodríguez de la Pinta M.L., Lucas J.C., Alonso Cobo M.T., Cruzet Fernández F.
Viral hepatitis among health care workers: Time trends
Hepatitis víricas en personal sanitario: Evolución temporal [in Spanish]
The objective of this study was to examine the trends in the incidence of viral hepatitis cases among workers of a Spanish hospital between 1979 and 2003. 253 cases of occupational disease caused by a biological agent were recorded during this period, including 89 cases of hepatitis (35.2%). The distribution of hepatitis cases by category of staff shows that qualified nurses and physicians are the most affected. The incidences of all types of hepatitis and hepatitis B show a decreasing trend during the study period, with very low rates since 1985 when hepatitis B vaccination was first introduced. A significant decrease was also observed for hepatitis C or non-A, non-B (NANB) hepatitis.
Medicina y seguridad del trabajo, Mar. 2004, Vol.L, No.194, p.11-21. Illus. 47 ref.


CIS 05-468 Percaz Arrayago M.A., Ruiz Cirauqui A.M., Esquiroz Ayesa I.
Evaluation of hepatitis B serology among workers exposed to biological hazards
Valoración de serologías de hepatitis B en trabajadores con riesgo biológico [in Spanish]
The vaccination protocol in effect in Spain for workers exposed to hepatitis B virus calls for revaccination every five years. Since some recent studies suggest that the immunological memory may persist for at least twelve years, the serology of a group of 163 workers vaccinated since 1996-1997 was examined to establish their immunological state and to determine whether it would be possible to increase the revaccination intervals. Results indicated that more than 85% of the vaccinated workers still had protective antibody levels above 20UI/ml after five years and that it would be possible to extend the period between revaccination.
Medicina y seguridad del trabajo, Aug. 2003, Vol.XLX, No.192, p.1-7. Illus. 8 ref.

CIS 05-224 de Souza Ciorlia L.A., Zanetta D.M.T.
Hepatitis C in healthcare workers: Risks of exposure and infection
Hepatite C em profissionais da saúde: risco de exposição e infecção [in Portuguese]
This review article is devoted to the topic of hepatitis C and the risks of exposure and infection among health care personnel. Contents: general aspects concerning hepatitis C; epidemiology; diagnosis; preventive measures in the absence of vaccines or HCV-specific IgG immunoglobulins; notification of accidents; occupational accidents involving biological material; consequences of cut or needlestick accidents and microcutaneous exposures.
Revista brasileira de saúde ocupacional, 2003, Vol.28, No.107/108, p.91-100. 66 ref.

CIS 04-621 Hsieh H.I., Wang J.D., Chen P.C., Cheng T.J.
Synergistic effect of hepatitis virus infection and occupational exposures to vinyl chloride monomer and ethylene dichloride on serum aminotransferase activity
This study examines the synergistic effect of occupational chemical exposure and hepatitis virus infection on serum aminotransferase activity. A total of 568 male workers who were employed in five polyvinyl chloride and four vinyl chloride monomer (VCM) manufacturing factories were studied. Workers were classified into high, moderate and low exposure groups according to their level of exposure to chemical mixtures. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and anti-hepatitis C antibody were assayed. Hepatitis virus infection and increased body mass index were associated with abnormal serum aminotransferase activity. In workers with hepatitis virus infection, those with high exposure had a higher prevalence of abnormal AST and ALT compared to low exposure; among those without hepatitis virus infection, no significant differences of prevalence of abnormal AST and ALT were found between different chemical exposure groups. There was a significant trend of increasing risks of increased AST and ALT in moderate and high exposure groups with hepatitis virus infection. Such a synergistic effect was more prominent among HBeAg-positive workers. It is concluded that mixed exposures to 1,2-ethylene dichloride and VCM have a positive synergistic effect with hepatitis virus infection on liver damage.
Occupational and Environmental Medicine, Oct. 2003, Vol.60, No.10, p.774-778. Illus. 25 ref.

CIS 04-469 Vaidya S.R., Tilekar B.N., Walimbe A.M., Arankalle V.A.
Increased risk of hepatitis E in sewage workers from India
Considering faeco-oral transmission of hepatitis E virus (HEV), the risk of infection was assessed among sewage workers. The study involved 147 sewage workers and age-matched controls without exposure to sewage. IgG-anti-HEV positivity in enzyme-linked immunosorbent assay was significantly higher among sewage workers (56.5%) than among controls (19%). Furthermore, a significant rise in anti-HEV positivity was observed among sewage workers working for over five years. Multivariate regression analysis identified contact with sewage as the independent variable associated with anti-HEV positivity. Strict adherence to good working practices must take the top priority for the protection of these workers from sewage pathogens.
Journal of Occupational and Environmental Medicine, Nov. 2003, Vol.45, No.11, p.1167-1170. 20 ref.

CIS 03-753 Maroni M., Mocci F., Visentin S., Preti G., Fanetti A.C.
Periportal fibrosis and other liver ultrasonography findings in vinyl chloride workers
To investigate the presence of liver lesions and their relationship with vinyl chloride exposure, a liver ultrasonography examination was conducted in 757 workers involved in the production of vinyl chloride and PVC. The study involved an assessment of past and present vinyl chloride exposure of each worker, the collection of personal, lifestyle and health history data, routine liver function tests and liver ultrasonography. No cases of liver malignancies were detected. Angiomas and liver cysts were found with occurrence frequencies comparable to that of the general population. However, cases of hepatomegalia (34.7%), steatosis (31.8%) and periportal fibrosis (16.0%) were observed. Periportal fibrosis was shown to be associated with vinyl chloride exposure, but only when maximum exposure in the subject's history had been at least 200ppm as a yearly average; no effects were observed at 50ppm or below.
Occupational and Environmental Medicine, Jan. 2003, Vol.60, No.1, p.60-65. 42 ref.

CIS 03-441 National Code of Practice for the control of work-related exposure to hepatitis and HIV (blood-borne) viruses
Contents of this Code of Practice (1st edition, NOHSC:2010 (1993), see CIS 94-2115): introduction (hepatitis viruses and HIV); hazard identification; risk assessment; risk control (sharps, safe working procedures, standard precautions, risk control strategies for certain occupations, education and training, exposure incidents, vaccination, monitoring and evaluation). In the appendices: discrimination and privacy; principles of the storage, transport and disposal of clinical waste; what to do in the event of exposure of if you find a syringe; principles of standard precautions; workers with hepatitis B, C and HIV; glossary; sources of information.
AusInfo Government Info Shops,, Australia, 2nd ed., Dec. 2003. xiii, 53p. 19 ref. [in English]


CIS 08-1469 OSHA Fact Sheet - Bloodborne pathogens
Bloodborne pathogens are infectious materials in blood that can cause disease in humans, including hepatitis B and C and human immunodeficiency virus (HIV). Workers exposed to these pathogens risk serious illness or death. This information sheet explains the protection against bloodborne pathogens provided by the OSHA standard specifying the legal obligations of employers to prevent exposure among workers at risk. These obligations include hazard evaluation, exposure evaluation, implementing engineering controls, providing personal protective equipment, information and training of personnel, medical supervision and maintaining records.
U.S. Department of Labor, Occupational Safety and Health Administration, 200 Constitution Avenue, Washington, D.C. 20210, USA, 2002. 2p. 4 ref. [in English]

CIS 02-1943 Lot F., Migueres B., Yazdanpanah Y., Tarantola A., Abiteboul M., Domart M., Bouvet E.
Occupational HIV and HCV seroconversions among health care workers in France - Situation as of 30 June 2001
Séroconversions professionnelles par le VIH et le VHC chez le personnel de la santé en France - Le point au 30 juin 2001 [in French]
This article presents the results of an ongoing study on contaminations by the human immunodeficiency syndrome (HIV) and the hepatitis C virus (HCV) among health care workers in France as of 30 June 2001. No new cases of HIV seroconversion were reported since 1997, the total number of cases since the start of the study remaining at 13. With respect to HCV, 43 seroconversions were reported, of which 32 were the result of contacts with patients known to be infected at the time of accidental exposure. The breakdown in the number of cases is given by occupation, by health care department and by geographical region, together with data concerning the circumstances of the accidental infection, clinical surveillance and biological monitoring, medical follow-up evolution. The study protocol and the questionnaires are included as appendices.
Documents pour le médecin du travail, 2nd Quarter 2002, No.90, p.157-166. Illus. 5 ref.

CIS 02-1942 Averhoff F.M., Moyer L.A., Woodruff B.A., Deladisma A.M., Nunnery J., Alter M.J., Margolis H.S.
Occupational exposures and risk of hepatitis B virus infection among public safety workers
A questionnaire and seroprevalence survey was conducted to determine the frequency and type of occupational exposures (OEs) and the risk of hepatitis B virus (HBV) infection experienced by public safety workers (PSWs). Of the 2910 PSWs who completed the survey, 6.8% reported at least one OE in the previous 6 months, including needlestick (1.0%), being cut with a contaminated object (2.8%), mucous membrane exposure to blood (0.9%), and being bitten by a human (3.5%). The rate of OE varied by occupation with 2.7% of firefighters, 3.2% of sheriff officers, 6.6% of corrections officers, and 7.4% of police officers reporting ≥1 OE. The HBV infection prevalence was 8.6%, and after adjustment for age and race, it was comparable to the overall US prevalence and did not vary by occupation. Administration of hepatitis B vaccine to PSWs early in their careers will prevent HBV infection associated with occupational and non-OEs.
Journal of Occupational and Environmental Medicine, June 2002, Vol.44, No.6, p.591-596. 23 ref.

CIS 02-1941 Rischitelli G., McCauley L., Lambert W.E., Lasarev M., Mahoney E.
Hepatitis C in urban and rural public safety workers
A sample of 719 Oregon public safety personnel (police officers, firefighters and corrections officers) was tested for hepatitis C virus (HCV) antibody after completing a risk questionnaire. Seven of nine positive enzyme immunoassay tests (78%) were confirmed with recombinant immunoblot assay, yielding confirmed prevalence estimates of 1.2% among the 406 firefighters and emergency medical technicians, and 0.7% in 274 corrections personnel. No cases were observed in the 29 participating police officers. Self-reports of the number of workplace exposures to blood were not associated with HCV positivity, and the number of years of public safety employment seemed to be slightly less for HCV-positive subjects. Two of the seven (28.6%) HCV-positive individuals reported having at least one non-occupational risk factor (odds ratio, 4.3), suggesting the greater relative importance of non-occupational exposures.
Journal of Occupational and Environmental Medicine, June 2002, Vol.44, No.6, p.568-573. 21 ref.

CIS 02-943 Chodick G., Lerman Y., Wood F., Aloni H., Peled T., Ashkenazi S.
Cost-utility analysis of hepatitis A prevention among health-care workers in Israel
This study was conducted to evaluate the cost-effectiveness of different strategies of preventing hepatitis A (HA) among physicians, nurses and paramedical staff. The strategies compared were passive immunization during a hepatitis A outbreak, systematic mass vaccination of all workers, and screening for antibodies to HA virus followed by vaccination of non-immune employees. An epidemiological model was used to predict the prevented number of HA cases. The lowest cost per prevented HA case (USD 6240) was achieved by screening prior to vaccination among 18- to 39-year-old physicians and paramedical workers, and the highest (USD 61,858) by mass vaccination of nurses over 39 years of age. Taking USD 60,000 as a limit cost per saved quality-adjusted life year, selective vaccination for physicians and for paramedical workers is proposed. Mass vaccination of all health care workers, aside from nurses over 40 years of age, becomes cost-effective once the active HA vaccine price is reduced to USD 23.
Journal of Occupational and Environmental Medicine, Feb. 2002, Vol.44, No.2, p.109-115. 30 ref.


CIS 06-1286 HIV/AIDS, and hepatitis B and C - Preventing exposure at work
This booklet is aimed at employers and workers who are not expected to come into contact with blood and body fluids at their workplace but who could nonetheless have contact with these fluids in rare, isolated incidents that cannot be foreseen. This booklet describes the health effects caused by HIV/AIDS and hepatitis B and C viruses, together with their mode of infection, and explains how to prevent or reduce exposure to bloodborne pathogens. Includes examples of safe work practices.
WorkSafe, Workers' Compensation Board of British Columbia, Canada, 2001. iv, 34p. Illus. [in English]

CIS 03-440 Kralj N.
Technical and immunological methods of preventing hepatitis B viral infections
Sicherheitstechnische und immunologische Prävention berufsbedingter Hepatitis-B-Virus-Infektionen [in German]
In this thesis, a critical review of occupational hazards and epidemiology relating to hepatitis B infection was carried out, together with incidents that give rise to infections in occupational settings. The frequency with which the piercing of gloves occurred in hospital environments was also evaluated for the purpose of defining the conditions giving rise to such incidents. Results were compared to those of published studies. Despite the adoption of purely technical prevention measures such as wearing double-layer protective gloves or incision-resistant gloves, and protecting the skin to avoid skin diseases, protective vaccination remains an indispensable prevention measure.
FFAS, Postfach 5171, Freiburg, Germany, 2001. 124p. Illus. 152 ref.

CIS 02-1945 Brouwers J.F.
Proposed procedure to be adopted in non-hospital environments following injuries by potentially-contaminated blood-stained objects
Proposition de procédure à suivre, en dehors d'un milieu hospitalier, lors d'un accident du travail avec blessure causée par un objet souillé par du sang susceptible d'être contaminé [in French]
Outside of the hospital sector, many enterprises and public services are also confronted with the risk of occupational accident resulting in wounds acquired with objects possibly soiled by infected blood. Although the working procedure for such accidents is well known and regularly applied in hospitals, this is generally not the case in other sectors. This article proposes an approach derived from hospital recommendations. Appendices include information documents aimed at the enterprise-level occupational safety and health committee, at the medical practitioner treating the patient on the day of the accident and at the medical practitioner following this patient, as well as a list of hospitals in Belgium that are able to apply urgently a preventive AIDS tritherapy to injured workers who are not part of their personnel.
Médecine du travail & Ergonomie / Arbeidsgezondheitszorg & Ergonomie, 4th Quarter 2001, Vol. XXXVIII, p.167-178. 12 ref.

CIS 02-1823 Nomiyama T., Uehara M., Miyauchi H., Imamiya S., Tanaka S., Seki Y.
Causal relationship between a case of severe hepatic dysfunction and low exposure concentrations of N,N-dimethylformamide in the synthetics industry
A 19-year-old man suffered hepatic dysfunction after five months of exposure to dimethylformamide (DMF) at his job in the synthetic resins industry. Medical examinations and laboratory data revealed elevated levels of AST (578IU/L), ALT (1193IU/L), and γ-GTP (107IU/L), no viral infection with HAV, HBV, or HCV, and no history or evidence of hepatic injury, although he did have a slight abdominal abnormality and swelling which was detected by palpation. His urinary methylformamide level, as a biological exposure index of DMF, was 42.8mg/L, indicating 10-30ppm of DMF exposure. After two months, the worker was reinstated in a workplace where environmental DMF concentrations were less than those in the former workplace. On the 18th day after his reinstatement, there was again evidence of hepatic dysfunction. After the second period of medication and one month of rest from work, he had fully recovered and was reinstated, but to a workshop without DMF exposure.
Industrial Health, Jan. 2001, Vol.39, No.1, p.33-36. 12 ref.

CIS 02-815 Luo J.C., Kuo H.W., Cheng T.J., Chang M.J.W.
Abnormal liver function associated with occupational exposure to dimethylformamide and hepatitis B virus
N,N-Dimethylformamide (DMF) has excellent solvent properties and is used intensively in the production of synthetic leather and resins. It has caused hepatoxicity in human and animal studies. Hepatitis B virus (HBV) and hepatitis C virus infections are reported to be the major causes of chronic liver diseases (including liver cirrhosis and liver cancer) in Taiwan. This study examined the dose-response relationship of the observed abnormal liver function among the DMF-exposed workers and the interactions among DMF, other chemical exposures, HBV infection, and potential confounders on liver abnormalities. It was observed that a significant dose-response relationship existed between liver function abnormalities and DMF exposure among workers in Taiwan, and that HBV carrier status or increased BMI had synergistic effects with DMF exposure in causing liver abnormalities (abnormal liver function tests and clinical chronic liver diseases).
Journal of Occupational and Environmental Medicine, May 2001, Vol.43, No.5, p.474-482. 29 ref.

CIS 01-1836
Health and Safety Executive
Blood-borne viruses in the workplace - Guidance for employers and employees
Blood-borne viruses (BBVs) include hepatitis B, hepatitis C and hepatitis D, which affect the liver, and human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS). This guidance note is aimed at all persons involved in work where exposure to blood or other body fluids may occur. Contents include: description of BBVs; types of work where exposure to BBVs may occur; legal responsibilities of employers and employees; actions to be taken after possible infection with a BBV; special considerations for first-aid attendants.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 2WA, United Kingdom, July 2001. 8p. 11 ref.

CIS 01-1309
Department of Labor - Occupational Safety and Health Administration (OSHA)
Occupational Exposure to Bloodborne Pathogens; Needlestick and Other Sharps Injuries: Final Rule [USA]
This is a revision of the Bloodborne Pathogens standard (for 1991 original, see CIS 93-371) in conformity with the requirements of the Needlestick Safety and Prevention Act. New examples have been included in the definition of engineering controls, along with two new definitions (needleless systems and sharps with engineered sharps injury protections). In addition, employers who are required to establish an Exposure Control Plan must document how the Plan is implemented. Certain employers are also required to establish and maintain a log of percutaneous injuries from contaminated sharps.
Federal Register, 18 Jan. 2001, Vol.66, No.12, p.5318-5325. [in English] [in English]


CIS 06-218 Code of practice on the management of HIV/AIDS and hepatitis at workplaces
This revised code of practice provides practical guidance for the management of HIV/AIDS, hepatitis B and hepatitis C in the workplace. It describes the nature and means of transmission of the diseases and presents guidance on risk management: sources of infection; hazardous activities and occupations; control measures; personal hygiene; sharp instruments; cleaning and disinfection; spills; waste management; vaccination; personal protective equipment; information and training; monitoring and evaluation. Replaces CIS 99-1353.
WorkSafe Western Australia, 1260 Hay Street, West Perth, WA 6005, Australia, rev. ed. Sep. 2000. 46p. Illus. 10 ref. [in English]

CIS 02-430 Benbirk E., Tiberguent A., Dômont A.
Comparative study of the HAV seroprevalence among water purification station workers, sewage workers and administration workers
Enquête comparative de séro-prévalence de l'hépatite A entre les professionnels d'une station d'épuration, de l'assainissement et administratifs [in French]
An HAV seroprevalence study was conducted among 390 water-purification station workers, 201 sewage workers, and 643 non-occupationally exposed administrative workers. All workers were male, with similar age and socio-educational characteristics. After correcting for age, the rate of hepatitis A seroconversion for all populations was about 69%. Occupational exposure to sludge and sewage were the most important transmission risk factors for hepatitis A. Water-purification station workers exposed to soiled earth polluted with sludge were subject to major risk of hepatitis A transmission with an odds ratio of 1.85. For sewage workers, contact with floating corpses appeared to be an increasing occupational risk for hepatitis A, with an odds ratio of 1.59. A multivariate analysis was also performed to determine the characteristics of the exposed groups and evidence certain patterns of hepatitis A exposure. Vaccination against hepatitis A appears to be the best way to fight against this biological risk, although hygiene and safety measures must not be overlooked.
Archives des maladies professionnelles et de médecine du travail, Feb. 2000, Vol.61, No.1, p.7-28. Illus. 51 ref.

CIS 01-834 Borchini R., Riboldi L., Chiappino G.
Neoformed multiple hepatic angiomas following exposure to vinyl chloride monomer: A case study
Angiomi epatici multipli neoformati dopo esposizione a cloruro de vinile monomero: descrizione di un caso [in Italian]
This paper describes the case of a 60 year-old man with previous protracted exposure to vinyl chloride monomer (VCM). After a latency of 20 years, the man developed two hepatic hemangiomas, one characterized by rapid growth (4cm of diameter in 1 year) and surgically removed. On the basis of the anamnestic data (15 years in a PVC polymerization factory in the reactor vessels department) and considering the degree and duration of exposure to VCM, an occupational origin of the hepatic hemangiomas is probable. The ability of VCM to induce sclerosis, necrosis and endothelial hyperplasy in the liver tissue may represent the primum movens of hemangiomas.
Medicina del lavoro, May-June 2000, Vol.91, No.3, p.251-254. 8 ref.

CIS 00-1459 Weldon M., VanEgdom M.J., Hendricks K.A., Regner G., Bell B.P., Sehulster L.M.
Prevalence of antibody to hepatitis A virus in drinking water workers and wastewater workers in Texas from 1996 to 1997
To determine if wastewater workers had a higher prevalence of antibody to hepatitis A virus (anti-HAV) than drinking-water workers, 359 wastewater and 89 drinking-water workers were evaluated for risk factors by questionnaire and tested for anti-HAV. Anti-HAV positivity was 28.4% for wastewater and 23.6% for drinking-water workers. After adjustment for age, educational attainment and Hispanic ethnicity, the odds ratio for the association between anti-HAV positivity and wastewater industry employment was 2.0. Among wastewater workers, never eating in a lunchroom, ≥8 years in the waste water industry, never wearing face protection, and skin contact with sewage at least once per day were all significantly associated with anti-HAV positivity. Wastewater workers had a higher prevalence of anti-HAV than drinking-water workers, which suggested that wastewater workers may have been at increased risk of occupationally acquired hepatitis A.
Journal of Occupational and Environmental Medicine, Aug. 2000, Vol.42, No.8, p.821-826. 18 ref.


CIS 01-581 Murlidhar V.
Bloodborne occupational diseases of health care workers (HCW)
This manual on the risks of exposure to bloodborne diseases of health care personnel focuses on hepatitis B and C, HIV and AIDS transmission risks. Transmission mechanisms, risk factors for seroconversion following percutaneous injury, post-exposure prophylaxis, hygiene practices, decontamination and sterilization, personal protective equipment and vaccination are presented along with safety recommendations for dealing with sharp instruments and body fluids.
Society for Participatory Research in Asia (PRIA), 42 Tughlakabad Institutional Area, New Delhi 110062, India, 1999. i, 27p. 52 ref.

CIS 00-253 Kao J.H., Heptonstall J., Chen D.S.
Molecular methods of measurement of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection: Implications for occupational health practice
Over the past decade, several molecular techniques for the detection of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) have been developed that have implications for occupational health practice. This review describes the techniques used for qualitative and quantitative detection of the viral genome, and briefly explains nucleic acid sequencing and analysis of phylogenetic trees. The review also discusses the current and potential uses of these techniques in investigations of transmission of bloodborne viruses by patient to worker and worker to patient, in the management of occupational exposure to blood, in research, and in the development of guidance and policy on infected healthcare workers who perform procedures prone to exposure.
Occupational and Environmental Medicine, Nov. 1999, Vol.56, No.11, p.730-734. 31 ref.

CIS 99-1265 Lundqvist G., Flodin U., Axelson O.
A case-control study of fatty liver disease and organic solvent exposure
Thirty male cases of fatty liver disease (FLD) with available biopsy records were compared to 120 randomly selected controls. Questionnaire information was obtained about job titles and specific occupational exposures; exposure level categories were then assessed blindly for both cases and controls. Medical records were examined to determine possible confounding and/or interacting effects from alcohol, the use of drugs, and other diseases. Moderately intense and mixed solvent exposure for more than 1 year within the last 15 years prior to diagnosis resulted in an age-adjusted Mantel-Haenszel odds ratio of 4.3; for intense exposure, the odds ratio was 7.7. Confounding from alcohol, use of drugs, other diseases, and overweight could be ruled out with reasonable confidence. This study indicates that occupational exposure to organic solvents may play a role in the development of FLD, as indicated earlier in case reports and in one small case-control study. Topics: adiposis hepatica; alcoholism; case-control study; exposure evaluation; hepatotoxic effects; length of exposure; obesity; organic solvents.
American Journal of Industrial Medicine, Feb. 1999, Vol.35, No.2, p.132-136. 26 ref.

CIS 99-1254 Straif K., Weiland S., Werner B., Wienke A., Keil U.
Elevated mortality from nonalcohol-related chronic liver disease among female rubber workers: Is it associated with exposure to nitrosamines?
In a long-term mortality study of 2,875 female rubber workers in a plant producing tires or technical rubber goods, the excess mortality from cirrhosis of the liver was most pronounced for nonalcohol-related cirrhosis of the liver. Mortality from alcohol-related cirrhosis of the liver and from other alcohol-related diseases was not significantly elevated. All cases of nonalcohol-related cirrhosis had worked in production of technical rubber goods and risks increased with earlier years of hire and with longer duration of employment in this work area. Although results should be interpreted with caution, they suggest that the observed excess deaths from cirrhosis of the liver are associated with occupational risk factors. Exposure to nitrosamines may be a plausible risk factor. Topics: alcoholism; cirrhosis; cohort study; dose-response relationship; exposure evaluation; hepatic diseases; mortality; nitroso amines; risk factors; rubber industry; women.
American Journal of Industrial Medicine, Mar. 1999, Vol.35, No.3, p.264-271. Illus. 54 ref.


CIS 00-1761 Yana-Victor V., Auter A.F., Abiteboul D., Touati M.A., Sogni P., Conso F.
Fitness for work and health care workers who are chronic carriers of hepatitis virus B and/or C
Aptitude et soignants porteurs chroniques de virus de l'hépatite B et/ou C [in French]
Topics: chronic diseases; contagion; determination in blood; health care personnel; hepatitis; hospitals; infectious hepatitis; job-exposure relation; work aptitude; work organization.
Archives des maladies professionnelles et de médecine du travail, July 1998, Vol.59, No.4, p.231-235. 11 ref.

CIS 00-868 Miled S., Tigui M., Ammar H., Nouaigui H., Ben Laïba M.
Sero-epidemiologic study of hepatitis B among refuse collection workers of a Tunisian municipality
Etude séro-épidémiologique de l'hépatite virale B chez les agents de la propreté d'une municipalité tunisienne [in French]
Topics: antigens; biological hazards; cross-sectional study; immunity; infection control; infectious hepatitis; needle-stick injuries; questionnaire survey; refuse collection; risk awareness; serological reactions; Tunisia; vaccination.
SST - Santé et Sécurité au Travail, Oct. 1998, No.7, p.28-32. Illus. 16 ref.

CIS 99-2070 Arvanitidou M., Constantinidis T.C., Doutsos J., Mandraveli K., Katsouyannopoulos V.
Occupational hepatitis B virus infection in sewage workers
In this cross-sectional study the employees of a Greek sewage company were tested for hepatitis B virus (HBV) markers - HBsAg, anti-HBs, and anti-HBc - to determine the prevalence of HBV infection, assess the risk of exposed sewage workers becoming infected, and to evaluate the necessity for appropriate vaccination. The overall prevalence of HBV markers was 43.9%, and 6.6% of the employees were HBsAg carriers. The prevalence of past and current infection was significantly associated with exposure to sewage, with age, and with educational level, but only exposure to sewage was independently associated with positivity for HBV infection. Workers exposed to sewage should therefore be considered for vaccination against hepatitis B. Topics: antibodies; cross-sectional study; determination in blood; exposure evaluation; exposure tests; immunization; infectious hepatitis; sanitation services; sewage; vaccination; work in sewers.
Medicina del lavoro, Sep.-Oct. 1998, Vol.89, No.5, p.437-444. 11 ref.

CIS 99-1007 Brugha R., Heptonstall J., Farrington P., Andren S., Perry K., Parry J.
Risk of hepatitis A infection in sewage workers
In a study of 241 workers in a large water and sewerage company, frequent occupational exposure to raw sewage was a significant risk factor for hepatitis A virus (HAV) infection, independently of other known risk factors. Workers who are likely to be at risk of frequent exposure should have their immunity ensured. The salivary assay for IgG and anti-HAV described in the study is highly specific and would be suitable for prevaccination testing of older workers, who are more likely to be immune. Topics: antibodies; biological hazards; cross-sectional study; determination in blood; determination in saliva; infectious hepatitis; non-occupational factors; sewage treatment; vaccination; work in sewers.
Occupational and Environmental Medicine, Aug. 1998, Vol.55, No.8, p.567-569. 12 ref.

CIS 99-930 Du C.L., Wang J.D.
Increased morbidity odds ratio of primary liver cancer and cirrhosis of the liver among vinyl chloride monomer workers
Based on a search of hospital computer files on labour insurance, occurrence of disease was investigated in 2224 workers with occupational exposure to vinyl chloride monomer (VCM). There was a significantly increased risk of admission to hospital for primary liver cancer, cirrhosis of the liver and other chronic diseases among these workers. Ten out of 11 cases of hepatoma were carriers of the hepatitis B virus. Alternative agents of primary liver cancer were largely ruled out, suggesting that the combination of hepatitis B and VCM exposure may lead to primary liver cancer. Topics: vinyl chloride; chemical industry; cirrhosis; epidemiologic study; infectious hepatitis; liver cancer; morbidity.
Occupational and Environmental Medicine, Aug. 1998, Vol.55, No.8, p.528-532. 37 ref.

CIS 99-310 Ammon A., Petersen L.
Prevalence of antibodies to HBV and HCV among Berlin dentists and their assistants
HBV- und HCV-Antikörperprävalenz bei Berliner Zahnärzten und ihren Mitarbeitern [in German]
Topics: antibodies; biological hazards; dental services; epidemiologic study; infection control; infectious hepatitis; supply of personal protective equipment; vaccination.
Epidemiologisches Bulletin, 19 June 1998, No.24, p.171-174. 5 ref.

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