Sent: Thursday, October 11, 2007 12:51 PM
Subject: Alabama - Synagro says sewage workers don't get sick from sludge exposure

http://www.decaturdaily.com/decaturdaily/news/071011/stop.shtml

"Biosolids are regulated by the EPA," Loder said from her Arizona office. "Municipal plant workers work
with (them) every day and, as far as I know, there haven't been any health problems. Our company isn't
going to produce something that would affect people's health adversely."

Why would they lie? peer reviewed, published articles indicate sewage workers DO get sick


EPA States:
  • Composting is not a sterilization process and a properly composted product maintains an active
     population of beneficial microorganisms that compete against the pathogenic members. Under some
     conditions ,explosive regrowth of pathogenic microorganisms is possible

  • These organisms can potentially invade a normal, healthy human being and produce illness or
     debilitation
     http://www.epa.gov/owm/mtb/combioman.pdf  
Excerpt and underlined at http://www.deadlydeceit.com/EPA_Compost.html



Page 1            Dowd, Gerba Pepper & Pillai on health effects of sewage workers:
Pages 2 - 11   Thorn and Kerekes on health effects among sewage employees “ . . . respiratory symptoms, fatigue,

Pages 12 - 18  Douwes J, Mannetje  A & Heederik D on work-related symptoms in sewage workers
     “In the present study we focused on five groups of symptoms including flu-like, respiratory, mucous membrane and  
skin irritation, neurological, and gastrointestinal symptoms.”

Pages 20 - 28  Scarlett-Kranz JM, Babish JG, Strickland D & Lisk DJ on health among sewage workers


Pages 28(a)-(e) - Nethercott   JR & Holness  DL - health status of Toronto, Canada, sewage workers


Pages 30 -34   Rylander on health effects among sewage workers:  “The results confirm previous studies on the

Pages 34(a) - (d)  Friis L, Norback D & Edling C - Self-Reported Asthma and Respiratory
                      Symptoms in Sewage Workers   “Self-reported asthma was more common among the sewage
Pages 34 (e) - (o) - Zuskin,  E, Mustajbegovic J. Schachter  EN- “Sewage workers experience frequent acute and

“In sewage workers, acute symptoms during the work shift such as cough, dyspnea, chest tightness, irritation or

Page 35 -  Samadpour:  “Workers with weak immunity system get sick and leave the job . . . those with good immune
  systems continue working.”    (page 35)

Pages 36 - 64  List of articles regarding health effects among sewage workers

Pages 65-66 - Canada - sewage worker suffers skin sores and severe asthma

Pages 67-68 - North Carolina - sewage worker suffers severe diarrhea, GI problems, mast
                cell disease


SUPPLEMENT – update Spring 2005

Pages 69 – 75  Prevalence of Infectious Diseases and Associated Symptoms in Wastewater Treatment Workers.  “The
Pages 76 – 80 – Exposure to Bacterial Aerosols and Work-Related symptoms in Sewage Workers – “Personal
page 81 - http://www.miljomedicin.gu.se/rapporter/Rapporter/Rapport_2002_2.pdf


RAPPORT  2/02   EXPOSURE IN SEWAGE TREATMENT PLANTS – REPORT IN 3 PARTS  - 37 PAGES
A TOXICOLOGICAL INVESTIGATION
ENDOTOXIN
NITROGEN OXIDE CONTENTS IN EXHALED AIR – AN INFLAMMATORY MARKER

Jonsson Titti, Thorn, Jorgen


Pages 7-8   "Endotoxins in sewage plants.


Pages 82 – 86 Work related symptoms among sewage workers; a nationwide survey in Sweden.  J. Thorn, L. Beijer,
R Rylander – Occup. Environ Med. 2002; 59: 562-566  “Conclusions:  The results of this questionnaire survey show an

Pages  87, 88 and 89 – National Institute of Occupational Safety and Health – Hazard Alert – Biological Hazards in
    Sewage and Wastewater Treatment Plants – The Center to Protect Workers’ Rights  

Page 88 – Eur J Epidemiol. 1999 Mar; 15(3):261-5 – Schlosser O, Grall D, Laurenceau MN – Intestinal parasite

Page 89 – UK – South West Public Health Observatory
Pages 90-91 – TENNESSEE – Lawsuit filed on behalf of sick sewage sludge worker – young man’s whole system was
     poisoned with sludge bacteria -- Enterococcus Faecalis and Nocardia

Pages 92-93  Pro sludge researcher finds respiratory symptoms and skin lesions in sewage biosolids composting
     workers

Pages 94 – 98 –Bibliography of studies on sick sewer workers:


Arvanitidou M, Constantinidis TC, Doutsos J, Mandraveli K and Katsouyannopoulos V (1998) Occupational hepatitis B
virus infection in sewage workers. Med Lav 89: 437-444.

Babish JG, Stoewsand GS, Kranz JM, Boyd JN, Ahrens VD and Lisk DJ (1984) Toxicologic studies associated with the
agricultural use of municipal sewage sludge and health effects among sewage treatment plant workers. Regul Toxicol
Pharmacol 4(3): 305-321.
Brautbar N and Navizadeh N (1999) Sewer workers: Occupational risk for hepatitis C--report of two cases and review of
literature. Arch Environ Health 54: 328-330.
    “…sewer workers may be at increased risk of contracting hepatitis C.”

Brugha R, Heptonstall J, Farrington P, Andren S, Perry K and Parry J (1998) Risk of hepatitis A infection in sewage
workers. Occup Environ Med 55: 567-569.

Darragh A and Sandfort D (1996) Quantification of air contaminants at a municipal sewage sludge composting facility in
Colorado. 1996-03-05 Occupational Health and Safety Section, Colorado State University, Fort Collins, CO 80523.
De Serres G and Laliberte D (1997) Hepatitis A among workers from a waste water treatment plant during a small
community outbreak. Occup Environ Med 54(1): 60-22.
     “This report confirms that hepatitis A is an occupational hazard for sewage workers.”

Douwes J, Mannetje A and Heederik D (2001) Work-related symptoms in sewage treatment workers. Ann Agric Environ
Med 8(1): 39-45.
Dutkiewicz J, Jablonski L and Olenchock SA (1988) Occupational biohazards: a review. Am J Ind Med 14(5): 605-623.
Friis L, Norback D and Deling C, (1999) Self-Reported Asthma and Respiratory Symptoms in Sewage Workers. J.
Occup. Health 41: 87-90.
    “Self-reported asthma was more common among the sewage workers than other municipal workers.”

Friis L (2001) Health of municipal sewage workers. Comprehensive Summaries of Upsala Dissertations from the Faculty
of Medicine 1015, 67p. (http://publications.uu.se/theses/fulltext/91-554-4980-8.pdf)

Glas C, Hotz P and Steffen R (2001) Hepatitis A in workers exposed to sewage: a systematic review. Occup Environ
Med 58(12): 762-768.
   “The systematic review does not confirm an increased risk of clinical HA in workers exposed to sewage.”

Gregersen P, Grunnet K, Uldum SA, Andersen BH and Madsen H (1999) Pontiac fever at a sewage treatment plant in
the food industry. Scand J Work Environ Health 25: 291-295.

Iftimovici R, Iacobescu V, Copelovici Y, Dinca A, Iordan L, Niculescu R, Teleguta L and Chelaru M (1980) Prevalence of
antiviral antibodies in workers handling wastewater and sludge. Virologie 31(3): 187-189.

Kraut A, Lilis R, Marcus M, Valciukas JA, Wolff MS and Landrigan PJ (1988) Neurotoxic effects of solvent exposure on
sewage treatment workers. Arch Environ Health 43(4): 263-268.

Laitinen S, Kangas J, Kotimaa M, Liesivuori J, Martikainen PJ, Nevalainen A, Sarantila R and Husman K (1994)
Workers' exposure to airborne bacteria and endotoxins at industrial wastewater treatment plants. Am Ind Hyg Assoc J
55(11): 1055-1060.

Lundholm M and Rylander R (1980) Work related symptoms among sewage workers. Br J Ind Me 40(3): 325-329.

Lundholm M and Rylander R (1980) Occupational symptoms among compost workers. J Occup Med 22(4): 256-257.

Mattsby I and Rylander R. (1978) Clinical and immunological findings in workers exposed to sewage dust. J Occup Med
20(10): 690-692.

Melbostad E, Eduard W, Skogstad A, Sandven P, Lassen J, Sostrand P and Heldal K (1994) Exposure to bacterial
aerosols and work-related symptoms in sewage workers. Am J Ind Med 25(1): 59-63.

Morse DL, Kominsky JR, Wisseman CL 3d and Landrigan PJ (1979) Occupational exposure to
hexachlorocyclopentadiene. How safe is sewage? JAMA 241: 2177-2179.


NIOSH HETA 94-0182-2519. Waste Water treatment Health Hazard Evaluation, Little Blue Valley Sewer District,
Independence MO.

NIOSH HETA 83-440-1537. Occupational Fatality Following Exposure to Hydrogen Sulfide - Nebraska.

Richardson DB (1995) Respiratory effects of chronic hydrogen sulfide exposure. Am J Ind Med 28(1): 99-108.

Rylander R (1999) Health effects among workers in sewage treatment plants. Occup Environ Med 56(5): 354-357.

Salano R and Copello F (1998) An epidemiological study of a group of workers employed in the maintenance of a
sewer network and of urban waste water treatment plants. Med Lav 89: 393-403.

Scarlett-Kranz JM, Babish JG, Strickland D and Lisk DJ (1987) Health among municipal sewage and water treatment
workers. Toxicol Ind Health 3(3): 311-319.

Scarlett-Kranz JM, Babish JG, Strickland D, Goodrich RM and Lisk DJ (1986) Urinary mutagens in municipal sewage
workers and water treatment workers. Am J Epidemiol 124(6): 884-893.
   “Sewage workers had a significantly higher risk for urinary mutagens.”

Schlosser O, Grall D and Laurenceau MN (1999) Intestinal parasite carriage in workers exposed to sewage. Eur J
Epidemiol. 15: 261-265.

Weldon M, VanEgdom MJ, Hendricks KA, Regner G, Bell BP and Sehulster LM (2000) Prevalence of antibody to
hepatitis A virus in drinking water workers and wastewater workers in Texas from 1996 to 1997. J Occup Environ Med
42(8): 821-826.

Zuskin E, Mustajbegovic J and Schachter EN (1993) Respiratory function in sewage workers. Am J Ind Med 23(5): 751-
761.

Pages 99 – 101   AMERICAN FEDERATION OF STATE, COUNTY AND MUNICIPAL EMPLOYEES, AFL-CIO (

Page 102-103 – Finland study of waste and sewage treatment facilities -

Page 104 – 67 page report available on line:
http://www.diva-portal.org/diva/getDocument?urn_nbn_se_uu_diva-627-1__fulltext.pdf
         HEALTH OF MUNICIPAL SEWAGE WORKERS by Lennart Friis

"Page 48 - "The significant finding of study V, less nausea among the sewage workers, was interpreted to be a result
page 51: (The sewage workers) "had significantly more self-reported asthma than comparable workers. In a

Page 105 – Australia, Aug. 2004 – toxic fumes from chemical dumping sicken sewer workers
Page 106 – Michigan sewer worker sickened from exposure to PCBs in sludge

May 2006
ADD to sick sewer workers report:
Dr. Eugene Cole, Brigham Young University, Provo, Utah
https://www.scrthq.org/secure/documents/sewage_and_health.pdf


Online ISSN: 1097-0274    Print ISSN: 0271-3586
American Journal of Industrial Medicine
Volume 33, Issue 6, 1998. Pages: 571-577

Published Online: 6 Dec 1998

Prevalence of infectious diseases and associated symptoms in wastewater treatment workers
Sadik A. Khuder, PhD *, Tammy Arthur, MSc, Michael S. Bisesi, PhD, Eric A. Schaub, MD, MPH
Department of Occupational Health, Medical College of Ohio, Toledo, Ohio
email: Sadik A. Khuder (skhuder@vortex.mco.edu(internet))

Keywords
waste water; employees; infectious diseases; symptoms; epidemiology

Abstract
Wastewater treatment workers (WWTW) are potentially exposed to a variety of infectious agents and toxic materials.
We conducted a retrospective epidemiological study to examine the prevalence of infectious diseases and associated
symptoms in WWTW. From a possible 242 WWTW, 150 completed a questionnaire that provided data pertaining to the
diagnosis of an infectious disease or the prevalence of associated symptoms over a 12-month period. Comparison
data were obtained from questionnaires completed by 54 college maintenance and oil refinery workers. The WWTW
exhibited a significantly higher prevalence of gastroenteritis, gastrointestinal symptoms (specifically abdominal pain),
and headaches. No significant differences were found with regard to respiratory and other symptoms. Employees
classified by exposure categories did not exhibit significant differences in the prevalence of symptoms. While significant
differences were found with regard to the health status of WWTW and controls, it appears that these risks are confined
to symptoms and infectious diseases associated with the gastrointestinal system and are not inclusive of all such
symptoms or diseases. Am. J. Ind. Med. 33:571-577, 1998. © 1998 Wiley-Liss, Inc.

Accepted: 4 February 1998

*Correspondence to Sadik A. Khuder, Department of Occupational Health, Medical College of Ohio, P.O. Box 10008,
Toledo, OH 43699-0008

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1: Med Pr. 2005;56(3):213-22.        Related Articles,   Links          

[Exposure assessment to harmful agents in workplaces in sewage plant workers]

[Article in Polish]

Cyprowski M, Szarapinska-Kwaszewska J, Dudkiewicz B, Krajewski JA, Szadkowska-Stanczyk I.

Zakladu Srodowiskowych Zagrozen Zdrowia, Instytutu Medycyny Pracy im. prof. J. Nofera w Lodzi. marc@imp.lodz.pl

BACKGROUND: The purpose of the study was to evaluate exposure to biological and chemical agents in a sewage
treatment plant. MATERIALS AND METHODS: Sampling was carried out in the summer and wintertime at the morning
workshift. Ninety-nine sewage workers taking part in the study were divided into four occupational subgroups:
mechanical treatment, biological treatment, sewage sludge treatment, and operation control workers. Exposure to: H2S,
SO2, Pb, Cd, Cr3+, Cr6+, endotoxins, (1 --> 3)-beta-D glucans, and microorganisms was evaluated with special
identification of Gram-negative rods. RESULTS: The concentrations of dust containing heavy metals and
concentrations of gases from all stations did not exceed MAC values. Concentrations of endotoxins ranged from 0.08
to 223 ng/m3, and glucans from 0.00 to 163 ng/m3. The highest concentrations were found among sewage sludge
treatment workers, in the summertime (geometric mean value = 37 ng/m3). In the winter, concentrations were almost
ten times lower. Over sixty percent of all results exceeded the proposed reference value for airborne endotoxins (10
ng/m3). Concentrations of airborne bacteria in the sewage plant were at low level (10(2)( cfu/m3), except the sludge
lagoon and sludge concentration building, where the results exceeded the proposed reference value for mesophilic
bacteria (10(5) cfu/m3) "Environmental" bacteria (Pseudomonas, Burkholderia, Shewanella) predominated in the
samples. There were also found enterobacteria genus (Enterococcus, family Enterobacteriaceae)--good indicators of
hygienic cleanliness of the air. CONCLUSIONS: The study proved that the exposure varied and depended on the stage
of sewage treatment. The sewage sludge treatment process was characterized by the highest emission of bioaerosols.
All microorganisms found in the sewage plant belong to the second occupational risk group, under the ordinance of the
Ministry of Health.

PMID: 16218135 [PubMed - indexed for MEDLINE]

Workers' exposure to airborne bacteria and endotoxins at industrial wastewater treatment plants.

Laitinen S, Kangas J, Kotimaa M, Liesivuori J, Martikainen PJ, Nevalainen A, Sarantila R, Husman K.

Kuopio Regional Institute of Occupational Health, Finland.

A study of sewage workers' exposure to airborne culturable bacteria and inhaled endotoxins was performed at nine
waste-water treatment plants that treat mainly industrial effluents.

“. The most common genera of airborne gram-negative bacteria were acinetobacter, citrobacter, enterobacter,
klebsiella, and pseudomonas. High levels of exposure to bacteria and bacterial endotoxin usually were related to
certain phases of the treatment process. The microbiological contamination of air was highest near the inlets where
incoming wastewater entered the basins, in the sludge treatment area, and inside the biofilter tower. In these spaces it
is necessary to control and reduce exposure to airborne bacteria and endotoxin at wastewater plants. Am Ind Hyg
Assoc J. 1994 Nov;55(11):1055-60.”
**************************************************************************************
Occurrence and seasonal variation of airborne gram negative bacteria in a sewage treatment plant.

Stampi S, Zanetti F, Crestani A, De Luca G.

Department of Medicine and Public Health, University of Bologna, Italy.

A study was carried out to determine the microbial density and the seasonal variation of airborne Gram negative
bacteria in a sewage treatment plant.
72% of the samples contained "other" Gram negative bacteria such as Aeromonas hydrophila, Serratia marcescens,
Enterobacter cloacae and others. With the exception of Legionella spp. and Salmonella, all other bacteria were more
frequent and numerous in the October-March period, when temperatures were lower and humidity higher. Although the
oxidation tanks were covered overall contamination was nevertheless high, thus presenting a potential health risk for
plant workers. New Microbiol. 2000 Jan;23(1):97-104.
Double trouble: health risks of accidental sewage release.

Bridges O.

University of Surrey, Guildford, Surrey GU2 7XH, UK. o.bridges@surrey.ac.uk

Occupational health risks from long-term exposure to sewage are well documented [Am J. Ind. Med. 25 (1994) 59; Ann.
Agric. Environ. Med. 81 (2001) 39; Am J. Ind. Med. 40 (2001) 170]. Some studies suggest an increase in the incidence
of specific cancers [Am J. Ind. Med. 19 (1991) 75; J. Occup. Med. 36 (1994) 31]. There are also many reports of acute
fatalities in confined spaces (sewage chambers and pipes) [H&S at Work 13 (1991), 10; FACE report: sewer worker
dies when inflatable sewer plug bursts in Washington, DC, Performer, National Institute For Occupational Safety and
Health, 19th July 1990]. In a residential area incidents of sudden sewage release can be regarded as double trouble
because both the emergency service personnel and the local residents may be exposed to a galaxy of chemical and
microbiological agents present in sewage. However, data on the effects of acute non-occupational exposure due to
accidental sewage releases is still very limited. The incidents investigated here took place at two different locations in
the southern part of the UK. In both incidents the symptoms experienced by those exposed were more serious than
expected by the public health experts. Chemosphere. 2003 Sep;52(9):1373-9.

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Occurrence, removal and seasonal variation of thermophilic campylobacters and Arcobacter in sewage sludge.

Stampi S, De Luca G, Varoli O, Zanetti F.

Department of Medicine and Public Health, University of Bologna, Italy. serenata@kaiser.alma.unibo.it

The presence of thermophilic campylobacters and Arcobacter was investigated in four types of sewage sludge taken
from the treatment plant in Bologna (Italy): primary, activated, thickened and anaerobically digested sludge.
Campylobacter jejuni and Campylobacter coli were more numerous during the March-September period and were
found only in primary sludge (22.7%) with mean counts of 278 MPN/g dry matter and 1403 MPN/g dry matter
respectively. Arcobacter butzleri were found in all types of sludge with frequencies of 80% in activated and thickened
sludges and 41% in digested sludges. They were more numerous in the spring/summer period with peaks in April, May,
June and September. They were less sensitive to anerobic digestion than fecal bacteria, probably due to their
microaerophilic growth properties. However, since they are found in anaerobically digested sludges at mean values of
7649 MPN/g dry matter the land application of digested sludges may cause high risks infection. Zentralbl Hyg
Umweltmed. 1999 Jun;202(1):19-27.

******************************************************************************************

Microbial contamination of air by activated sludge units (author's transl)]

[Article in German]

Wanner HU.

). In a closed pool altogether considerably higher values were measured: In the immediate neighbourhood of the
activated sludge unit they amounted to abt. 10 000-25 000 germs/m3; in the hall 3000-4000 germs/m3 were measured,
whereby the part of coliform bacteria amounted to 1-2% and that of enterococci to 2-4%. It has to be taken into
account that besides the measured intestinal flora further pathogenous agents are present in the aerosols. In closed
units, therefore, a greater risk of aerogenous infections exists, whereas in open-air pools this danger can be judged as
very small. Zentralbl Bakteriol [Orig B]. 1975 Sep;161(1):46-53.
Antibiotic resistance of E. coli in sewage and sludge.

Reinthaler FF, Posch J, Feierl G, Wust G, Haas D, Ruckenbauer G, Mascher F, Marth E.

Institute of Hygiene, University of Graz, Universitatsplatz 4, Austria. franz.reinthaler@uni-graz.at

The aim of the study is the evaluation of resistance patterns of E. coli in wastewater treatment plants without an
evaluation of basic antibiotic resistancemechanisms.Investigations have been done in sewage, sludge and receiving
waters from three different sewage treatment plants in southern Austria. A total of 767 E. coli isolates were tested
regarding their resistance to 24 different antibiotics. The highest resistance rates were found in E. coli strains of a
sewage treatment plant which treats not only municipal sewage but also sewage from a hospital
. . . and thus sewage treatment processes contribute to the dissemination of resistant bacteria in the environment.
Water Res. 2003 Apr;37(8):1685-90


http://www.swpho.org.uk/waste/sewage.htm United Kingdon

Occupational diseases of sewage treatment workers

1. Have studies been done on human populations?

Yes.
There was one review  (Thorn and Kerekes, 2001)) and 38 primary studies. The health effects investigated were
symptoms (17 studies), infections, i.e. hepatitis A, hepatitis C, legionella, leptospirosis, gastroenteritis (16 studies),
mortality (3 studies), reproductive outcomes (1 study), biomarkers (3 studies) and cancer (5 studies).

2. Have hazards been identified?

Yes.
From the mortality and cancer studies, no hazards were identified. From studies on symptoms and infections, the
following hazards were identified - bacteria, bacterial endotoxins, hydrogen sulphide, and organic solvents.

3. Does the appearance of the hazard precede the health outcome? Is the association biologically plausible?

Yes.
For symptoms, it is plausible that pathogenic micro-organisms, bacterial endotoxins, organic solvents and hydrogen
sulfide could be related to the symptoms observed.
************************************************************************************


CDC – CENTERS FOR DISEASE CONTROL AND PREVENTION  

http://www.cdc.gov/niosh/elcosh/docs/d0200/d000283/d000283.html

"During any part of treatment, transport, or application of sewage sludge, you can be exposed to materials that can
cause disease. This is true even if you work around treated (class B) biosolids. Careful work habits can help protect
you."
Hazard Alert — Biological Hazards in Sewage and Wastewater Treatment Plants

The Center to Protect Workers' Rights

During construction and maintenance of sewage and wastewater plants, workers may be killed by drowning, trench
collapses, falls, confined spaces, and exposure to chlorine or hydrogen sulfide gas. The work can also make you sick.

Sewage and wastewater contain bacteria, funguses, parasites, and viruses that can cause intestinal, lung, and other
infections. If equipment, work practices, and personal protective equipment (PPE) don’t protect you from swallowing
these agents, you can get sick. One kind of parasite can get into your skin, even if you do not have a cut or a rash.

During any part of treatment, transport, or application of sewage sludge, you can be exposed to materials that can
cause disease. This is true even if you work around treated (class B) biosolids. Careful work habits can help protect
you.
Some Biological Hazards That May Be in Sewage Or Wastewater

Bacteria may cause diarrhea, fever, cramps, and sometimes vomiting, headache, weakness, or loss of appetite. These
are some bacteria and