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Systematic review Occup Environ Med: first published as 10.1136/oemed-2020-107164 on 25 May 2021. Downloaded from Global infectious disease risks associated with occupational exposure among non- healthcare workers: a systematic review of the literature Sofie Acke ,1,2 Simon Couvreur,3 Wichor M Bramer,4 Marie- Noëlle Schmickler,2 Antoon De Schryver,1 Juanita A Haagsma5 ► Additional supplemental ABSTRact Key messages material is published online Objectives Employees in non-healthcare occupations only. To view, please visit the may be in several ways exposed to infectious agents. journal online (http:// dx. doi. What is already known about this subject? org/ 10. 1136/ oemed- 2020- Improved knowledge about the risks is needed to identify ► Employees in different types of work may be in 107164). opportunities to prevent work- related infectious diseases. several ways exposed to biological agents: more The objective of the current study was to provide an 1 or less accidentally, through animal contact or Family Medicine and updated overview of the published evidence on the Population Health (FAMPOP), by contact with other humans. Faculty of Medicine and Health exposure to pathogens among non-healthcare workers. Sciences, University of Antwerp, Because of the recent SARS- CoV-2 outbreaks, we also What are the new findings? Wilrijk, Belgium aimed to gain more evidence about exposure to several 2 ► Many non- healthcare workers also have Research and Development, respiratory tract pathogens. Mensura Occupational Health evidence of exposure to infectious pathogens; Services, Brussel, Belgium Methods Eligible studies were identified in several new occupational groups and pathogens 3 Department of Twin Research, MEDLINE, Embase and Cochrane between 2009 and are described. Exposure to respiratory tract King’s College London, London, 8 December 2020. The protocol was registered with pathogens was mentioned in 30 out of37 UK International Prospective Register of Systematic Reviews 4 (81.1%) non-healthcare occupations that met Medical Library, Erasmus MC, (CRD42019107265). An additional quality assessment Rotterdam, The Netherlands our inclusion criteria. Many of these respiratory 5Department of Public Health, was applied according to the Equator network tract pathogens are readily transmitted where Erasmus MC, Rotterdam, Zuid- guidelines. employees congregate (workplace risk factors). Holland, The Netherlands Results The systematic literature search yielded 4620 papers of which 270 met the selection and quality How might this impact on policy or clinical Correspondence to criteria. Infectious disease risks were described in 37 practice in the foreseeable future? Dr Juanita A Haagsma, occupational groups; 18 of them were not mentioned Department of Public Health, ► A combined risk factors approach (disease and Erasmus MC, 3000 CA before. Armed forces (n=36 pathogens), livestock farm workplace and worker risk factors) may result Rotterdam, Netherlands; labourers (n=31), livestock/dairy producers (n=26), in a comprehensive risk assessment strategy. j. haagsma@ erasmusmc. nl abattoir workers (n=22); animal carers and forestry More research is needed on the impact of workers (both n=16) seemed to have the highest risk. http://oem.bmj.com/ Received 22 October 2020 workplace (eg, crowding, exposure to dust Revised 7 February 2021 In total, 111 pathogen exposures were found. Many of and welding fumes) and worker (eg, age and Accepted 12 February 2021 these occupational groups (81.1%) were exposed to immunosuppression) risk factors to obtain a respiratory tract pathogens. more systematic approach to prevent biological Conclusion Many of these respiratory tract pathogens risks among non-healthcare employees. were readily transmitted where employees congregate (workplace risk factors), while worker risk factors seemed to be of increasing importance. By analysing existing on September 26, 2021 by guest. Protected copyright. knowledge of these risk factors, identifying new risks They constituted slightly more than 30% of the and susceptible risk groups, this review aimed to raise work- related mortality in the African region vs less awareness of the issue and provide reliable information than 5% in high-income countries. The attribut- to establish more effective preventive measures. able fraction for infectious diseases was highest for women, both in high- income countries and other WHO regions (high-income region: men, 4.8%, vs women, 32.5%, and for the other regions: men, INTRODUCTION 3.1%, vs women, 20.7%). Morbidity from work- Work-related diseases accounted for 2.4 million related infectious diseases is expected to be much (86.3%) of the total estimated deaths attributed to higher, although the true extent of incident cases work in the updated report for the International is difficult to establish due to under- reporting.2 © Author(s) (or their Labour Organisation (ILO), published in 2017.1 Educational interventions to increase this reporting employer(s)) 2021. Re- use permitted under CC BY. Fatal occupational injuries accounted for the of occupational diseases by physicians have been 3 Published by BMJ. remaining 13.7%. The estimated fatal work-related studied by a former systematic review. mortality by cause in the year 2015, mentioned According to the WHO, work- related diseases To cite: Acke S, Couvreur S, in the same report, was as follows: circulatory have multiple causes, where factors in the work Bramer WM, et al. Occup Environ Med Epub diseases (31%), work- related cancers (26%), respi- environment may play a role, together with other ahead of print: [please include ratory diseases (17%) and occupational injuries risk factors, in the development of such diseases. Day Month Year]. doi:10.1136/ (14%). Communicable diseases counted for 9% On the other hand, an occupational disease is oemed-2020-107164 and were more common in low-income countries. any disease contracted primarily as a result of an Acke S, et al. Occup Environ Med 2021;0:1–9. doi:10.1136/oemed-2020-107164 1 Systematic review Occup Environ Med: first published as 10.1136/oemed-2020-107164 on 25 May 2021. Downloaded from exposure to risk factors arising from work activity. Occupational to respiratory tract pathogens among non- healthcare occupa- exposure is defined as exposure to potentially harmful chemical, tional groups. physical or biological agents that occurs as a result of occupa- tional factors. Only a small subset of biological agents—patho- METHODS gens—may cause disease in humans. Infectious diseases can be Introduction transmitted via direct contact (including percutaneous), droplet, This systematic review was performed according to the guide- airborne (bioaerosol), vehicles (such as food, water and fomites) lines of the Preferred Reporting Items for Systematic Reviews and vectors. Transmission of biological agents in the workplace and Meta- Analyses (http://www. prisma- statement. org). The may occur in two directions: workers can acquire infections in objective was formulated using the PICOS criteria (PICOS: the workplace and then also may serve as vectors that spread the population: non-healthcare workers; intervention/exposure: disease to others, such as clients and coworkers. Occupations exposures to environmental processes which involve many involving interaction with subgroups of the general population, different microorganisms (composting, recycling and waste particularly infected persons, pose an increased risk of infection. water recycling), through animal contact (agriculture and food Disease transmission patterns are also relevant to those whose processing) or through contact with humans; comparison: non- work brings them in contact with animals, putting them at risk exposed workers or general population; outcome (primary): of zoonotic infections.2 4 prevalence, incidence and/or occurrence rate of symptomatic Since the former key review of Haagsma et al,2 not only infectious disease and/or seroconversion and/or immune- related new occupations are noticed but also new pathogens like and respiratory conditions; outcome (secondary): independent SARS- CoV-2. Also, some occupations (eg, welding) might risk factors; and study: observational studies including cohort increase susceptibility of workers to infection on exposure to studies, case–control studies, cross- sectional studies, outbreak an infectious agent, without increasing the exposure to the reports and case series (three or more cases).To avoid unnec- pathogen per se.5 6 essary duplication, the protocol was sent to the International In the current pandemic of the infectious disease COVID-19, Prospective Register of Systematic Reviews database and regis- the Belgian Centre for Occupational Disease Risks (Fedris) regis- tered under the number CRD42019107265 (http://www. crd. tered 7930 declarations for healthcare workers and 79 declara- york.ac. uk/ PROSPERO/). Duplicate records were checked by tions for employees in other, essential sectors (police inspectors, EndNote V.X7. warehouse worker–food salesmen and firefighters) up to 13 October 2020.7 Indeed, not only healthcare workers are affected by the pandemic SARS- CoV-2 virus. Although the majority of Definitions the earliest patient cases reported possible zoonotic or environ- This study focused on biological agents such as bacteria, viruses, mental exposure at the Huanan Seafood Wholesale Market in parasites or fungi, and was limited to work- related infectious Wuhan, it is now clear that human- to human transmission has disease, that is, infectious
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