title: Health effects among employees in sewage treatment plants: A literature survey.
abstract: BACKGROUND
  Over the years, there have been regular reports in the media of work-related symptoms among employees at sewage treatment plants. Concern has spread among employees over the lack of knowledge of risk agents' symptoms, and diseases in that environment. This paper reviews the investigations of health risks in employees working in the sewage treatment plants.
  
  
  METHODS
  A literature search was performed with the search terms; sewage, waste water, health effects, infection, and health hazards. Articles on health effects in relation to sewage were selected.
  
  
  RESULTS
  Work in sewage water plants can involve exposure to different types of microorganisms and chemicals. The bacterial exposure is dominated by bacteria that naturally occur in nature. However, different bacteria and viruses that give rise to infections can be present in this environment and thus there exists a risk of infection, especially of hepatitis A. Investigations suggest that gastrointestinal tract symptoms are more common among employees at sewage treatment plants than among controls. Respiratory symptoms, fatigue, and headache have also been reported in several investigations. The cause of the symptoms is unknown, although certain data suggest that they are caused by inflammation. The results suggest that endotoxin in Gram-negative bacteria may be one of the causative agents. As regards cancer, some studies report an increased risk of stomach cancer and a few studies report an increased risk of cancer in the larynx, liver or, prostate or of leukemia. The spread of the cancers over a multitude of organs does not support a hypothesis of causality with agents commonly found in sewage treatment plants.
  
  
  CONCLUSIONS
  Further investigations are needed to determine the work-related effects and ascertain the causal agents.
authors.affiliation: Department of Environmental Medicine, Göteborg University, Sweden. jorgen.thorn@envmed.gu.se
authors.forename: J
authors.initials: J
authors.lastname: Thorn
authors.forename: E
authors.initials: E
authors.lastname: Kerekes
mesh_terms: D002423:Cause of Death; D006801:Humans; D007239:Infections / Q000453:epidemiology; D009369:Neoplasms / Q000453:epidemiology; D016272:Occupational Health; D012449:Safety; D012722:Sewage; D018505:Waste Management
chemical_list: D012722:Sewage