title: Interactions of pathogens and irritant chemicals in land-applied sewage sludges (biosolids).
abstract: BACKGROUND
  Fertilisation of land with processed sewage sludges, which often contain low levels of pathogens, endotoxins, and trace amounts of industrial and household chemicals, has become common practice in Western Europe, the US, and Canada. Local governments, however, are increasingly restricting or banning the practice in response to residents reporting adverse health effects. These self-reported illnesses have not been studied and methods for assessing exposures of residential communities to contaminants from processed sewage sludges need to be developed.
  
  
  METHODS
  To describe and document adverse effects reported by residents, 48 individuals at ten sites in the US and Canada were questioned about their environmental exposures and symptoms. Information was obtained on five additional cases where an outbreak of staphylococcal infections occurred near a land application site in Robesonia, PA. Medical records were reviewed in cases involving hospitalisation or other medical treatment. Since most complaints were associated with airborne contaminants, an air dispersion model was used as a means for potentially ruling out exposure to sludge as the cause of adverse effects.
  
  
  RESULTS
  Affected residents lived within approximately 1 km of land application sites and generally complained of irritation (e.g., skin rashes and burning of the eyes, throat, and lungs) after exposure to winds blowing from treated fields. A prevalence of Staphylococcus aureus infections of the skin and respiratory tract was found. Approximately 1 in 4 of 54 individuals were infected, including 2 mortalities (septicaemia, pneumonia). This result was consistent with the prevalence of S. aureus infections accompanying diaper rashes in which the organism, which is commonly found in the lower human colon, tends to invade irritated or inflamed tissue.
  
  
  CONCLUSIONS
  When assessing public health risks from applying sewage sludges in residential areas, potential interactions of chemical contaminants with low levels of pathogens should be considered. An increased risk of infection may occur when allergic and non-allergic reactions to endotoxins and other chemical components irritate skin and mucus membranes and thereby compromise normal barriers to infection.
authors.affiliation: US Environmental Protection Agency, National Exposure Research Laboratory, Athens, GA, USA. LewisDaveL@aol.com
authors.forename: David L
authors.initials: DL
authors.lastname: Lewis
authors.forename: David K
authors.initials: DK
authors.lastname: Gattie
authors.forename: Marc E
authors.initials: ME
authors.lastname: Novak
authors.forename: Susan
authors.initials: S
authors.lastname: Sanchez
authors.forename: Charles
authors.initials: C
authors.lastname: Pumphrey
mesh_terms: D000393:Air Pollutants / Q000009:adverse effects*; D002170:Canada / Q000453:epidemiology; D016009:Chi-Square Distribution; D004781:Environmental Exposure / Q000032:analysis*; D016021:Epidemiologic Studies; D005260:Female; D005308:Fertilizers / Q000009:adverse effects*; D006256:Hazardous Waste / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D012120:Respiration Disorders / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000821:virology; D012722:Sewage / Q000009:adverse effects*; D012988:Soil Microbiology; D012989:Soil Pollutants / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology
chemical_list: D000393:Air Pollutants; D005308:Fertilizers; D006256:Hazardous Waste; D012722:Sewage; D012989:Soil Pollutants