Work-related Helicobacter pylori infection among sewage workers in municipal wastewater treatment plants in Belgium.
BACKGROUND
Most studies among sewage workers of wastewater treatment plants (WWTPs) have found a higher prevalence of gastrointestinal symptoms than among non-sewage exposed workers. Waterborne transmission of Helicobacter pylori (H pylori) has been hypothesised, as the bacteria can survive into an aqueous environment and has been detected in sewage. A health and hygiene questionnaire has demonstrated a higher prevalence of peptic ulcers among Belgian WWTP operators and maintenance workers than among non-sewage exposed colleagues.


OBJECTIVE
To assess the seroprevalence of H pylori infection in Belgian sewage workers at municipal WWTPs, and to determine whether sewage exposure is an important risk factor for acquisition of H pylori and the possible association with gastrointestinal symptoms.


METHODS
A seroprevalence study of H pylori antibodies was conducted among 317 WWTP employees (operators, maintenance workers, laboratory personnel, other job). Information about demographic variables, possible H pylori risk factors, working history, and history of current gastrointestinal symptoms during last 3 months was obtained by a questionnaire. The presence of H pylori IgG was investigated with an ELISA. The results were compared with those of 250 employees of a pharmaceutical company (operators, maintenance workers, laboratory personnel).


RESULTS
The prevalence of H pylori IgG antibodies among sewage workers was 16.7% (95% CI 12.6 to 20.8%) compared to 13.6% (95% CI 9.4 to 17.8%) among the control group. In a logistic regression model with controlling for age and educational levels, OR study/control group was 1.02 (95% CI 0.58 to 1.80 with p=0.93). No significant associations were found between the H pylori status and gastrointestinal symptoms, occupational exposures in different tasks, nor with hygienic practices.


CONCLUSIONS
Our results do not suggest that H pylori infection is a probable cause of part of gastrointestinal symptoms among Flemish municipal sewage workers of WWTPs.
IDEWE, Interleuvenlaan 58, B-3001 Heverlee-Leuven, Belgium. wim.vanhooste@idewe.be
Wim
W
Van Hooste
Anne-Marie
AM
Charlier
Paul
P
Rotsaert
Simon
S
Bulterys
Guido
G
Moens
Marc
M
van Sprundel
Antoon
A
De Schryver
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001530:Belgium / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000382:microbiology*; D016481:Helicobacter Infections / Q000453:epidemiology / Q000209:etiology*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology / Q000382:microbiology*; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis; D012307:Risk Factors; D012722:Sewage / Q000009:adverse effects* / Q000382:microbiology; D014871:Water Microbiology; D055815:Young Adult
D012722:Sewage