Review
Hepatitis A in workers exposed to sewage: a systematic review
C Glasc, P Hotza, R Steffenb
a Unit for
Occupational and Environmental Health, Institute for Social and
Preventive Medicine, University of Zurich, Sumatrastrasse 30, CH-8006
Zurich, Switzerland, b Division of
Epidemiology and Prevention of Communicable Diseases, Institute for
Social and Preventive Medicine, University of Zurich, Switzerland, c Sozialversicher- ungsanstalt
des Kantons Zürich (SVA Zürich), Röngtenstrasse 17, Zürich,
Switzerland
Correspondence to: Dr P Hotz photz{at}ifspm.unizh.ch
Accepted 4 July 2001
OBJECTIVES
To assess
whether the scientific literature supports the hypothesis that workers
exposed to sewage are at higher risk of hepatitis A (HA).
METHODSAll original
papers reporting epidemiological studies published in English, French,
or German which reported on the risk of HA infection in workers exposed
to sewage were eligible. They were identified by several methods and
each original paper was assessed independently with a checklist by two
people. Studies were classified according to the strength of their
design. Non-eligible studies were also examined to assess the impact of
publication bias. If the risk estimates diverged widely, causes for
heterogeneity were assessed. A distinction was made between
seroprevalence studies based on subclinical HA (defined only by the
presence of anti-HA antibodies) and clinical HA.
RESULTS17 eligible
studies were identified. No indication of an increased risk of clinical
HA could be found. For seroprevalence the studies with the strongest
design suggested a slightly increased risk of subclinical HA with an
odds ratio (OR) <2.5. Heterogeneity was considerable and precluded a
meta-analysis. Considering non-eligible studies would still decrease
the OR.
CONCLUSIONSThe
systematic review does not confirm an increased risk of clinical HA in
workers exposed to sewage. An increased risk of subclinical HA cannot
be excluded but the association between seropositivity and exposure to
sewage was not strong and became still weaker if publication bias was
taken into account.
Keywords: hepatitis A; sewage; systematic review
© 2001 by Occupational and Environmental Medicine
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
-
Wild, P, Ambroise, D, Benbrik, E, Tiberguent, A, Massin, N
(2006). Mortality among Paris sewage workers.. Occup. Environ. Med.
63: 168-172
[Abstract] [Full Text]
- Full Text
- Full Text (PDF)
- Table 3 - Long version
- Submit a response
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
- Citation Map
Services
- Email this link to a friend
- Similar articles in this journal
- Similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Bookmark with
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
