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Work-related Helicobacter pylori infection among sewage workers in municipal wastewater treatment plants in Belgium
  1. Wim Van Hooste1,
  2. Anne-Marie Charlier1,
  3. Paul Rotsaert1,
  4. Simon Bulterys1,2,
  5. Guido Moens1,2,
  6. Marc van Sprundel3,
  7. Antoon De Schryver1,3
  1. 1IDEWE Occupational Health Services, Heverlee-Leuven, Belgium
  2. 2Catholic University of Leuven, Faculty of Medicine, Department of Occupational, Environmental and Occupational Medicine, Leuven, Belgium
  3. 3University of Antwerp, Faculty of Medical Sciences, Department of Epidemiology and Social Medicine, Antwerpen, Belgium
  1. Correspondence to Dr WLC Van Hooste, IDEWE, Interleuvenlaan 58, B-3001 Heverlee-Leuven, Belgium; wim.vanhooste{at}


Introduction 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.

Objectives 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.

  • Helicobacter pylori
  • sewage workers
  • occupational risk
  • wastewater treatment plant
  • gastrointestinal symptoms
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  • Conflict of interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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