Table 3

Studies with clinical outcome

Reference Definition of outcome Results Comments
Eligible studies
 Lermanet al (1999)28 Clinical HA in 1993–4HA patients retrieved from three sources: (1) cases reported to the local health district offices (HA is a notifiable disease in Israel); (2) reports from laboratories (IgM); (3) discharges from general hospitals. 85% Of the cases were confirmed serologically.
 Brugha et al(1998)29 Clinical diagnosis of viral hepatitisThe company records showed no cases of viral hepatitis in the 5 years before the study.
 Trout et al(2000)33 History of jaundice or hepatitis in the pastHistory of hepatitis more frequent in exposed (12%–13%) than in control subjects (0%–1%). Difference hardly interpretable because of differences in age, sex and socioeconomic levels between the four subgroups. Moreover, no distinction between time before and after beginning employment was done and no good association between anti-HAV antibodies and clinical history was found.
Definition of hepatitis: NI
 DeSerres et al(1995)35 History of jaundice and hepatitisNo case of jaundice after the beginning of employment was found.
 Schlosser and Roudot-Thoraval (1995)36 History of jaundiceHistory of jaundice not more frequent in the exposed group.
No distinction between jaundice before and after beginning employment.
 Henget al (1994)37 Hospital admission because of acute HA after start of work in the sewage treatment plant.No control group
 Skinhojet al (1981)38 History of “jaundice or liver disease unrelated to gall bladder disease”11Episodes of jaundice reported. Eight cases occurred before present occupation (three sewer workers, three gardeners, two clerks). Three cases in sewer workers but none in the control groups occurred during their current employment
 Khuderet al (1998)39 Occurrence of jaundice or HA 1995–1996. Self administered questionnaireNo case of jaundice or HA recorded in either group
 Rosset al (1998)44 Diagnosis of HA reported by consultants in communicable diseases control (n=116).No cases occurred in sewerage workers
Non-eligible studies
 Clark et al(1984)45 Continuous collection of self reported illness dataBoth workers who seroconverted reported hepatitis symptoms at a time consistent with the period in which the seroconversion occurred (the number of seronegative workers at the beginning of follow up was 249).
 PHLS working group (1991)15 Cases of HA (interview and salivary IgG and IgM)Sources for identification of HA cases were apparently (a) notifications made by medical practitioners and (b) voluntary laboratory reports.
No increased risk in sewage workers was found according to Maguire60
 Tornberg and Ronne (1997)48 Notified cases of HAHA is a mandatory notifiable disease in Denmark
The authors wrote that sewage workers “may be particularly at risk although the risk is still low”.
  • NI=no information was found in the publication.