OCCUPATIONAL DISEASES

AND HAZARDS
S-J. M. MITI,
RN, RM, BScN
INTRODUCTION
• Every occupation has its own hazards and

diseases that the workers get exposed to in

the course of their work.
• Some diseases can be avoided while
others cannot as result from small
cumulative exposures experiences over a
INTRODUCTION CONT’D

• Long period of time despite health and

safety measures being put in place.

• It is, therefore, important for public Health

Nurses to be aware of these and how to

manage them in order to offer quality
services to the clients.
OBJECTIVES
• GENERAL OBJECTIVE

• By the end of the session, student nurses

should be able to acquire knowledge of

occupational health diseases and hazards
and be able to use it in their nursing
practice
 OBJECTIVES CONT’D

• SPECIFIC OBJECTIVES

• By the end of the session, students should be

able to:

1. Define terms occupation, disease and

hazard.

2. Mention the common occupational diseases

OBJECTIVES CONT’D

3. Discuss the occupational health diseases:

• Eye injuries and control

• Pulmonary diseases and control

• Zoonoses

• Occupational dermatosis and prevention

• Personal hygiene, protective clothing &

OBJECTIVES CONT’D

• barrier creams

• Relationship between employment and

non-occupational diseases (HIV/AIDS)

DEFINITION OF TERMS
• Disease: A deviation from normal health

status associated with a characteristic

sequence of signs and symptoms and
caused by a specific etiologic agent.
(Dictionary of Occupational health Nursing)
DEFINITIONS CONT’D

• Hazard: a risky, perilous, or dangerous

condition or situation that could result in the

exposure of individuals to unnecessary
physical or health risks.
•A dangerous condition, potential or
inherent, that can interrupt or interfere with
DEFINITIONS CONT’D

• the expected orderly progress of an activity.

• Occupation: that trade, profession, or

other activity which occupies ones time for
compensation.
• Occupational Disease: a disease which is

a result of exposure to a hazardous

DEFINITIONS CONT’D

• Material, physical agent, biological

organism, or ergonomic stress in the
course of one’s work. Or
• A disease resulting from an exposure
during employment to conditions or
substances detrimental to health.
DEFINITIONS CONT’D

• Impairment of health not caused by

accident but by exposure to conditions
incidental to and arising out of or in th
course of one’s employment.
COMMON OCCUPATION
HEALTH DISEASES
• Occupational health diseases affect various

systems of the human body according to

the tissue affinity of the causative agent.
• They classified according to the system

affected e.g. skin, respiratory, nervous

system, eye..
 CONTINUED
• Some of the diseases that affect workers are:

• Anthrax, brucellosis, rabies, leptospirosis;

• Pneumoconiosis; silicosis, Asbestosis,

Occupational bronchitis and emphysema,
occupational asthma, byssinosis, extrinsic
allergic alveolitis
Occupational infections- zoonoses

• There are a lot of diseases that can be

acquired from animals.

• Zoonoses are common among workers

who are constantly in contact with animals

e.g. farm workers, zoo workers.
Cont’d
• ANTHRAX

• Anthrax is a rare zoonosis caused by

Bacillus anthracis , a spore-forming Gram

+ve bacterium that can survive in soil for
long periods.
Anthrax cont’d
• Epidemiology

• Anthrax occurs mainly in herbivores and is

endemic in the Middle East, Africa, and Asia.

• It is transmitted to humans from infected

animal products, but not human-to-human

spread.
Anthrax cont’d
• Nineteen confirmed cases were notified in

England and Wales 1981–2009 (most were

occupational).
• Since 2009 large outbreaks have occurred

in drug users from infected heroin.

• In zambia, some cases have been reported
Anthrax cont’d
• In some parts of the country especially

among horse handlers and some farm and

wildlife workers.
• Actual statistics are not availale as most

cases go unnoticed.
• It is a NOTIFIABLE disease.
ANTHRAX CONTINUED

• Clinical features

• There are three clinical forms of anthrax;

cutaneous anthrax is the most common.

• Occupationally acquired anthrax is usually

cutaneous.
• Inhalational anthrax in non-endemic areas
Anthrax cont’d
• raises the possibility of bioterrorism.
• Cutaneous anthrax

• Skin lesion appears days or weeks after

exposure, usually on the head, neck, arms,

or hands.
• The lesion is surrounded by oedema and
 Cont’d
• Develops into a characteristic painless ulcer

with a black centre (eschar).

• Cutaneous anthrax can be complicated by

septicaemia.
• GASTROINTESTINAL ANTHRAX

• Acquired by consuming undercooked infected

meat.
Cont’d
• Inhalational anthrax

• Much rarer than cutaneous anthrax but

higher in mortality.
• Characterized by influenza- like illness;

onset up to 48hrs after exposure.

Cont’d
• Causal exposures/industries

• Laboratory staff handling anthrax spores or

infected material
• Workers handling infected hides, e.g.
leather tanners
• Workers handling infected animals, e.g.
Cont’d
• abbatoir workers, veterinary practitioners

• Postal workers (deliberate release)-

Biological weapons
Cont’d

• Clinical assessment and diagnosis

• Suspected cases should be investigated in

liaison with the Special Pathogens

Reference Unit (SPRU) 1 which offers
diagnostic services for rare pathogenic
organisms.
Cont’d

• Investigation includes:

• • Detailed exposure history

• • Serology

• • Blood cultures

• • Swab of lesion fluid for stain and culture

Cont’d

• Biopsy lesion : polymerase chain reaction

(PCR) for b. Anthracis DNA

• Additionally, for inhalational anthrax, CXR,

CT scan of thorax, LFTs.

Prognosis
• Untreated, 5–20% of cutaneous anthrax

cases are fatal.

• Inhalational anthrax is often fatal (775%

despite optimal treatment).

• Prevention Inactivated acellular vaccine

available from the HPA.

Prevention cont’d
• Vaccination only offered to occupational groups

at high risk of exposure (laboratory staff handling

spores/infected material).

• Vaccine not indicated in the public unless

exposed.

•.
MANAGEMENT

• Medical management: Undertaken in

liaison with the Centre for Infectious
diseases.
• Cutaneous anthrax is treatable with oral

antibiotics;
• ciprofloxacin is the drug of choice.
Cont’d
• Management of inhalational anthrax is

• very specialized, involving IV ciprofloxacin

plus two other antibiotics

Post-exposure prophylaxis

• Following exposure, antibiotic treatment ±

vaccination is indicated.
• Antibiotics for 60 days:

• initial 3 days—oral ciprofloxacin 500mg bd

• remaining 57 days—oral ciprofloxacin

500mg bd OR oral doxycycline 100mg bd
CONT’D
•• Immunization:
• Three doses at 0, 3, and 6wks after

exposure given with vaccine, duration of

post-exposure prophylaxis (PEP) antibiotics
can be up to 4wks
• Further doses given at 6mths and 1yr, if
CONT’D
• continuing exposure

• PEP not required for case’s contacts unless

exposed to original source.

Compensation

• in the UK anthrax is a prescribed disease

(B1) for Industrial Injuries

• Disablement Benefit in workers who have

contact with anthrax spores, including

contact with animals infected by Anthrax, or
Compensation

• those involved in handling, loading,

unloading, or transport of a type susceptible
to infection with anthrax or of the products or
residues of such animals
• • HCWs are eligible for NHS Injury Benefit if

they contract anthrax at work and lose pay as

a result.
BRUCELLOSIS
• Brucellosis

• A group of zoonoses caused by the

bacterial species Brucella :
• B. melitensis : sheep and goats

• B. abortus : cattle

• B. suis : pigs.
CONT’D
• Other species are:

• B. ovis

• B. canis,

• B. neotome

• B. microfti and recently isolted in marine

animals, B. maris.
EPIDEMIOLOGY
• The main source of non-occupational
brucellosis is unpasteurized milk products.
Tissue transplant & sex as well
• Epidemiology

• The disease is still endemic in Africa, the

Middle East, Asia, and South America.

EPIDEMIOLOGY CONT’D
• Brucellosis is rare in the UK, USA, Japan,

Australia.
• The 10 cases per year seen in the UK are

almost always acquired abroad.

• There is likely to be under-reporting of

laboratory –acquired occupational infection.

EPIDEMIOLOGY CONT’D
• Recent studies in rural areas of Zambia have

shown that brucellosis is endemic in the

livestock – wildlife interface areas of the blue
lagoon (herd prevalence between 14.1% &
46.2%) and Lochinvar (28.1% & 74%) game
management areas. (Muma et al., 2006)
EPIDEMIOLOGY CONT’D

• Human brucellosis is the most common

zoonosis in the world accounting for 500

000 reported cases annually.
• In Zambia, brucellosis is still a disease of

both socio- economic and public health

importance. (Muma et al 2006)
CLINICAL FEATURES

• Incubation period: 2–8wks

• Symptoms are Non-specific :

• Fever and malaise

• Arthralgia

• The disease can affect any organ system.

Causal exposures/industries (mode of transmission)

• Occupational transmission is through:

• Direct contact with non-intact skin,

• inhalation, or ingestion.

• Direct skin exposure occurs in occupations

that handle raw meat and unpasteurized

dairy products.
CONT’D
• Respiratory exposure is through washing

down farm or slaughterhouse buildings.

• • Farm workers

• • Abattoir workers

• • Meat packers (raw products)

• Veterinary practitioners
CONT’D
• Animal laboratory workers

• Laboratory workers handling Brucella

species or infected material.
• Brucella is a potential candidate for
bioterrorism in view of its high infectivity on
inhalation.
MANAGEMENT

• Clinical assessment

• Diagnosis is by serology and culture of

blood and body fluids in liaison with the

TDRC and Zambia National Public Health
Institute (ZNPHI).
• History of exposure is very important.
TREATMENT AND PROGNOSIS

• Treatment is with antibiotics, usually

combination of Tetracycline-streptomycin or
tetracycline-rifampicin
• PROGNOSIS

• Brucellosis is rarely fatal, but it can cause

prolonged debilitating illness.

PREVENTION

• There is no human vaccine

• Prevention is through good hygiene

practice in slaughterhouses and farms,
including hand washing and wearing
respiratory protection for aerosol-
generating procedures.
COMPENSATION

• Brucellosis is a prescribed disease for

Industrial Injuries Disablement Benefit in

those who handle animals infected by
Brucella , or their carcasses or their
untreated products, or laboratory
specimens containing Brucella .
Relevant legislation

• Brucellosis is notifiable (to Local Authority

Proper Officers) under the Health

Protection (Notification) Regulations 2010
• Brucellosis that is readily attributable to

work is reportable to occupational health

• Board and the workers compensation
board for consideration for compensation.
•LEPTOSPIROSIS
LEPTOSPIROSIS

• Leptospirosis is a zoonotic disease caused

by a spirochaete bacterium of the genus

Leptospira .
• There are many different pathogenic
varieties that use different animal hosts.
• Common carriers of the organism are rats
Cont’d
• ( L. ictohaemhorrhagica), cattle ( L. hardjo ),

and pigs. Dogs do also carry the organism.

• Transmission is through water contaminated

with urine of these animals or blood/flesh.

• Person to person transfer is rare, if it occurs

at all.
Leptospirosis cont’d
• Epidemiology

• Leptospirosis is uncommon. Between 28

and 81 cases per year have been notified

in the UK over the past 10yrs. Some of
these are acquired during leisure activities
or overseas.
Epidemiology cont’d
• In 2010, 42 cases were notified in the UK,

including 10 of occupational origin.

• In USA, largest recorded outbreak occurred in

1998; 775 people were exposed, 110 became

infected.
• In the Philipines, outbreak was reported on
Epidemiology cont’d
• January, 2012 in 2 northern cities
devastated by floods where almost 300
cases and 15 deaths occurred.
CLINICAL FEATURES

• Incubation most commonly 7–14 days

(range 2–30 days)
• Biphasic clinical illness.

1. Acute bacteraemic phase

• Bacteria are disseminated to every organ

system. Characterized by influenza like).

CLINICAL FEATURES Cont’d
• symptoms, headache, chills, and myalgia.

• High fever, chills, vomiting or diarrhoea.

• Most cases are mild and resolve without

treatment,
• Rarely severe illness occurs (Weil’s disease)
 CLINICAL FEATURES Cont’d

2. Immune phase (Weil’s Disease)

• Follows acute phase in some cases.

• Recurrence of fever, associated with jaundice,

conjunctivitis, abdominal pain, meningitis,

rash kidney failure, arrhythmias & lung
problems.
Causal exposures/industries

• Transmission is by direct or indirect contact

with infected animal urine or contaminated

water.
• This usually occurs through intact mucous

membranes or non-intact skin:

• • Farm workers
Cont’d
• Sewerage workers

• Dog handlers

• Abbatoir workers

• Veterinary practitioners.

• Military personnel
CLINICAL ASSESSMENT AND DIAGNOSIS

• Obtain a comprehensive history which

should include history of exposure
• Physical examination should be done.
(helps to establish phase of disease)
• Serological tests are available through the

infectious disease unit at TDRC, UTH lab

or ZNPHI
Cont’d
• Blood culture and CSF in the 1st week of

illness.
• Urine culture ( after 10 days of the illness)-

bacteria takes a long time to grow.

• Liver function test. ELISA, PCR

• Full blood count, malaria test

Treatment and prognosis

• Mild disease: Oral penicillin ( ampicillin or

amoxicillin) or doxycycline.
• Severe cases: IV antibiotics (penicillin G)

recently: 3rd generation cephalosporins-

cefotaxime & ceftriaxone have become
widely used, & intensive support are
required.
Cont’d
• Penicillin G 2mu q.i.d IV/IM

• Doxycycline/ Tetracycline 100mg b.d orally.

• Erythromycin 500mg b.d P.O if allergic to

penicillin
• Ceftriaxone 1gm IV OD or Cefotaxime 1gm

IV 6hrly OR Azithromycin 500mg IV OD

Treatment cont’d
• Supportive treatment - aggressive

• Rehydration if hypotensive

• Monitor vital signs, urine output

• Dealing with unpleasant effects of jaundice

like itching
Prognosis
• Prognosis is good if the diagnosis is made

early and appropriate treatment started.

• Emergency and Intensive Care Units in

rural areas should be aware of the

possibility of leptospirosis in febrile icteric
illnesses.
Prevention

• There is no vaccine for humans

• Prophylactic doxycycline (200mg weekly)

can be given for high-risk occupational

tasks
• Reduce rodent populations by avoiding

rubbish accumulation and culling (selective

slaugter
Prevention cont’d
• Infected farm animals can be immunized

and treated
• PPE (especially waterproof gloves and

footwear) for jobs that entail splashing or

immersion in rivers, puddles, or sewage
• Advise workers of risk and symptoms;
Prevention cont’d
• Information cards are often used for this

purpose.
• Cover cuts and abrasions with waterproof

dressings.
• Wash new cuts thoroughly if acquired near

potentially contaminated water.

Prevention cont’d
• Wash hands with soap and water after

handling animals or animal products.

• Check and ensure that dogs are vaccinated

against leptospirosis.
Compensation

• Leptospirosis is prescribed schedule II

disease in the Workers’ Compensation Act
for Industrial Injuries Disablement Benefit
for those who work in places which might
be infested by rats, field mice, voles, or
other small mammals,
Cont’d
• In dog kennels or the care or handling of

dogs, or
• In contact with bovine animals or their meat

products, or pigs or their meat products.

Relevant legislation

• Since 2010, leptospirosis is no longer

notifiable under public health legislation in

the UK. However,
• Leptospirosis that is reliably attributable to

work is reportable.
• In Zambia, it is a notifiable disease.
Cont’d
• Reading assignment

• Read more on Weil's disease

REFERENCES

• HPA (2012). Brucella Reference Unit (BRU)

Liverpool . Available at: M http://

www.hpa.org.uk/ProductsServices/InfectiousDiseases/Lab
oratoriesAndReferenceFacilities/BrucellaReferenceUnit
.

• Oxford Handbook of Occupational Health.

2nd Edition.
 RABIES
• It is a deadly viral disease of the central

nervous system (CNS) that can affect

mammals.
• It is caused by a genus Lyssaviruses
formerly rabies virus of the rhabdoviridae
family
• It is a neurotropic virus
Overview cont’d

• Most wild mammals can get infected with

rabies.
• Most susceptible animals include bats,
raccoons, skunks, coyotes, foxes and
wolves.
• Rabies in domestic animals can be
Overview cont’d
• prevented by a vaccine. However, dogs,

• Cats and livestock can be infected if not

vaccinated.
• Cats currently make up most of the
reported cases among domestic animals in
the USA.
Overview cont’d
• In Zambia, dogs make up the highest

reports of cases of the disease.

WORKERS AT RISK OF RABIES

• Some workplaces create a risk of exposure

to the rabies virus.

• There are 3 main groups of workers at risk:

1. Workers whose job require frequent

exposure to animal species that can
transmit the virus. These include:
CONT’D
• Veterinary technicians,

• Animal control officers, and

• Wildlife workers

2. Workers whose jobs may incidentally

expose them to a carrier animal species
such as: Spelunkers (cave explorers) and
CONT’D
• Some construction workers e.g. performing

bridge retrofitting jobs).

• 3. research laboratory and vaccine facility

workers who work with live rabies virus ,

and other lab workers such as those
performing rabies diagnostic testing.
CONT’D
• Other jobs may also pose a risk to the

workers e.g. health care workers caring for

infected patients although there are no
documented cases of patient to health
worker transmission.
EPIDEMIOLOGY

• Rabies is found world wide, however, it is

rare in the US due to animal control

programmes. Wildlife account for 90% of
cases.
• In 1997, only 4 cases of human rabies were

reported to CDC.
CONT’D

• In Zambia, the transmission rate to human

is not clear where the source is although

dogs account for a high percentage of
reported transmission to humans.
MODE OF TRANSMISSION
• Humans can be infected when an infected

animals saliva gets through an open

wound, usually the animal’s bite) or through
mucous surface such as eyes, nose, mouth
• Only the saliva or brain tissue of an

infected animal is thought to be infectious.

Cont’d
• Very rarely, humans can be infected with

rabies through non-bite exposure at

workplaces with high concentration of the
rabies virus.
CLINICAL FEATURES
• Incubation Period

• Varies depending on amount of virus

introduced in the body.
• The closer to the CNS the is, the shorter the

incubation period. (head & neck = < 1month)

• .Can be between 1 week to over a year.
CONT’D

• An incubation period as long as 19 yrs has

been reported.
• Incubation period is Usually 1-2 months.

• Rabies progresses through 4 clinical stages

of the:

1. Prodrome
CONT’D

2. Acute neurologic period

3. Coma

4. Death
• In extreme rare cases,

• Recovery.
CONT’D

• PRODROME

• Can last from 1 – 4 days.

• Symptoms are most often non-specific and

consist of:
• Fever, headache, fatigue, loss of appetite,

nausea, vomiting, sore throat and non

CONT’D

• Productive cough.

• The first specific rabies symptom may be:

• Pain or parasthesia (abnormal burning

sensation) at or around the site of
exposure.
• Occurs in about 50-80% of patients
CONT’D

• Acute Neurologic Period

• Lasts about 2 – 7 days

• The 1st neurologic symptoms may include:

• Hyperactivity, confusion, hallucinations,

seizures, anxiety, agitation or other bizarre
behaviour, neck stiffness, or paralysis.
CONT’D

• Other S & S seen during tis stage are:

• Fever, rapid breathing, excessive

salivation, twitching, and convulsions.
• During this stage the mental state
progresses from confusion to
disorientation, stupor, and finally coma.
CONT’D

• COMA

• May last anywhere from hours to months

• Death during coma usually occurs as a result

of respiratory failure or a variety of other

complications.
• RECOVERY: from presumed rabies has been
CONT’D

• Reported in 3 cases all of which has

received either pre- exposure prophylaxis

or post exposure prophylaxis before the
onset of symptoms.
DIAGNOSIS
• No test currently available to diagnose

rabies in humans before clinical symptoms

appear.
• History of exposure is the only helpful

information in diagnosis.
• Rabies should be suspected in patients
 CONT’D

• Who develop progressive encephalitis even if

there is no history of exposure.

• MANAGEMENT

• There are modern vaccines available now.

• PEP

• The decision to give PEP is easier nowadays

CONT’D

• It is based on the following factors:

1. Whether there was direct physical contact

saliva or other materials known to

transmit rabies.

2. Whether the species of animal is known

to carry rabies, and whether rabies is

CONT’D

• Known to be present in the animal

population in the geographical area the
exposure occurred.
3. The exposure situation e.g. whether the
animal was provoked or it attacked without
being provoked.
CONT’D

4. Whether the animal, if it is a domestic dog

or cat, remains healthy after being
quarantined for ten days and watched for
signs of rabies.
• N.B: domestic dogs and cats that bite

humans must be quarantined for 10days &

CONT’D

• Watched for signs of rabies or be killed

immediately and tested for rabies.

• If the animal develops signs and symptoms

of rabies, it should be killed and PEP given

to the person who was bitten.
• Wild animals that bite humans must be
CONT’D

• Killed immediately and tested for rabies as

it is not known for how long the virus is

present in the saliva of infected animals.
• PEP is recommended in situation where a

bat in found in a room where there was a

person sleeping, unattended child, mentally
CONT’D

• Disabled or intoxicated person.

• Other management include:

• Immediate treatment of the wound;

• Wash thoroughly with 20% soap solution

and rinse with large amounts of water.

• Soap with quaternary ammonium compound
CONT’D

• Have been recommended to inactivate the

rabies virus.
• Tetanus toxoid booster should be given.

• Antibiotic treatment are usually indicated.

This is supportive treatment.

PRE-EXPOSURE PROPHYLAXIS

• Given to workers at risk of exposure.

• Given also to those who travel to foreign

countries where canine rabies is endemic.

• Those who may face delay in accessing

medical attention e.g. workers in remote

areas where vaccine are not readily available
CONT’D

• Prevention to be effective:

• 3 vaccines should be given; 1 injection per

week for 3 weeks.

• Blood testing should be done after the

series of injections and every 2-6 year

thereafter.
CONT’D

• Single booster dose given if protection

becomes ineffective.
• If a previous vaccinated person is exposed

to rabies virus, 2 additional doses are given.

• Potential Side Effects:

• Pain, low grade fever after PEP.

CONT’D

• Preventive immunization:

• Pain, redness, swelling at the injection site

in 30-74% of patients
• Systemic reactions: headache, nausea,
abdominal pain & muscle aches : 5-10%.
• 6% more severe reaction: skin rash which
CONT’D

• May be accompanied by arthritis, nausea,

vomiting & fever.

• No deaths reported.

• Reactions are due to preservatives not the

vaccine itself.
 PREVENTION AND CONTROL

• Rabies control programmes e.g. vaccination

of all domestic animals.

• Strict control of human settlement in areas

full of wild animals e.g. game parks.

• Pre- and post exposure treatment of exposed

persons and those at risk of exposure.

ASSIGNMENT

• Read and write notes on the nursing care

of a client with rabies.

• Due date: Tuesday 10th December, 2019
REFERENCES
• CDC control, Human Rabies. Texas and
New Jersey, 1997, 1998.

• CDC control, Compedium of Animal rabies

control, 1997, MMWR 46:RR-4