A Clustering of Immune-mediated Polyradiculoneuropathy among Swine Abattoir Workers Exposed to Aerosolized Porcine Brains, Indiana, United States
ABSTRACT In November 2007 a novel neuropathy, immune-mediated polyradiculoneuropathy (IP), was identified among workers at a Minnesota swine abattoir where a unique compressed air technique was used to remove porcine brains. An epidemiologic investigation at another abattoir in Indiana that also uses this process was launched to evaluate workers self-reporting neurologic illness compatible with IP. A nested case-control study was performed to identify cases and risk factors. Six confirmed, one probable, and three possible IP cases were detected. IP cases were 28-52 years old, of Latino origin, and 62.5% female. Onset dates ranged from April 2005-December 2007; 60% were hospitalized. IP cases at this plant were similar in clinical presentation and exposure risks to those detected in Minnesota. Swine abattoirs using similar brain extraction methods should discontinue this process.
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ABSTRACT: In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004-November 2007. Median age was 32 years (range, 21-55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6-26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5-68.5), and worked within 0-10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2-80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNgamma) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNgamma in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting.PLoS ONE 03/2010; 5(3):e9782. DOI:10.1371/journal.pone.0009782 · 3.53 Impact Factor
Article: Hersenschade door werk?[Show abstract] [Hide abstract]
ABSTRACT: Er bestaat een breed scala aan gezondheidseffecten door blootstelling aan allerlei neurotoxische stoffen in het werk, variërend van milde narcotische effecten tot invaliderende neurologische aandoeningen zoals parkinsonisme en dementie. Ook kan een acute intoxicatie door bijvoorbeeld zwavelwaterstof of koolmonoxide een direct letaal effect hebben. Klassieke neurologische beroepsziekten veroorzaakt door kwik, lood en bestrijdingsmiddelen komen sporadisch voor in Nederland. Ook chronische toxische encefalopathie (CTE), ook wel organisch psychosyndroom (OPS) genoemd, is op zijn retour door de vervangingsplicht, betere hygiëne en gezondheidsbewaking bij het werken met neurotoxische stoffen. Onverwacht kunnen zich toch nieuwe beroepsziekten voordoen door veranderde werkmethoden, nieuwe stoffen of andere toepassingen van bekende neurotoxische stoffen; enkele voorbeelden hiervan worden gegeven. Bij acute intoxicaties is het causaal verband meestal evident, maar vindt onderzoek naar de precieze oorzaak vaak marginaal plaats doordat in de acute fase de zorg primair op behandeling is gericht; leermomenten voor preventie worden hierdoor gemist. Bij chronische intoxicaties, waarbij het ziektebeeld sluipend ontstaat, is de causale diagnostiek lastig door het minder specifieke ziektebeeld met complexe differentiaaldiagnostiek. Aan de hand van twee ziektegeschiedenissen wordt ingegaan op de diagnostiek, revalidatie en preventie van beroepsziekten door neurotoxische stoffen.Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde 10/2010; 18(8):363-368. DOI:10.1007/BF03089130
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ABSTRACT: We and others have recently reported that prions can be transmitted to mice via aerosols. These reports spurred a lively public discussion on the possible public-health threats represented by prion-containing aerosols. Here we offer our view on the context in which these findings should be placed. On the one hand, the fact that nebulized prions can transmit disease cannot be taken to signify that prions are airborne under natural circumstances. On the other hand, it appears important to underscore the fact that aerosols can originate very easily in a broad variety of experimental and natural environmental conditions. Aerosols are a virtually unavoidable consequence of the handling of fluids; complete prevention of the generation of aerosols is very difficult. While prions have never been found to be transmissible via aerosols under natural conditions, it appears prudent to strive to minimize exposure to potentially prion-infected aerosols whenever the latter may arise - for example in scientific and diagnostic laboratories handling brain matter, cerebrospinal fluids, and other potentially contaminated materials, as well as abattoirs. Equally important is that prion biosafety training be focused on the control of, and protection from, prion-infected aerosols.Prion 07/2011; 5(3):138-41. DOI:10.4161/pri.5.3.16851 · 1.97 Impact Factor