Hepatitis A in workers exposed to sewage: a systematic review

Area of Science:

• Occupational Health
• Epidemiology
• Infectious Diseases

Background:

• Workers exposed to sewage may face occupational health risks.
• Hepatitis A (HA) is a potential concern in such occupational settings.
• Previous hypotheses suggested an elevated risk of HA among sewage workers.

Purpose of the Study:

• To systematically review scientific literature on the risk of hepatitis A (HA) in workers exposed to sewage.
• To evaluate the evidence supporting or refuting the hypothesis of increased HA risk in this occupational group.

Main Methods:

• Conducted a systematic review of eligible epidemiological studies published in English, French, or German.
• Included studies reporting on the risk of HA infection in sewage-exposed workers.
• Assessed study designs, evaluated publication bias, and examined heterogeneity among risk estimates, distinguishing between clinical and subclinical HA.

Main Results:

• Identified 17 eligible studies; no evidence supported an increased risk of clinical HA.
• Strongest study designs suggested a slightly increased risk of subclinical HA (odds ratio <2.5).
• Considerable heterogeneity precluded meta-analysis, and publication bias further weakened the association.

Conclusions:

• The systematic review does not confirm an increased risk of clinical hepatitis A in workers exposed to sewage.
• An elevated risk of subclinical HA cannot be definitively excluded but the association is weak and diminished by publication bias.
• Further research may be needed to clarify the nuanced relationship between sewage exposure and subclinical hepatitis A.