Expert forecast on emerging biological risks related to occupational safety and health (OSH)

1. Expert forecast on emerging biological risks related to occupational safety and health (OSH)

2. Background: Community Strategy for OSH • 2002-2006: asked the Agency “to anticipate risks and bring them under control” and “to create a European Risk Observatory, to provide forward-looking information for policy-makers” • 2007-2012: consolidates the role of the ERO as regards risk anticipation and in particular to include biological hazards. The Agency should “help to pinpoint and monitor trends and new risks and identify measures which are essential.”

3. European Risk Observatory (ERO) • Aim: the identification of emerging risks • Analyse trends, anticipate changes in the world of work and their possible effects on OSH • Stimulating reflection among the Agency’s stakeholders and providing a platform for debate

4. Emerging risks: “New and increasingrisks” “New” if: • A completelynew risk, or • A long-standing issue newly considered a risk due to a change in public perception, or • New scientific knowledge leads a long-standing issue to be identified as a risk

5. “New andincreasing risks” “Increasing” if… • The number of hazards leading to the risk is growing, or • There is a higher likelihood of exposure to those hazards, or • The harm caused is worsening (in severity, or in numbers affected)

6. Expert forecasts of ERs: Delphi surveys • 4 Delphi surveys(physical, chemical, biological & psychosocial risks): • 520 experts invited to participate • Round 1: Identification of issues • Round 2: Validation and prioritisation • Round 3: Final consultation • Forecast by 188 experts (RR=35%):prioritised lists of ERs if necessary

7. Expert forecast: Emerging Biological risksMain results 109 experts contacted/ 36 responses received in 3rd round • OSH risks linked to pandemics • Drug-resistant pathogens (e.g. Methicillin Resistant Staphylococus Aureus - MRSA) • Indoor moulds • Poor maintenance of HVAC systems: spread of Legionella, aspergilosis & drug-resistant micro-organisms (in hospitals) - Maintenance workers are also at risk! • Biological agents in waste treatment • Endotoxins (recycling, livestock industry, etc.) • Difficult assessment of biological risks • Combined exposure to airborne biological agents and chemicals

8. Biological agents in the workplace Situation in the EU (1) • 15% of EU workers report handling dangerous substances (DS)[1] • Nearly one in 10 workers (9%) reports being exposed to infectious materials (such as waste, body fluids and laboratory materials) [1] • More women (5%) than men (2%) report a high level of such exposure as they work more in occupations that involve biological hazards and exposure [1] [1]EU working condition survey 2005

9. Biological agents in the workplace Situation in the EU (2) • In France, 15% of the workforce (2.6 million workers) are exposed to biological agents in their jobs in 2003 [2] • More than 50% of those are employed in health and social work, where 66% are in contact with biological agents [2] • High exposure also found in agriculture, manufacture of food products, services to individuals and households, research and development, and sanitation activities. [2] • [2]SUMER survey 2003

10. Biological agents in the workplace Situation in the EU (3) • 320,000 workers die worldwide every year of communicable diseases caused by biological agents [1] • 5,000 of these fatalities in the European Union • At least 15% of all new cases of cancer worldwide are caused by viruses, bacteria or parasites (e.g. aflatoxin B1 from Aspergillius flavus, hepatitis B, wood dust) [2] • 1,900 cases of recognised occupational diseases due to biological agents in the EU-15 in 2001 [3] • Long workplace absences due to infectious diseases [1]Driscoll, T., & al. ‘Review of estimates of the global burden of injury and illness due to occupational exposures’, American Journal of Industrial Medicine, 2005 [2]Bosch et al. 'Infections', UICC Handbook for Europe, International Union Against Cancer, 2004 [3]EODS, 'Occupational diseases in Europe in 2001', Eurostat

11. Pandemics and OSH risks (1) • New pathogens emerge (SARS, avian flu, Marburg) & “old” ones re-emerge (cholera, dengue, measles, yellow fever) • Over ¾ of human diseases are zoonoses • A new contagious virus could spread worldwide in less than 3 months due to high speed/volume of international transport. • 89 Dutch poultry workers infected with A/H7N7 in 2003

12. Pandemics and OSH risks (2) • In 2003, 2 nurses and 1 doctor died from SARS in Toronto, after contact with an infected individual from China. This outbreak led to 128 SARS infections, mostly in medical staff. • High risk of dengue fever in international trade of goods: • California: in 2001, Aedes albopictus found in 14 tyre-resellers - was introduced by a cargo ship from China. • France: 1st found in 1999 in a tyre plant  national monitoring system

13. Pandemics and OSH risks (3) • 3 million health care workers (out of 35millions) exposed to HBV, HCV and HIV every year via percutaneous injuries.In 2005, 24.5 million workers lived with HIV out of 38.6 infected persons worldwide. Also affects sex workers, transport and mobile workers. • Pandemics are not only a workplace issue because it affects the workforce, but also because the workplace can play a crucial role in limiting transmission • Need to be dealt with globally and in cooperation between various disciplines, such as OSH, public health, animal health, environmental protection and food safety.

14. Drug-resistant microorganisms (1) • Contributing factor: overuse or misuse of antibiotics • E.g. MRSA and TB in health care, especially in hospitals • Extensively drug-resistant TB resistant to 2nd line drugs has appeared worldwide, especially where HIV prevalence is high • Inhalation of virginiamycin-resistant gram+ bacteria in swine facilities may contribute to quinupristin-dalfopristin-resistant gram+ infections in humans, with few treatment options

15. Drug-resistant microorganisms (2) • In farming: EU-ban since 01/06 on antibiotics for non-medical purposes, but still used e.g. in intensive farming with overcrowded unsanitary conditions prone to infections.  Inevitable but controllable  Overlap with public sphere: control programmes for monitoring the use of antibiotics

16. Indoor mould • 100,000 species of moulds identified - over 1.5 million may exist • Ubiquitous indoors, even in newer buildings due to construction/insulation techniques and HVAC systems • Upper respiratory diseases, asthma, infections, headaches, allergies, irritation of the nose, throat, eyes and skin, SBS • An increase in mould-related diseases is reported In Finland (2002) moulds caused 264 work-related diseases, of which 155 allergies, in healthcare (71cases), public administration (49), agriculture (43), education (42), construction (7) • Health-based exposure limits are not yet established • Guidelines exist but are not harmonised

17. Waste treatment activities (1) • New, growing industry – Germany: 300,000 workers * • DK: collecting solid waste is one of the most hazardous jobs**: • illness rate twice as high as in other jobs • and infectious diseases rate six times as high. • Complex mixtures of airborne micro-organisms, incl. mould and their toxins (e.g. endotoxins), and VOCs * Le risque biologique encouru par les salariés en Europe, Europgip, 2007 ** Mapping health and safety standards in the UK waste industry. Bomel Limited, HSE

18. Waste treatment activities (2) • Effects: upper airway inflammations, pulmonary diseases, ODTS, allergies, skin diseases, irritation of the eyes and mucous membranes, gastrointestinal problems • Environmental policies address OSH issues insufficiently - waste handling / treating technologies even increase risks for workers Not possible to eliminate biohazards completely, but possible to reduce the generation of dust and aerosols - Example of preventive measures from the Member States  Adapt prevention to the particularity of the branch / activity

19. Endotoxins • Mostly found in organic dust, which is widespread in occupational settings: farming, swine and poultry housings, waste and sewage treatment, and even indoor workplace with mould growth. • Responsible for many of the virulent effects of gram-negative bacteria • Effects: ODTS, chronic bronchitis, allergies, asthma-like symptoms, fever – can contribute to toxi-infections, organ failure, septic shock, and even death. • Paradox: May induce but also protect from asthma, respiratory allergies and sensitisation allergens • The lack of reliable, harmonised quantitative exposure assessment methods hampers the risk assessment.  Need for standardised measurement methods

20. Assessment of biological risks Directive 2000/54/EC: Employers must assess the risks BUT: • The state of knowledge on biohazards is still scarce • Employers’ and workers’ awareness for biological agents is low, in particular where their presence is unintentional • Need for validated, harmonised measurement methods to enable the exposure assessment • Need for more epidemiological and clinical data to establish reliable dose-effect relationships • Need for research on effects of combined exposures • Good Practice available in some the Member States

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22. Expert forecast on emerging biological risks related to OSH Additional information: • Agency’s information on biological agents:http://osha.europa.eu/en/topics/ds/biological_agents • Agency’s single entry point on dangerous substances:http://osha.europa.eu/en/topics/ds • Publication: http://osha.europa.eu/en/publications/reports/7606488/view • European Risk Observatory: http://riskobservatory.osha.europa.eu • European Agency for Safety and Health at Work: http://osha.europa.eu/ Thank you for your attention!