Avian Influenza A(H9N2) Virus in Poultry Worker, Pakistan, 2015.

Avian influenza A(H9N2) virus isolated from a poultry worker in Pakistan in 2015 was closely related to viruses detected in poultry farms. Observed mutations in the hemagglutinin related to receptor-binding affinity and antigenicity could affect cross-reactivity with prepandemic H9N2 vaccine strains.

Avian Influenza A Virus Infection among Workers at Live Poultry Markets, China, 2013-2016.

We conducted a 3-year longitudinal serologic survey on an open cohort of poultry workers, swine workers, and general population controls to assess avian influenza A virus (AIV) seroprevalence and seroincidence and virologic diversity at live poultry markets (LPMs) in Wuxi City, Jiangsu Province, China. Of 964 poultry workers, 9 (0.93%) were seropositive for subtype H7N9 virus, 18 (1.87%) for H9N2, and 18 (1.87%) for H5N1. Of 468 poultry workers followed longitudinally, 2 (0.43%), 13 (2.78%), and 7 (1.5%) seroconverted, respectively; incidence was 1.27, 8.28, and 4.46/1,000 person-years for H7N9, H9N2, and H5N1 viruses, respectively. Longitudinal surveillance of AIVs at 9 LPMs revealed high co-circulation of H9, H7, and H5 subtypes. We detected AIVs in 726 (23.3%) of 3,121 samples and identified a high diversity (10 subtypes) of new genetic constellations and reassortant viruses. These data suggest that stronger surveillance for AIVs within LPMs and high-risk populations is imperative.

Good job, bad job: Occupational perceptions among Latino poultry workers.

OBJECTIVES: Immigrant workers frequently take jobs that are physically demanding, provide low wages, and result in injuries (e.g., poultry production and processing). Through a qualitative approach, this paper elicits poultry workers' evaluations of their jobs and set them in the larger context of their lives. METHODS: Semi-structured interviews were conducted with 65 poultry workers in western North Carolina. Workers were asked to discuss job characteristics, physical and psychological impacts of their employment, and perceived health risks. RESULTS: Immigrant workers valued the stability, benefits, upward mobility, and pay offered. They disliked the physical demands, the potential perceived effects of the job on their health, and the interactions with bosses and peers. CONCLUSIONS: Workers' willingness to endure dirty, dangerous, and demanding (3-D) conditions of poultry must be understood in the context of other employment options, structural violence, and their focus on immediate family needs that positive aspects of these jobs can fulfill. Am. J. Ind. Med. 59:877-886, 2016. © 2016 Wiley Periodicals, Inc.

Avian-origin influenza A(H7N9) infection in influenza A(H7N9)-affected areas of China: a serological study.

Serological surveillance conducted in areas of an outbreak of influenza A(H7N9) infection in China found no seropositivity for antibodies specific for avian-origin influenza A(H7N9) among 1129 individuals of the general population, whereas >6% of 396 poultry workers were positive (on the basis of a hemagglutination inhibition titer of ≥ 80) for this subtype, confirming that infected poultry is the principal source of human infections and that subclinical infections are possible. Fourteen days after symptom onset, elevated levels of antibodies to A(H7N9) were found in 65.8% of patients (25/38) who survived but in only 28.6% of those (2/7) who died, suggesting that the presence of antibodies may improve clinical outcome in infected patients.

Seroprevalence to avian influenza A(H7N9) virus among poultry workers and the general population in southern China: a longitudinal study.

BACKGROUND: Confirmed cases of avian influenza A(H7N9) virus infection in humans continue to occur in mainland China. Few confirmed cases have occurred in poultry workers despite potentially higher rates of exposure. METHODS: A serological survey was conducted in May and December 2013 in poultry market workers, and in March and September 2013 in the general population. Blood samples were collected and tested for antibodies to H7N9 and H5N1 viruses by hemagglutination inhibition (HI) assays. Multivariable analysis was employed to identify risk factors related to H7N9 infection indicated by serology among poultry workers. RESULTS: In the poultry workers, 36 of 501 (7.2%) in May and 56 of 375 (14.9%) in December had HI antibody titers ≥1:160 to H7N9. Of 96 individuals who participated in both surveys, 52 (54.2%) workers had a ≥4-fold rise in H7N9 antibody titers from May to December. In a multivariable analysis, female sex (odds ratio [OR], 2.713; 95% confidence interval [CI], 1.098-6.705) and ≥10 years of occupational exposure (OR, 3.592; 95% CI, 1.246-10.354) were identified as risk factors for infection. Seroprevalence against H5N1 at ≥1:160 was low in May (4/501 [0.8%]) and December (3/375 [0.8%]). In the general population, 0 of 417 individuals in March and 0 of 408 individuals in September had antibody titers ≥1:160 to H7N9 or to H5N1. CONCLUSIONS: Although none of the participants in our study had virologically confirmed H7N9 infection, the high proportion of poultry workers with serologic evidence of H7N9 infection between May and December 2013 suggests a substantial risk of mild H7N9 infections in this group, supporting stricter control measures in live poultry markets.

Highly pathogenic avian influenza A(H7N3) virus in poultry workers, Mexico, 2012.

We identified 2 poultry workers with conjunctivitis caused by highly pathogenic avian influenza A(H7N3) viruses in Jalisco, Mexico. Genomic and antigenic analyses of 1 isolate indicated relatedness to poultry and wild bird subtype H7N3 viruses from North America. This isolate had a multibasic cleavage site that might have been derived from recombination with host rRNA.

Mild illness in avian influenza A(H7N9) virus-infected poultry worker, Huzhou, China, April 2013.

During April 2013 in China, mild respiratory symptoms developed in 1/61 workers who had culled influenza A(H7N9) virus-infected poultry. Laboratory testing confirmed A(H7N9) infection in the worker and showed that the virus persisted longer in sputum than pharyngeal swab samples. Pharyngeal swab samples from the other workers were negative for A(H7N9) virus.

Prevalence of bifid median nerves and persistent median arteries and their association with carpal tunnel syndrome in a sample of Latino poultry processors and other manual workers.

INTRODUCTION: The prevalence of bifid median nerves and persistent median arteries, their co-occurrence, and their relationship to carpal tunnel syndrome (CTS) are only understood partially. METHODS: We screened 1026 wrists of 513 Latino manual laborers in North Carolina for bifid median nerves and persistent median arteries using electrodiagnosis and ultrasound. RESULTS: A total of 8.6% of wrists had a bifid median nerve, and 3.7% of wrists had a persistent median artery independent of subgroup ethnicity, age, gender, or type of work. An association with definite carpal tunnel syndrome was not found. The presence of either anatomic variant was associated with a high likelihood of co-occurrence of another variant in the same or the contralateral wrist. CONCLUSIONS: The occurrence of median anatomic variants can be determined in field studies using ultrasound. Persistent median arteries and bifid median nerves tend to co-occur but do not put manual laborers at additional risk of developing CTS.

Quinolone-resistant Escherichia coli at the interface between humans, poultry and their shared environment- a potential public health risk.

BACKGROUND: Commensal Escherichia coli residing in the guts of humans and animals are reservoirs of multidrug resistance (MDR) genes, including quinolone resistance genes, in humans and poultry. This study aimed to characterize quinolones resistance in E. coli recovered from poultry workers, chickens, and poultry farm/market environments in Abuja, Nigeria. METHODS: This was a cross-sectional study conducted between December 2018 and April 2019 comprising poultry workers, chickens and their poultry farm/market environments. This study characterized E. coli isolates from stool, faecal and environmental samples using antimicrobial susceptibility testing and whole-genome sequencing methods. Core-genome multilocus sequences-based phylogeny was used to determine the relatedness between quinolone-resistant E. coli isolates. Data were analyzed using descriptive statistics. RESULTS: Of 110 E. coli isolates, quinolone-resistant phenotypes were observed in 68.2% (n = 75) isolates. Whole-genome sequencing detected plasmid-mediated quinolone resistance (PMQR) genes in 63.6% (n = 70) isolates. The most prevalent PMQR gene detected in 56 of these 70 E. coli isolates was qnrS1, followed by qnrB19 in 14 isolates and aac(6')-lb-cr in two isolates. Fifteen ciprofloxacin and 19 nalidixic acid-resistant isolates respectively showed double mutations in the quinolone-resistance determining regions (QRDRs) of gyrA, with single or double mutations in parC, and a single mutation in parE. The most prevalent amino-acid substitutions observed were S83L + D87N in gyrA (46.5%, n = 20), S80I in parC (51.2%, n = 22) and S458A in parE (14%, n = 6). About 2.9% (2/70) of PMQR isolates were extended-spectrum beta-lactamase (ESBL) producers while 2.9% (2/70) had plasmid-mediated colistin resistance (PMCR) genes. CONCLUSIONS: PMQR genes were prevalent in E. coli isolates recovered from healthy humans, chickens and poultry farm/market environments. PMCR genes (mcr-1.1) occurred in PMQR-positive isolates recovered from manure and drinking water originating from poultry farm/market environments. It was found that the gene encoding ESBL coexisted with qnrS-positive isolates of human and avian origin. Horizontal transfer of PMQR genes among E. coli isolates in the human-poultry-environment interface has public health implications for the spread of antimicrobial resistance. Relevant government agencies should enforce regulations to restrict the use of critically important antimicrobials in poultry production.

Respiratory symptoms and lung functional impairments associated with occupational exposure to poultry house pollutants.

This study aimed to assess respiratory symptoms and the pulmonary function test (PFT) in a group of poultry workers. The prevalence of respiratory symptoms was determined. Airborne concentrations of total and repairable dusts exceeded the threshold limit values. Gram-positive cocci and Cladosporium were the dominant genera of bacteria and fungi, respectively. The prevalence of respiratory symptoms was significantly higher in the exposed subjects. Mean baseline values of forced expiratory volume (FEV1), FEV1 to forced vital capacity (FVC) ratio (FEV1/FVC) and peak expiratory flow (PEF) were significantly lower in the exposed group. Significant cross-shift decrements were noted in vital capacity (VC), FVC, FEV1, PEF and FEV1/FVC of the exposed subjects. A dominant pattern of lung function abnormality was found to be obstructive. Exposure to poultry pollutants may result in a significant increase in the prevalence of respiratory symptoms as well as both acute reversible and chronic irreversible decrements in the PFT.

Avian influenza A (H9N2) virus infections among poultry workers, swine workers, and the general population in Beijing, China, 2013-2016: A serological cohort study.

BACKGROUND: Few studies have reported on the seroprevalence of antibodies against avian influenza A (H9N2) virus and the incidence of these infections in the northern China and among swine workers. METHODS: We conducted a serological cohort study among people working with poultry or swine or the general population in Beijing, China. It comprised four cross-sectional serological surveys in November 2013, April 2014, April 2015, and April 2016. Blood samples collected from the participants were tested for anti-H9N2 antibodies using a hemagglutination-inhibition (HI) assay. Multivariable Poisson regression model was then used to compare the person-month incidence rates for H9N2 viral infections among the three groups, assessed by incidence rate ratio (IRR). RESULTS: In the four cross-sectional surveys, the highest seroprevalence of anti-H9N2 antibodies (HI titer ≥ 80) was recorded in the poultry workers (2.77%, 19/685) in April 2016, while the lowest was recorded in the general population (0.09%, 1/1135) in April 2015. The highest incidence density rate for H9N2 infections across the whole study period was recorded among the poultry workers (3.75/1000 person-months), followed by the swine workers (1.94/1000 person-months) and the general population (1.78/1000 person-months). Multivariable analysis showed that the poultry workers were at higher risk (IRR: 2.42, 95% CI: 1.07-5.48; P = 0.034) of contracting H9N2 virus than the general population. CONCLUSIONS: Although the seroprevalence of H9N2 antibodies was low in Beijing, the poultry workers were at higher risk of contracting H9N2 viral infections than the general population. Closer monitoring and strengthened protection measures for poultry workers are warranted.

Sero-epidemiologic study of influenza A(H7N9) infection among exposed populations, China 2013-2014.

BACKGROUND: The first human infections of novel avian influenza A(H7N9) virus were identified in China in March 2013. Sentinel surveillance systems and contact tracing may not identify mild and asymptomatic human infections of influenza A(H7N9) virus. OBJECTIVES: We assessed the seroprevalence of antibodies to influenza A(H7N9) virus in three populations during the early stages of the epidemic. PATIENTS/METHODS: From March 2013 to May 2014, we collected sera from the general population, poultry workers, and contacts of confirmed infections in nine Chinese provinces reporting human A(H7N9) infections and, for contacts, second sera 2-3 weeks later. We screened for A(H7N9) antibodies by advanced hemagglutination inhibition (HI) assay and tested sera with HI titers ≥20 by modified microneutralization (MN) assay. MN titers ≥20 or fourfold increases in paired sera were considered seropositive. RESULTS: Among general population sera (n=1480), none were seropositive. Among poultry worker sera (n=1866), 28 had HI titers ≥20; two (0.11%, 95% CI: 0.02-0.44) were positive by MN. Among 61 healthcare and 117 non-healthcare contacts' sera, five had HI titers ≥20, and all were negative by MN. There was no seroconversion among 131 paired sera. CONCLUSIONS: There was no evidence of widespread transmission of influenza A(H7N9) virus during March 2013 to May 2014, although A(H7N9) may have caused rare, previously unrecognized infections among poultry workers. Although the findings suggest that there were few undetected cases of influenza A(H7N9) early in the epidemic, it is important to continue monitoring transmission as virus and epidemic evolve.

Cage Versus Noncage Laying-Hen Housings: Worker Respiratory Health.

The objective of this study was to compare respiratory health of poultry workers in conventional cage, enriched cage and aviary layer housing on a single commercial facility, motivated by changing requirements for humane housing of hens. Three workers were randomly assigned daily, one to each of conventional cage, enriched cage, and aviary housing in a crossover repeated-measures design for three observation periods (for a total of 123 worker-days, eight different workers). Workers' exposure to particles were assessed (Arteaga et al. J Agromedicine. 2015;20:this issue) and spirometry, exhaled nitric oxide, respiratory symptoms, and questionnaires were conducted pre- and post-shift. Personal exposures to particles and endotoxin were significantly higher in the aviary than the other housings (Arteaga et al., 2015). The use of respiratory protection was high; the median usage was 70% of the shift. Mixed-effects multivariate regression models of respiratory cross-shift changes were marginally significant, but the aviary system consistently posted the highest decrements for forced expiratory volume in 1 and 6 seconds (FEV1 and FEV6) compared with the enriched or conventional housing. The adjusted mean difference in FEV1 aviary - enriched cage housing was -47 mL/s, 95% confidence interval (CI): (-99 to 4.9), P = .07. Similarly, for FEV6, aviary - conventional housing adjusted mean difference was -52.9 mL/6 s, 95% CI: (-108 to 2.4), P = .06. Workers adopting greater than median use of respiratory protection were less likely to exhibit negative cross-shift pulmonary function changes. Although aviary housing exposed workers to significantly higher respiratory exposures, cross-shift pulmonary function changes did not differ significantly between houses. Higher levels of mask use were protective; poultry workers should wear respiratory protection as appropriate to avoid health decrements.

Knowledge, attitudes, and poultry-handling practices of poultry workers in relation to avian influenza in India.

UNLABELLED: Avian influenza (AI) is a viral disease of domestic and wild birds. The recent pandemics caused by highly pathogenic AIA (H5N1) in domestic poultry is currently rated phase 3 by the World Health Organization on the pandemicalert scale. MATERIALS AND METHODS: A pretested and semistructured survey instrument was administered to both live bird market and poultry farm workers in two most populous cities in Karnataka in South India to collect data on demographics, knowledge, attitude, and practices among them. RESULTS: The mean age was similar among both population groups (31.5 years). There was a higher level of biosecurity practices adopted in poultry farms compared with those adopted in live bird market. Knowledge regarding AI was acceptable but poorly correlated with actual biosecurity practices. DISCUSSION: Live bird market and poultry farm workers have been identified as the weakest link in the prevention and control of the spread of AI in the two most populous cities studied in Karnataka. CONCLUSION: Risk reduction models of behavior change targeting these groups are important toward the control and prevention of AI spread.