SEWAGE WORKERS AND HEPATITIS RISK
"Should workers in sewage treatment plants receive hepatitis vaccine?" inquires WALTER EWING, MD, of Orillia, Ont.
Hepatitis B virus (HBV) is only occasionally found in the feces of infected individuals, and human as well as animal data suggest that the oral-fecal route of transmission is neither efficient nor chemically significant in the epidemiology of HBV. Also, water and food are almost never identified as the source of infection. For these reasons, there doesn't seem to be any basis for recommending HBV vaccine to sewage workers because of occupational exposure. On the other hand, sewage workers are known to be at increased risk for hepatitis A virus (HAV). I'm not aware of any studies or recommendations so far, however, for the administration of HAV vaccine to these individuals. Ref: Lemon SM and Thomas DL. Vaccines to prevent viral hepatitis. N Engl J Med 1997;336(3):196-204.