213221 Neurologic symptoms associated with raising poultry and swine among participants in the Agricultural Health Study

Sunday, November 8, 2009

Meghan Davis, DVM, MPH , Department of Environmental Health Sciences, Johns Hopkins School of Public Health, Baltimore, MD
Freya Kamel, PhD, MPH , Epidemiology Branch and National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC
Jane Hoppin, ScD , Epidemiology Branch and National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC
Michael Alavanja, DrPH , Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
Laura Freeman, PhD , Niehs, NIEHS, Research Triangle Park, NC
Gregory Gray, MD, MPH , Dept of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
Guy McKhann, MD , Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
Kenrad Nelson, MD , Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
Ellen K. Silbergeld, PhD , Department of Environmental Health Sciences, Johns Hopkins School of Public Health, Baltimore, MD
Background:Guillain-Barré Syndrome (GBS) is the leading cause of acute peripheral neuropathy worldwide. The major identified risk factor is recent foodborne infection with Campylobacter jejuni. Although food animal production may expose workers to Campylobacter, only one previous study examined occupational risks for C. jejuni-associated neurologic disease. Methods:In this cross-sectional analysis of data from the Agricultural Health Study, a study of North Carolina and Iowa farmers recruited 1993-1997, we tested the hypothesis that swine and poultry exposure (surrogates for Campylobacter exposure) increased prevalence of GBS-like neurologic symptoms among 15,932 farmers. We examined the symptoms numbness and weakness, which are relevant to inflammatory peripheral neuropathies, including GBS, as well as other symptoms not relevant to GBS. Using multivariate analysis, we tested symptom prevalence among farmers with self-reported occupational poultry or swine exposure compared to farmers who reported no occupational animal exposure. We evaluated four exposure categories: swine farmers, swine workers, poultry farmers and poultry workers. Results:Among swine farmers and workers, risk of numbness was increased 18% and 23% respectively and risk of weakness was increased 22% and 28% respectively (p<0.05). Among poultry farmers and workers, risk of numbness was increased 27% and 25% respectively (p<0.05) and risk of weakness was increased by 19% and 23% respectively, but the latter increases were not statistically significant (p=0.10 and 0.07). No increase in self-reported speech or vision problems was observed. Conclusions:Occupational contact with live poultry or swine, potentially related to higher exposure to C. jejuni, was associated with increased reporting of symptoms of GBS-like peripheral neuropathy.

Learning Objectives:
Discuss potential risks of neurologic symptoms to pig and poultry farmers compared to farmers who do not work with animals.

Keywords: Occupational Health, Agricultural Work Safety

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Professional positions 2000- present Large and small-animal clinical veterinary experience 2007- present Graduate Student, Johns Hopkins School of Public Health, Baltimore, MD 2007-08: MPH Program, Sommer Scholar. Research in occupational health risks of farmers. 2008-present: Dept. of Environmental Health, Sommer Scholar. Research in occupational health risks associated with farm environments. Research in microbiology. Recent Awards and Other Professional Activities Sommer Scholar, M.P.H program and Ph.D. program, JHSPH, 2007 – present. Delta Omega Honor Society, M.P.H., JHSPH, Inducted May 2008 Teaching Assistant, JHSPH, 2008-present: Dr. Homayoon Farzadegan. Perform TA duties for Summer Institute 2008: Epi of HIV and Advanced HIV; Serve as Lead TA for 2008-09 online course series: Human Viral Infections, Epi of HIV, and Advanced HIV. Serve as assistant TA for 2008-09 onsite courses: Human Viral Infections and Epi of HIV; Give lectures in “HIV-Malaria Co-infection,” and “Rabies.” Professional Memberships: Pennsylvania Veterinary Medical Association, Maryland Veterinary Medical Association, American Veterinary Medical Association, American Public Health Association, Society for Epidemiologic Research Selected Papers and Presentations MPH Program Capstone Presentation, May 2008: “Neurologic symptoms associated with poultry and swine raising among participants in the Agricultural Health Study.” Silbergeld ES, Davis MF, Leibler JH, and Peterson AE. One Reservoir: Redefining the Community Origins of Antimicrobial Resistant Infections. Chapter in Medical Clinics of North America. November, 2008. Olsen SJ, Ying M, Davis MF et al. Multidrug-resistant Salmonella typhimurium infection from milk contaminated after pasteurization. Emerg Infect Dis. 2004 May;10(5):932-5. Davis, Meghan & the W&M Fever Study Group & Carl W. Vermeulen. 1 Dec 95. Additional Anti-Bacterial Mechanisms of Fever: Malformation of the Cell Envelope; Suppressed Ribosome Content; Induction of Dormancy Coupled with Thermal Killing. (Poster session)
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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