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					    Poultry Production in
Maryland: Environmental
 Impacts and Community
            Health Issues
Ellen Silbergeld
EHS/BSPH
July 2006
Research at JHSPH on Poultry
Production
 EPIDEMIOLOGY
    EXPOSURE, HEALTH OUTCOMES
 PRODUCT MONITORING
    POULTRY PRODUCTS TESTING
 ENVIRONMENTAL STUDIES
    PATHWAYS AND ROUTES OF EXPOSURE
       AIR, WATER, DUSTS, SOILS
       BIOTIC TRANSFERS – WILDLIFE STUDIES
 MOLECULAR MICROBIOLOGY
    TRACKING PATHOGEN MOVEMENT
    TRACKING GENE TRANSFER
    MICROBIAL POPULATION GENETICS/DIVERSITY
 POLICY ANALYSIS
    ECONOMIC ANALYSES
    SCIENTIFIC BASIS for RISK ASSESSMENT
The CAFO (Concentrated Animal Feeding
Operation): Changes in Food Animal
Production since1930

 Factory farms –
  integrated production
  model
 Concentrated, high
  volume housing and
  processing
 Highly intensive
  localization
 Broad integration of food
  production and
  distribution
 THE GEOGRAPHIC CONCENTRATION
 OF POULTRY PRODUCTION – 50 YEARS
 in US


                              US poultry production, 1949
                              Each dot = 50,000 chickens




US poultry production 1991
Each dot = 740,000 chickens
DELMARVA POULTRY INDUSTRY

                600-800 million broiler
                 chickens produced annually.

                6000 broiler chicken houses

                2,500 chicken growers

                15,000 poultry employees

                Total annual gross income of
                 Delmarva broiler industry:
                 exceeds 1.3 billion dollars.
Many Nonfood Routes of Exposure
and Transfer  ENVIRONMENT
                                   rivers and streams
                   Irrigation
                   Drinking water
                                                            Bay
                   Manure spreading                                  Swimming
                       Farm effluents                  Sewage
   Offal

                                     Slaughter          Handling             HUMANS
                    FARMS
  Animal                             Harvesting                            Farmers,
                                                       Preparation
  feeds                                                                    workers,
                                     Processing                            communities
                                                      Consumption



                                                                        High Risk Populations
                                                  Contact               • Children
Adapted from Dr. Ruth Etzel USDA                                        • Elderly
                                                                        • Immunocompromised
THE OTHER PRODUCT OF CAFOs
The DelMarVa Penninsula:
The “other product” of poultry production

  >1,000,000 tons of “manure”
   produced by ~800 million
   chickens/yr
  Integrators own the birds
  Growers own the waste
  Management - largely land
   applied
Why are we concerned?

 More biosolids applied
  than land can handle
 Contributes to surface and
  groundwater
  contamination
 Increased nutrient runoff
  into surface waters
 Detectable presence of
  drugs and resistance
  determinants in
  groundwater
WHO IS AT RISK FOR EXPOSURE?

Workers and growers who work in broiler
 houses
Workers who handle live chickens at
 processing plants
Household members of these persons
Community residents
The Poultry Environment Health Study

HYPOTHESES
  PERSONS WITH DIRECT EXPOSURE TO
   THE POULTRY ENVIRONMENT ARE AT
   INCREASED RISK OF EXPOSURE TO ABR
  EXPOSED PERSONS ARE AT INCREASED
   RISK OF BACTERIA-ASSOCIATED
   OUTCOMES
  THERE IS A GRADIENT OF EXPOSURE, AND
   HEALTH RISK, AMONG WORKERS, THEIR
   FAMILIES AND THE COMMUNITY
The Poultry Environment Health Study

SUBJECTS
  POULTRY HOUSE WORKERS
  “LIVE HANGERS”
  GROWERS
  HOUSEHOLD MEMBERS

  COMMUNITY RESIDENTS
Working in the poultry industry
Living
near the
poultry
industry
The Poultry Environment Health Study

EXPOSURE RISKS
  PATHOGENS
  ANTIBIOTIC RESISTANCE
  ANTIBIOTICS
  ARSENIC
PATHWAYS
  AIR, WATER, DUSTS, WILDLIFE, CAUGHT
   FISH, FOOD PLANTS
                                                AIRBORNE BACTERIA inIN CAFOS ARE
                                                    Figure 2: Antibiotic-Resistant Bacteria Present Indoor Air Samples Collected
                                                                                   from a Swine CAFO
                                          110
                                                MULTI DRUG RESISTANT
                                                 100     100     100      100     100     100       100              100       100                      Coagulase-negative Staphylococcus
                                                                                                             97                                         (n = 44)
                                          100
                                                                                                                                                        Viridans Group Streptococcus
Percentage of Tested Isolates Resistant




                                          90                                                                                           86
                                                                                                                                                        (n = 45)
                                          80                                                                                                            Non-E. faecalis Enterococcus
                                                                                                                                                        (n = 29)
                                                                                                                                                67
                                          70

                                          60

                                          50

                                          40

                                          30

                                          20

                                          10
                                                                                                                                                                   0        0       0
                                           0
                                                  Multi-drug Resistant        Erythromycin              Tetracycline              Virginiamycin*                      Vancomycin
                                                (Resistant >=2 Classes   (Breakpoint >= 8 ug/ml)   (Breakpoint >= 16 ug/ml)   (Breakpoint >= 4 ug/ml)            (Breakpoint >= 32 ug/ml)
                                                MDR of Antibiotics)      ERYTH-R                   TET-R                      VM-R                                     VAN-R
                                                                                                      Antibiotic
                                                            Chapin et al (2005) EHP
Air releases from CAFO ventilation
systems
The Poultry Environment Health Study

 OUTCOMES
  BACTERIAL CARRIAGE
  REPORTED DIARRHEAL DISEASE
  RESPIRATORY FUNCTION TESTS
  NEUROLOGICAL SYMPTOMS
 METHODS
  ISOLATION OF BACTERIA FROM STOOL;
   MEASUREMENT OF ANTIBODIES IN SERA
  QUESTIONNAIRES
  RESPIRATORY FUNCTION TESTING
 Poultry Health Study: Health Status
 in poultry workers– Preliminary
 Results
 Self reported symptoms: PW and referents
   PW report more frequent GI symptoms
       OR 2-5
   PW report much more frequent respiratory symptoms
       OR 2.6-35
   PW report much more frequent neuromuscular
    symptoms, including paralysis, problems with vision
    and speech
       OR 5.4-13.8
Arsenic sources - US
ARSENIC – THE FORGOTTEN
ANTIBIOTIC
extensive use of arsenicals in broiler feeds
documented contamination of waste and
 amended land
percolation into groundwater
arsenic is a human carcinogen and
 associated with skin, liver, and
 cardiovascular disease
ARSENIC and POULTRY
 Roxarsone, arsanilic acid used in poultry as
  coccidiostats and growth promoters – 45 g/ton
  feed
 GP – continuous lifelong exposure in feeds
 arsenicals excreted (>70%)
 100-200 mg/bird (900 million/yr)
 50,000-90,000 mt/year arsenic
 arsenicals    inorganic arsenic
 leach into groundwater
SHALLOW AQUIFERS IN DELMARVA
A SUGGESTIVE TRACE?
What does this tell us about avian flu?




    ?                                     ?




                        ?
Wild avians contact poultry houses




             Photo courtesy of Dr Donald Burke
What are the risks of occupational
contact and AF exposure?
 Three papers
  Koopmans et al (2004)
      National surveillance study in Netherlands; symptom
       driven
      2003 H7N7 outbreak HPAI
      All farmers, workers, families, veterinarians in outbreak
       regions
  Bridges et al (2001)
      Outbreak investigation of poultry workers and govt
       investigators
      Hong Kong 1997-8 H5N1
  Myers et al (2006)
      Cross sectional study of Iowa pork farmers, meat
       processing workers, veterinarians; Univ of Iowa referent
       group
      Swine influenza transmission risks
Risks of Influenza A/ (H5/N1) infection in
poultry workers: Hong Kong 1997-8
  Odds of antibody carriage:
   Farm/hatchery workers              2.7
   Work on farm >10% bird mortality   2.2
   Touching live poultry              5.8
   Feeding live poultry               2.4
   Butchering live poultry            3.1
  [referents: government workers]



   Occupational dose: response
   observed
                 ACKNOWLEDGEMENTS

 STUDENTS
   Jon Furuno, Amy Chapin, Lance Price, Jay Graham, Amira
    Roess, Meche Nweke, Keeve Nachman, Carter Erwin, Patrick
    Butler, Redwan Huq,
 COLLEAGUES
   Carol Resnick, Rocio Vailes, Pat Charache, Kellogg Schwab,
    Rolf Halden, Pat Breysse, Bill Spannhake, Kris Macri, Tim
    Buckley, Pat Charache, John Griffin, Kazim Sheikh, Vasken
    Aposhian, Tracy Hancock, Henrik Wegener
   Carole Morison, Patrick Harmon, Jim Lewis, Pilar Perez,
    Jackie Nowell -- UFCW
 FUNDING
   CLF, Grace, HHMI, NIOSH, Winslow and Baker Foundations

				
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