Tetanus-diphtheria (Td)....All adults, and especially sewage workers, should be up-to-date on Td immunization. For those who have completed the basic series of three immunizations, a booster should be given every ten years.

 No other immunizations are routinely recommended at the present.

b. Not Routinely Recommended

 Poliomyelitis - Sewage workers are at very slight risk of vaccine polio virus exposure but at virtually no risk of wild polio virus exposure. No cases of occupationally acquired paralytic poliomyelitis in U.S. sewage workers have been documented since polio vaccine came into widespread usage.

Typhoid Fever - The risk of this disease for sewage workers in California is exceedingly small. Only one case has ever been reported in a California sewage worker and this was in an individual who had received at least one dose of typhoid vaccine nine months previously.

Immune globulin (IG) and Hepatitis A Vaccine - Routine hepatitis A immunoprophylaxis is not recommended due to lack of evidence of significant occupational risk for sewage workers in this country (MMWR 1996; 45 No. RR-15).

Hepatitis B Vaccine - While blood and other body fluids (e.g., menstrual discharges, etc.) enter the sewage stream, hepatitis B virus is present only in very dilute concentrations. No cases of hepatitis B have been linked to sewage exposure in the U.S. Moreover, since hepatitis B is not transmitted by the fecal-oral route, there is little risk from municipal sewage.

Cholera - The risk of cholera for sewage workers is extremely remote. Only a few cases of imported cholera are reported each year in California and there has been no secondary transmission. Vibrio cholerae concentrations in California sewage are so dilute as to probably be non-infectious. (Whereas 102 Shigella are needed to cause disease, as many as 106 to 108 V. cholerae are needed.) Even if cholera did result, specific treatment is readily available.

Finally, a word about HIV and the risk of AIDS from sewage. The remarks made above about hepatitis B, and its extreme dilution in sewage, apply to HIV as well - except that the level of HIV in sewage would be even several orders of magnitude less than that of hepatitis B. Moreover, like hepatitis B, HIV is not transmitted by the fecal-oral route. Thus, the risk of hepatitis B from sewage is virtually non-existent and the risk of HIV transmission from sewage is even less.

Reported by: Immunization Branch, Division of Communicable Disease Control, California Department of Health Services.

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=25898



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