Dear Mr. Toffey: 
First of all,    only includes cases through May 2001.    My victims report updated through September 2002 is available on CD . . . and my most recent update - sludge victims, Fall 2002 - 2003 (which is a work in progress as new cases come to my attention on a weekly basis) is available in hard copy.
Reference is made to your comment to Dr. Oostdam as follows:
"Our toxicologist has been working with Philadelphia's biosolids workers
for about a dozen years and has not encountered medical conditions that he
believes draw a connection between worker health and the workplace
exposure. "
In addition to my compilation of reports,statements, articles, etc. re adverse health effects suffered by neighbors of sludge sites, I have also prepared a packet of info regarding health problems of sewage workers.  Below is the  table of contents of this packet . . . . . .  however, Please note this packet has NOT been updated for a long time  . . .at the end of the "contents" are some of the other articles I have to add if and when I find the time to  revise  the "sewage workers" report to include newer articles    . . . . .  
 (pages 1 - 35 are published, peer reviewed articles on adverse health effects of sewage workers --pages 36-64 are lists of other articles on this subject which I have not had time to obtain and/or review  . . . pages 65 - 68 are anecdotal accounts from  actual sick sewage workers) . . . as I said before . . . this report  is old (from 2001) and needs updating . . .


Page 1            Dowd, Gerba Pepper & Pillai on health effects of sewage workers (excerpt from

"Ecological Risk Assessment - Bioaerosol Transport Modeling and Risk

               Assessment in Relation to Biosolid Placement" by Scot E. Dowd, Charles

               P. Gerba, Ian L. Pepper, and Suresh D. Pillai - J. Envir. Qual. 29:343-348 (2000):


     "...the potential for an increased risk of work-related illness in such biosolid workers is collaborated (sic) by numerous epidemiological studies which have shown higher rates of illness in wastewater workers."


     "Clinically, these illnesses were usually manifested as undue tiredness and headaches that were evident after work.   Additionally, other symptoms such as respiratory problems, nonspecific bowel dysfunction, irregular heartbeat, nausea, vomiting, and diarrhea were also common complaints."


Pages 2 - 11   Thorn and Kerekes on health effects among sewage employees “ . . . respiratory symptoms, fatigue, headache . . . data suggest they are caused by inflammation . . . endotoxin in Gram-negative bacteria may be one of the causative agents.”


Pages 12 - 18  Douwes, Mannetje & Heederik on work-related symptoms in sewage workers

“In conclusion, sewage treatment workers develop a large variety of work-related symptoms that are not likely caused by endotoxin exposure only.”   “In this study we found a significant positive association between self-reported exposure and clusters of flu-like and neurological symptoms.   We also found a very strong association between exposure and skin rash, palpitations, fatigue and forgetfulness.”


     “In the present study we focused on five groups of symptoms including flu-like, respiratory, mucous membrane and skin irritation, neurological, and gastrointestinal symptoms.”


Pages 20 - 28  Scarlett-Kranz, Babish, Strickland & Lisk on health among sewage workers


“Sewage workers reported a significantly higher frequency of headache, dizziness, sore throat, skin irritation and diarrhea . . . “


Pages 28(a)-(e) - Nethercott & Holness - health status of Toronto, Canada, sewage workers

“This investigation revealed that many workers reported “influenza-like” symptoms, cough, sputum production, wheezing, sore throat and skin complaints . . . The workers tended to have somewhat reduced lung function.”


Pages 30 -34   Rylander on health effects among sewage workers:  “The results confirm previous studies on the presence of airways and intestinal inflammation among workers in sewage treatment plants.  The most likely causative agent in endotoxin” . . .


Pages 34(a) - (d)  Friis, Norback & Edling - Self-Reported Asthma and Respiratory

                             Symptoms in Sewage Workers   “Self-reported asthma was more common among the sewage workers than other municipal workers.   This might be caused by occupational exposure to irritant or inflammatory substances.”    “Since several sewage workers were referred to our department with a diagnosis of asthma or other respiratory illness, the question was raised whether the exposure in present day Swedish sewage plants may increase the risk of respiratory disease.”


Pages 34 (e) - (o) - Zuskin, et al - “Sewage workers experience frequent acute and chronic                    respiratory symptoms and exhibit objective evidence of respiratory dysfunction”


     “In sewage workers, acute symptoms during the work shift such as cough, dyspnea, chest tightness, irritation or dryness of the throat, secretions, dryness or bleeding of the nose, dizziness, headache, and skin irritation were specifically recorded.”  (page 34(h)- )



Page 35 -  Samadpour:  “Workers with weak immunity system get sick and leave the job . . . those with good immune systems continue working.”    (page 35)


 Pages 36 - 64  List of articles regarding health effects among sewage workers


Pages 65-66 - Canada - sewage worker suffers skin sores and severe asthma


Pages 67-68 - North Carolina - sewage worker suffers severe diarrhea, GI problems, mast

                       cell disease



TO BE ADDED  to next printing of my sick sewage workers report: 


Prevalence of infectious diseases and associated symptoms in wastewater treatment workers
Sadik A. Khuder, PhD *, Tammy Arthur, MSc, Michael S. Bisesi, PhD, Eric A. Schaub, MD, MPH
Department of Occupational Health, Medical College of Ohio, Toledo, Ohio
Thank you for your help.    Helane Shields, Alton, NH
Online ISSN: 1097-0274    Print ISSN: 0271-3586
American Journal of Industrial Medicine
Volume 33, Issue 6, 1998. Pages: 571-577

Published Online: 6 Dec 1998
Prevalence of infectious diseases and associated symptoms in wastewater treatment workers
Sadik A. Khuder, PhD *, Tammy Arthur, MSc, Michael S. Bisesi, PhD, Eric A. Schaub, MD, MPH
Department of Occupational Health, Medical College of Ohio, Toledo, Ohio
email: Sadik A. Khuder (

 waste water; employees; infectious diseases; symptoms; epidemiology

Wastewater treatment workers (WWTW) are potentially exposed to a variety of infectious agents and toxic materials. We conducted a retrospective epidemiological study to examine the prevalence of infectious diseases and associated symptoms in WWTW. From a possible 242 WWTW, 150 completed a questionnaire that provided data pertaining to the diagnosis of an infectious disease or the prevalence of associated symptoms over a 12-month period. Comparison data were obtained from questionnaires completed by 54 college maintenance and oil refinery workers. The WWTW exhibited a significantly higher prevalence of gastroenteritis, gastrointestinal symptoms (specifically abdominal pain), and headaches. No significant differences were found with regard to respiratory and other symptoms. Employees classified by exposure categories did not exhibit significant differences in the prevalence of symptoms. While significant differences were found with regard to the health status of WWTW and controls, it appears that these risks are confined to symptoms and infectious diseases associated with the gastrointestinal system and are not inclusive of all such symptoms or diseases. Am. J. Ind. Med. 33:571-577, 1998. © 1998 Wiley-Liss, Inc.

Accepted: 4 February 1998

*Correspondence to Sadik A. Khuder, Department of Occupational Health, Medical College of Ohio, P.O. Box 10008, Toledo, OH 43699-0008


5.4          Composting
5.4.1            Reviews and primary studies
Two review papers were found of the health impacts of composting (Maritato et al 1992, Environment Agency 2001). The main health impacts from composting (Bunger et al 2000) are:

.   Inflammatory responses of the upper airways - congested nose, sore throat and dry cough

.   Toxicoses - toxic pneumonitis due to endotoxins

.        Infections - respiratory tract and skin

.        Allergies - bronchial asthma, allergic rhinitis, extrinsic allergic alveolitis (hypersensitivity pneumonitis)

The people most likely to be affected are workers in centralised composting facilities. Of the primary studies of health impacts, one is a case control study and the rest are case reports.  The case control study (Bunger et al 2000) found that compost workers had significantly more symptoms and diseases of the airways (p=0.003) and the skin (p=0.02) than the control subjects and they had significantly increased antibody concentrations against fungi and actinomycetes. No studies were found about the health impacts to residents living by composting facilities.



Eur J Epidemiol. 1999 Mar; 15(3):261-5  INTESTINAL PARASITE CARRIAGE IN WORKERS EXPOSED TO SEWAGE - Schlosser O, Grall D, Laurenceau MN - Generale des Eaux, Occupational Health Dept., Paris, France . . . excerpt:  "The results of this study emphasize an occupational risk of intestinal protozoan infestation in workers exposed to sewage."




Exposure to Bacterial Aerosols and Work-Related Symptoms in Sewage Workers, Erik Melbostad MC, Wijnand Eduard, PhD, Asbjorn Skogstad, MSc, Per Sandven, MD, Jorgen Lassen, MD, Per Sostrand, MSc, and Karl Heldal, BSc 

American Journal of Industrial Medicine  25:59-63 (1994)


"Discussion:  Higher exposure levels to rod-shaped and total bacteria were found among sewage workers with airway symptoms, headache, tiredness, and nausea than among workers not reporting these symptoms. . . Our study suggests a relationship between rod-shaped bacteria, or some other factor linked to these bacteria, and the symptoms of headache and tiredness, and possibly symptoms from the airways and gastrointestinal tract as well."



INFLAMMATION RESEARCH 50 (2001) 254-261  Birkhauser Verlag, Basel, 2001 . . .




J. Thorn  Dept. of Environmental Medicine, Goteborg University, Box 414 30 Goteborg, Sweden


p. 259:  "Beyond exerting effects in the exposure site itself, the lung, inhaled LPS (Lipopolysaccharide -- Bacterial Endotoxin) may affect the central nervous system.   This was demonstrated in several studies by increases in general symptoms such as fatigue, headache, fever, chills and malaise after LPS inhalation."


"The importance of the findings in these studies on acute inhaled LPS bear to the occupational environments.   The symptoms reported in studies investigating organic dust environments often comprise a variety of non-specific symptoms, such as irritation in the eyes, nose and throat, cough (dry or with phlegm), nasal congestion, breathlessness, headache, heaviness in the head and unusual tiredness."


"Furthermore, the inflammatory changes found after LPS inhalation challenges in humans (asthmatics and healthy subjects) suggest the presence of an unspecific airways inflammation and a similar relation can be expected among persons continuously exposed to endotoxin in organic dust environments."




WORK RELATED SYMPTOMS AMONG SEWAGE WORKERS:  A NATIONWIDE SURVEY IN SWEDEN   J. Thorn, L. Beijer, R Rylander - Occup. Envir. Med. 2002: 59: 562-566


"Results:  Significantly increased risks for airway symptoms, chronic bronchitis, and toxic pneumonitis, as well as central nervous system symptoms such as headache, unusual tiredness, and concentration difficulties were found among the sewage workers compared with controls.   Furthermore, an increased risk for non-specific work related gastrointestinal symptoms was found among the sewage workers; an increased risk for joint pains, related to pains in more than four joints, but not with loading, was also found."


"Conclusions:   The results of this questionnaire survey show an increased risk for airway, gastrointestinal, and general symptoms such as joint pains and central nervous system symptoms among sewage workers."




Okay, that's enough for one email . . . I have other articles to include in the next update of  "sewage workers do get sick" report . . . . you have to  understand, Mr. Toffey . . . my husband and I are retirees on social security -- WERF doesn't  provide  us with grants worth hundreds of thousands of dollars (such as the ones  given to Ned Beecher, NEBRA, (to promote "public acceptance" of sludge/biosolids) and to Christine Bean/Dr. Aaron Margolin, UNH -- to study parasites in sludge biosolids (the largest and easiest to detect pathogen and the one of least interest and/or concern) . .

WE have to pay all our own expenses for telephone, postage, copying, computer cartridges, printing, etc.


But perhaps that is the reason why grass roots researchers like us have more credibility with average Americans faced with invasion of their quiet, clean neighborhoods by the sludge mongers - - -  than the waste industry and their  state and federal "regulators" (who  most people  recognize   as "facilitators" who bulldoze aside local concerns and force this toxic/pathogenic waste from urban and industrial sources on unwilling Rural communities) . . . people know and understand that we have NO vested and/or financial  interest one way or the other with the results of our research and/or the sludge controversy. 


By separate email, I will send you a list compiled by a friend in Virginia regarding articles about sewage workers who do get sick . . . . I haven't had time to cross reference, cross research and integrate their list with mine . . . perhaps you could use some of that freely flowing WERF money to do this job ?? !!  


Helane Shields, sludge researcher, Alton, NH