Évaluation des risques des professionnels exposés aux produits utilisés dans les activités de soin et de décoration de l’ongle

L'Anses publie ce jour les résultats de son expertise sur l'évaluation des risques pour la santé des professionnels exposés aux produits utilisés dans les activités de soin et de décoration de l'ongle. Au vu du grand nombre de substances auxquelles sont exposés les professionnels, l'Agence émet une série de recommandations à destination des différents acteurs concernés : les metteurs sur le marché, les professionnels du secteur, les pouvoirs publics, les institutions et organismes de recherche et de prévention. Ces recommandations portent à la fois sur des mesures de prévention et de protection à mettre en œuvre, la sécurité chimique des produits cosmétiques et l'évaluation de l'exposition des professionnels, ainsi que sur des mesures relatives à la formation et à l'information des professionnels.
En 2009, à la demande de la Direction générale de la santé (DGS), l'Agence nationale de sécurité du médicament et des produits de santé (ANSM) a évalué le risque, pour les consommateurs, lié à l'utilisation du toluène dans les produits cosmétiques, et plus particulièrement dans les vernis à ongles, sans cependant prendre en compte les risques éventuels pour la santé des professionnels. Ces professionnels sont en outre amenés à manipuler des produits contenant d'autres substances chimiques dangereuses que le toluène. L'ANSM a donc saisi l'Anses afin d'évaluer les risques liés à l'exposition des professionnels aux produits utilisés pour le soin et la décoration de l'ongle.

Source: https://www.anses.fr/fr/content/professionnels-du-soin-et-de-la-d%C3%A9coration-de-l%E2%80%99ongle-exposition-%C3%A0-de-nombreuses-substances

Pneumococcal Vaccination Among Adults With Work-related Asthma

Introduction: Pneumococcal vaccination is recommended for all adults with asthma and a Healthy People 2020 goal aims to achieve 60% coverage among high-risk adults, including those with asthma. Adults with work-related asthma have more severe asthma symptoms than those with non−work-related asthma and are particularly vulnerable to pneumococcal pneumonia.
Methods: To assess pneumococcal vaccination coverage by work-related asthma status among ever-employed adults aged 18–64 years with current asthma, data from the 2012–2013 Behavioral Risk Factor Surveillance System Asthma Call-back Survey for ever-employed adults (18–64 years) with current asthma from 29 states were examined in 2016. Adults with work-related asthma had ever been told by a physician their asthma was work-related. Pneumococcal vaccine recipients self-reported having ever received a pneumococcal vaccine. Multivariate logistic regression was used to calculate adjusted prevalence ratios and associated 95% CIs.
Results: Among an estimated 12 million ever-employed adults with current asthma in 29 states, 42.0% received a pneumococcal vaccine. Adults with work-related asthma were more likely to have received a pneumococcal vaccine than adults with non−work-related asthma (53.7% versus 35.0%, respectively, prevalence ratio=1.24, 95% CI=1.06, 1.45). Among adults with work-related asthma, pneumococcal vaccine coverage was lowest among Hispanics (36.2%) and those without health insurance (38.5%).
Conclusions: Pneumococcal vaccination coverage among adults with work-related asthma and non−work-related asthma is below the Healthy People 2020 target level. Healthcare providers should verify pneumococcal vaccination status in their patients with asthma and offer the vaccine to those not vaccinated.

Source: Dodd, K. E., & Mazurek, J. M. (2017). American Journal of Preventive Médicine, 53(6), 799–809.

Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid

Cleaning and disinfecting products consisting of a mixture of hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are widely used as sporicidal agents in health care, childcare, agricultural, food service, and food production industries. HP and PAA are strong oxidants and their mixture is a recognized asthmagen. However, few exposure assessment studies to date have measured HP, PAA, and AA in a health care setting. In 2015, we performed a health and exposure assessment at a hospital where a new sporicidal product, consisting of HP, PAA, and AA was introduced 16 months prior. We collected 49 full-shift time-weighted average (TWA) air samples and analyzed samples for HP, AA, and PAA content. Study participants were observed while they performed cleaning duties, and duration and frequency of cleaning product use was recorded. Acute upper airway, eye, and lower airway symptoms were recorded in a post-shift survey (n = 50). A subset of 35 cleaning staff also completed an extended questionnaire that assessed symptoms reported by workers as regularly occurring or as having occurred in the previous 12 months. Air samples for HP (range: 5.5 to 511.4 ppb) and AA (range: 6.7 to 530.3 ppb) were all below established US occupational exposure limits (OEL). To date, no full-shift TWA OEL for PAA has been established in the United States, however an OEL of 0.2 ppm has been suggested by several research groups. Air samples for PAA ranged from 1.1 to 48.0 ppb and were well below the suggested OEL of 0.2 ppm. Hospital cleaning staff using a sporicidal product containing HP, PAA, and AA reported work-shift eye (44%), upper airway (58%), and lower airway (34%) symptoms. Acute nasal and eye irritation were significantly positively associated with increased exposure to the mixture of the two oxidants: HP and PAA, as well as the total mixture (TM)of HP, PAA, and AA. Shortness of breath when hurrying on level ground or walking up a slight hill was significantly associated with increased exposure to the oxidant mixture (P = 0.017), as well as the TM (P = 0.026). Our results suggest that exposure to a product containing HP, PAA, and AA contributed to eye and respiratory symptoms reported by hospital cleaning staff at low levels of measured exposure.

Source: Hawley, B., Casey, M., Virji, M. A., Cummings, K. J., Johnson, A. et Cox-Ganser, J. (2017). Annals of Work Exposures and Health.

Occupational Exposure to Vapor-Gas, Dust, and Fumes in a Cohort of Rural Adults in Iowa Compared with a Cohort of Urban Adults

Problem/Condition: Many rural residents work in the field of agriculture; however, employment in nonagricultural jobs also is common. Because previous studies in rural communities often have focused on agricultural workers, much less is known about the occupational exposures in other types of jobs in rural settings. Characterizing airborne occupational exposures that can contribute to respiratory diseases is important so that differences between rural and urban working populations can be assessed.
Reporting Period: 1994–2011.
Description of System: This investigation used data from the baseline questionnaire completed by adult rural residents participating in the Keokuk County Rural Health Study (KCRHS). The distribution of jobs and occupational exposures to vapor-gas, dust, and fumes (VGDF) among all participants was analyzed and stratified by farming status (current, former, and never) then compared with a cohort of urban workers from the Multi-Ethnic Study of Atherosclerosis (MESA). Occupational exposure in the last job was assessed with a job-exposure matrix (JEM) developed for chronic obstructive pulmonary disease (COPD). The COPD JEM assesses VGDF exposure at levels of none or low, medium, and high.
Results: The 1,699 KCRHS (rural) participants were more likely to have medium or high occupational VGDF exposure (43.2%) at their last job than their urban MESA counterparts (15.0% of 3,667 participants). One fifth (20.8%) of the rural participants currently farmed, 43.1% were former farmers, and approximately one third (36.1%) had never farmed. These three farming groups differed in VGDF exposure at the last job, with the prevalence of medium or high exposure at 80.2% for current farmers, 38.7% for former farmers, and 27.4% for never farmers, and all three percentages were higher than the 15.0% medium or high level of VGDF exposure for urban workers.
Interpretation: Rural workers, including those who had never farmed, were more likely to experience occupational VGDF exposure than urban workers.

Source: https://www.cdc.gov/mmwr/volumes/66/ss/ss6621a1.htm

Associations Between Disinfection By-Product Exposures and Craniofacial Birth Defects

Objective: Examine associations between craniofacial birth defects (CFDs) and disinfection by-product (DBP) exposures, including the sum of four trihalomethanes (THM4) and five haloacetic acids (HAA5) (i.e., DBP9).
Methods: We calculated first trimester adjusted odds ratios (aORs) for different DBPs in a matched case-control study of 366 CFD cases in Massachusetts towns with complete 1999-2004 THM and HAA data.
Results: We detected elevated aORs for cleft palate with DBP9 (highest quintile aOR = 3.52; 95%CI: 1.07, 11.60), HAA5, trichloroacetic acid (TCAA), and dichloroacetic acid. We detected elevated aORs for eye defects with TCAA and chloroform.
Conclusion: This is the first epidemiological study of DBPs to examine eye and ear defects, as well as HAAs and CFDs. The associations for cleft palate and eye defects highlight the importance of examining specific defects, and of examining DBPs beyond THM4.

Source: Kaufman, J. A., Wright, J. M., Evans, A., Rivera-Núñez, Z., Meyer, A. et Narotsky, M. G. (2017). Journal of Occupational and Environmental Medicine.

Assessment of Ambient Exposures Firefighters Encounter While at the Fire Station

An Exploratory Study
Objective: Firefighters are at an increased risk for many types of cancer. Although most studies on this topic focus on exposures encountered while fighting fires, exposures at the fire station are also cause for concern. This pilot study aimed to describe air quality within a few fire stations in and around Boston, Massachusetts, and to investigate physical and organizational factors that may influence levels of contaminants in stations.
Methods: Air sampling of particulate matter less than 2.5 μm in diameter (PM2.5) and particle-bound polycyclic aromatic hydrocarbons (PAHs) was completed at four fire stations in Spring, 2016. Sampling occurred in the kitchen, truck bay, and just outside the station. Data were analyzed to assess differences between and within stations. Interviews (n =7) were conducted with officers at each station to explore health and safety-related organizational policies and practices. Interviews were transcribed and analyzed for thematic content.
Results: At each station, levels of contaminants were higher in the truck bays than either the outdoors or kitchen, and varied the most throughout the day. The station with the highest exposures in the truck bay had the lowest levels in the kitchen, which was possibly explained by new building materials and effective separation between building zones. The age and layout of the stations appeared to determine the extent to which policies favoring exhaust capture were implemented.
Conclusion: Levels of PM2.5 and PAH inside fire stations may contribute to firefighter cancer risk. Through understanding contaminant variability, we can begin to design and test interventions that improve cancer prevention.

Source: Sparer, E. H., Prendergast, D. P., Apell, J. N., Bartzak, M. R., Wagner, G. R., Adamkiewicz, G., ... et Sorensen, G. (2017). Journal of occupational and environmental medicine, 59(10), 1017-1023.

State of the evidence 2017: an update on the connection between breast cancer and the environment

Singly and in combination, these toxicants may have contributed significantly to the increasing rates of breast cancer observed over the past several decades. Exposures early in development from gestation through adolescence and early adulthood are particularly of concern as they re-shape the program of genetic, epigenetic and physiological processes in the developing mammary system, leading to an increased risk for developing breast cancer. In the 8 years since we last published a comprehensive review of the relevant literature, hundreds of new papers have appeared supporting this link, and in this update, the evidence on this topic is more extensive and of better quality than that previously available.
Increasing evidence from epidemiological studies, as well as a better understanding of mechanisms linking toxicants with development of breast cancer, all reinforce the conclusion that exposures to these substances – many of which are found in common, everyday products and byproducts – may lead to increased risk of developing breast cancer. Moving forward, attention to methodological limitations, especially in relevant epidemiological and animal models, will need to be addressed to allow clearer and more direct connections to be evaluated.

Source: Gray, J. M., Rasanayagam, S., Engel, C., & Rizzo, J. (2017). Environmental Health, 16(1), 94.

Virus de la grippe du porc et risque d’infection chez les travailleurs de l’industrie du porc

La grippe du porc est une maladie virale respiratoire aiguë et très contagieuse qui se propage par les aérosols, et par contacts directs ou indirects avec des animaux malades ou porteurs asymptomatiques. Des flambées de grippe ont lieu tout au long de l'année 2016 chez les porcs, avec une incidence accrue à l'automne et en hiver dans les zones tempérées. Le porc peut aussi être infecté simultanément par des virus influenza humains et aviaires, ce qui donne la possibilité au matériel génétique de ces différents virus, de se recombiner et d'engendrer un nouveau virus, appelé « virus réassortant » contenant des gènes provenant de diverses espèces animales. Ces virus réassortants sont alors bien adaptés pour infecter l'Homme. En 2009, un virus réassortant contenant des gènes de plusieurs virus porcins est apparu chez l'Homme au Mexique. Ce virus, appelé A(H1N1)pdm09, déclaré « pandémique* » par l'OMS (1) a été responsable de 18 500 décès dans le monde. Depuis, les transmissions de l'homme vers l'animal et vice-versa, ont souvent eu lieu (2). Actuellement, ce virus circule parmi les populations porcines dans de nombreuses régions du monde et est aussi responsable d'épidémie saisonnière chez l'homme. Selon l'InVS*, en 2010-2011 en France, 789 cas graves de grippe ont été signalés dont 151 (19 %) avec décès. La majorité des cas était due à ce virus A(H1N1)pdm09. Les symptômes cliniques généraux étaient les mêmes que ceux de la grippe saisonnière* classique, allant d'une infection asymptomatique jusqu'à une pneumonie grave pouvant entraîner le décès. Les gens contractent les virus influenza porcins soit à partir de porcs infectés soit par transmission interhumaine. Etant donné que les cas bénins peuvent passer inaperçus, on ignore quelle est l'étendue réelle de la contamination chez l'homme. Les deux articles analysés ci-dessous ont étudié le risque d'infection par ces virus chez les travailleurs de la filière porcine et estimé l'efficacité des protections respiratoires pour éviter la contamination.

Source: http://bvs.mag.anses.fr/sites/default/files/BVS-mg-032-Oppliger-Kramer.pdf

Elevation of Circulating Th17/Th22 Cells Exposed to Low-Level Formaldehyde and Its Relevance to Formaldehyde-Induced Occupational Allergic Contact Dermatitis

Objectives: The aim of this study was to investigate the effects of formaldehyde exposure on Th17 and Th22 cells and its relevance to human occupational allergic contact dermatitis (OACD).
Methods: Circulating IL17-/IL22-secreting cells and serum IL17/IL22 levels in formaldehyde-exposed workers at Occupational Exposure Limit and nonexposed controls were assessed.
Results: The IL17+ and IL22+ cell population were detected in both CD3+CD8- and CD3+CD8+ cells. The percentages of circulating IL17+ and IL22+ T cells in the workers with and without ACD history were all elevated, which were more remarkable in the ones with ACD history. Serum levels of IL17 and IL22 between the workers and controls were not significantly different.
Conclusions: Low-level formaldehyde exposure may increase circulating IL17-/IL22-producing T cells (CD8- and CD8+), possibly involved in the development of human OACD. But it may not alter serum levels of IL17/IL22 before the appearance of OACD symptoms.

Source: Mai, W., Liu, X., Su, G., Zhou, W., Wen, Z., & Lu, D. (2017). Journal of Occupational and Environmental Medicine, 59(9), 817-821.

Protéger les travailleurs du froid : mieux comprendre pour mieux agir

Dans de nombreux secteurs industriels, les travailleurs sont confrontés à des contraintes thermiques extrêmes et en particulier à des froids pouvant être intenses. Des normes internationales définissent le travail au froid à des températures égales ou inférieures à 10°C. Par exemple, les ouvriers de l'industrie alimentaire de transformation sont exposés, plusieurs heures par jour, à des températures comprises entre 0 et +10°C pour maintenir la chaine du froid (à des fins de conservation des denrées alimentaires) voire même à des températures inférieures à -20°C pour les produits congelés. Que ce soit dans des lieux fermés (entrepôts frigorifiques, abattoirs) ou en extérieur (construction, agriculture, services publics, etc.), la contrainte thermique par le froid peut avoir des conséquences importantes sur la santé (gelures, hypothermie), sur la sécurité (perte de vigilance et de sensibilité) et s'avérer parfois fatale.
Le premier article de cette veille explore les performances cognitives de huit participants humains exposés 24 heures à une température de 7,5°C. Il en découle quelques recommandations en cas d'exposition prolongée au froid. Le second article présente de récents travaux menés sur le transfert de chaleur à travers différentes couches textiles, utilisées dans la conception de vêtement de protection contre le froid (VPF). En particulier, il rapporte l'influence des caractéristiques géométriques, structurelles et de masse de ces couches sur les propriétés de transfert de masse et de chaleur, et donc sur le confort thermique, à travers des VPF.

Source: http://bvs.mag.anses.fr/sites/default/files/BVS-mg-032-Vinches-Halle.pdf

IARC Monographs Volume 112: Some Organophosphate Insecticides and Herbicides

This volume of the IARC Monographs provides evaluations of the carcinogenicity of some organophosphate insecticides and herbicides, including diazinon, glyphosate, malathion, parathion, and tetrachlorvinphos.
Diazinon acts on a wide range of insects on crops, gardens, livestock, and pets, but most uses have been restricted in the USA, Canada, and the European Union since the 1980s. Glyphosate is the most heavily used agricultural and residential herbicide in the world, and has been detected in soil, air, surface water, and groundwater, as well as in food. Malathion is one of the oldest and most widely used organophosphate insecticides, and has a broad spectrum of applications in agriculture and public health, notably mosquito control. The insecticide parathion has been largely banned or restricted throughout the world due to toxicity to wildlife and humans. Tetrachlorvinphos is banned in the European Union, but continues to be used in the USA and elsewhere as an insecticide on animals, including in pet flea collars.

Source: http://monographs.iarc.fr/ENG/Monographs/vol112/

Elevated Exposures to Polycyclic Aromatic Hydrocarbons and Other Organic Mutagens in Ottawa Firefighters Participating in Emergency

On-Shift Fire Suppression
Occupational exposures to combustion emissions were examined in Ottawa Fire Service (OFS) firefighters. Paired urine and dermal wipe samples (i.e., pre- and post-event) as well as personal air samples and fire event questionnaires were collected from 27 male OFS firefighters. A total of 18 OFS office workers were used as additional controls. Exposures to polycyclic aromatic hydrocarbons (PAHs) and other organic mutagens were assessed by quantification of urinary PAH metabolite levels, levels of PAHs in dermal wipes and personal air samples, and urinary mutagenicity using the Salmonella mutagenicity assay (Ames test). Urinary Clara Cell 16 (CC16) and 15-isoprostane F2t (8-iso-PGF2α) levels were used to assess lung injury and overall oxidative stress, respectively. The results showed significant 2.9- to 5.3-fold increases in average post-event levels of urinary PAH metabolites, depending on the PAH metabolite (p < 0.0001). Average post-event levels of urinary mutagenicity showed a significant, event-related 4.3-fold increase (p < 0.0001). Urinary CC16 and 8-iso-PGF2α did not increase. PAH concentrations in personal air and on skin accounted for 54% of the variation in fold changes of urinary PAH metabolites (p < 0.002). The results indicate that emergency, on-shift fire suppression is associated with significantly elevated exposures to combustion emissions.

Source: Keir, J. L., Akhtar, U. S., Matschke, D. M., Kirkham, T. L., Chan, H. M., Ayotte, P., ... & Blais, J. M. (2017). Environmental Science & Technology.

Standard Guide for Using Probability Sampling Methods in Studies of Indoor Air Quality in Buildings

ASTM D5791 - 95
Studies of indoor air problems are often iterative in nature. A thorough engineering evaluation of a building (1-4)3 is sometimes sufficient to identify likely causes of indoor air problems. When these investigations and subsequent remedial measures are not sufficient to solve a problem, more intensive investigations may be necessary.
This guide provides the basis for determining when probability sampling methods are needed to achieve statistically defensible inferences regarding the goals of a study of indoor air quality. The need for probability sampling methods in a study of indoor air quality depends on the specific objectives of the study. Such methods may be needed to select a sample of people to be asked questions, examined medically, or monitored for personal exposures. They may also be needed to select a sample of locations in space and time to be monitored for environmental contaminants.

Source: https://www.astm.org/Standards/D5791.htm

Mesothelioma incidence and asbestos exposure in Italian national priority

Objectives This study aimed to (i) describe mesothelioma incidence in the Italian national priority contaminated sites (NPCS) on the basis of data available from the Italian National Mesothelioma Registry (ReNaM) and (ii) profile NPCS using Bayesian rank analysis.
Methods: Incident cases of mesothelioma and standardized incidence ratios (SIR) were estimated for both genders in each of the 39 selected NPCS in the period 2000–2011. Age-standardized rates of Italian geographical macro areas were used to estimate expected cases. Rankings of areas were produced by a hierarchical Bayesian model. Asbestos exposure modalities were discussed for each site.
Results: In the study period, 2683 incident cases of mesothelioma (1998 men, 685 women) were recorded. An excess of mesothelioma incidence was confirmed in sites with a known past history of direct use of asbestos (among men) such as Balangero (SIR 197.1, 95% CI 82.0–473.6), Casale Monferrato (SIR 910.7, 95% CI 816.5–1012.8), and Broni (SIR 1288.5, 95% CI 981.9–1691.0), in sites with shipyards and harbors (eg, Trieste, La Spezia, Venice, and Leghorn), and in settings without documented direct use of asbestos. The analysis ranked the sites of Broni and Casale Monferrato (both genders) and Biancavilla (only for women) the highest.
Conclusions: The present study confirms that asbestos pollution is a risk for people living in polluted areas, due to not only occupational exposure in industrial settings with direct use of asbestos but also the presence of asbestos in the environment. Epidemiological surveillance of asbestos-related diseases is a fundamental tool for monitoring the health profile in NPCS.

Source: Binazzi A, Marinaccio A, Corfiati M, Bruno C, Fazzo L, Pasetto R, Pirastu R, Biggeri A, Catelan D, Comba P, Zona A. (2017). Scand J Work.

Le prélèvement surfacique: vers un nouvel outil d'évaluation

Afin de répondre à la demande de méthodes d'évaluation de l'exposition aux polluants qui se déposent sur les surfaces de travail, l'INRS a entrepris de mettre au point des méthodologies d'évaluation standardisées permettant d'envisager différentes actions de prévention. Une étude a été menée afin d'identifier les paramètres qui influent sur l'efficacité des prélèvements, ainsi que leur degré d'influence.

Source: Estève, W. (2017). Hygiène et sécurité du travail (248), p. 66-71.

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