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Concurrent exposure to drug-resistant Staphylococcus aureus, influenza A virus, and hepatitis E virus among industrial hog operation workers

Session: Poster Abstract Session: Occupational Health
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: In the US, there is growing evidence that industrial-scale livestock production is a reservoir of exposure to antimicrobial resistant bacteria, including S. aureus, and emerging viruses, including influenza and hepatitis E virus (HEV). The public health implications of multi-pathogen exposures at the human-animal interface have not been fully evaluated. We aimed to actively surveil industrial hog operation (IHO) workers to fill critical knowledge gaps about concurrence of exposure to drug-resistant S. aureus, influenza A virus, and HEV.

Methods: 22 IHO workers collected 316 nasal swabs before and after an IHO work shift over 7 d and again 14 d after enrollment. Swabs were cultured for S. aureus presence and assessed for multidrug-resistance (MDR = resistance to >2 antimicrobial drug classes), tetracycline-resistance (antimicrobial additive to livestock feed), clonal complex (CC), and absence of the scn gene (marker of livestock association). Influenza A virus matrix gene and hepatitis E virus (HEV) RNA per nasal swab were estimated by qPCR.

Results: Influenza A virus matrix gene RNA was detected in 10/208 nasal swabs from 8/22 workers. Of the eight workers carrying influenza A virus, six were persistent and two were intermittent S. aureus carriers. Four of the eight carried MDRSA and one persistently carried methicillin-resistant S. aureus (MRSA) that was also MDR. All eight workers carrying influenza virus also carried HEV in ≥ 1 other nasal swab. Two workers concurrently carried influenza A virus and HEV (1 swab each) – one was a persistent MDR-MRSA carrier and both were carriers of tetracycline-resistant, MDR, CC398, scn negative S. aureus (livestock-associated clones). 

Conclusion: Concurrent exposure to influenza A virus and HEV among individuals who persistently carry drug-resistant, livestock-associated S. aureus, MRSA and MDR S. aureus, has important public health implications. Future active surveillance is warranted at the human-animal interface and should assess risks of broader transmission (from work into the home and community) as well as the infectivity and pandemic potential of zoonotic pathogen strains.

Christopher Heaney, MS, PhD1, Nora Pisanic, PhD2, Maya Nadimpalli, MS3, Jessica Rinsky4, David Love, PhD5, Keeve Nachman, PhD5, Trish M. Perl, MD, MSc, FIDSA, FSHEA6, Steve Wing, PhD4 and Jill Stewart, PhD3, (1)Epidemiology and Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, (2)Epidemiology and Environmental Sciences, Johns Hopkins University School of Public Health, Baltimore, MD, (3)Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, (4)Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, (5)Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (6)Johns Hopkins University School of Medicine, Baltimore, MD


C. Heaney, None

N. Pisanic, None

M. Nadimpalli, None

J. Rinsky, None

D. Love, None

K. Nachman, None

T. M. Perl, None

S. Wing, None

J. Stewart, None

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