Database

The great majority of human tuberculosis infection cases are contracted as a result close proximity to an infected person with overt illness. 10% of infected people will become ill with the disease, in most circumstances, carriers who are well will not act as a source of infection. In the UK most new cases are among those who contracted the disease while resident abroad. Evidence from: HPA Press Release 2nd November 2006 “Cases of Tuberculosis rise steeply during 2005” The cost of treating a drug-sensitive case of tuberculosis has been estimated to be £6,040, rising to £60,000 if the organism is multi-drug resistant. In 2004 7% of cases died, mostly among those aged over 65. In 2005 8.7% of TB cases were resistant to at least one first line drug. Drug resistance was highest in London and lowest in Northern Ireland but did not vary with country of origin. Further detail: 6#7-8 8

A very large number of traceable zoonotic events occur each year in the EU. Most result in mild illness but some are very serious/fatal. Tracing policy varies from one state to another but most events are caused by contaminated food or drink. People can carry disease while suffering no ill-effects and pass the disease on to others through food handling. Evidence from: The EFSA Journal (2006) 403, 1-62 “Zoonoses, Zoonotic Agents and Antimicrobial Resistance in the European Union in 2004” Bacteria were the cause of the majority of confirmed zoonotic infections in humans in the EU in 2004: Salmanellosis 192,703 cases (42 per 100,000)(principally from raw hen egg, [broiler] flesh and egg products, probably transmitted in animal feeds, between 2% and 18% of fresh poultry meat samples test positive, below 10% in pig meat, outbreaks have also been traced to foods washed with contaminated water, disease in humans is usually reversible, but was reported to have led to 12 deaths) Fur

Rates of TB infection in cattle are increasing rapidly. Tracing the origin of infections is becoming more facile. Risks to Professional Indemnity and product liability exposures should increase. Evidence from: PDO Davies. Journal of the Royal Society of Medicine. (2006) Vol.99 p 539 -540 “Tuberculosis in humans and animals: are we a threat to each other?” In the past 20 years the number of infected herds has increased from 88 to 5,539 per year. The main reason is probably increased rates of cattle to cattle transmission as animals are increasingly moved from farm to farm. There is a highly effective test of disease status; it should be possible to isolate infected cattle. Cause of loss could be traced to a duty-holder. Further detail: 6#7-8 6

This study of just one kind of medicine, used in a wide variety of settings, highlights the potential for accidental exposure to non-nursing staff, especially those with a low awareness of the potential for contamination of patient skin, clothing and bedding. Evidence from: T Meijster et al. Ann. Occ. Hyg. (2006) Vol.50 p 657 – 664 “Exposure to Antineoplastic Drugs outside the Hospital Environment” The degree of risk to home care and nursing home staff cannot be assessed from this study. However, it is clear that protocols are not providing as much protection as would be expected in a hospital setting. It should be expected that employees will come into contact with drugs which are not fully metabolised and metabolic by products, especially where these are present on the skin of the patient. Further detail: 6#7-8 5

This research confirmed in that use of wastes for the purposes of soil improvement provides a mechanism for contamination of food with live microbiological pathogens. Guidance on the management of wastes for application to farm land is expected soon. Evidence from: FSA News October 2006 “Transmission of Pathogens from Farm and Abattoir Waste to the Food Supply Chain and its Impact on the Microbiological Safety of Food” Recycling of animal wastes is becoming more sophisticated but as yet there is no definitive guidance of risk management. Some viruses are very much more persistent in wastes than are E coli. E coli is the usual reference species for risk assessment. Further detail: 6#7-8 4

The study confirms that there is no risk-free exposure to Radon. It also finds no interaction between radon and smoking; the risks are simply additive. In our view, this means that compensation issues should remain separate; material contribution should not be an issue. Evidence from: S Darby et al. Scand J Work Env Health (2006) Vol.32 supp1 p 1-16. “Residential Radon and lung cancer – detailed results of a collaborative analysis of individual data on 7148 persons with lung cancer and 14,208 persons without lung cancer from 13 epidemiological studies in Europe.” For lifelong non-smokers, the risks of lung cancer at 100 Bq/m³ and 400 Bq/m³ were estimated to be 1.2 and 1.6 respectively, relative to no radon exposure. For those smoking 15 – 20 cigarettes per day the relative risk of lung cancer would be 25.8 at 0 radon exposure, 29.9 at 100 Bq/m³ and 42.3 at 400 Bq/m³. Further detail: 6#7-8 3