In March 2017, more than 171,000 chickens in the United States had avian influenza. The current epidemics of avian influenza virus in China demonstrate that it is possible for humans with direct contact with infected poultry, or been in areas where infected poultry have been slaughtered can become sick and die from avian influenza. U.S. poultry processing factory workers are in contact with bird feces, blood, and tissues. It is time for us to ensure that these men and women are provided paid sick time, hand-washing facilities, and adequate personal protective equipment.
On March 16th, 2017, a highly pathogenic avian influenza (HPAI) virus was found in two separate commercial poultry sites in the United States. The virus found in the two sites within Lincoln County, TN, was confirmed as a North American wild bird lineage H7N9 by the USDA APHIS National Veterinary Services Laboratory (USDA, APHIS, 2017). Within the same month, low pathogenic avian influenza (LPAI) H7 viruses were found in commercial operations in Tennessee, Kentucky, and Georgia. Three backyard flocks in Alabama also tested positive for low pathogenic avian influenza in March 2017. The press release confirmed H7, presumptive low pathogenic avian influenza in a commercial flock in Georgia (Georgia Department of Agriculture), low pathogenic avian influenza in western Kentucky (Kentucky Department of Agriculture), and the Avian Influenza in Tennessee (Tennessee Department of Agriculture).
Outbreaks of HPAI occur around the world. In the ‘2016 H5 HPAI Around the World’ document, 19 countries in Europe, 5 countries in the Middle East, 12 countries in Asia, and 7 countries in Africa reported highly pathogenic avian influenza H5 subtypes (USDA, 2017). The virus that causes avian influenza is spread quickly from bird to bird via contact with contaminated respiratory secretions and feces. Avian influenza viruses use birds as their hosts, and infect humans in isolated, rare, individual cases (Swayne, n.d.)
There are some avian influenza strains that are able to cross the species barrier and infect humans, such as the avian influenza virus A Asian lineage H7N9. As of April 3rd, 2017, the World Health Organization reports that there have been 1,347 laboratory-confirmed human infections with this specific virus since 2013 (WHO, 2017). The symptoms of people infected with this virus include severe pneumonia, fever, cough, and shortness of breath (WHO, 2014). According to the U.S. Centers for Disease Control and Prevention, about 40% of the people confirmed with Asian H7N9 virus infection have died (CDC, 2017).
An article entitled “Changes in avian flu virus in China causes concern” reported that the outbreaks of avian influenza Asian lineage H7N9 among people living in China could cause an influenza pandemic. In order to prevent a pandemic of influenza, which would be a situation where a high proportion of the population over a wide geographic area could be affected, the United Nations’ Food and Agriculture Organization and World Organization for Animal Health, jointly announced an international alert to promote rapid detection and response to this strain of avian influenza (Linden, 2017).
How Humans Get Infected with Avian Influenza
Chickens, turkeys, ducks, and geese infected with LPAI may not appear ill. Despite the lack of symptoms, studies in 2005 and 2007 show that LPAI viruses are present in the respiratory and gastrointestinal tissues of infected chickens (Swayne, 2005; Zepeda, 2007). According to the Merck Manuel Veterinary Manual, chickens infected with HPAI will be infected throughout their body and up to 100% of the birds in the flock will die within a few days (Swayne, Overview of Avian Influenza). HPAI viruses have been shown to be present in the blood, bone, and breast and thigh meat of chickens (Swayne, 2005).
The World Health Organization reports that most of the humans infected with the Asian lineage H7N9 avian influenza had direct contact with infected poultry, had visited wet markets, or been in areas where infected poultry had been kept or slaughtered (WHO, 2014). Currently, the Asian lineage H7N9 avian influenza is not easily spread from human to human. However, this may change if a person infected with the H7N9 avian influenza is also infected at the same time with a seasonal human influenza. Influenza viruses have separate gene segments, which allow viruses from different species to mix and create a new virus via a process called genetic reassortment. The Centers for Disease Control and Prevention states that “it is possible that the process of genetic reassortment could occur in a person who is co-infected with an avian influenza A virus and a human influenza A virus,” (CDC, 2015).
avian influenza virus typically enters via the mouth, nose, and eyes.
The United States Department of Agriculture’s Foreign Animal Disease Preparedness Response Plan states that among people who are in contact with infected poultry, avian influenza virus typically enters via the mouth, nose, and eyes. Liquid or solid particles containing the virus could be inhaled into a person’s respiratory system or brought into contact with the eyes, nose, or mouth via unwashed hands (USDA APHIS, 2014).
Health Risks to Poultry Processing Employees within the United States
In the United States, the majority of people who eat chicken are not in direct contact with infected poultry. Most of us do not raise our own meat birds, buy freshly killed chicken at wet markets, or hang out in areas where meat birds are raised or slaughtered. Instead, U.S. consumer buy plastic-wrapped packages of cut and deboned chicken body parts from grocery stores or buy pre-cooked chicken from fast food establishments and restaurants. The avian influenza virus is inactivated in the presence of soap and heat. Avian influenza is not a disease that is spread from eating properly cooked chicken, turkey, duck, or goose.
There are 250,000 employees across the country who work in poultry processing plants
However, people who work in the U.S. poultry processing plants that process live chickens into meat may be at risk of avian influenza infection. Every day, 30 million chickens are killed to produce the chicken meat we eat (Oxfam America, 2015). There are 250,000 employees across the country who work in poultry processing plants, with yearly turnover rates of up to 100% (Oxfam America, 2015). The beginning of the poultry processing line involves women and men who work as ‘live hang’ and ‘manual back dock’ employees. Their job is to lift live birds one at a time out of the catch-cages or off the supply conveyer. They hang these birds by their feet onto a shackle conveyer. According to the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), these employees are at risk of contracting respiratory diseases such as cryptosporidiosis, psittacosis, and Newcastle disease due to contact with dirt and dried poultry feces released from the feathers of the birds (DOL OSHA, Task 3: Live hang).
Protective Equipment for People who are in Constant Contact with Liquid or Solid Particles that may Contain Avian Influenza Virus
In 2014, a component of the United States Department of Agriculture (USDA) released the second draft of their HPAI standard operating procedure (SOP) which outlined Health and Safety & Personal Protective Equipment guidance for poultry employees who may have prolonged direct contact with infected birds or contaminated surfaces (USDA APHIS, 2014). The SOP recommended that workers put on personal protective equipment (PPE) in designated areas before entering potentially contaminated areas. The suggested PPE included disposable underwear, sock booties, two-piece scrub suit, Tyvek® or similar protective cover-all with boot pouches and hood, steel-toed rubber boots, goggles, an air purifying respirator, an impermeable cut-resistant apron, and double-gloves of nitrile or latex disposable gloves underneath larger chemical-resistant gloves (USDA APHIS, 2014).
Existing Personal Protective Equipment for Poultry Processing Workers
As mentioned above, many of the men and women working in poultry processing facilities are exposed to feces, blood, respiratory, and gastrointestinal tissues. These bodily fluids may contain avian influenza viruses. Unfortunately, the conditions in these facilities are not conducive to adequate PPE compliance.
There are short films posted on the Oxfam Lives on the Line – The high human cost of chicken website advocating for workers in poultry companies (Oxfam America, 2015). In these videos, none of the workers were wearing air purifying respirators, goggles, or hooded coveralls. In particular:
- The employees shown hanging live birds appeared to be wearing sweatshirts and jeans underneath a large rubber apron (Oxfam America, 2015).
- The poultry processing employees working with bloody carcasses were shown wearing transparent gowns made up of cotton or synthetic material, a hair net, impermeable arm sleeves, and a rubber apron.
- The employees pictured on the cutting and deboning lines appeared to be wearing cloth-smocks over their own pants, dresses. Many of the men and women had bare skin showing from their elbows to their wrists and some were wearing sneakers.
It is possible that the limited use of PPE could be due to challenges some poultry companies place on their employees. In the Oxfam Research Report, it states that “interviews with workers and advocates revealed a diversity of practices around safety equipment. Some plants provide all the necessary equipment; some provide only some of the items; some provide one or two of each item and then require the worker to buy any additional items needed if they become damaged” (Oxfam, 2015). Prior to 2010, Pilgrim’s Pride Corporation had no agreement to pay employees for their time putting on and taking off PPE in their processing plants (US Department of Labor, January 2010). On June 3rd, 2010, an injunction against Tyson Foods Incorporated ensured “that for the first time, Tyson poultry processing workers will be paid for all the time they spend at the plant putting on and taking off protective and sanitary items, a process known as donning and doffing, as well as for the time they spend washing and sanitizing themselves and the items,” (US Department of Labor, June 2010).
Decontaminating and Health Monitoring of People who are in Constant Contact with Liquid or Solid Particles that may contain Avian Influenza Virus
The USDA HPAI SOP recommends that poultry employees who may have prolonged direct contact with infected birds or contaminated surfaces take the following actions upon leaving potentially contaminated areas: remove their PPE, shower, and change into clean underwear and clothes. In addition to being offered an influenza antiviral drug daily, their health should be monitored for the development of avian influenza symptoms (USDA APHIS, 2014).
Poultry processing workers are not provided timely opportunities to leave the factory line even when they have to use the bathroom. If men and women are being forced to urinate and defecate on themselves due to a lack of replacement workers, my suspicion is that there may be inadequate hand washing and showering facilities (Oxfam America, 2015).
Regarding health monitoring, the Oxfam research report says that their interviews and reviews of industry research did not provide one example of a line worker who got paid time off for sick days (Oxfam America, 2015). The lack of sick days results in workers who show up to work even if they have a cold or seasonal human influenza. Workers obtain their medical care through medical personnel stationed in the facility. Referrals to an outside doctor must be pre-approved by the poultry processing facility if the worker wants their insurance company to cover the cost (Oxfam America, 2015).
This spring, the North American lineage H7N9 avian influenza virus was found in commercial poultry operations in Tennessee, Kentucky, Alabama, and Georgia. This strain is different that the Asian lineage H7N9 avian influenza virus currently circulating in China. The Asian lineage H7N9 virus is responsible for causing severe pneumonia and death among people in China who have had direct content with infected poultry, visited wet markets, or been in areas where infected poultry have been slaughtered.
In the United States, 30 million chickens are processed every day
In the United States, 30 million chickens are processed every day inside poultry processing facilities. Many of the 250,000 employees working on the lines are breathing in dirt and dried poultry feces (DOL OSHA, Task 3: Live hang), are having poultry blood splashed into their mouth and eyes (DOL OSHA, Task 4: Kill room attendant), or at risk of having their hands cut with the sharp knives and poultry scissors that were used to remove internal organs, entrails, and sections of raw meat from bird carcasses.
Current conditions inside U.S. poultry processing facilities may be ideal for starting an influenza pandemic for the following reasons:
- There is a high chance that line workers feel obligated to show up to work with colds and seasonal human influenza because they are not provided with paid sick time (Oxfam America, 2015).
- Employees may not have adequate time for hand washing since there are reports of workers who are not provided the opportunity to leave the line to use the toilet in a timely fashion (Oxfam America, 2015).
- Poultry processing facilities may inadvertently be discouraging the use of PPE such as air purifying respirators, goggles, hooded coveralls, steel toed rubber boots, impermeable cut-resistant aprons, and disposable gloves underneath larger chemical-resistant gloves, due to the following restrictive policies (Oxfam America, 2015):
- Employers not paying their employees for the time to properly put on and take off equipment
- Requiring that their employees purchase or replace their damaged PPE rather than providing quality protection for the employee
The presence of avian influenza in the United States is a wake-up call for U.S. consumers, large poultry processing facilities, OSHA, and infectious disease epidemiologists. It is time for all of us to get invested in the health and well-being of the people processing our chicken. It is our duty to ensure that workers in the United States who are at risk of being in contact with meat infected with avian influenza virus are protected and their health is monitored to prevent an influenza epidemic or influenza pandemic.
Alabama Department of Agriculture and Industries. (2017). Avian Influenza Updates and Helpful Information. Retrieved from http://www.agi.alabama.gov/s/avian-influenza
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