Some occupational groups are inevitably at greater risk of exposure to vectors and illness. Health care personnel are particularly prone to the risk of needlesticks and similar accidents, as well as dealing with patients with pathogens that can be spread by airborne droplets or by direct contact with body fluids and faeces. The difficulties in preserving high levels of risk avoidance in a rural hospital setting are all too common and emphasised by the tragic deaths of health care workers assisting patients with Ebola infection in Uganda or Congo-Crimean haemorrhagic fever in South Africa, the Middle East (Suleiman et al., 1980) and Pakistan (Burney et al., 1980). Tuberculosis has always been a problem for health care staff and remains a hazard for those working overseas in areas of high endemicity (Harries et al., 1997).
Other groups, such as veterinarians and agricultural workers, will be at increased risk of zoonotic infections such as brucellosis, Q fever and anthrax through contact with animals. Forestry workers, construction workers and other project workers may venture into forested or other rural ecosystems and be at risk of arthropod-borne diseases such as trypanosomiasis, onchocerciasis, loiasis, filariasis, rickettsial infection, leishmaniasis and yellow fever.
Aid workers and others in refugee or school settings are at risk of acquiring diseases of overcrowding such as respiratory infections and meningococcal disease. Military personnel constitute a special group. Although they may have received adequate immunisation and advice on malaria prevention, the latter advice may not be heeded in difficult field conditions. Their activities may result in considerable exposure to a wide variety of soil-borne pathogens, for example hookworms and Strongyloides spp, as well as to arthropod-borne and food- and waterborne illnesses. Sexually transmitted diseases also continue to be a particular problem in military personnel and merchant seamen.
Table 12.3 summarises some of the typical risks associated with different patterns of exposure behaviour.
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