Health and Safety                                                                        July 2009

 updated August 28, 2009
Also see composting page for a description of "Chronic Obstructive Pulmonary Disease" as in "Acute toxic alveolitis,
otherwise known as "organic dust toxic syndrome" as in Sewage Sludge Disease caused by toxic dusts.

We don't normally think of enteric bacterial infections as coliforms.  But 60 years ago they did. Today we only hear of
coliform bacteria in conjunction with water testing -- along with the statement that they do not cause disease.
are identified as a group of gram negative bacteria (fecal, soil, water) that ferment lactose to produce gas and/or acid
at 37C when incubated for 24-48 hours. The Eijkman [fecal coliform] test was developed and assumed to prove recent
fecal contamination of water by human gram negative enteric bacteria (E.coli) that continued to grow at an elevated
temperature of 46C.. It was assumed that all other coliform bacterial growth was suppressed at the elevated
temperature. In the following 1949 study the title says coliform, but it uses the fecal coliform test which would miss some
of the current causes of urinary tract infections.

Wet and stained films of centrifuged deposits from catheter specimens of the urines were examined and
the urines cultured on MacConkey's medium and blood agar. Any coliform bacilli isolated were
identified by biochemical tests, and their sensitivity to sulphanilamide, penicillin, and streptomycin was
determined. The fermentation reactions using glucose, marnitol, lactose, sucrose, and salicin were
employed. Other tests used were: the formation of indole, gas production at 44' C., utilization of citrate,
Vosges Proskauer test (Barritt's modification), and the methyl red reaction. The coliform bacilli were identified
by the criteria described in Topley and Wilson's Principles of Bacteriology and Immunity (third edition).
Of the eighteen strains of Bact. aerogenes tested, six produced gas at 44o C. after 48 hours' incubation
though not after 24 hours'. They were, however, classified as Bact. aerogenes. P. vulgaris was distinguished
from P. morgani by the ability to swarm on blood agar. The paracolon bacilli included three anaerogenic strains, two of
which were late lactose fermenters.
J. clin. Path.-(1949), 2,- 134

Isolation of Acinetobacter from Soil and Water
Before the isolation of a large number of strains from soil and water in our laboratory, most of the available strains of
Acinetobacter had been isolated from clinical specimens (eyes, ears, nasopharynx, abscesses, blood, wounds, genital
samples, stools, urine, etc.), and had been assigned a variety of specific names (2). In recent times, and
with increasing frequency, these bacteria have been implicated in cases of postoperative meningitis, respiratory tract
infections, endocarditis, and septicemia, particularly after extensive antibiotic treatment (4, 8).

Health effects of Organics

Epidemiological Study of Klebsiella pneumoniae Among Pulp and Paper Mill Workers
Biochemical testing revealed the over 50 percent (range from 4 to 97 percent) of the fecal coliform bacteria associated
with pulp and paper mill processing were identified as bacteria of the genus Klebsiella, of  which K. pneumoniae was
found to be the most prevalent species.
Sampling of paper mill workers resulted in Klebsiella isolation from the upper respiratory tract. Klebsiella biotyping
revealed that the Klebsiella isolation from a pulp mill worker matched the Klebsiella biotype  found in the plant's
processing waters. An addition relationship was observed between Klebsiella biotypes isolated from plant sanitary
sewers and the mills processing waters. -- the U.S. Environmental Protection Agency should not encourage recycling
within the pulp and paper industries as a means of reducing waste discharges.

Potential Health Effects from Viable Emissions and Toxins Associated with Wastewater Treatment Plants and Land
Application Sites.
wastewater treatment does not completely remove pathogens and may become concentrated in the sludge. Exposure
to airborne pathogens and toxins can effect the health of workers at wastewater treatment plants and land application
site, and on the populations living in the vicinity of the treatment plants and land application sites. Precautions should
be taken to limit human exposure to these airborne pathogens and toxins. [
This study is interesting because it only
mentions 3 types of bacteria and 5 classes of viruses and the statement
], "Under special circumstances an
infection can develop from a single virus, protozoan, or helminth

Diagnosis of coliform infection in acutely dysuric women.
We reevaluated conventional criteria for diagnosing coliform infection of the lower urinary tract in symptomatic women
by obtaining cultures of the urethra, vagina, midstream urine, and bladder urine. The traditional diagnostic criterion,
greater than or equal to 10(5) bacteria per milliliter of midstream urine, identified only 51 per cent of women whose
bladder urine contained coliformis. We found the best diagnostic criterion to be greater than or equal to 10(2) bacteria
per milliliter (sensitivity, 0.95; specificity, 0.85). Although isolation of less than 10(5) coliforms per milliliter of midstream
urine has had a low predictive value of previous studies of asymptomatic women, the predictive value of the criterion of
greater than or equal to 10(2) per milliliter was high (0.88) among symptomatic women the prevalence of coliform
infection exceeded 50 per cent. In view of these findings, clinicians and microbiologists should alter their approach to
the diagnosis and treatment of women with acute symptomatic coliform infection of the lower urinary tract.
N Engl J Med. 1982 Aug 19;307(8):463-8.

Health Effects of Land Treatment: Microbiological (1982) Norman Edward Kowal EPA quotes from the 1863 work, The
Natural Laws of Husbandry, Even the most ignorant peasant is quite aware that th rain falling upon his dung-heap
washes away a great many silver  dollars, and that it would be much more profitable to him to have on his fields what
now poisons the air of his house and  streets of the village; but he looks on unconcerned and leaves matters to take
their course, because they have always  gone on in the same way.  "In the context of the present-day conventional
wastewater treatment we might add "poisons the rivers and streams" as  well." Surface water pollution from land
treatment site runoff is not considered since proper system design should prevent   direct runoff to surface waters
(Sorber and Guter 1975).

Invasive Salmonella dublin Infections Associated With Drinking Raw Milk
Salmonella dublin is a serotype of Salmonella that is host-adapted to cattle and rarely
infects people. In one year (1980-1981) we diagnosed five cases of salmonellosis due to
S dublin at the Veterans Administration Medical Center, San Diego. Four patients had
positive blood cultures and one died. A sixth patient, diagnosed in 1978, had a mycotic
aortic aneurysm but survived. Compared with nine patients who had Salmonella infections
due to other serotypes, the S dublin patients were older, had a greater number of
underlying chronic illnesses and were more seriously ill with their infections. Four of the
six S dublin cases occurred in association with drinking "certified" raw milk from a
commercial dairy.

Correlation of Elastase Production by Some Strains of Aspergillus fumigatus with Ability to Cause Pulmonary Invasive
Aspergillosis in Mice
All 36 mice exposed to elastaseproducing strains died within 48 to 96 h. Lung tissue from dead mice showed hyphae
and necrosis of the alveoli.
INFECTION AND IMMUNITY, Jan. 1984, p. 320-325 Vol. 43, No. 1

Bacteria of Public Health Significance Associated with Fish Reared in Treated Wastewater
The suitability of tertiary wastewater ponds for aquaculture was evaluated in term of fish production obtained and
significance of bacteria in wastewater. -- The relative abundance of of selected bacterial colony types was found over
the course of the experiment. -- Fecal coliforms and fecal streptococci were commonly found from both the water and
fish  -- Klebsiella was the most common fecal coliform from the water while aermonas hydrophila was the most common
from fish. Streptococcus fascalis was the most common fecal streptococcus from water and fish.

Risk of Infectious Disease from Use of Sludge on Land and Methods to Reduce These  Risk
Viruses highly absorbed or contained in solids. Proportion in sludge is high.
Pathogen runoff is a concern as is transmission by crops and livestock .
Infectious dose of many thousands unlikely to be digested to cause disease, however bacteria regrow.
[One organism ingested may triple every hour creating millions/billions within the  one to three days it takes the disease
to show up in the human body]

Health Effects of Land Application of Municipal Sludge
A survey of 1008 publicly owned treatment works, accounting for over 2 million dry metric tons per day of sludge, found
17% of the total sludge to be utilized in large scale food-chain landspreading, 12% in large scale nonfood-chain
landspreading, and 21% in distribution and marketing systems (much of which probably ends up in gardens and lawns).
With the application to land of large volumes of wastewater and sludge, it is evident that considerable potential for
adverse effects exists. (
Runoff  to surface water is not considered, since it is assumed that this will be
prevented in a well-managed sludge land application operation.
) -- only a fraction of the total viruses in
wastewater and other environmental sample may actually be detected.-- what is a safe waiting period before crop
harvested for human consumption is really and unsettled issue. -- Bacterial survival in soil 2 months to one year and on
plants, 1 to 6 months. Virus survival on soil is 3 to 5 months and on plants 1 to 2 months. -- The literature to date
suggests little danger of bacterial, viral, or protozoan disease to animals grazing at land application sites if grazing does
not resume until four weeks after last application -- Epidemiological studies suggest little effect of land application on
disease incidence. However,
many questions on the public health consequences of land application of
wastewater and sludge remain.

Characterization of Heat-Stable Enterotoxin from a Hypertoxigenic Escherichia coli Strain That Is Pathogenic for Cattle
An enterotoxigenic Escherichia coli (ETEC) strain isolated from a calf with clinical scours was found to
produce over 17- to 60-fold more heat-stable enterotoxin (STa) than four laboratory-adapted bovine ETEC
strains. The purified STa of this strain was identical to those produced by other ETEC strains. A severe form
of scours was induced in 5- to 15-day-old colostrum-fed calves and in 1- to 2-week-old piglets by oral
administration of the purified STa. This study demonstrates that STa is a mediator of diarrhea in newborn
calves and piglets and that under identical growth conditions diverse strains of bovine ETEC may produce
variable amounts of homologous STa's.

Role of Streptococcus mutans in Human Dental Decay
Dental infections such as tooth decay and periodontal disease are perhaps the most common bacterial infections in
humans. Their non-life-threatening nature and their ubiquitousness have minimized their significance in overall human
health. Yet the economic burden for the treatment of these dental infections can be staggering. In the United States the
annual cost for the symptomatic treatment of dental infections
in 1977 was over 11 billion dollars (69), and this had increased to about 24 billion dollars in 1984 -- In particular, the
evidence that implicates the mutans streptococci (MS) (81, 209) and the lactobacilli (LB) as being responsible for the
majority of human dental decay will be examined. -- spirochetes (204, 216, 221), black-pigmented bacteroides (221,
304, 306, 354), Actinobacillus actinomycetemcomitans (361), Eubacterium (255), and Wolinella sp. (328), are
associated with the diverse clinical entities that are classified as periodontitis (221, 268).

Risk assessment of opportunistic bacterial pathogens in drinking water. (1997)
Rusin PA, Rose JB, Haas CN, Gerba CP.
This study was undertaken to examine quantitatively the risks to human health posed by heterotrophic plate count
(HPC) bacteria found naturally in ambient and potable waters. There is no clear-cut evidence that the HPC bacteria as
a whole pose a public health risk. Only certain members are opportunistic pathogens. --HPC bacteria in drinking water
often include isolates from the following genera: Pseudomonas, Acinetobacter, Moraxella, Aeromonas, and
Xanthomonas. Other bacteria that are commonly found are Legionella and Mycobacterium. All these genera contain
species that are opportunistic pathogens which may cause serious diseases. For example, the three nonfermentative
gram-negative rods most frequently isolated in the clinical laboratory are (1) Pseudomonas aeruginosa, (2)
Acinetobacter, and (3) Xanthomonas maltophilia. P. aeruginosa is a major cause of hospital-acquired infections with a
high mortality rate. Aeromonas is sometimes associated with wound infections and suspected to be a causative agent
of diarrhea. Legionella pneumophila causes 4%-20% of cases of community-acquired pneumonia and has been ranked
as the second or third most frequent cause of pneumonia requiring hospitalization. The number of cases of pulmonary
disease associated with Mycobacterium avian is rapidly increasing and is approaching the incidence of M. tuberculosis
in some areas. Moraxella can cause infections of the eye and upper respiratory tract.

Australia -- Statement of Principles concerning EXTRINSIC ALLERGIC ALVEOLITIS, Veterans’ Entitlements Act 1986
Extrinsic allergic alveolitis is associated with a restrictive pattern of respiratory function tests.
Examples include farmer’s lung, bird-fancier’s lung, ventilation pneumonitis and woodworker’s lung.
The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that
extrinsic allergic alveolitis and death from extrinsic allergic alveolitis can be related
to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.
“antigenic source” means the source of the antigen responsible for causing extrinsic allergic alveolitis. Examples of
antigenic sources include: · Detergent powder,·
Sewage sludge contaminated with micro-organisms, · Wood dust
contaminated with micro-organisms, ·
Compost dust contaminated with micro-organisms, etc.[reactive chemical

Legionella: Human Health Criteria Document
Legionella bacteria are aerobic gram-negative rods associated with respiratory infections. Legionella
pneumophila was first recognized as a disease entity from a pneumonia outbreak at a 1976 Convention of the
American Legion in Philadelphia. Of the 42 known species of Legionella, 18 have been linked to pneumonia
infections in humans. -- In a later study, Palmer et al. (1995) examined tertiary treated (including chlorination) sewage
effluents that are used as reclaimed water and aerosols obtained from above a secondary sewage treatment basin for
the presence of Legionella. The bacteria were detected in samples of reclaimed water at all four sites tested using two
detection methods: polymerase chain reaction and direct fluorescent antibody (see Chapter 7, Section A for
explanation of detection methods). The researchers noted that they were not able to culture Legionella obtained from
any of the reclaimed water samples, suggesting that chlorine may injure Legionella and cause them to enter a viable
but nonculturable state. Legionella were detected in the air obtained from above secondary treatment (activated
sludge) aeration tanks at one site using polymerase chain reaction, direct fluorescent antibody, and plate culture.
NIOSH HD 10 Safety Recommendations (2000)
Workers Exposed to Class B Biosolids During and After Field Application  Workers may be exposed to disease-causing
organisms while handling, applying or disturbing Class B biosolids on agricultural lands or mine reclamation sites. The
detection of enteric bacteria in a limited number of air and bulk samples confirms the potential for workers to be
exposed to organisms which have been associated with gastrointestinal symptoms and illness. Operations where
employees are potentially exposed to Class B biosolids include transport, loading, unloading, and application activities.
Other potentially exposed workers include compost workers, surface miners working around reclamation sites, and
farmers. Appropriate personal protective equipment should be required for all job duties likely to result in exposure to
Class B biosolids. The choices of personal protective equipment include goggles, splash-proof face shields,
respirators, liquid-repellant coveralls, and gloves. Face shields (that fit over the employee’s hard hat) should be made
available for all jobs where there is a potential for  exposure to spray, high-pressure sewage leaks, or aerosolized
biosolids during land application. Gloves should be used when touching biosolids or surfaces exposed to biosolids.
Management and employee representatives should work together to determine which job duties are likely to result in
this type of exposure and which type of equipment is needed. A qualified health and safety professional should provide
training or retraining in the appropriate use of personal protective equipment.  

Public health aspects connected to the use of sludge on land
Recycling of organic material to agriculture is a desirable aim from the point of view of saving raw
materials which are of limited availability such as phosphorous, but this aim may conflict with the necessity to protect
humans, animals and plants from undesired infections as well as with general aims of environmental protection. This
report covers only the hygienic aspects of the use of sludge on land. However, undesired organic and inorganic
pollutants can also cause risks and must be kept in mind. -- This includes the direct transmission of pathogens to
humans or animals and plants of agricultural importance as well as the introduction of these pathogens into the
biozoenosis and  environment by the application of such material as organic fertilizers. --  Indirect transmission to
humans is of special importance, because the introduction of pathogens into the food chain via contaminated fertilizer
leading to contaminated animal feed resulting in infection of farm animals and / or excretion of pathogens is of basic
epidemiological significance.-- This direct relationship between fertilizing with sewage sludge and infection in cattle fed
with forage after spreading was reported by BREER (1981) for Salmonella (Fig. 1). -- Table 8 demonstrates the
importance of birds as carriers of salmonella. Sewage treatment plants have been identified as one of the sources of
infection in sea-gulls. Additional means of introduction of certain pathogens were demonstrated by
KÖHLER (1993). He identified a Salmonella Enteritidis lysotype in waste delivered from West-Berlin to a waste disposal
site in the former GDR and followed the introduction of this pathogen via birds into the chicken populations and finally
to humans via products containing eggs.

Guidance for Controlling Potential Risks to Workers Exposed to Class B Biosolids (2002) DEPARTMENT OF HEALTH
AND HUMAN SERVICES Centers for Disease Control and Prevention National Institute for Occupational Safety and
Class A biosolids may also present some health risk to workers, since some chemicals and biologic constituents in
Class A biosolids are not regulated by the EPA.  Enteric organisms that may be found in biosolids include, but are not
limited to, Escherichia coli, Salmonella, Shigella, Campylobacter, Cryptosporidium, Giardia, Norwalk virus, and
enteroviruses. Exposure may potentially result in disease (e.g., gastroenteritis) or in a carrier state in which an infection
does not clinically manifest itself in the individual but can be spread to others. These enteric organisms are usually
associated with self-limited gastrointestinal illness but can develop into more serious diseases in sensitive populations
such as immune-compromised individuals, infants, young children, and especially the elderly.  Personal Protective
Equipment (PPE).— Appropriate PPE should be provided for all workers likely to have exposure to biosolids. The
choices of PPE include goggles, splash-proof face shields, respirators, liquid-repellent coveralls, and gloves. Face
shields should be made available for all jobs in which there is a potential for exposure to spray or high-pressure leaks,
or aerosolized biosolids during land application. Management and employee representatives should work together to
determine which job duties are likely to result in this type of exposure, to conduct appropriate on-site monitoring, and to
determine which type of PPE is needed in conjunction with a qualified safety and health professional. If respirators are

Interactions of pathogens and irritant chemicals in land-applied sewage sludges (biosolids)
Affected residents lived within approximately 1 km of land application sites and generally complained of irritation
(e.g., skin rashes and burning of the eyes, throat, and lungs) after exposure to winds blowing from treated
fields. A prevalence of Staphylococcus aureus infections of the skin and respiratory tract was found.
Approximately 1 in 4 of 54 individuals were infected, including 2 mortalities (septicaemia, pneumonia). This
result was consistent with the prevalence of S. aureus infections accompanying diaper rashes in which the
organism, which is commonly found in the lower human colon, tends to invade irritated or inflamed tissue.

Dental caries is a preventable infectious disease
Dental caries is the most common infectious disease affecting humans. The principal  causative agents are a group of
streptococcal species collectively referred to as mutans streptococci of which streptococcus mutans and streptococcus
sobrinus are the most important agents of human caries. Plaque on teeth are biofilms

BACTERIAL BIOFILMS: An Emerging Link to Disease Pathogenesis
The role of biofilms in the pathogenesis of some chronic human infections is now widely accepted. However, the criteria
used to determine whether a given infection is caused by biofilms remain unclear. In this chapter we discuss three
infections that are caused by biofilms—infectious kidney stones, bacterial endocarditis, and cystic fibrosis lung
infections—and focus on the role of the biofilm in disease pathogenesis. Biofilms are also important as environmental
reservoirs for pathogens, and the biofilm growth mode may provide organisms with survival advantages in natural
environments and increase their virulence. The consequences of pathogens living in environmental biofilms and an
analysis of some specific environmental biofilm systems are presented. Annual Review of Microbiology, Vol. 57: 677-
701 (Volume publication date October 2003)

Human intestinal bacteria as reservoirs for antibiotic resistance genes
Human intestinal bacteria have many roles in human health, most of which are beneficial or neutral for the
host. In this review, we explore a more sinister side of intestinal bacteria; their role as traffickers in antibiotic
resistance genes. Evidence is accumulating to support the hypothesis that intestinal bacteria not only
exchange resistance genes among themselves but might also interact with bacteria that are passing
through the colon, causing these bacteria to acquire and transmit antibiotic resistance genes.
-- passing through the human colon on a regular basis are pathogens such as Streptococcus pneumoniae and
Staphylococcus aureus; -- In addition to such pathogenic transients, there are potentially pathogenic
members of the intestinal microflora itself, such as Escherichia coli, Enterococcus species, Clostridium
species and Bacteroides species [18,19]
TRENDS in Microbiology Vol.12 No.9 September 2004

Potentially pathogenic features of heterotrophic plate count bacteria isolated from treated and untreated drinking

Heterotrophic plate counts (HPCs) are commonly used to assess the general microbiological quality of drinking water.
Drinking water quality specifications worldwide recommend HPC limits from 100 to 500 cfu ml(-1). A number of recent
studies revealed evidence that these bacteria may not be as harmless as generally accepted. It appears that immuno-
compromised individuals are particularly at risk. This would include the very young and very old patients with diseases
such as AIDS and patients on therapy for purposes such as organ transplantation and cancer treatment. In this study,
339 bacterial colonies were isolated at random from selected treated and untreated drinking water in South Africa using
routine heterotrophic plate count tests. In a first step to screen for potentially pathogenic properties, 188 (55.5%) of the
isolates showed alpha- or beta-haemolysis on human- and horse-blood agar media. Subsequent analysis of the
haemolytic isolates for enzymatic properties associated with pathogenicity revealed the presence of chondroitinase in
5.3% of the isolates, coagulase in 16.0%, DNase in 60.6%, elastase in 33.0%, fibrinolysin in 53.7%, gelatinase in
62.2%, hyaluronidase in 21.3%, lecithinase in 47.9%, lipase in 54.8% and proteinase in 64.4%. Fluorescein and
pyocyanin were not produced by any of the isolates. Among the haemolytic isolates, 77.7% were resistant to oxacillin 1
microg, 59.6% to penicillin G 2 units, 47.3% to penicillin G 10 units, 54.3% to ampicillin 10 microg and 43.1% to
ampicillin 25 microg. Cell culture studies revealed that 96% of haemolytic isolates were cytotoxic to HEp-2 cells, and
98.9% of the 181 cytotoxic isolates adhered to HEp-2 or Caco-2 cells. HEp-2 cells were invaded by 43.6%, and Caco-2
cells by 49.7%, of the 181 cytotoxic isolates. The invasion index on HEp-2 cells ranged from 1.9 x 10(-1) to 8.9 x 10(-6),
whereas the invasion index on Caco-2 cells varied between 7.7 x 10(-2) and 8.3 x 10(-6). The most commonly isolated
genera with these potentially pathogenic features were
Aeromonas, Acinetobacter, Aureobacterium, Bacillus,
, Corynebacterium, Klebsiella, Moraxella, Pseudomonas, Staphylococcus, Tsukamurella and Vibrio.
The results obtained in this study support earlier findings on potentially pathogenic features of bacteria detected by
routine HPCs on drinking water. These findings are in agreement with some epidemiological studies, which indicated an
association between HPCs in drinking water and the incidence of gastroenteritis in consumers. However, the extent of
the health risk concerned needs to be defined in more detail for meaningful revision of quality guidelines for HPCs in
drinking water. Copyright 2003 Elsevier B.V.

DEATHS IN 2005         CDC's death and mortality report for 2005,  
According to EPA's sludge policy (40 CFR 503.9(t)) the pollutants (i.e., organic chemical substances,  inorganic
chemical substances and pathogenic organisms -- bacteria and viruses, etc.) in sewage products  recycled for
beneficial use on food crops, parks, school grounds, home lawns and gardens could have had  a significant impact  in
the cause of deaths.

Nocardial Cerebral Abscess Associated with Mycetoma, Pneumonia, and Membranoproliferative Glomerulonephritis
Nocardial brain abscesses remain a clinical challenge. We successfully treated a patient with nocardial brain abscess,
mycetoma, pneumonia, and glomerulonephritis. Nocardial soft tissue involvement, mycetoma, is well known. However,
the fact that actinomycetoma can metastasize may not be as well appreciated. The association between nocardiosis
and glomerulonephritis should be better clarified. JOURNAL OF CLINICAL MICROBIOLOGY, June 2007, p. 2072–2074  

Escherichia coli bacteraemia in Canberra: incidence and clinical features
E. coli is the most common cause of bacteraemia in Canberra, and incidence increases with age. Most cases have a
community onset, but many episodes are related to health care procedures. Ongoing surveillance is important for
identifying risk factors that may be modified to reduce disease.
MJA 2008; 188: 209–213 (file 5)

Dental Decay: The Hidden Health Crisis According to Maryland Senator Ben Cardin's staff, dental decay is now the
most common chronic childhood disease in the US, affecting twenty percent of children aged 2 to 4, fifty percent of
those aged 6 to 8, and nearly sixty percent of fifteen year olds. It is five times more common than asthma among school
age children, and nearly 40 percent of African-American children have untreated tooth decay in their adult teeth.
Improper hygiene can increase a child's adult risk of having low birth-weight babies, developing heart disease, or
suffering a stroke. Eighty percent of all dental problems are found in just 25 percent of children, primarily those from
lower-income families.

EPA Announces New Steps to Protect Americans from Lead Poisoning
Lead causes a variety of adverse health effects, including brain and nervous system disorders, high blood pressure
and hypertension, and reproductive problems.  For children, even low levels of exposure to lead can cause a host of  
developmental effects such as learning disabilities, decreased intelligence, and speech, language, and behavioral
problems, which can impact children for a lifetime.
[The solution]: A new effort to ban the manufacture of lead in tire

Infectious  Disease Tables --   including inorganic and organic diseases

EPIDEMICS?               PANDEMICS?     COINCIDENCE? Parallels sludge biosolids use!

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