Volume 6: Human Health, 1989-96
8. Development of guidance on occupational risks from BSE and other TSEs
1990
Guidance for veterinary surgeons, slaughterhouse workers and farmers
Meetings of the combined CDTFZ & BSE

Guidance for veterinary surgeons, slaughterhouse workers and farmers

MAFF takes the lead on guidance for veterinary surgeons

8.90 As agreed on 25 July 1989, MAFF, in consultation with the BVA, produced a circular entitled 'Guidance for Veterinary Surgeons handling known or suspect cases of BSE' in January 1990. ¹ This covered the precautions to be taken during the initial examination of suspect cases, when taking and handling blood samples, during and after the calving of a BSE suspect and during post-mortem examination of a BSE suspect. The precautions included:

1. isolating the animal away from noise;
2. ensuring free access to exits for those dealing with the animal;
3. handling such animals firmly but quietly;
4. arrange for the animal to be restrained safely, preferably in a crush (animal handling crate);
5. wearing plastic or latex gloves for oral cavity examinations;
6. disposal of gloves by incineration;
7. recommendation to use vacutainers rather than syringes when taking blood samples;
8. proper disposal of needles;
9. protective clothing to be worn during calving;
10. minimal handling and safe disposal of placentae;
11. protective clothing during post-mortem examination; ²
12. proper disinfection routines.

8.91 On 26 February 1990, HSE issued a circular to its Area Directors and Inspectors drawing their attention to the January guidance for veterinary surgeons and stating:

Whilst the guidance (prepared in consultation with the British Veterinary Association and HSE) is aimed primarily at veterinary surgeons, it does contain information and guidance which may be relevant to others engaged in agriculture and similar occupations.

. . .

Inspectors may use the guidance as appropriate when giving advice on BSE. ³

HSE guidance for slaughterhouse workers and the issuing of 'BSE cards'

8.92 On 14 February 1990, Dr Matthews wrote to Dr Gompertz about the pending guidance notes for abattoir workers, stating that MAFF were 'receiving some criticism, especially from veterinary quarters, for not issuing earlier guidance'. ⁴ He pointed out that this might have been prompted by MAFF's circulation of the guidance notes to veterinary surgeons.

8.93 In February 1990, HSE published the pocket carry card entitled 'BSE and carcase disposal'. ⁵ This was aimed at those handling the carcasses of BSE-infected cattle and gave HSE contact telephone numbers, addresses and bullet point advice stating:

In the UK cows suffering from BSE are now slaughtered and their carcases taken for disposal.

While it is very unlikely that BSE will affect human health, it is important to take reasonable hygiene precautions in handling carcases of these animals.

The precautions suggested here will also protect you from other diseases of cattle known to affect man.

So when handling BSE carcases:

• cover cuts and abrasions with waterproof dressings before work starts;
• wear protective clothing including gloves;
• avoid cuts and puncture wounds during work;
• use eye protection if there is risk of splashing;
• wash your hands before eating drinking and smoking;
• wash down contaminated areas with detergent and water;
• rinse protective clothing free of debris after use and wash with detergent and water;
• report all accidents to your employer. ⁶

8.94 On 23 March 1990, Mr Lawrence minuted Mr Maslin expressing concern about 'HSE's inaction' in giving guidance to occupational groups that might come into contact with BSE. He said that despite pressure from MAFF, HSE's process had been slow in an area where they and DH should have been taking the initiative for a number of the groups concerned. ⁷ He commented:

Our problem is that whilst it is for HSE to take the lead in this it is our Ministers who take the flak on any aspect of BSE. ⁸

8.95 He recapitulated the advice issued so far:

- MAFF laboratory staff July 1988.

- To those handling, carting and disposing of suspected BSE carcases issued in August 1989 - but not in the final form we would have liked.

- General advice on zoonoses in agriculture - issued by HSE in December 1989 - BSE gets a mention but on the basis that there is no evidence of a risk for humans.

- Advice to veterinary surgeons - issued by MAFF in January 1990.

Farmers are advised about BSE, including safety aspects, when disease is suspected but a general note will shortly be going to all cattle farmers.

The one major outstanding area is abattoir workers (I think it was this aspect that led to criticism on Face the Facts). I believe that HSE are close to finalising this. ⁹

8.96 In the event, the guidance prepared jointly by the Meat Trades Joint Working Party and HSE (in consultation with DH and MAFF) was issued to the industry later that month. This was entitled 'Guidance Note 5: BSE' and advised 'on the occupational hazards from BSE of handling meat and meat produce in the abattoir and meat preparation industry'. ¹⁰ The introduction to the guidance drew attention to the Bovine Offal (Prohibition) Regulations 1989, which had come into force in November 1989. ¹¹ The guidance was also issued as an NIG minute to HSE Inspectors covering the industry. ¹²

8.97 The guidance advised on hygiene measures, including wearing protective gear and avoidance of injuries with instruments that might have come into contact with SBO and placentae. Employers were also advised about their responsibilities to provide adequate washing facilities and first aid supplies and to ensure a high standard of general housekeeping was maintained. ¹³

CDTFZ and discussions on BSE

8.98 During the early part of 1990 the CDTFZ met twice to consider those zoonoses agreed to be within the group's remit. BSE was discussed briefly during these meetings. At the third meeting, on 30 January 1990, the layout and content of the BSE cards was discussed. ¹⁴ At the fourth meeting, on 26 March 1990, Mr North reported on the issue of Guidance Note 5 (see paragraph 8.97) which was being printed by the British Meat Manufacturers' Association (BMMA) and 'should reach 90% of abattoirs, very quickly'. The Chairman pointed out that it should be clear that the guidance had been produced by the meat trade in consultation with HSE, MAFF and DH. Mr North also said that a more detailed look at work practices in slaughterhouses was required and this would be taken forward with the HSE/Meat Trades Joint Working Party. ¹⁵

HSE BSE Working Group merges with CDTFZ: guidance for renderers considered

8.99 At the fifth CDTFZ meeting, held on 31 May 1990, Dr Gompertz raised the question of the future of the HSE BSE Working Group. ¹⁶ Because the membership of both groups was largely the same and as the HSE BSE Working Group had not met for six months, it seemed sensible to combine the two. There was general agreement although it was pointed out that this was not to imply that the members felt that BSE was a zoonosis. It was agreed that the merged group would be titled Cross-Divisional Task Force on Zoonoses and BSE (CDTFZ & BSE).

8.100 Mr North felt that more detailed guidance was needed for abattoir workers covering the precautions to be taken against dangers of infection from and treatment of the more serious injuries, eg, deep cuts. The meeting also agreed that there was a need to investigate the risk factors related to the inhalation of aerosols in these work-places. The minutes record:

It was pointed out that there was also likely to be an increase in the use of band-saws, etc, and generally, unless there was to be a radical change in the way slaughterhouses are run, which seemed unlikely, risks could not be completely eradicated and workers would have to accept this and take sensible precautions. ¹⁷

8.101 Mr North pointed out that there was also clearly a need for guidance aimed at workers in the rendering side of the trade. He agreed that this would be produced as guidance from the Food NIG. ¹⁸ This guidance took two years to produce.

Farming industry on the agenda: MAFF takes the lead

8.102 On 2 January 1990, Mr D Wilks (Senior Agricultural Inspector, HSE) had written to Dr Gompertz questioning the need for written guidance to the farming industry on BSE. There was already guidance for laboratory workers and slaughterers and there was soon to be guidance for veterinary surgeons on handling known or suspect BSE cases. While he recognised the sensitive nature of the issue, he was concerned that HSE were claiming a lack of evidence that BSE was zoonotic yet they were issuing more guidance on BSE than any other zoonoses. In his opinion there was no need to issue further guidance to farmers/farm workers on this subject. He pointed out:

We would not be able to say anything new and would just reiterate the need for some protective clothing, washing facilities and good personal hygiene. ¹⁹

8.103 Dr Gompertz agreed:

I am quite happy to accept your view that there is no immediate need to issue guidance on BSE to farmers and farm workers. ²⁰

8.104 However, in February 1990, Dr Matthews wrote to Mr Gompertz enclosing draft advisory notes to farmers. ²¹ He stated that, despite Mr Wilks's opinion that no further guidance to farmers was needed, MAFF had already been in the process of producing the notes. In June 1990, MAFF issued 'Bovine Spongiform Encephalopathy (BSE) Advisory Notes for Farmers' which included a section entitled 'Health and Safety' providing brief guidelines for the management of BSE suspects. ²² The guidance, which had been agreed with HSE, stated that there was no evidence that BSE was infectious to humans but advised that BSE suspects be isolated and handled firmly but quietly. Whenever animals had to be treated on the farm, whether BSE suspects or not, strict hygiene procedures were to be followed so as to prevent the risk of spreading disease from animal to animal, and from animal to handler. It also advised consultation with a veterinary surgeon about breeding from offspring of cows infected with BSE. The note advised that further health and safety guidance could be obtained from HSE.

Discovery of cats with TSEs and implications for occupational health

8.105 On 10 May 1990, Dr Gompertz received a copy of a minute sent by Dr Pickles to Dr Metters (Deputy CMO) in which she reported the discovery of a spongiform encephalopathy (SE) in a cat. ²³ Dr Pickles identified two possible explanations: either that cats had been susceptible for years and previous cases had gone unrecognised or that a new agent, presumably BSE, was virulent in a way that previous agents such as scrapie had not been. She pointed out that the second possibility was most 'unlikely' but more worrying as it 'challenged the assumption we have made for humans by analogy with scrapie'. ²⁴ She added:

The potential hazard for humans from cats can be assessed on the assumption feline spongiform encephalopathy behaves like others in the family, in particular in the way infective agent is distributed. Parenteral exposure to 'risk' (ie lymphoid/nervous) tissue are the main concern.

8.106 She stated that accidental exposure in an occupational setting was being referred to HSE and that veterinarians were being informed by BVA. She also pointed out that neurophysiologists and others who experimented on cats might also need advice. ²⁵

8.107 The discovery of SE in a cat sparked off intense media speculation about the transmissibility of BSE and a full description of events is given earlier (see Chapter 4). As described there, during this period the Agriculture Committee produced a report on BSE having received evidence from many quarters. ²⁶ DH submitted a memorandum to the Committee outlining its involvement. The memorandum had been agreed with MAFF and HSE. Under the heading 'Potential Occupational Risks' it stated:

The Southwood group accepted that accidental inoculation with infected bovine material is a possibility in certain occupations. Laboratory staff working on the brains of BSE animals have adopted strict precautions to avoid such injuries. Advice has also been issued by the HSE to those handling the carcases of infected animals and in collaboration with the Meat Trade Federation also to workers in abattoirs. Additional advice is being considered for farm workers. The Ministry of Agriculture, Fisheries and Food has provided advice to veterinarians after consulting the HSE. The HSE is maintaining a Working Group on BSE and will tailor or modify guidance as and when new information arises of relevance to health and safety. ²⁷

Development of guidance for those working in zoos and zoological gardens with ungulates

8.108 SEs were also being recognised in an increasing range of zoo animals during this period. This led to the production of guidance for those who came into contact with them. On 24 August 1990, MAFF distributed guidance entitled 'Spongiform Encephalopathies in Zoo Animals'. The section on health and safety had been prepared in consultation with HSE. ²⁸ By way of introduction the guidance stated:

Since June 1986, five cases of a spongiform encephalopathy have been found in zoo ungulates. Recent press reports on these cases have highlighted the need for zoos to be vigilant for further cases. These notes give brief general guidance on this type of disease and the procedures that should be followed. Because of the limited knowledge of spongiform encephalopathies in captive zoo species they are largely based on experience of BSE and scrapie. ²⁹

8.109 The guidance advised on:

1. recognising SE symptoms in animals (including cattle);
2. procedure for reporting suspected cases to veterinary surgeons and the local Divisional Veterinary Officer of MAFF;
3. health and safety (including handling affected animals; procedure for treating animals whether suspected of having an SE or not; hygiene practices during handling and calving); and
4. breeding.

8.110 The guidance further advised that all staff involved with animals should be instructed and trained in identifying symptoms that could be related to BSE. ³⁰

Meetings of the combined CDTFZ & BSE

8.111 Following the agreement to merge the HSE BSE Working Group and CDTFZ in May 1990, the new combined group did not meet until 6 September 1990. On this occasion BSE was discussed briefly. Dr Ide (Food NIG) and Mr Lister reported that employers in the meat trade saw little need for further guidance and so were not willing to cooperate. The group decided that the most appropriate approach was to seek to have an observer on the Spongiform Encephalopathy Advisory Committee (SEAC). Mr Lister was to approach contacts in MAFF and report back on progress. ³¹

8.112 Dr Ide also reported that the first steps had been taken towards investigating the need to produce guidance on BSE for workers in the rendering trade. He said that the trade association had been contacted but it appeared that as workers had no contact with possibly infected animal tissue there might not be any need to carry this forward. It was agreed to leave this aside for the time being. The rest of the meeting was concerned with the list of zoonoses (as agreed in the previous CDTFZ meeting). A further meeting was scheduled for November. ³²