Andrew Antolic

Greg Doyon

Meat Packers Case

#1 What are the processes involved in meatpacking

that can put people at risk of developing chronic disease?

The process of the head table is causing Progressive Inflammatory Neuropathy. This is a disease where your body’s immune system attacks the nerve or sheath that surrounds them. The foreign pig tissue being inhaled is causing the body’s immune system to attack its own neural tissue and causing inflammation in the nerve roots in the bottom half of the spinal cord. The purpose of the head table is to remove the pig brains from the skull. The brains are blasted out by a high-pressured air. The air and brains both travel through the same hole within the skull. The air pressure is so high that it aerosolizes the brains and the workers around the head table are inhaling it. They are getting sick from the aerosolized pig brains.

#1 continued What was the prevalence? 14 total. 12 in Austin, MN and 2 in Delphi, IN

What was the index case? The index case was the first patient. Tests showed his

spinal cord was severally inflamed.

How was a communicable disease ruled out? A communicable or infectious disease was ruled out

because they knew it didn’t spread person to person since the relatives of the sick did not become ill. Also, no one who ate the pork from the plant became sick. None of the workers showed signs of infectious diseases. Also the health department did scores of tests for bacteria, viruses, and parasites showed no signs of infection.

#1 Continued Definition on the case? Study design? Significant risk

estimates? The case is a mysterious autoimmune disease where aerosolized

pig brains is causing the immune system to attack its own neural tissue of the workers inhaling the brains. The study design used in MN was to determine who is getting sick, how they are getting sick, and why they are getting sick. The risk estimates first started with all employees within the plant, until the health department narrowed down the ill workers to only one section of the plant where a specific task was done.

Agree with how investigation was done? Yes I agree with the way the investigation was done. The health

department employees first went to the health records at the plant. The noticed that all the sick employees were from the head table. They then investigated the head table and decided that the procedure done there was causing harm to the workers.

#2 How are toxins ruled out?

Toxins were ruled out because none of the affected workers reported infectious disease symptoms, such as fever, before the onset of their neurological symptoms. Some chemicals can cause neuropathies. This can also be excluded if the head table workers are exposed to the same chemicals as the other workers who are not getting sick.

#3 How was work-relatedness determined and why

is that important in the investigation?

All 14 workers worked at or near the compressed air systems that blow the pig brain out of the skull. This is important to the investigation because it isolates the head table workers as being the ones that are getting sick. It means that the other workers are safe from getting ill under current procedure.

#4 Controls at plant prior to and following the

Minnesota health department visit? Prior to the Minnesota health department visit, the

workers at the head table were exposed to aerosolized pig brains. The workers would use high-pressured blasts of air to remove the pig brain from the skull. The workers would wear a hard hat, gloves, lab coats, and safety glasses; however their mouths and noses were still exposed. The workers in and around the head table would get splattered with pig brains, landing on their skin and inhaling the aerosolized brains since they did not have any masks or face shields. During the visit by Dr. Lynfield, the plant halted operations at the head table that day and ordered face shields for the head table workers. Along with the face shields, workers at the head table were ordered to wear long sleeves

#5 What ethical considerations are raised here for the

meat packing laborers, which are low-wage and largely immigrant? Some ethical considerations that apply to these workers

include: Since this is a job that requires relatively low skill there will always be laborers who can take the place of a worker who is laid off, fired, or can no longer perform their duties. The consideration for Quality Pork is do they show compassion for the migrant laborers and try to help them recover from their illness along with fixing their operations at the plant or do they continue what they’re doing with no regard for the migrants health, hiring cheap new labor when those who fall ill can no longer work.

#6 What information will you gather in the Delphi

plant to begin to address the hypothesis?

What measurements if any were taken to protect the workers from the aerosolization of the pig brains? Was the setup for the “backing heads” and “blowing brains” process the same? Were the tools used in the process the same as those found at Quality Pork? Are the clinical ailments of the workers from the Delphi plant similar to those found at Quality Pork? Is the Delphi plant as “exceptionally clean” as the one at Quality Pork.

#7 IH, USDA Meat Inspector, and a Veterinarian: Describe their roles in the

recognition, evaluation, and control phases of your study and the process you would use to gather them. IH- The industrial hygienist would be responsible for taking air samples and other

samples in order to determine what if any of the pig brain is reaching the laborers breathing zone. As well as inspecting mechanical aspects of the operation to see if maybe the pressurized air is too high. They may also be able to make recommendations on PPE for the laborers should administrative and engineering controls prove inadequate. Evaluation & Control

Inspector- the USDA meat inspectors would be responsible for inspecting the pigs being slaughtered before, during, and after for diseases, abnormalities, and other potential dangers to the end consumer (of which we can consider the laborer to be a consumer of pork through aerosolization). The inspector will also be for reference to government-imposed regulatory compliances as well as monitoring processes for anything out of compliance. Control & Recognition

Veterinarian- the Veterinarian will be a useful reference for any health problems that they can identify with the pigs. I think that having a Veterinarian conduct an autopsy on some of the pigs, especially the brains for any adulterations or abnormalities in the pigs would be useful for ruling out other causes of disease and illness. Recognition & Evaluation

#8 Using Hill’s criteria for causality, provide your view on a casual

relationship between the exposure of aerosolized hog brain and the disease described as progressive inflammatory neuropathy. All 12 workers who had fallen ill reported that they were in fact healthy

individuals before the onset of the neurological symptoms. 11 of the 12 patients had evidence of “axonal or demyelinating peripheral neuropathy”. 7 of the 12 patients had confirmed elevated blood protein levels in their CSF. 5 of the 12 had spinal inflammation. And all 12 workers work at or near the “blowing brains” work stations. The OR for cases working at the head table was 7, significantly higher than the warm room controls. “Case-patients also were more likely to have removed brains” with an OR of 15.3. Along with the disease not being associated with travel outside of the country, it seems fairly evident that laborers who work at the head table and are involved in the “blowing brains” process are more likely to be affected by this “progressive inflammatory neuropathy” than those who do not work at the head table.

#9 Precautions you might take at your plant

assuming similar processes to the Minnesota plant.

I would probably find a way to refine the process of “blowing brains” so that there is more confinement to the process, possibly requiring the laborer to wear a supplied air respirator and even consideration to add a walk in laminar flow style hood to capture aerosolized particles so that others in the area are not exposed as well.

#10 Elements of a surveillance program for this or

similar diseases that you may want to recommend.

I believe surveillance for this operation could involve monthly testing of workers by nurses/doctors for symptoms related to those who have previously fallen ill to the progressive inflammatory neuropathy. As well as making sure that the laborers are wearing the proper PPE. If the process is absolutely required then one may begin to refine the process so that risk is not as evident while still complying with government regulations. I believe that the underlying problem that would be found in surveillance is the use of the compressed air to “blow the brains” of the pig at the head table.