Pathogens, pulmonary function, and the nasal microbiome of dairy workers
Date
2024
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Abstract
Dairy workers are exposed to bioaerosols that are diverse in both size (0-100 µm in aerodynamic diameter) and inflammatory constituents (e.g. endotoxins, muramic acid, and β-glucans). Bioaerosol exposure at dairies is associated with a higher prevalence of chronic obstructive pulmonary disease (COPD), chronic bronchitis, asthma, respiratory pneumonitis, and asthma-like reductions in pulmonary function. More recently, opportunistic pathogens present at dairies such as the novel influenza D virus (IDV), influenza A (IAV), and livestock-associated Methicillin-resistant Staphylococcus aureus (MRSA) have also been a focus of research, as these pathogens can infect workers and pose a public health risk through community spread. Intrinsic factors such as genetics and childhood exposures likely play a major role in exposure response and respiratory disease pathology, but little research has been focused on the nasal microbiome's role in pathogen exposure and cross-shift changes of pulmonary function. From a longitudinal (2-5 working shifts) cohort of dairy workers in the High Plains Region of the US, this research analyzed pathogens found in the nares of dairy workers via pre- and post-shift nasal lavages. The same nasal lavages underwent targeted 16S rRNA gene sequencing to quantify the bacterial communities that comprise the nasal microbiome. Spirometry was also performed on dairy workers pre- and post-shift to measure cross-shift changes in pulmonary function. Overall, 32.1% (n=237) of nasal lavages tested positive for Methicillin-susceptible Staphylococcus aureus (MSSA), 11.4% tested positive for MRSA, 17.3% for IDV, 2.5% for IAV, and 1.3% for influenzas C virus (ICV). Only 1 of the original 31 participants never tested positive for a pathogen during their workweek. Differences in nasal microbiome characteristics emerged based on pathogen positivity, and differential abundance analysis revealed significant differences in genera based on the positivity of both bacterial and viral pathogens. The dairy workers in this study also experienced decreases in cross-shift pulmonary function. The average decrease in forced expiratory volume in one second (FEV1) over 108 working shift was -74.4 ml, and the average decrease of forced vital capacity (FVC) was -92.5 ml. Significant differences in microbiome characteristics did emerge based on post-shift and cross-shift spirometry performances, and taxonomic differences were noted in participants performing poorly on cross-shift FVC. The nasal microbiomes of workers also underwent community state typing, and participants in CST3 showed the most resilience to cross-shift changes in lung function. This research also investigated the efficacy of a hypertonic saline nasal lavage in improving cross-shift changes in pulmonary function. From a cohort of 44 dairy workers, 22 workers received pre- and post-shift hypertonic saline nasal lavages with an osmotic concentration of 400 milliosmole (mOsm). The 22 participants in the control group received pre- and post-shift normotonic saline (308 mOsm) nasal lavages. Based on constructed mixed linear models, the treatment improved cross-shift outcomes of the forced expiratory flow at 25-75% of the vital capacity (FEF25-75%), but had little effect on FEV1 and FVC. The use of a pre- and post-shift lavage of any osmolarity, however, appeared to reduce the burden of cross-shift pulmonary function decline often experienced by dairy workers. For the first time, this research showed that both viral and bacterial pathogens are present in the nares of US dairy workers. This work also identified the nasal microbiome characteristics that may play a role in pathogen exposure and cross-shift lung function outcomes. The use of a saline nasal lavage as an intervention was also explored, and the intervention appeared to improve cross-shift pulmonary function outcomes.
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Embargo expires: 08/16/2025.