Hog CAFOs Can Affect Human Health

Hogs in a confinement facility. Photo: Courtesy Farm Sanctuary

Iowa produces more corn, soybeans, hogs, and egg-laying hens than any other state in the US. There are approximately 100 million farm animals — and only 3 million people. Animal feces is actually the state’s largest product. MRSA bacteria — which can cause the flesh-eating disease — and swine flu are growing problems. Concerned about these facts, Blue Planet Green Living (BPGL) contacted Dr. Allan Kornberg, a physician who serves on the board of directors of the Farm Sanctuary. We asked Dr. Kornberg about the human health effects associated with farm animals in confinement. — Joe Hennager, Co-Founder, Blue Planet Green Living

BPGL: Here in the middle of Iowa, we have the largest number of confined animal feeding operations (CAFOs) in the nation. We have environmental problems, not just with air pollution, but also with water pollution. Another concern is the potential spread of disease from animals to humans. For example, we have a friend who recently contracted the flesh-eating disease from MRSA [antibiotic-resistant Staph]; she lost a limb and very nearly died. We also have had cases of swine flu in Iowa. What we want to know is, what are the effects of CAFOs — particularly hog confinements — on diseases in humans?

KORNBERG: The hot topic in the press has been the threat of a swine flu epidemic, and MRSA is ongoing. Then there are the general environmental and medical issues for workers and citizens in these communities, who are suffering from manure, and air and water pollution, and so on.

Let me start with MRSA. There have been some epidemiological reports of a spread of MRSA from pigs to humans in Iowa. MRSA stands for methicillin-resistant Staphylococcus aureus (S. aureus), or Staph in the common jargon. Staph is a bacteria that’s been around since the beginning of time — since before we humans appeared on the planet. Many humans carry Staph on our skin, in our noses, that sort of thing. It’s common that we can be carriers in ways that do not cause disease. If I put swabs in the noses of five people, we’d probably have one who would have Staph aureus.

MRSA is a kind of Staph aureus that’s resistant to the great majority of antibiotics. This is a big problem, since staph aureus — even if it colonizes healthy people — sometimes can cause disease. The typical way to treat it, though not the only way, is with antibiotics.

The reason there’s a lot of Staph aureus that’s resistant to the common antibiotics — methicillin is in the penicillin family — is the heavy use of antibiotics. This was initially true in human medical care and now, especially, in agriculture. This is particularly common in confinement agriculture — otherwise known as factory farming.

What happens, then, is that bacteria are exposed to antibiotics. Let’s suppose I have an infection and take an antibiotic that’s going to wipe out the great majority of disease-causing bacteria in my body. Because there’s billions of them, a few will evolve or mutate and will become resistant to the antibiotic. It’s just evolution on a very rapid cycle scale, since bacteria double every twenty minutes or so, as opposed to the rate of many higher species, which could be years or decades. So the bacteria that are resistant will survive and prosper in an environment where the other bacteria are being killed off by antibiotics.

Antibiotics are wonderful. They save millions of people. But by using antibiotics aggressively and overusing them, either in human health or in agriculture, we’re creating antibiotic-resistant bacteria. Some of this has happened in human medicine, which is why people shouldn’t take antibiotics for colds, because a cold is a virus, and antibiotics don’t help.

What’s been happening in agriculture for a long time is the move toward placing animals in confinement conditions, which creates great distress and cruelty to the animals. The agriculture industry pushes harder and harder with the confined space to get the high yield in production, treating animals as production units. If you throw a lot of antibiotics at the animals, you’re probably able to have more animals survive in a highly unnatural and difficult environment, and perhaps they’ll get larger faster. I think the last numbers I saw were, believe it or not, something like 70% of all antibiotics used in North America are used in agriculture, and most of the rest are used in human health and veterinary medicine.

What happens now are antibiotic-resistant bacteria are created in agriculture, especially in factory farming. Then some Staph aureus are converted to MRSA, and that MRSA spreads from pigs or other animals to humans. If one is cooking pork until it is medium- to medium-well-done, that will kill the bacteria. The people working in factory farms and slaughterhouses who come in contact with pigs, and the people who handle raw meat, including a food preparer at home handling raw meat — they are the ones most likely to come in contact with MRSA, if it’s present.

If a human gets sick from MRSA, it’s much harder to treat. Before the heavy use of antibiotics in confinement agriculture, the great majority of humans who would come into contact with MRSA would be in hospitals — at least in developed countries. This is true for two reasons: One, you’re more likely to get MRSA if you’re frail or sick. And, two, there’s a lot of antibiotics in a hospital environment, causing antibiotic-resistant bacteria.

But now we’re getting cases of what’s called community-acquired MRSA in otherwise well people.  This is due in large part to the overuse of antibiotics. Arguably, there should be very little antibiotics used in agriculture. In  confinement agriculture, given the conditions of filth and the close quarters, we’ve taken normal staph aureus that’s harmless to well people in general, and we’ve converted it to a kind of bacteria that’s resistant to antibiotics and can be more aggressive.

If someone gets MRSA — if you simply get a boil or a big pimple, it can be treated by lancing. But if it becomes an invasive disease, like pneumonia or sepsis (blood infection) — or urinary tract infections and the like, it can be life-threatening and difficult to treat. If somebody has a serious MRSA infection, they need to be hospitalized, because the only antibiotics that might work are the kinds you have to give by I.V. in a hospital, not just pills you can take as an outpatient. So we’ve really created a disease in the combination of factory farming in agriculture and the use of antibiotics in agriculture. Put those two together, and humans being close to pigs, in this example, that has enabled some of the spread.

BPGL: How does MRSA transfer into a flesh-eating disease?

KORNBERG: It can be flesh-eating. That tends to be scary language; it’s almost science fiction-like. You’ve probably heard of staph infections. Staph is simply a bacteria that can affect any part of the body. One part of the body that’s commonly affected is skin. If it’s a superficial skin infection or a boil, and the boil is lanced, or somebody takes an antibiotic, and it’s not MRSA, but regular staph, then everybody’s fine. If the staph is MRSA and harder to treat, and it gets to a deeper layer than the skin surface, it can spread like wildfire. It can really destroy deeper tissue: fascia, muscles, down to bone. Then that’s a catastrophic infection that can lead to death. If it’s a blood infection, it can require amputations and so on.

BPGL: Is there a name for that moment when it turns from just a surface infection to a deeper one?  Or is it just staph in general?

KORNBERG: It’s just staph in general. I think most physicians would tend to describe it by the anatomic area, so if it involved muscle, we might call it myositis and so on. The flesh-eating infection is when Staph or other bacteria invade the lining of muscle, the fascia, and its called necrotizing fasciitis.

BPGL: How is it possible for an average citizen to find out how many Staph infections exist, to find out if there’s an epidemic level of it in an area? There don’t seem to be public notices about MRSA, though there are notices about the swine flu.

Hogs in CAFOs live in crowded conditions. Photo: © Jura - Farm Sanctuary

Hogs in CAFOs live in crowded conditions. Photo: © Jura - Fotolia

KORNBERG: Probably one reason is that swine flu — or influenza in general — can spread rapidly and dramatically, person to person. You can have an epidemic in area, or a state or country or the world, fairly quickly. Although there’s no doubt MRSA spreads person to person, it tends not to spread in the same virulent way. If you have one  child in a school with swine flu, you might get twenty or fifty or a hundred the next week. If you have one  child with MRSA, you might get another case, but you’re not going to get a hundred. So while MRSA can be devastating, and people can die from it, it doesn’t have the same sort of spread that H1N1 or other influenza viruses have.

BPGL: MRSA bacteria is either airborne or waterborne. Does the means of spreading change depending on how it’s carried?

KORNBERG: If it’s airborne or waterborne, it could be in the soil. It could be communicated skin to skin, person to person, animal to person — any of those ways.

BPGL: We live in Iowa, an area of the country that has a higher particulate level of MRSA in the air and water. So do we, therefore, live in an area in which people are more apt to acquire such a disease?

KORNBERG: It’s certainly plausible and logical. There’s reason to be concerned about that, given the [agricultural] industry you have in Iowa, but I’m not sure that that’s been well-proven yet.

BPGL: Has there ever been a study about farmers — especially those who handle hogs — acquiring staph infections at a higher level than the general population? Is there any study indicating that people living in a state with a high concentration of CAFOs have a higher incidence of acquiring staph?

KORNBERG: What’s been shown so far is a number of individual cases in the US, Canada, and Europe. Presumably, it happens in the developing world, too, but it’s not been studied as well there. There’s been evidence of a few individual cases where — in a sophisticated lab like the Centers for Disease Control (CDC), or perhaps some state public health departments, but not your average community hospital — they can subtype the staph. Although Staph aureus is one kind of bacteria, there are many, many subtypes.

If an individual, a farmer or slaughterhouse worker, has MRSA, and you know what its subtype is, then you go back to the place they work. If you find the same subtype there, you can reasonably conclude that it was an occupational exposure. That’s been done several times, and I think one of those studies took place in Iowa.

To pick an example, many years ago, there were environmental dumps like Love Canal, and you’d find a three- or four- or fivefold increase in certain types of cancer in communities, presumably because of an increase in a carcinogen, and those are highly suggestive kinds of studies.

But I don’t think there are any studies about MRSA and pig farming that have found such a huge increase on a population basis. All I’ve seen have been individual cases. I’ve not seen a population study. It might be that the best place to look for information would not be the hospitals, even a teaching hospital; it’d be the Department of Public Health. If I were a director there, I would hope I’d be interested in knowing this, and I would hope that I would not be influenced by industry in the state. That would be a good place to start — and/or the Centers for Disease Control (CDC).

This long building is a typical Iowa CAFO (though it has a unique air-filtering device attached). Photo: Joe Hennager

This long building is a typical Iowa CAFO (though it has a unique air-filtering device attached). Photo: Joe Hennager

BPGL: I don’t know if we can draw a conclusion with a few stories, but we’re looking at the higher risk of disease, whether it be cancer from the chemicals or the disease from the bacteria that’s in the air and water. Is there any way you can contract some of these diseases by drinking water? Does it survive the water treatment process?

KORNBERG: No. For MRSA, that would not be a real risk. Your tap water should be safe. It would be more a matter of if the factory farms are dumping only partially treated manure — which they do — that gets into soil and water, that’s a way for it to spread in the environment. But if it’s gone through a treatment plant, it should be safe.

BPGL: If they’re spreading manure on frozen ground, and that gets into the waterways, and then into the reservoir, where people recreate — is it a possibility that they could get MRSA from the water in which they’re swimming?

KORNBERG: If they are swimming in it, sure.  You are at risk there.

BPGL: If we start taking water samples, is there a particulate level that would indicate a level of risk for swimmers or water skiers?

KORNBERG: To know if there’s a public health issue would require a laboratory saying something like: Last year we had two cases of Staph aureus and zero of MRSA. And this year, we have nine cases of staph aureus and three of MRSA. Then you should start to be concerned about that. It’s the amount that’s MRSA versus plain staph.

BPGL: If a member of the public went, not to the hospital, but to the Department of Public Health, to inquire, should this information be available to the public?

KORNBERG: It should be. I’m a physician, not a lawyer, but the short answer is, yes. The Department of Public Health should provide such answers, whereas a hospital, for confidentiality reasons and so forth, tends to be much more careful with such information. If there are communities that are seeing increased incidence of MRSA, then it would be the duty of the public health authorities to find out why and put a stop to it.

BPGL: What we’ve been told by a scientist is that, when air is sampled within twenty-five yards of a hog confinement facility, the particulate level of MRSA is thousands of times its normal safety level, even up to five miles away.

KORNBERG: If that’s true, that would really be a concern. From an epidemiological point of view, if you have higher concentrations of MRSA right around a farm and decreasing concentrations concentrically around that farm, but still higher than normal, until it eventually gets to baseline, that’s highly suggestive that the farm is related to the increased incidence of MRSA.

BPGL: There appears to be no filtering system, no devices placed for safety, to reduce any of the methane or any of the bad chemicals that are coming out of the hog CAFOs, let alone the bacteria.

KORNBERG: There are other bacteria — E. coli would be a common one — that come from pigs, from manure, that are a public health danger. Swine flu is a virus, so it has a different epidemiology. But in terms of skin-to-skin contact, a lot of it’s in manure, so there’s nothing really different about MRSA in terms of how a farmer would handle that. When there are very high concentrations of animals and manure in an environment, and it’s not being processed in a public health-friendly way, you raise the risk.

BPGL: I’m just kind of amazed that they haven’t developed some kind of filtering system for the air that escapes CAFOs, let alone the sewage that gets into the water. Just the airborne particulates alone are kind of frightening.

KORNBERG: I agree. And then it becomes a question of what does it cost, and how large is the risk, and what are the politics, and so on.

BPGL: The only way that the level of risk can be proved, though, is to use statistics as to the death rates and acquisition of these particular diseases. It doesn’t seem that information is available — or, if it is available, it isn’t being disseminated.

KORNBERG: That’s true. Having more MRSA in the environment around factory farms is a worry, because it suggests that, if not improved over time, it will run the risk of serious disease in humans. The conclusive piece, of course, in any epidemiological study would be if Iowa has very little MRSA disease in humans historically, and all of a sudden there’s a number of cases, and most of them are coming from people who work in factory farms or live near factory farms. It wouldn’t take a rocket scientist to conclude that the factory farms are related to the spread of MRSA in that situation. But one would have to have that data and make that conclusion, and that’s the responsibility of public health authorities.

BPGL: Farmers don’t allow anyone into CAFOs — not even public health people to count the pigs. Based on the possibility of contamination, they have the legal right to keep people out of their hog lots. So we’re in a position where the data is hidden behind the walls of these confinements. No one sees them, no one knows what’s going on. Then you also have the issue of the torture and cruelty being experienced by these animals, where cramming in one or two extra pigs per pen results in a few extra few dollars.

In the last days of their life, there’s absolutely no way hogs can lie down, or move around at all. We don’t know what’s happening inside these confinements, because farmers are worried that humans will spread disease to their entire herd.

KORNBERG: The conditions for the pigs in those environments are horrific. Pigs can’t turn around, and there’s filth, and so on. And then you have sows that are in gestation in those conditions. There’s much that is horrific for the animals in factory farming, and it’s certainly reasonable to be concerned, from a human health point of view, that if you have that many animals — especially pigs — in that kind of confinement environment, that you would run risks in human health.

You would have to show that’s real, and hopefully there won’t be, but if there were a few cases of necrotizing fasciitis with people that live or work around these farms, I would expect that the public health authorities would presumably feel some need to be aggressive. That would be their responsibility.

MRSA is not insignificant. Most people that get or die from MRSA are people that are in hospitals that have serious underlying disease. About a hundred thousand people a year get MRSA, and about 20,000, or one of out five, die, which is about as many people who die from HIV/AIDS in America.

So it’s not an inconsequential disease at all. Not that we should be any less sympathetic, if it’s someone that’s at the end of their life, who’s in their eighties or nineties and has multiple organ failure. But if it’s a healthy and vigorous person, who’s going about their life and picks up MRSA in the environment, it’s obviously a catastrophe. There’s real risk of more of that.

BPGL: I guess what I’d like to see is if the National Children’s Study, in which individuals will be followed from before birth and for several decades, will show that being in an agricultural-based community creates a higher incidence of certain diseases, possibly including the necrotizing fasciitis. I hope that they will get a good cross-section of children from agricultural families. The sampling in Iowa is only in Polk County (where Des Moines is located), and will be headquartered in an inner-city hospital.

KORNBERG: In general terms, if one were looking for MRSA incidence where MRSA is believed to be linked principally to hospital environments — this has been sort of the historical, common way; it’s in hospitals where there’s lots of antibiotics going around — then one would look around hospitals. If one is concerned about a new spread of MRSA from an environmental or industrial agricultural basis, then one would look where those communities are.

About Dr. Kornberg

Allan E. Kornberg MD is Senior Vice President for the National Initiative for Children’s Health Quality (NICHQ) and a pediatrician with 25 years of clinical and executive experience. Dr. Kornberg’s most recent healthcare post prior to joining NICHQ was as CEO of Network Health, a Medicaid health plan serving the poor in Massachusetts. He has also been Medical Director with Harvard Pilgrim Health Care, the Executive Director and Medical Director for the physician-hospital organization at Scottish Rite Children’s Medical Center, and Chief of Emergency Medicine at Buffalo Children’s Hospital. Dr. Kornberg is a member of Farm Sanctuary’s Board of Directors, and served as the U.S. Executive Director for the World Society for the Protection of Animals, a global animal welfare charity based in London, UK.

About Farm Sanctuary

Rescued hogs at the Farm Sanctuary lead a very different life from hogs in confinement. Photo: © Derek Goodwin, Farm Sanctuary

Farm Sanctuary is the nation’s leading farm animal protection organization. Since incorporating in 1986, Farm Sanctuary has worked to expose and stop cruel practices of the “food animal” industry through research and investigations, legal and institutional reforms, public awareness projects, youth education, and direct rescue and refuge efforts. Farm Sanctuary shelters in Watkins Glen, N.Y., and Orland, Calif., provide lifelong care for hundreds of rescued animals, who have become ambassadors for farm animals everywhere by educating visitors about the realities of factory farming. Additional information can be found at www.farmsanctuary.org or by calling 607-583-2225.

Joe Hennager

Blue Planet Green Living