Waste Collection and Viral Hepatitis: Assessing the Occupational Risk of HBV and HCV

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Waste collection and viral hepatitis:  Assessing the occupational risk of HBV and HCV

Ippoliti et al.

This article examines a continuation of other studies which have looked and hepatitis B and hepatitis C infections in waste collections personnel.  Hepatitis antigen and antibody levels were measured to look at infection and immunization status.  With a higher risk, waste collectors have a relatively high risk of hepatitis infection.  This article needs to address some comments for further consideration.

1. More information should be given regarding the participants in this study. In particular, which area of Italy was this study performed.  There is a rural and urban breakdown in the patient categorization, but how is that defined.  Was this near a large metropolitan area?  Regarding the breakdown of positives, how were the different positives divided amongst rural and urban individuals? 
2. Is there a larger amount of intravenous drug use that would correlate with HCV infection in different areas?
3. In the discussion, the authors should compare HBC and HCV infection rates to other public workers that would have the propensity or risk of infection. Is a heightened risk only for waste collections personnel?

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

• The question about evaluation the prevalence of HBV and HCV among waste collectors scrutinizing the associated risk factors is original and well-defined.  The article is written in an appropriate way, with high scientific soundness.
• The results provide an advancement of the current knowledge (HBsAb was detected in 66 individuals (56.9%), while HCVAb was found in 4 (3.4%). Logistic regression showed HBV immunization and longer job experience as significant factors associated with HBsAb presence).
• The work fits the journal scope.
• The results interpreted appropriately and they are significant. It is very important to emphasize that all weaknesses of the study have been addressed.
• The conclusions are  justified and supported by the results. Waste collection may increase HBV infection risk due to occupational exposure, unlike HCV, which requires blood-to-blood contact. Preventive strategies, including education, protective equipment, and HBV vaccination, are essential. Ensuring vaccination coverage among waste collectors could reduce infection risk. The conclusions are interesting for the readership of the journal.
• The data and analyses are presented appropriately.
• The methodology is described with sufficient details to allow another researcher to reproduce the results.
• The limitations of the study are honestly presented with the detailed discussion about weaknesses of the methodology and statistics. (The predominantely male study population – not representative sample;  lack of encompassing  the collection of data pertaining to the participants' adherence to standard safety protocols. While the chi-squared test did not reveal statistically significant associations between HBsAb positivity and the examined variables, the logistic regression analysis identified HBV immunization and job experience as significant predictors.probably due  to differences in the statistical power and the manner in which each method evaluates associations).
• There an overall benefit to publishing this work because the work advances the current knowledge.
• The English language is appropriate and understandable.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

I appreciate the opportunity to review your manuscript, which addresses an important but often overlooked occupational health issue: the risk of HBV and HCV infections among waste collectors. The study is well-structured, presents relevant data as well as offers practical recommendations for workplace safety and public health policies/guidelines. Your use of serological markers and statistical analysis provides a solid foundation for assessing risk and the inclusion of logistic regression strengthens the conclusions - even without strong significance presented there. The tables summarizing demographic and seroprevalence data are clear, making the findings easy to interpret. Moreover, the emphasis on HBV vaccination and occupational safety adds a valuable public health perspective. Thus, I am very supportive of the paper. 

However, I think that there are a few areas that could be improved to enhance the impact of the presented study. Namely:

The sample size, while informative, is relatively small (116 participants - it is not bad, but not good as well), which limits the generalizability/real life impact of the findings. This should be acknowledged more clearly in the discussion section.

What is more, while the study identifies a potential occupational risk for HBV, it lacks direct data on key exposure factors, such as needlestick injuries or the use of personal protective equipment (PPE) or mix of both of them. Including this information, or at least discussing its absence, would strengthen the conclusions regarding transmission risk patterns.

The interpretation of HCV risk also needs further discussion. The study suggests that waste collection is not a majoor risk factor for HCV, but alternative explanations, such as underreporting or differences in transmission routes, should be considered. Another piont that could be clarified is the discrepancy between the X2/chi-squared results and the logistic regression datas. While this is acknowledged, a more detailed explanation of why the chi-squared test did not show significance, while logistic regression did, would help readers better understand these results.

Beyond these main points, there are a few minor issues to address dueing the peer-review proces. The discussion section is somewhat repetitive in places and could be made more concise. There are also minor typographical and grammatical errors that should be corrected during proofreading.

Additionally, some references, particularly those discussing prior HBV and HCV studies, could be integrated more smoothly into the discussion for better flow - as well as might be updated since some of them are rather older than up-to-date.

Overall, this is a well-executed study that contributes meaningfully to our understanding of occupational risks for HBV and HVC. The findings support stronger workplace vaccination policies and preventive strategies. With minor refinements,particularly incorporating more details on occupational exposure and clarifying statistical interpretations, the paper will be even stronger.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

The Authors provided their revised manuscript along with the responses for my previous comments. They addressed them in a very well manner, what made me switch my former decision - minor revisions into the recommendation for the acceptance.