Four times “the full of a hen egg shell”

An exploration of the public health challenges posed by honey bees and beekeeping

There is not an animal that lives on the earth nor a being that flies on its wings, but they form parts of communities like yourself

Quran 6:38

1. Rationale

2. Pest control issues and the law

3. Bee stings, typical and hypersensitive (allergic) reactions and their

treatment

4. The health of the beekeeper

5. The contamination, treatment and composition of honey

5.1 Legislation

5.2 Clostridium botulinum

5.3 Toxic nectar

5.4 Toxic pollen

5.5 Veterinary drugs

5.6 Pesticides

5.7 Organic status

6. The processing, bottling and sale of honey

6.1 Legislation and due diligence

6.2 Hazard analysis and HACCP

6.3 Materials used for processing and storage

6.4 The composition and labelling of honey

7. Proactive and responsible

References

Glossary of beekeeping terms

(Where indicated in the text, beekeeping terms are explained in the glossary)

1. Rationale

There are an estimated 35,000 beekeepers in the UK managing approximately 200,000 honey bee colonies (see Glossary)(1). These bees forage for a radius of up to 3 miles from their hives (see Glossary) and, at peak size, there are 50-60,000 bees per colony (2). The total value of insect pollination, of which 80% is attributed to honey bees (3,4,5), is calculated at £172.2 million for outdoor crops and £29.8 million for glasshouse crops (1,6,7). It is estimated that one in three mouthfuls of food consumed in the UK has been pollinated by a honey bee (1). Honey production is estimated at 4000 tons per annum with a value of £15.7 million (8).

The significant social, nutritional, economic and environmental impact of beekeeping for humans combined with the widespread distribution of honeybees, their physiological capacity to sting and their propensity to reproduce colonies through swarming (see Glossary) means that they pose specific public health challenges and yield broad public health benefits. This is reflected by the application of legal controls on food, work and the environment to beekeeping and hive products.

Public health benefits include the widespread use of hive products (see Glossary) in modern medicine, the pollination of foodstuffs, social protection, economic regeneration and the development of social capital. This work considers the public health challenges posed by honey bees, beekeeping and honey production in the UK (or where specified, England and Wales).

2. Pest control issues and the law

Pest control duties in England and Wales are the responsibility of local authorities (Unitary/Metropolitan or, where a two-tier system exists, District and Borough Councils) and, unless contracted out to private companies, are usually delivered through environmental health departments and Environmental Health Officers (EHOs). Since 1999, local authority services have been subjected to Best Value scrutiny. Best Value was trailed in the White Paper Modern Local Government (9) and passed into legislation in the Local Government Act 1999 (10), which received Royal Assent on 27 July 1999. It sets out a vision of councils listening to the people they serve, building up their communities, working in partnership with others and delivering efficient services to high standards measured through audit using the “4 Cs”:

· Challenge

· Consult

· Compete

· Compare

Best Value and its’ predecessor, Compulsory Competitive Tendering has resulted in pest control services responding to the public health threat posed by rats, less so mice and for threats posed by bees usually being dealt with “at cost” or informally through liaison with local beekeepers.

The key pest control issues concerning bees are

· The siting of bee hives causing a loss of enjoyment of property and gardens

· Incidents of stinging

· Swarms

· Spotting on windows, washing and vehicles due to bee faeces

A suit brought against a beekeeper by a neighbour or local authority who wishes to complain about bees must be founded in negligence or nuisance. Relevant legislation covering statutory nuisances is found in the Public Health Act 1936 (11) and Clauses 79 –82 of the Environmental Protection Act 1990 (12). Local authorities bring the majority of cases but Section 82 of the 1990 Act enables individuals to act independently. This is summarised with accompanying notes in Table One.

Table One: Extracts from the Environmental Protection Act 1990 (12) with accompanying notes based on Case Law by the author (italics)

Section	Text of Act (with comments in italics)
Section 79	…..the following matters constitute “statutory nuisances” for the purposes of this Part, that is to say – (f) any animal kept in such a place or manner as to be prejudicial to health or a nuisance It is not necessary to prove that a nuisance is prejudicial to health. It is sufficient to show that it interferes with personal comfort.
Section 80	(1) Where a local authority is satisfied that a statutory nuisance Exists, or is likely to occur or recur, in the area of the authority, the local authority shall serve a notice (“an abatement notice”) imposing all or any of the following requirements – (a) requiring the abatement of the nuisance or prohibiting or restricting its occurrence or recurrence. (b) Requiring the execution of such works, and the taking of such other steps, as may be necessary for any of those purposes And the notice shall specify the time or times within which the requirements of the notice are to be complied with. (3) The person served with the notice may appeal against the Notice to a Magistrates’ Court within the period of twenty-one days beginning with the date on which he was served with the notice. (4) If a person on whom an abatement notice is served, without reasonable excuse, contravenes or fails to comply with any requirement or prohibition imposed by the notice, he shall be guilty of an offence. In other words, it is crucial that the beekeeper acts quickly and either accepts the Notice and acts upon it or appeals to the Magistrates’ Court within the time limit.
Section 81	(3) Where an abatement notice has not been complied with, the local authority may, whether or not they take proceedings for an offence under Section 80 (4) above, abate the nuisance and do whatever may be necessary in execution of the notice.

Section 82

(1) A Magistrates’ Court may act under this section on a complaint

Made by any person on the ground that he is aggrieved by the existence of a statutory nuisance.

(2) If the Magistrates’ Court is satisfied that the alleged nuisance

Exists, or that although abated it is likely to recur on the same premises, the Court shall make an order for either or both of the following purposes –

(a) requiring the defendant to abate the nuisance, within a time specified in the order, and to execute any works necessary for that purpose;

(b) prohibiting a recurrence of the nuisance and requiring the defendant, within a time specified in the order, to execute any works necessary to prevent the recurrence.

Under this section, the Claimant can take action by making a complaint himself and does not need the support of the local authority.

Negligence involves damage caused by negligence to another person to whom one has an obligation to take care. In the context of beekeeping, it is difficult to imagine a case in nuisance which does not involve negligence. For example, if the Claimant is complaining about the number of hives, the way in which they are sited or about bees with a vicious temperament then he is claiming that the Defendant’s conduct amounts to a nuisance and also that it is caused by the Defendant’s negligence (13). Case Law (14,15,16) shows that the Claimant must prove not only that they are enduring a legal nuisance but they must also satisfy the court that it is the Defendant’s bees that are causing the problem.

Occasionally, the concept of “scienter” is still used. Scienter is an action involving strict liability, irrespective of any negligence. It argues that if a person keeps a wild animal and it causes damage, then they are liable for the damage. Scienter is Latin for “knowingly” and the case is that the beekeeper knows that bees are likely to cause damage (17).

Ownership and responsibility for swarms of bees revolves around the division of animals into two classes i.e. ferae naturae (wild animals) and domitae naturae (domesticated animals)(18). A person can clearly be said to be responsible for a wild animal when it is confined in a cage. It becomes a wild animal again and the responsibility of no-one if it escapes unless it has an “animus revertendi” (an intention to return). If classed as the latter, it is still the responsibility of the owner even when not on their land. Application of this principle to bees is problematic. A bee on a foraging flight clearly has the necessary intention of returning to the hive of animus revertendi. On this basis, the bee is still the property of the beekeeper. However, when bees swarms they do not intend to return to the hive.

Case Law, commencing with Blackstone (19) considers bees to be ferae naturae.

If there is a civil claim involving bees in England and Wales, it is almost always decided in the County Court by a Circuit Judge sitting alone without a jury. The County Court is bound to follow the decisions of superior English & Welsh Courts and previous legal case law. If there are no decisions exactly on the point, the court looks to similar decisions in other Common Law countries which, whilst not binding, are classed as “persuasive”.

3. Bee stings, typical and hypersensitive (allergic) reactions and their

treatment.

Bee stings vary in effect from a minor source of pain and irritation to serious illness and rare fatalities. An average four or five deaths each year in the UK are attributed to bee or wasp stings (20).

The true incidence of bee stings in the general population is difficult to determine because the majority of those stung treat themselves with home remedies. UK research (21) suggests that 10% of the population are stung per annum by bees and wasps and that about 40,000 people have bee venom hypersensitivity.

Research elsewhere suggests population bee venom hypersensitivity rates in the USA of between 0.35-0.4%(22,23) and 1-2% (24,25) and 2-4% in Switzerland (26).

Bee venom is a complex mixture of pharmacologically and biochemically active proteins and peptides together with a number of smaller molecular substances. Approximately 50 microgrammes is injected in a sting. The main constituents and component effects of bee venom are outlined in Table 2.

Table 2: The main constituents and component effects of bee venom (27,28,29)

Substance	Category of Substance	Effect
Phospholipase A	Enzyme	Destroys phospholids (essential component of cell membranes).
Hyaluronidase	Enzyme	Breaks down hyaluronic acid (interstitial tissue substance which binds cells together). Allows venom to spread quickly from point of entry.
Acid Phosphatase	Enzyme	Splits phosphate from organic compounds.
Melittin	Toxic peptide	Damages cells (including blood cells).
Apamin	Toxic peptide	Toxic to nervous system.
Mast Cell Degranulating (MCD) Peptide	Toxic peptide	Liberates histamine from Mast Cells (concentrated in airways, blood vessels, gut & skin). Histamine causes changes in these organs, notably constriction of airways and dilation of blood vessels.
Secapin	Toxic peptide
Tertiapin	Toxic peptide
Histamine	Molecular substance	See MCP Peptide.

Dopamine	Molecular substance	Vaso-active amine acting as adjuvant to major toxins in venom.
Noradrenaline	Molecular substance	Vaso-active amine acting as adjuvant to major toxins in venom.

The amount of swelling caused by a sting in a normal non-allergic individual is strongly influenced by the toughness and laxity of the skin where it enters. Certain critical sites such as the inside of the mouth and throat are dangerous because of the massive swelling that can occur. The Median Lethal Dose for an average sized adult is between 500 and 100 stings (20,30).

Immunity and Hypersensitivity (or allergic reaction) to bee venom results differing levels of antibodies present in the gamma globulin fraction of serum proteins. These are known as immunoglobulins. Humans produce 5 major types of immunoglobulin. The function and proportions of these are outlined in Table 3.

Table 3: Types, proportions and functions of human immunoglobulins*

(31,32,33,34)

Type	Proportion	Function
Ig* A	13%	Defence against invasion by micro-organisms at body surfaces. Present in saliva, tears, sweat and secretions of respiratory and alimentary tracts.
Ig* D	1%	Not known.
Ig* E	Trace	Defence against parasitic diseases. Attaches itself to special receptor sites on surface of basophil leucocytes of blood and mast cells widely distributed in skin, respiratory tract and gut.
Ig* G	80%	Defence against bacterial invasion. Synthesized and circulate freely in blood and tissue fluids.
Ig* M	6%	As for Ig*G

Gell and Coombs (35) classified hypersensitivity reactions into four principal types. Using their classification, based on differences in pathogenesis, hypersensitivity to bee venom results in Type 1 and Type 3 reactions.

Type 1 reactions occur in individuals who produce excess IgE antibodies when exposed to the components of bee venom. The combination of IgE and venom components at the surface of a mast cell has a damaging effect on its cell wall. This triggers enzyme systems in the cell releasing pharmacologically active substances such as histamine, serotonin, slow reacting substances of anaphylaxis and prostaglandins. These very potent vasoactive agents are responsible for the general and local manifestations of acute allergic reaction. Further, these individuals produce very little of the protective IgG type.

Clinical presentation of this Type 1 reaction includes large local reactions (two phases culminating in extensive swelling), systemic reactions (including urticaria, bronchospasm, nausea, vomiting, abdominal pains and faintness) and anaphylaxis. This latter may result in death from circulatory collapse and respiratory obstruction.

Type 3 reactions occur when the antigen combines with an IgG antibody class known as precipitin. This results in antigen/antibody aggregates in the blood stream with activation of the complement system leading to release of tissue-damaging enzymes. Clinical presentations of Type 3 reactions include Arthus reaction swelling, serum sickness (including malaise, fever, joint pains, swollen lymph nodes, kidney disturbance), encephalitis, polyneuritis and renal failure.

This combined constitutional tendency (called atopy) is genetically controlled and the relevant genes recognised (36).

Three forms of treatment of bee stings and hypersensitivity can be considered:

· Immediate treatment after a sting

· Prophylactic drug treatment

· Immunotherapy

Immediately after being stung, the sting should be removed by scraping it out. It should not be grasped, as this will squeeze more venom into the wound.

Calamine lotion or cold water compresses are effective soothing applications. If inflammation is severe, a steroid cream should be applied. Dermatological good practice states that antihistamine preparations should not be used as repeated use causes skin sensitization. A sting in the mouth will require medical attention to maintain the airway. Treatment for an adult should comprise

· Intravenous soluble steroid e.g. Methylprednisolone sodium succinate 125mg

· Intramuscular adrenaline 0.5mg-1mg

The key to effective treatment of systemic reactions is adrenaline (37). Mild symptoms can be treated with inhalation of an aerosol preparation of adrenaline acid tartrate. Severe symptoms should be treated with subcutaneous injection of 0.5-1mg as a 1 in 1000 solution. Precharged syringes for self-administration are available on prescription and are known as an “EpiPen”.

Anaphylaxis requires prompt treatment with intramuscular adrenaline 0.5mg-1mg as a 1 in 1000 solution followed by 10-20mg of chlorpheniramine and 125mg of methylprednisolone sodium succinate intravenously (20, 38). If there is no response in five minutes, the adrenaline dose should be repeated. The individual should be placed in the recovery position and transfer to hospital arranged.

Prophylactic treatment by beekeepers usually comprises oral antihistamine (most commonly chlorpheniramine 4mg) taken about an hour before visiting an apiary. Occasionally Mast-cell stabilizers (Sodium cromoglycate and ketotifen) are prescribed for the prevention of asthma attributable to inhaled allergens. However, therapeutic effect requires adherence to a complex treatment regime and this treatment is rarely considered appropriate (39).

Bee venom allergy is diagnosed with a detailed history of the allergic reaction backed up by tests for venom-specific IgE antibodies. It is crucial that the insect responsible for the sting is correctly identified. Bee and wasp venoms, for example, contain distinct major allergens. Immunotherapy (desensitization) is offered to individuals with severe reactions and those with moderate reactions on the basis of risk of a future sting. Immunotherapy is highly effective although it carries a 10% risk (20) of inducing systemic allergic reactions and anaphylaxis. Conventional treatment is a course of weekly injections over three months starting with small doses and increasing to 100 microgrammes. Maintenance injections are then given at monthly intervals. Contraindications include concurrent treatment with medication likely to impair treatment (e.g. beta-blockers or other adrenergic blocking drugs) and pregnancy. Treatment is not recommended for children under 5 and people with chronic asthma and severe dermatitis (40).

3. The health of the beekeeper

The health of people employed commercially in the beekeeping and hive products industry is covered by the Health and Safety at Work Act 1974 (41). This covers the apiary (see Glossary), hive product extraction, processing, storage and delivery areas. Whilst this legislation does not cover the leisure beekeeper or extraction, processing and storage work undertaken in private dwellings, the health risks identified through its’ implementation and the good practice used to ensure adherence should be adopted by all beekeepers so far as is reasonably practicable.

The responsibility (“general duties”) for health and safety at work lies with the employer, the self-employed, persons in control of premises and employees as outlined in Sections 2-9 of the Act. Enforcement of the legislation is carried out by the Health and Safety Executive (although local authority environmental health officers will sometimes address workplace health issues involved in the processing and storage of hive products). The co-ordination of these endeavours is agreed between the two parties at the Health and Safety Executive / Local Authority Liaison Committee (HELA).

The Bee Farmers Association of the UK identifies protecting the health of beekeepers as one of their Objects (42). The British Beekeepers Association identifies three major threats to the health of the beekeeper (43). Allergy to bee venom occurs mainly in people who are frequently stung by bees. Consequently this is the most significant threat to the health of the beekeeper and is covered above. The two most significant additional risks to the health of the beekeeper are sensitivity to inhaled hive dust and stress on, and damage to, the back. After a brief explanation of the former, the use of risk assessment and response in back care will be used as an example of how health and safety at work legislation can be used to improve the health of the beekeeper. The key Statutory Instruments governing work place responsibilities in this area are the Manual Handling Operations Regulations 1992 (44) and the Management of Health and Safety at Work Regulations 1999 which require employers and the self-employed to assess risks to health and safety (45).

The temperature inside a beehive is normally higher than the ambient environment. When a beekeeper opens a hive from above, warm air rises from the brood nest into the face carrying thousands of particles of dusts, much of which is organic matter derived from bees, larval debris and pollen. This is a highly potent allergenic material which, when inhaled by a susceptible beekeeper, causes allergic symptoms including sneezing, itchy eyes and running nose. Like hay fever, the pathogenesis is IgE based and the recommended treatment is prophylactic use of an antihistamine. Long term inhalation can result in serious Extrinsic Allergic Alveolitis in some individuals (40).

Eighty percent of people working in agriculture suffer ill health in either the back, neck or limbs (46). The use of the vertical hive in the UK means that most apiary and extraction work is done by manual labour involving frequent bending as well as lifting, lowering and carrying heavy loads. The spine works best and is least stressed when upright and well aligned. Spinal stability in the manual labour of the beekeeper is compromised by three forces. Compression forces stress the disc, shear forces stress the facet joints and torque forces can damage the disc and facet joints, especially when the spine is under load (47,48,49). Risk assessment of manual labour and the identification and implementation of safe lifting principles (or alternatives to lifting) using ergonomics and nationally endorsed good practice guidance is the key to adherence to work place legislation in this area. From the principles of biomechanics and research data the Health and Safety Executive have produced guidelines for the amount of weight which can be safely lifted and lowered in zoned areas in front of the body (50). Table 4 illustrates how this can be done through consideration of 4 elements in the workplace. The enforcement of the legislation by the Health and Safety Executive will usually result in an Improvement Notice although rarely may result in a Prohibition Notice or Prosecution.

Contents

Section

Table 2: The main constituents and component effects of bee venom (27,28,29)

Enzyme

Table 3: Types, proportions and functions of human immunoglobulins*

(31,32,33,34)

The environment

The task

The load

The worker