Background: Waste water may contain pathogenic human and animal excreta-derived microorganisms that can cause infections. Municipal sewage workers are a relevant neglected high-risk population especially in the absence of effective protective equipment and lack of hygienic practices mainly washing hands. Objective: The present study aims to assess the hazards of infection with microorganisms among municipal sewage workers as a neglected population, besides those infections that maybe acquired via sources other than their occupational hazard. Subjects and Methods: A cross-sectional study was conducted on sewage workers from different sectors in Alexandria Governorate, Egypt. Collected stool samples were subjected to the following techniques; Kato-Katz, ether concentration, Jones' Media culture, modified Ziehl-Neelsen, and quick hot Gram-chromotrope staining. Stool samples were also tested for Helicobacter pylori antigen (H. pylori Ag). Serum was separated for detection of viral hepatitis C antibodies (HCV Ab), and HBV surface antigen (HBVs Ag). Results: Out of the 410 examined workers, 289 (70.5%) were infected; among them 111 (38.4%) had mixed infections. It was found that 56.8%, and 31.2% harbored intestinal parasitic infections (IPIs) and H. pylori, respectively; and 12.2% had hepatitis mainly HCV (9.8%). Protozoal infections amounted to 54.6%, and only 5.9% had helminthic infections. Blastocystis spp. was the most prevalent parasite (46.8%) followed by Cryptosporidium spp., Entamoeba histolytica/dispar and Microsporidium spp. (15.6%, 11.7%, and 7.8%, respectively). Almost equal percentages were recorded for single IPI and multiple infections (28.3%and 28,5% respectively). Significantly higher rates of IPIs and H. pylori were observed among workers who were in frequent contact with sewage. Also, IPIs were statistically higher among young workers (<40 years), while hepatitis was significantly more prevalent among those from rural areas. Conclusion: Although almost all the detected microbiological infectious hazards can affect sewage workers via sources other than their occupational hazard, our findings call for the importance of self-protection measures that should be in association with regular medical investigation and treatment. inTRoduCTion Water-borne diseases are associated with lack of safe sanitation practices [1]. Waste water treatment plant (WWTP) workers are obliged to work in harsh and dirty conditions as it is difficult to maintain good hygienic practices and very difficult to avoid accidental contact with sewage [2]. Hazards include chemicals that enter sewage treatment plants as industrial effluents, as well as pathogenic microorganisms found in sewage sludge. Waste water treatment (WWT) results in the generation of aerosols containing chemicals, microorganisms, and solvent vapors [3]. Related symptoms have been reported among sewage workers, including eye and nose irritation, lower airway and skin symptoms, headache, fatigue, and dizziness [4]. An increase in the risk of asthma as well as decreas...