Vaccinating welders against pneumonia

MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.
Occupational Medicine (Impact Factor: 1.03). 07/2012; 62(5):325-30. DOI: 10.1093/occmed/kqs055
Source: PubMed


In 2011, the Department of Health in England recommended that welders should each receive a single dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23).
To assess the evidence behind the advice and its practical implications.
The review was informed by a systematic search in Medline, which related pneumonia to welding and/or exposure to metal fume, and was supplemented using the personal libraries of the authors.
There is consistent evidence that welders die more often of pneumonia, especially lobar pneumonia, are hospitalized more often for lobar and pneumococcal pneumonia, and more often develop invasive pneumococcal disease (IPD). It is estimated that one case of IPD may be prevented over a 10-year period by vaccinating 588 welders against pneumococcal infection.
A good case exists that employers should offer PPV23 vaccination to welders and other employees exposed to metal fume. Additionally, reasonable measures must be taken to minimize exposure to welding fume, and welders should be encouraged not to smoke.

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Available from: Martin P Cosgrove, Jul 04, 2015
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    • "Millions of workers weld as a part of their job duties with more than 430,000 full-time welders in the United States [1]. Data suggests that welders are immune compromised and in fact, welders are more prone to develop bronchitis and pneumonia [1] and it was recommended to vaccinate welders against pneumonia [2]. Animal studies support these findings and show localized immunosuppression by the inability of the lung to clear a bacterial infection following welding fume inhalation exposure [3]-[5]. "
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    ABSTRACT: Welding fume is an exposure that consists of a mixture of metal-rich particulate matter with gases (ozone, carbon monoxide) and/or vapors (VOCs). Data suggests that welders are immune compromised. Given the inability of pulmonary leukocytes to properly respond to a secondary infection in animal models, the question arose whether the dysfunction persisted systemically. Our aim was to evaluate the circulating leukocyte population in terms of cellular activation, presence of oxidative stress, and functionality after a secondary challenge, following welding fume exposure. Rats were intratracheally instilled (ITI) with PBS or 2 mg of welding fume collected from a stainless steel weld. Rats were sacrificed 4 and 24 h post-exposure and whole blood was collected. Whole blood was used for cellular differential counts, RNA isolation with subsequent microarray and Ingenuity Pathway Analysis, and secondary stimulation with LPS utilizing TruCulture technology. In addition, mononuclear cells were isolated 24 h post-exposure to measure oxidative stress by flow cytometry and confocal microscopy. Welding fume exposure had rapid effects on the circulating leukocyte population as identified by relative mRNA expression changes. Instillation of welding fume reduced inflammatory protein production of circulating leukocytes when challenged with the secondary stimulus LPS. The effects were not related to transcription, but were observed in conjunction with oxidative stress. These findings support previous studies of an inadequate pulmonary immune response following a metal-rich exposure and extend those findings showing leukocyte dysfunction occurs systemically.
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    Occupational Medicine 12/2012; 62(8):665-6. DOI:10.1093/occmed/kqs166 · 1.03 Impact Factor
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    ABSTRACT: Over the past 20 years, evidence has accumulated that occupations entailing exposure to metal fume (principally welders) are at increased risk of developing and dying from pneumococcal and unspecified lobar pneumonia.1-9 The hazard is apparent in people working with ferrous metal,2 ,4 may extend to other metals4 and is reversible following cessation of exposure.1 ,4 ,5 There are indications that the ultrafine particles in welding fume promote adherence of pneumococci to bronchial epithelium,10 but the underlying mechanisms are not yet well established. Nevertheless, in 2011, the independent Joint Committee on Vaccination at the English Department of Health (DH) judged that the evidence of increased risk was sufficient to recommend that employers offer welders vaccination against pneumococcus.11 This was a new measure that had not previously been applied in other countries. Subsequently, on the advice of the UK Health and Safety Executive (HSE), the DH weakened its recommendation, stating only that vaccination ‘should be considered for those at risk of frequent or continuous occupational exposure to metal fume (e.g. welders), taking into account the exposure control measures in place’.12 Then after some delay, HSE published guidance for employers in which they were advised to …
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