Pneumokokkenvaccinatie en lassers: als de rook om je hoofd is verdwenen

Abstract

Pneumococcal vaccination and welders: when the smoke dissipates… Although pneumococcal disease is a major cause of morbidity and mortality, it is a rare disease in the working population. Since several decades, exposure to metal fumes is known to increase the risk of lobar pneumonia among an important occupational group, namely welders and metal workers. The theory is that metal fume alters the bacterial properties and/or the worker’s ability to withstand infection. The exact mechanisms are, however, still unclear. Outbreaks of invasive pneumococcal disease (IPD) caused by the siderophilic, gram-positive bacterium Streptococcus pneumoniae have been quite rare. However, several outbreaks have been reported at Finnish, French, Northern Irish, Norwegian, Singaporean and Swedish shipyards since 2015. Shipyard workers might have a higher risk of developing IPD mainly due to specific environmental factors present at shipyards. Preventive measures may include pneumococcal vaccination, improved ventilation, occupational hygiene measures, reinforcement of the proper use of respiratory protective equipment and anti-smoking campaigns. Therefore, targeted pneumococcal vaccination is recommended and should be offered to welders and potentially others with relevant occupational exposure to metal fumes (inorganic dusts) after the for an employer obligated risk assessment. This has been discussed in for example Norway, Sweden and the United Kingdom, but there is a need for increased international awareness of the occupational risk of severe pneumococcal disease.