Vaccinating Welders against Pneumococcus: Evidence from a Systematic Review and Meta-Analysis

Abstract

Workers occupationally exposed to welding dusts and fumes have been suspected to be at increased risk of invasive pneumococcal disease (IPD). Since the 2010s, the United Kingdom Department of Health and the German Ständige Impfkommission (STIKO) actively recommend welders undergo immunization with the 23-valent polysaccharide (PPV23) pneumococcal vaccine, but this recommendation has not been extensively shared by international health authorities. The present meta-analysis was therefore designed to collect available evidence on the occurrence of pneumococcal infection and IPD among welders and workers exposed to welding fumes, in order to ascertain the effective base of evidence for this recommendation. PubMed, Embase and MedRxiv databases were searched without a timeframe restriction for the occurrence of pneumococcal infections and IPD among welders and workers exposed to metal dusts, and articles meeting the inclusion criteria were included in a random-effect meta-analysis model. From 854 entries, 14 articles (1.6%) underwent quantitative analysis, including eight retrospective studies (publication range: 1980–2010), and six reports of professional clusters in shipbuilding (range: 2017–2020). Welders had an increased likelihood of developing IPD compared with non-welders (odds ratio 2.59, 95% CI 2.00–3.35, I2 = 0%, p = 0.58), and an increased likelihood of dying from IPD (standardized mortality ratio (SMR) 2.42, 95% CI 1.96-2.99, I2 = 0%, p = 0.58). Serotype typing was available for 72 cases, 60.3% of which were represented by serotype 4, followed by 12F (19.2%) and serotype 8 (8.2%). Although the available data derive from a limited number of studies, available results suggest that pneumococcal vaccination should be recommended for workers exposed to welding fumes, and vaccination strategies should consider the delivery of recombinant formulates in order to combine the direct protection against serotypes of occupational interest with the mucosal immunization, reducing the circulation of the pathogen in occupational settings characterized by close interpersonal contact.

Seroprevalence of Crimean Congo Hemorrhagic Fever Virus in Occupational Settings: Systematic Review and Meta-Analysis

“…Second, even though nearly all studies extensively reported how the samples were recruited, the actual representativity of the assessed occupational groups from the targeted areas remains unclear. This issue is particularly significant when dealing with estimates from agricultural settings and/or low-income countries, where occupational and residential environments are hardly dichotomized [ 93 , 94 ], and job descriptions could fail to appreciate the actual exposures [ 93 , 94 , 100 , 101 , 102 , 103 ]. As participants can perform several tasks at the same time (e.g., agricultural workers that also care for animals on a daily basis, possibly performing their slaughtering), corresponding sources of exposure are also highly overlapped, suggesting a quite cautious appraisal of the eventual estimates.…”