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Community-acquired pneumonia and welding

Keith Palmer and Martin Cosgrove
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DOI: https://doi.org/10.7861/clinmedicine.13-2-214b
Clin Med April 2013
Keith Palmer
1MRC Lifecourse Epidemiology Unit, University of Southampton
Roles: Professor of occupational medicine
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Martin Cosgrove
2Cherry Hinton Medical Centre
Roles: Consultant occupational physician
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Editor – We read with interest the recent review of community-acquired pneumonia (CAP) (Clin Med December 2012 pp 538–43) and write to draw attention to a relatively neglected risk factor for CAP that physicians may wish to learn about.

Relative to their social class peers, welders have been dying of pneumonia in excess for at least eight decades.1 Evidence for this comes mainly from successive national analyses of occupational mortality in England and Wales, which have clarified that risk particularly relates to lobar and pneumococcal pneumonia, and is short-term and reversible (evident in current welders but not in retired welders).2,3 Welders are also more commonly admitted to hospital with CAP, especially lobar pneumonia, as demonstrated by a large case-control study from the West Midlands.4 Risks in relation to microbiologically confirmed pneumococcal infection tripled, although were also apparent for a range of other microorganisms, including Legionella, Mycoplasma and Haemophilus influenzae.4 Similar reports relating to lobar and pneumococcal infection in welders subsequently emerged from Sweden5 and Canada.6

Britain has some 70,000 at-risk workers in welding occupations. Other at-risk groups include a range of workers who share occupational exposure to metal fumes in common (eg moulders and core makers, and furnace men in foundries).2,3

In response to growing evidence on risk, the Joint Committee on Vaccination and Immunisations (JCVI), on behalf of the Department of Health in England, recommended in 2011 that all welders be offered a single dose of the pneumococcal polysaccharide vaccine PPV-23.7 This advice was modified in 2012, extending recommended use to a broader range of workers with exposure to metal fumes. Further details and a discussion of the potential strengths and limitations of PPV-23 vaccination in at-risk occupations have been published elsewhere.1

Footnotes

  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

  • © 2013 Royal College of Physicians

References

  1. ↵
    1. Palmer KT,
    2. Cosgrove M.
    Vaccinating welders against pneumonia. Occup Med 2012; 62: 325–330.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Coggon D,
    2. Inskip H,
    3. Winter P,
    4. Pannett B.
    Lobar pneumonia: an occupational disease in welders. Lancet 1994; 344: 41–44. doi:10.1016/S0140-6736(94)91056-1
    OpenUrlCrossRefPubMed
  3. ↵
    1. Palmer KT,
    2. Cullinan P,
    3. Rice S,
    4. et al.
    Mortality from infectious pneumonia in metal workers: a comparison with deaths from asthma in occupations exposed to respiratory sensitizers. Thorax 2009; 64: 983–6.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Palmer KT,
    2. Poole J,
    3. Ayres JG,
    4. et al.
    Exposure to metal fume and infectious pneumonia. Am J Epidemiol 2003; 157: 227–233. doi:10.1093/aje/kwf188
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Torén K,
    2. Qvarfordt I,
    3. Bergdahl IA,
    4. Järvholm B
    . Increased mortality from infectious pneumonia after occupational exposure to inorganic dust, metal fumes and chemicals. Thorax 2011; 66: 992–6.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Wong A,
    2. Marrie TJ,
    3. Garg S,
    4. et al.
    Welders are at increased risk for invasive pneumococcal disease. Int J Infect Dis 2010; 14: e796–e799. doi:10.1016/j.ijid.2010.02.2268
    OpenUrlCrossRefPubMed
  7. ↵
    Department of Health. Immunisation against Infectious Disease. London: DH, 2006. www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131000.pdf [Accessed 1 February 2013].
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Community-acquired pneumonia and welding
Keith Palmer, Martin Cosgrove
Clinical Medicine Apr 2013, 13 (2) 214-215; DOI: 10.7861/clinmedicine.13-2-214b

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Community-acquired pneumonia and welding
Keith Palmer, Martin Cosgrove
Clinical Medicine Apr 2013, 13 (2) 214-215; DOI: 10.7861/clinmedicine.13-2-214b
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