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The University of Southampton
Medicine

Preventing invasive pneumococcal disease in the UK's workforce

On the strength of evidence from University of Southampton researchers, the Department of Health (DH) recommended employers offer 80,000 welders vaccination against pneumococcus to prevent cases of invasive pneumococcal disease which can be fatal. The advice received extensive media attention and has influenced research and safety practice internationally

Research Challenge

National analyses conducted by our team highlighted that this hazard had existed for decades. On reviewing earlier analyses we found consistently elevated death rates from pneumonia among occupations exposed to metal fume dating back to 1930.  This had not attracted attention when the original analyses took place.

Context

In 1992 our MRC team were commissioned by the Office for National Statistics to undertake an annual national analysis of occupational mortality covering 1979-90.

Our findings indicated a marked excess of deaths from pneumonia in welders exposed to metal fume. More than 2.55 times more deaths were observed in welders of working age than expected, but no excess of deaths after retirement age.  This suggested a hazard that disappeared after exposure ceased.

Our Solution

Building on findings from death certificates, our team undertook Britain's largest study of hospitalised community-acquired pneumonia (CAP) comparing men with and without CAP admitted to the same hospital wards. The data confirmed a risk of the disease from recent exposure to metal fume and showed an effect on incidence and fatality.

Preliminary evidence from further studies suggests ultrafine particulates in metal fume are responsible. Our goal is to develop a biomarker that allows safe exposure levels to be defined.

The Impact

A sustained programme of research, carried out by our researchers accumulated sufficient evidence for the DH to recommend that welders and other workers with exposure to metal fume, be offered immunisation against pneumococcal infection.

The introduction of immunisation can prevent significant numbers of deaths and serious infections occurring at relatively young ages.

Other countries are conducting their own research and issuing hazard warnings on the strength of our work and our team have been asked to contribute to the development of HSE guidance on vaccination for metal workers.

Our findings indicated a marked excess of deaths from pneumonia in welders exposed to metal fumes
Welder vaccinated against pneumococ

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