L-670. Association Between Occupation and Invasive Pneumococcal Disease: Welders are at Increased Risk
Session: Poster Session: The World of Community-Acquired Pneumonia
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
Welders and those in occupations with significant exposure to metal fumes are at increased risk of pulmonary infection. The Streptococcus pneumoniae Alberta Team (SPAT) was formed to study various aspects of invasive pneumococcal disease (IPD) in the province of Alberta, Canada (pop. ~3.3 million). A retrospective chart review of all cases of IPD in the province from 2000-2004 was conducted, with the results for relevant occupations summarized in the following table:
Table 1: Occupation & Attack Rates of IPD
OccupationIPD Cases between 2000-2004Attack Rate / 100,000 (95% CI)P-value (Fisher's Exact Test)
Welders1822.7 (12.23, 33.23)<0.001
Electricians612.2 (2.45, 22.04)0.326
Farmers73.1 (0.81, 5.42)1.000
Day Care Workers810.5 (3.21, 17.70)0.551

When compared to the general adult population between ages 18-65 [8.6 cases/100,000/year, 95%CI 8.02-9.17], there was a statistically significant increase in attack rates of IPD in welders. In comparison, there was no statistically significant increase of attack rates in other potential “at risk” occupations such as electricians, day care workers, or farmers. Of the 18 cases in welders, there was an increased prevalence of serotypes 4 (6/18; 33% vs. 133/863; 15%, P = 0.05) and 8 (3/18; 17% vs. 75/863; 7%, P = 0.208). 11 cases (61%) were caused by serotypes in the experimental 13-valent pneumococcal vaccine. 17 of the patients had bacteremic pneumococcal pneumonia and 1 had meningitis, and there was no geographic clustering of cases. 13 (72%) were current tobacco smokers.
We conclude that welders are at increased risk of IPD and should be considered for routine administration of the pneumococcal polysaccharide vaccine.
and the SPAT Group, Alexander Wong, MD, Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada, Gregory Tyrrell, PhD, National Centre for Streptococcus, James D. Kellner, MD, Alberta Children's Hospital, Calgary, AB, Canada, Thomas Marrie, MD, Walter C. Mackenzie Hlth. Sci. Ctr., Edmonton, AB, Canada and  A. Wong, None.