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接触金属烟雾的男性中发生严重肺炎球菌疾病暴发——通过肺炎球菌疫苗接种进行检测、应对及未来预防

Serious pneumococcal disease outbreak in men exposed to metal fume - detection, response and future prevention through pneumococcal vaccination.

作者信息

Ewing Judith, Patterson Lynsey, Irvine Neil, Doherty Lorraine, Loughrey Anne, Kidney Joe, Sheppard Carmen, Kapatai Georgia, Fry Norman K, Ramsay Mary, Jessop Lucy

机构信息

Public Health Agency, Health Protection Service, Northern Ireland, UK.

Public Health Agency, Health Protection Service, Northern Ireland, UK; UK Field Epidemiology Training Programme, Public Health England, UK.

出版信息

Vaccine. 2017 Jul 13;35(32):3945-3950. doi: 10.1016/j.vaccine.2017.06.010. Epub 2017 Jun 19.

Abstract

Welders and those exposed to metal fume are known to be at increased risk of pneumococcal pneumonia and invasive pneumococcal disease. Current UK guidance recommends that vaccination against pneumococcus be considered in those at risk of frequent or continuous occupational exposure to metal fume, taking into account the exposure control measures in place. We report an outbreak of serious pneumococcal disease that occurred between April and June 2015 among a multinational workforce exposed to metal fumes while working on the refurbishment of an oil rig in a Belfast shipyard. Four confirmed and five probable cases were identified, which occurred despite the use of environmental control measures and the availability of respiratory protective equipment. To provide direct protection to those at risk of pneumococcal disease and to eradicate carriage of pneumococcus and interrupt transmission, pneumococcal polysaccharide vaccine (PPV23) and antibiotic prophylaxis were offered to 680 individuals identified as potentially exposed to metal fume. Low levels of prior pneumococcal vaccination were reported among this target group (<1%). Genomic sequencing indicated a common strain of serotype 4 pneumococcus in two of the confirmed cases and a distinct serotype 4 in one case. The fourth confirmed case was identified as likely serotype 3 using a serotype-specific immunoassay on a urine specimen. Both serotypes 3 and 4 are vaccine-preventable strains covered by the conjugate and polysaccharide pneumococcal vaccines currently available. We propose that consideration should be given to strengthening implementation around pneumococcal vaccination for those exposed to metal fume through their work, even when other control measures are in place, to reduce the risk of future cases and outbreaks of serious pneumococcal disease.

摘要

众所周知,焊工和那些接触金属烟雾的人患肺炎球菌肺炎和侵袭性肺炎球菌病的风险会增加。英国现行指南建议,对于有频繁或持续职业性接触金属烟雾风险的人群,应考虑接种肺炎球菌疫苗,同时要考虑到现有的接触控制措施。我们报告了一起严重肺炎球菌病的暴发,该病于2015年4月至6月间发生在贝尔法斯特造船厂一艘石油钻井平台翻新工程中接触金属烟雾的多国工人中。尽管采取了环境控制措施并配备了呼吸防护设备,但仍确认了4例病例,疑似病例5例。为了直接保护有肺炎球菌病风险的人群,并根除肺炎球菌携带和阻断传播,向680名被确定可能接触金属烟雾的个体提供了肺炎球菌多糖疫苗(PPV23)和抗生素预防措施。据报告,这一目标人群中既往肺炎球菌疫苗接种率较低(<1%)。基因组测序显示,在2例确诊病例中为4型肺炎球菌的常见菌株,1例为不同的4型菌株。通过对尿液标本进行血清型特异性免疫测定,第四例确诊病例被确定可能为3型。3型和4型均为目前可用的结合型和多糖型肺炎球菌疫苗所覆盖的可通过疫苗预防的菌株。我们建议,即使已采取其他控制措施,对于因工作接触金属烟雾的人群,也应考虑加强肺炎球菌疫苗接种的实施,以降低未来严重肺炎球菌病病例和暴发的风险。

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