Vaccinating welders against pneumonia.

BACKGROUND In 2011, the Department of Health in England recommended that welders should each receive a single dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23). AIMS To assess the evidence behind the advice and its practical implications. METHODS The review was informed by a systematic search in Medline, which related pneumonia to welding and/or exposure to metal fume, and was supplemented using the personal libraries of the authors. RESULTS There is consistent evidence that welders die more often of pneumonia, especially lobar pneumonia, are hospitalized more often for lobar and pneumococcal pneumonia, and more often develop invasive pneumococcal disease (IPD). It is estimated that one case of IPD may be prevented over a 10-year period by vaccinating 588 welders against pneumococcal infection. CONCLUSIONS A good case exists that employers should offer PPV23 vaccination to welders and other employees exposed to metal fume. Additionally, reasonable measures must be taken to minimize exposure to welding fume, and welders should be encouraged not to smoke.