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Invasive Pneumococcal Disease: Which Workplace Exposures Raise the Risk?

<乌鸦传媒視頻 class="dek">—That was the question asked by Swedish investigators who examined the effect of occupational exposures鈥攊ncluding their nature and work location鈥攐n the risk of transmission of invasive pneumococcal disease.

By Erin Kello, PhD
Reviewed by Jason F. Okulicz, MD, Infectious Disease Service, San Antonio Military Medical Center, San Antonio, TX; Professor of Medicine, Uniformed Services University of the Health Sciences

Transmission of invasive pneumococcal disease (IPD) has historically been associated with workplace exposures, including close contact with other workers. The authors of a new study hypothesized that occupational exposures, combined with a work environment that promotes close contact with the public and/or coworkers, may increase the odds of IPD transmission. To test this hypothesis, they recently used modified job-exposure matrices created to assess the risk of workplace exposure to Streptococcus pneumoniae.1

How the study was constructed

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For this case-control, matched cohort study, the authors recruited a study population using the SmiNet registry, a mandatory reporting system for communicable diseases in Sweden.1 Patients ages 20 to 65 years with a positive S. pneumoniae culture were included in the study. An index date indicating when the positive sample had been collected was recorded.

Six controls were matched to each case based on gender, age, and locality of residence. Occupational histories for the cohorts from 2005 to 2019 were obtained from a Swedish national socioeconomic database known as LISA. Cases and controls with no reported occupation and/or no reported income were excluded.

To explore the association of IPD with pneumonia, the authors identified IPD cases with deaths and/or hospitalizations due to pneumonia. These criteria identified 3 groups: all IPD cases (n=3968), IPD cases with pneumonia (n=2887), and matched controls (n=17,968). Characteristics of cases and controls were mostly comparable; however, patients with IPD were more likely to have diabetes mellitus (9.6% of cases; 4.0% of controls) and to use oral steroids or immunosuppressive drugs (21.2% of cases; 5.6% of controls).

Examining risk via a job-exposure matrix

The primary outcome measure was the effect of occupational exposures on the risk of IPD transmission. A job-exposure matrix was constructed with 5 dimensions of transmission:

  • Number of workers in close contact
  • Nature of contacts with other workers and the public
  • Workplace contamination, as defined by sharing of materials and surfaces
  • Work location (inside, outside)
  • Social distancing while at work

The matrix also included 3 interaction factors: migrant status, gender, and occupational exposure to fumes. For each dimension of risk, there were 3 levels of exposure (no risk, medium risk, and high risk). 

The authors constructed 3 models to assess IPD risk. Model 1 adjusted only for matching strata. In addition to the adjustment for Model 1, Model 2 considered chronic obstructive pulmonary disease, ethanol abuse, and use of immunosuppressive drugs. Model 3 adjusted for all variables in the previous 2 models, but re-added controls linked to excluded cases (n=23,874).

Results for each of the 3 models were largely comparable, with Model 3 having slightly narrower confidence intervals (CIs). Across models, the highest risk of transmission (odds ratio [OR] 1.19, 95% CI 1.04 to 1.38) was associated with working mostly outside or partly inside for less than 4 hours a day.

Several other interesting findings emerge

Across the 5 transmission factors, odds ratios were generally increased for males and decreased for females. Participants born in Sweden had a slightly higher risk (OR 1.19, 95% CI 1.07 to 1.32) associated with frequently sharing materials/surfaces with the general public, whereas those not born in Sweden had a higher risk (OR 1.23, 95% CI 0.88 to 1.71) associated with sharing materials/surfaces with coworkers or the general public.

Fume exposure increased the odds of IPD transmission in those who shared materials and/or surfaces with coworkers or the general public (OR 1.69, 95% CI 0.72 to 3.95). For workers exposed to fumes, working in groups of 30 or fewer people (OR 1.58, 95% CI 0.68 to 3.67) was associated with elevated odds of transmission compared with working in groups larger than 30 people (OR 1.22, 95% CI 0.50 to 2.97).

Clinically, the findings suggest that some occupational exposures put workers at an increased risk of IPD. 鈥淚n conclusion, we confirmed our hypothesis that IPD was associated with working in close contact with coworkers or with the general public,鈥� the authors wrote. 鈥淥utside work was associated with increased odds for IPD, especially for men.鈥�1

Finally, and perhaps most importantly: 鈥淲e did not observe that contact with infected or ill patients or persons was associated with IPD.鈥�1

Published:

Erin Kello is a freelance medical writer. She earned her PhD in biological anthropology with a concentration in epigenetics at the University of Pittsburgh.

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