Pneumococcal pneumonia on the job: Uncovering the past story of occupational exposure to metal fumes and dust

Abstract

The objectives of this study are to elucidate the early history of risk for pneumococcal pneumonia from occupational exposure to metal fumes and dusts, and to demonstrate the importance of searching older literature when performing reviews. We performed manual searching for articles in the Library of the Surgeon General's Office (the precursor to Index Medicus), in the Hathi Trust database, in PubMed, andby screening reference lists in literature appearing before the introduction of PubMed. An early body of literature, from the 1890s onward, recognized that pneumonia was linked to "Thomas slag," a steel industry byproduct containing iron, manganese, and lime. Researchers, mainly in Germany, showed that workers in metal-dust-exposed occupations, especially using manganese, manifested an increased incidence of pneumococcal pneumonia. An outbreak of pneumococcal pneumonia in the 1930s implicated manganese fume in its etiology. In the immediate post-World War II period, there was a brief flurry of interest in pneumonia from exposure to potassium permanganate that was soon dismissed as a chemical pneumonitis. After a hiatus of two decades, epidemiologic investigations drew attention to the pneumonia risks of welding and related metal fume exposure, bringing renewed interest to the forgotten role of pneumococcal pneumonia as an occupational disease. Occupational or environmental inhalation of manganese, iron, or irritants may be causally related to increased pneumococcal pneumonia risk. In particular, the risk associated with manganese seems to be overlooked in recent literature. An important conclusion is the importance of obtaining additional evidence through a deeper assessment of the literature in a broad historical context.

Vaccinating Welders against Pneumococcus: Evidence from a Systematic Review and Meta-Analysis

“…The usual risk factors for IPD and their severe outcomes in adults are identified as: abuse of alcohol; smoking history; chronic heart, lung, liver or renal disease; decreased immune function; functional or anatomic asplenia; diabetes; cochlear implants; and liquor fistulas [ 5 , 7 ]. Interestingly, an increased occurrence of PNX pneumonia and IPD among workers belonging to certain occupational groups has been repeatedly reported [ 8 , 9 , 10 ], particularly among welders and professionals exposed to welding fumes [ 11 , 12 , 13 , 14 , 15 ]. More precisely, a previous systematic review on work-related pneumococcal diseases identified an occupational burden equal to 10.0%, with an attributable fraction ranging between 38% and 70% [ 16 ].…”

Temporal risk assessment – 20th century Pb emissions to air and exposure via inhalation in the Swedish glass district

“…However, when exposure levels are characterized from contemporary data, a drawback is that one then neglects the possibility that observed health effects may not derive from current exposure but rather from a historical situation that may deviate significantly from the present. In a recent article, Torén et al (2022) highlighted the critical role of interpreting dose-response relationships and risks in a historical context. The same point of view was expressed by Coudon et al (2021), who argued that a high incidence of diseases linked to e.g.…”

Transmission factors and exposure to infections at work and invasive pneumococcal disease

“…It has been proposed that the circulation of this specific genotype is facilitated by crowded conditions. In workplaces, occupational exposures to inorganic dust, silica dust, and metal fumes are also risk factors for pneumococcal pneumonia 14−16 …”

“…In workplaces, occupational exposures to inorganic dust, silica dust, and metal fumes are also risk factors for pneumococcal pneumonia. 14 , 15 , 16 …”