In November 2011 in the “Green Book”, (Immunisation against Infections Disease), the Department of Health (DoH) recommended that welders should each receive a single dose of Pneumococcal vaccine (PPV23) to prevent against possible pneumococcal pneumonia infection.
This was revised in October 2012 when the DoH went on to recommend that employers make arrangements for vaccination of employees who were exposed to welding or metal fume against pneumonia.(Health and Safety Executive- HSE)
Where did this information come from?
Pneumococcal Pneumonia is caused by bacteria called Streptococcus Pneumoniae, which commonly lives quite safely in the upper respiratory tract (nose and throat) of around 70% healthy people. There are around 90 different types of these bacteria which, if they enter the bloodstream (invasive pneumococcal disease or IPD) can cause serious diseases including pneumonia, septicaemia and meningitis. These severe illnesses carry a fatality rate estimated to be at 5-12% in adults of working age. (Palmer and Cosgrove 2012).
In 2012 an in depth study was carried out at Southampton University by Palmer and Cosgrove into the evidence for this guidance and its practical implications.
The conclusion of this study was that “There is consistent evidence that welders die more often of pneumonia, especially lobar pneumonia, are hospitalised more often for lobar and pneumococcal pneumonia, and more often develop invasive pneumococcal disease.”
Within their review they cited evidence that showed welders as being up to six times more likely to suffer from pneumococcal pneumonia noting that this disease usually affects the very young, the elderly or those with poor immunity.
Palmer and Cosgrove go on to state that there was a good case for employers to offer the PPV23 vaccination to welders and other employees exposed to metal fume. They also advised that reasonable measures should be taken to reduce employee exposure to welding or metal fume and that these staff should be encouraged not to smoke as smoking increases risk of IPD.
Based on this information Health and Safety Executive (HSE) produced guidance for employers in which they stated:
“There is an association between exposure to metal fume and pneumonia and infectious pneumonia, particularly lobar pneumonia and between welding and invasive pneumococcal disease. PPV (single 0.5 ml dose in those who have not received PPV previously) should be considered for those at risk of frequent or continuous occupational exposure to metal fume (eg welders), taking into account the exposure control measures in place. Vaccination may reduce the risk of invasive pneumococcal disease but should not replace the need for measures to prevent or reduce exposure.”
The HSE identify that welders and those exposed to metal fume are also at risk of developing metal fume fever, occupational asthma and cancer so stress is placed upon the need for risk based health surveillance being in place for exposure to fume containing substances likely to harm respiratory health, e.g. irritants, sensitizers and carcinogens. They also note that current evidence suggests that welding fumes also causes Chronic Obstructive airways disease (COPD) however goes on to note that there is insufficient evidence to prove this at this time.
Within this guidance they provide a pneumonia vaccine decision flowchart to help employers who may wish to consider providing this vaccine. www.hse.gov.uk/pubns/eis44.pdf
Both the HSE and DoH also state that exposure control measures should be in place to prevent or reduce exposure to welding or metal fume in the first instance by adopting the hierarchy of control measures specified under COSHH 2002 before offering the pneumonia vaccine to their employees.
Palmer and Cosgrove note that the Green Book (DoH) does not specify any particular type of welding or welder that should be covered and suggest that all employees who regard themselves as welders should be offered the vaccine.
At this moment there is no DoH funding to help employers with providing this vaccine and there is no optimum age agreed at which the vaccine should be offered. There is also some disagreement as to how long the vaccine will last with estimates of 5-10 years being given; with evidence that the more given the greater the risk of side effects/ allergic reaction. Health Professionals have been advised to check the Green Book periodically for updates as to the provision of a longer lasting vaccine or the possibility of booster vaccines being introduced.
As employers you may also wish to highlight the importance of stopping smoking and provide encouragement as well as making available information regarding the support available thought the NHS for this.
Vaccination is not a regulatory requirement (HSE) and enforcement action will not be taken against employees who have not implemented a vaccination programme provided this decision is based on “a suitable and sufficient COSHH risk assessment” and that they “can demonstrate that fume exposure is effectively controlled.”
Control of Substances Hazardous to Health. The Control of Substances Hazardous to Health Regulations 2002 (as amended).Approved Code of Practice and Guidance L5 (6th Edition) HSE Books 2013 .
For further advice on Pneumonia Vaccination in the work place please contact us at:
Telephone: 023 8047 5000
Department of Health: Green Book : Sept 2013. Downloaded from https://www.gov.uk/government/…/Green-Book-Chapter-25-v5_2.pdf (no longer available) on 29th September 2014
Health and Safety Executive (2014): Pneumonia Vaccination for Employees exposed to Welding and Metal Fume. Downloaded from www.hse.gov.uk/pubns/eis44.pdf on 29th September 2014.
Palmer, K.T, Cosgrove M.P: Vaccinating welders against Pneumonia. Occupational Medicine 2012:62: 325-330.Downloaded from http://occmed.oxfordjournals.org/ at University of Southampton on September 29th 2014