Review pneumococcal outbreaks at shipyards

Review pneumococcal outbreaks at shipyards

During our meeting in Berlin 2020, we discussed the pneumococcal outbreaks on shipyards in recent years, based on the presentation on this topic from our Norwegian colleague Tor Erik Danielsen. There were also reports from Finland and France. In the early summer, one of our students used the literature research for her bachelor thesis to look into these recent outbreaks. Her aim was to define the occupational risk factors related to this increased IPD risk at shipyards. Her bachelor thesis is not an official publication, but we think it’s worthwhile to share it here. So underneath you find the abstract and a link to the thesis.

shipyard cruiseship
Picture by freakwave via Pixabay

Zoë Zwiers – Risk factors for invasive pneumococcal infections on shipyards: A systematic review, Bachelor Thesis  Bachelor of Medicine Amsterdam UMC, University of Amsterdam, July 2020


Introduction: Outbreaks of invasive pneumococcal infections happen, usually when a new Streptococcus pneumoniae (S. pneumoniae) strain is introduced in closed settings such as child day-care centers, schools, or nursing homes. However, recently outbreaks of invasive pneumococcal disease (IPD) have been reported at shipyards. The aim of this review is to define the occupational risk factors for IPD at shipyards. 

Methods: A systematic literature search was performed in the databases PubMed and Google Scholar from inception until the 11th of May 2020. Studies were included if they reported an IPD outbreak related to occupational exposure in shipyards. The quality of the studies was analysed with the Joanna Briggs Institute (JBI) critical appraisal checklist for case series. Primary outcome was the risk factors for IPD in shipyards. 

Results: From a total of 1479 studies, five case series were selected. The overall quality score of the studies was considered to be high. The results suggest that shipyard workers have a higher risk for developing IPD due to the working environment on shipyards. Risk factors contributing to the IPD susceptibility in shipyards were: exposure to respiratory irritants, current smoking, viral influenza infections, working and living in crowded environments, poor ventilation in the work environment rooms, poor usage of respiratory protective equipment and invalid vaccination status.

Conclusion: Shipyard workers might have a higher chance of developing IPD mainly due to specific environmental factors present at shipyards. To prevent future IPD outbreaks in shipyards, there is an urgent need to decrease the influence of risk factors in the working environment. Preventive measures may include pneumococcal- and influenza vaccination, improved ventilation in crowded workspaces, occupational hygiene measures, reinforcement of proper use of respiratory protective equipment, improvement of housing conditions, and an anti-smoking campaign. Cohort or case-control studies may reveal how work factors increase the risk for IPD and whether particular preventive measures can prevent pneumococcal diseases.

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