KUALA LUMPUR, July 25 – Physicians have called for pneumococcal vaccination at the high- risk workplace to prevent the spread of pneumococcal disease among workers who may be exposed to various respiratory illnesses, including pneumonia.
Respiratory hazards at workplaces including dust like crystalline silica, a dust found in the air of mines, or glass manufacturing facilities can cause respiratory diseases such as tuberculosis — a chronic bacterial infection in the lung, said respiratory and chest physicians.5
Dr Hilmi Lockman, a consultant respiratory physician at Prince Court Medical Centre, said that workers who are exposed to dust are highly likely to be exposed to respiratory or lung diseases.2
Studies in the United States in 2019 revealed that workplaces may contribute to several respiratory diseases, such as asthma, chronic bronchitis, tuberculosis, as well as community-acquired pneumonia.2
“Yes, for example, workplaces that have dust like construction sites, manufacturing companies can trigger respiratory diseases like asthma.” Dr Hilmi told CodeBlue.2
“Inhaling chemical fumes like methane and carbon monoxide are poisonous to body cells. Exposure to chemical and poisonous gas can affect one’s throat, windpipe and can also lead to chronic bronchitis.”3
Besides that, firefighters are also exposed to toxic gases and chemicals while performing their duties, which eventually puts them at risk of contracting mild to severe respiratory diseases.4
When asked about the prevalence of pneumococcal pneumonia at workplaces, Dr Hilmi said: “Pneumococcal disease generally can be classified into two categories. Invasive and non- invasive pneumococcal pneumonia.6
“Although pneumococcal pneumonia vaccination among children have changed incidence and moratlity rate in that group, this is not the same for elderly adults and those with comorbidities.”6
Dr Hilmi noted that elderly people aged above 65 years7 individuals with chronic obstructive pulmonary disease (COPD) or chronic inflammatory lung disease, diabetes, and respiratory diseases, including those who smoke are at risk of contracting pneumococcal pneumonia.8
According to the National Health and Morbidity Survey (NHMS) 2019 by the Ministry of Health (MOH), about 8.1 per cent of the adult population in Malaysia, or 1.7 million people, have all three risk factors for diabetes, hypertension, and high cholesterol.9
One in five adults or 3.9 million people aged above 18 suffer from diabetes, according to NHMS 2019.9
A 2014 study by Shea KM et al found that multiple underlying medical conditions increased the risk of pneumococcal pneumonia in adults in the United States from 2007 to 2010. The rates of all-cause pneumonia for people with at-risk conditions — such as alcoholism, asthma, chronic heart disease, chronic liver disease, chronic lung disease, diabetes, neuromuscular or seizure disorders, or smoking and high-risk patients like those who suffer with HIV were higher compared to healthy people.10
It is to be noted that 45.8 per cent of Malaysian drinkers consume excessive alcohol, according to the 2019 NHMS survey.11
Another 2018 study stated that approximately five million Malaysian adults, or 22.8 per cent of those aged 15 years and over, are smokers.12
Prof Dr Abdul Razak Mutttalif, senior consultant chest physician and professor (Head of Medicine) at MAHSA University, said health care workers who have direct contact with patients, caregivers, and other individuals are also at risk of contracting some diseases like influenza while performing their duties.13
“People with the pneumococcal disease can spread the bacteria to others when they cough or sneeze.14
“So can you imagine how easily the disease can be transmitted to others in a workplace?”
When asked if vaccination could help prevent pneumococcal pneumonia, Dr Razak and Dr Hilmi agreed that pneumococcal vaccination provides good protection against the disease.15
“At the same time, good ventilation will also reduce the concentration of viral particles and dilute contaminants that we inhale,” Dr Razak added.16
A 1994 study at a crowded large urban prison in the US noted that severe overcrowding, inadequate ventilation, and other factors associated with inmates like the individual’s immune system – all contributed to an outbreak of pneumococcal disease there.17
Dr Razak and Dr Hilmi highlighted that workplace hazards should be handled with multidimensional approaches including maintaining physical safety standards like good ventilation16 and vaccinating employees against vaccine-preventable diseases such as pneumococcal pneumonia.15
The article is brought to you by Pfizer Malaysia. The contents represent the opinions and experience of respective individuals and do not necessarily represent the views or recommendation of Pfizer.
- Curcio D, Cane A, Isturiz R. Int J Infect Dis 2015;37:30-35.
- Blanc PD, Annesi-Maesano I, Balmes JR, et al. Am J Respir Crit Care Med 2019;199(11):1312-1334.
- MSD MANUAL Consumer Version. Gas and Chemical Exposure. Available at: https://www.msdmanuals.com/home/lung-and-airway-disorders/environmental-lung-diseases/gas-and-chemical-exposure. Accessed in February 2022.
- American Lung Association. Protect Lung Health for Firefighters and First Responders. Available at: https://www.lung.org/help-support/corporate-wellness/firefighters-lung-health. Accessed in February 2022.
- Johns Hopkins Medicine. Occupational Lung Diseases. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/occupational-lung-diseases. Accessed on March 2022.
- Drijkoningen JJC, Rohde GGU. Clin Microbiol Infect 2014;20(Suppl 5):45-51.
- American Lung Association. Get The Facts About Pneumococcal Pneumonia. Available at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/pneumococcal. Accessed on February 2022.
- Torres A, Blasi F, Dartois N, et al. Thorax 2015;70(10):984-989.
- National Health and Morbidity Survey 2019 (Fact Sheet). Non-communicable diseases, healthcare demand and health literacy. Available at: https://iptk.moh.gov.my/images/technical_report/2020/FactSheet_BI_AUG2020.pdf. Accessed on February 2022.
- Shea KM, Edelsberg J, Weycker D, et al. Open Forum Infect Dis 2014;1(1):ofu024.
- CodeBlue. Malaysians Binge Drink More Than British? Survey Claims. Available at: https://codeblue.galencentre.org/2020/06/03/malaysians-binge-drink-more-than- british-survey-claims/. Accessed in February 2022.
- Lim KH, Teh CH, Pan S, et al. Tob Induc Dis 2018;16:01
- Macintyre CR, Seale H, Yang P, et al. Epidemiol Infect 2014;142(9):1802-1808.
- MSD MANUAL Consumer Version. Pneumococcal Infections. Available at: https://www.msdmanuals.com/en-jp/home/infections/bacterial-infections-gram-positive-bacteria/pneumococcal-infections. Accessed in February 2022.
- Berical AC, Harris D, Dela Cruz CS, et al. Ann Am Thorac Soc 2016;13(6):933-944.
- Centers for Disease Control and Prevention. Ventilation in Buildings. Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html. Accessed in February 2022.
- Hoge CW, Reichler MR, Dominguez EA, et al. N Engl J Med 1994;331(10):643-648.