Vacunas en salud laboral: una oportunidad para prevenir e invertir en salud / Vaccines in occupational medicine: an opportunity to prevent and invest in health

La vacunación es la medida preventiva más costo-efectiva para evitar las enfermedades infecciosas inmunoprevenibles, a nivel individual y comunitario. Los riesgos biológicos laborales, deben ser manejados en un sistema de gestión del riesgo, donde la vacuna es el elemento clave de protección personal (EPP) específico cuya provisión y uso obligatorio tiene normas legislativas referidas a la entrega por el empleador, la capacitación en la prevención y el uso por el trabajador. En Chile, hay 8.364.282 trabajadores según datos de Superintendencia de Seguridad Social (SUSESO). La Ley 16.744 y sus Decretos Supremos (DS) indican las condiciones que se deben mantener en los lugares de trabajo y el derecho a saber por parte del trabajador; también existen circulares del Ministerio de Salud que incluyen situaciones y grupos especiales laborales a vacunar, pero es necesaria una normativa que oriente a trabajadores dependientes e independientes y a empleadores sobre qué vacunas colocar, en qué situaciones y a quiénes dependiendo de la actividad laboral. En este artículo, hacemos una reseña de la situación legal, de recomendaciones en otros países y enumeramos algunas vacunas que podrían implementarse en la población expuesta a riesgo.

Vaccination is the most cost-effective measure for immune-preventable infectious diseases, at individual and community level. Biological occupational hazards must be faced in a risk management system, where the vaccine is a specific key as an element of personal protection, whose provision and obligatory use has legislative norms related to the delivery by the employer, the training in the prevention and the use by the worker. Several countries count with technical guides for vaccination in the working population. In Chile in 2018, there were 8.364.282 workers according with Superintendence of Social Security. Law 16.744 and Supreme Decrees indicate the environmental conditions for workers and the right to know the risks; also, Ministry of Health has issued circulars where some working conditions need specific vaccination. Is for that reason that is necessary a regulation that guides dependent and independent workers and employers on when and which vaccines must be used depending on the labor activity. In this article, we review the legal situation, other guides in different countries and list some vaccines that could be implemented in the population at specifical risks.

Immunological correlates of cure in the first American Cutaneous Leishmaniasis patient treated by immunotherapy in Argentina: A case report. / Correlatos inmunológicos de curación en el primer paciente con Leishmaniasis Cutánea Americana tratado con inmunoterapia en Argentina: Reporte de un caso

A patient with localized cutaneous leishmaniasis due to Leishmania (Leishmania) amazonensis infection was treated with an antigen containing heat-killed L. (L.) amazonensis promastigotes plus BCG. Expression of T-cell differentiation, memory and senescence receptors markers were analyzed on T cell subpopulations, in order to establish the correlation between the percentages of expression of these receptors and his clinical status, at different stages of his follow up. The following case reports on the achievement of a successful clinical outcome with complete resolution after receiving immunotherapy. A thorough clinical and immunological follow up supporting the healing process of this patient’s lesion is presented in detail.

Un paciente con leishmaniasis cutánea localizada producida por Leishmania (Leishmania) amazonensis fue tratado con un antígeno compuesto por promastigotes de L. (L.) amazonensis muertos por calor combinado con BCG. Se analizó la expresión de distintos receptores de diferenciación, de memoria y de senescencia en las subpoblaciones de células T, con el fin de establecer una relación entre los porcentajes de expresión de dichos receptores y la clínica del paciente en diferentes momentos del seguimiento. Se reporta en este caso un resultado exitoso, con resolución completa de la lesión después de recibir la inmunoterapia, y se presenta en detalle un seguimiento clínico e inmunológico completo durante el proceso de curación.

Efeitos da radiação solar crônica prolongada sobre o sistema imunológico de pescadores profissionais em Recife (PE), Brasil / Effects of long-term chronic exposure to sun radiation in immunological system of commercial fishermen in Recife, Brazil

FUNDAMENTOS: Existe um consenso de que a exposição à radiação ultravioleta determina alterações n o sistema imunológico da pele, o que permite que se avente a hipótese de que a exposição prolongada e crônica ao Sol pode representar uma das maiores agressões ambientais à saúde humana. Entre as várias ocupações que requerem, necessariamente, exposição prolongada e crônica ao Sol está a de pescador. No entanto, a experiência clínica dermatológica, amealhada ao longo de vários anos de exercício da Medicina, não parece confirmar essa hipótese. OBJETIVO: Avaliar efeitos clínicos, histológicos e imunológicos da exposição crônica e prolongada à radiação ultravioleta em pescadores. MÉTODOS: Em estudo prospectivo, transversal, observacional, foram caracterizadas lesões dermatológicas, marcadores imunológicos e alterações histológicas de pescadores e subpopulações de linfócitos comparadas a grupo-controle. Empregaram-se testes de Mann-Whitney, exato de Fisher, Wilcoxon em nível de 0,05. RESULTADOS: Houve diferenças entre os grupos exposto e protegido em elastose (p = 0,03), ectasia de vasos dérmicos (p = 0,012) e número de células nas camadas epidérmicas entre os cones (p = 0,029). Foram mais comuns em pescadores CD45RO, CD68+ e mastócitos na pele (p = 0,040, p < 0,001 e p = 0,001); CD3CD8CD45RO no sangue (p = 0,016). CONCLUSÃO: As alterações sugerem que exposição crônica e prolongada ao sol promove tolerância à radiação ultravioleta, protetora da imunossupressão.

BACKGROUND: Among the various occupations which necessarily require long-term and chronic sun exposure is that of a fisherman. However, clinical experience in dermatology earned over several years of medical practice does not seem to confirm this hypothesis. OBJECTIVE: To evaluate clinical, histological and immunological effects of long-term and chronic exposure to ultraviolet radiation in fishermen. METHODS: A prospective, cross-sectional and observational study characterized skin lesions, immunological markers and histological alterations in fishermen, as well as lymphocyte subpopulations compared to a control group. Mann-Whitney, Fisher's and Wilcoxon statistical tests were used at a significance level of 0.05. RESULTS: There were significant differences between the exposed group and the group protected due to elastosis (p = 0.03), ectasia of dermal vessels (p = 0.012) and number of cells in the epidermal layers between cones (p = 0.029). Most common among fishermen were CD45RO, CD68 + and mastocytes in the skin (p = 0.040, p <0.001, p = 0.001) and CD3CD8CD45RO in the blood (p = 0.016). CONCLUSION: The alterations suggest that long-term and chronic sun exposure promotes tolerance to ultraviolet radiation, which protects against immunosuppression.

Asma e rinite ocupacionais: visão imunoalérgica / Occupational asthma and rhinitis: immunoallergic view

Objetivo: Revisar as características clínicas e diagnósticas da asma e da rinite ocupacionais, citando dados epidemiológicos e particularidades na terapêutica, com ênfase nos aspectos imunológicos que devem ser consideradas na visão do alergista. Fonte de Dados: Revisamos periódicos específicos na área de alergia e imunologia nos últimos 10 anos (1999-2009), considerando principalmente as publicações em inglês, indexadas no Medline e capítulos de livros. Síntese de Dados: São apresentados os aspectos epidemiológicos, clínicos e diagnósticos das doenças respiratórias ocupacionais alérgicas (asma e rinite), e ainda as dos agentes ocupacionais mais comumente envolvidos, descrevendo resumidamente os mecanismos imunológicos e não imunológicos responsáveis pelo quadro clínico. Conclusões: A maioria dos quadros de asma/rinite ocupacionais envolvem mecanismos imunológicos com ou sem a participação de anticorpos IgE, sendo que os quadros IgE mediados correspondem a menos que 5% do total, o que limita o uso de testes alérgicos no diagnóstico. O padrão ouro para a confirmação diagnóstica seria, portanto a provocação específica que reproduz a exposição no ambiente de trabalho, independentemente do mecanismo envolvido. A abordagem multiprofissional é muitas vezes necessária para restabelecer a qualidade de vida do trabalhador afetado.

Objective: To review the clinical and diagnostic features of occupational asthma and rhinitis, showing epidemiological data and a summarized therapy, with emphasis on immunological aspects that should be considered in view of the allergist. Sources of data: The author reviewed specific journals in the field of allergy and immunology in the last 10 years (1999-2009), considering the publications in english, indexed in Medline and also book chapters. Summary of data: The author reported epidemiological, clinical and diagnostic data of work-related allergic respiratory diseases (asthma and rhinitis), and also the characteristics of the most commonly involved occupational agents, describing briefly the immunological and not immunological mechanisms responsible for the cases. Conclusions: Most of the cases of occupational asthma/rhinitis involve immunological mechanisms with or without the participation of IgE antibodies, and the IgE-mediated cases correspond to less than 5% of the total, which limits the use of allergy tests in the diagnosis. The gold standard for diagnostic confirmation is therefore the specific challenge tests that intend to reproduce the exposure in the workplace, regardless of the mechanism involved. A multidisciplinary approach is often necessary to restore the quality of life of the affected workers.

Prevalencia de anticuerpos contra Bartonella henselae en niños, en adolescentes y en una población de riesgo ocupacional en Chile / Prevalence of Bartonella henselae antibodies in Chilean children, adolescents and veterinary workers

Background: Bartonella henselae is the causative agent of cat-scratch disease. Aim: To study the seroepidemiology of Bartonella henselae in healthy Chilean children and in a population with occupational risk. Material and methods: Serum IgG antibodies were determined by indirect fluorescence technique in 181 children and adolescents and in 107 technical and professional workers involved in the care of cats. Samples with titers equal to or greater than 64 were considered positive. Results: Twenty four (13.3%) children and 11 (10.3%) occupational risk subjects were seropositive. No significant differences by age and gender were observed. Conclusions: Assuming that seroprevalence indicates level of exposure to Bartonella henselae, these results suggest that this infection is endemic in Chile and, for this reason, the best antibody titer to diagnose acute cat-scratch disease should be higher than the figure recommended by the Centers for Disease Control in the in United States.

Detection of fungi spectrum in industrial and home bakeries and determinated fungal allergy with skin prick test.

Airborne fungal pathogens such as Penicillium, Aspergillus, Cladosporium, Trichophyton, and Alternaria may cause health problems. In this research, the fungal flora at different bakeries and their potential allergenic effects on the workers were investigated. We investigated 148 workers at 17 industrial type bakeries and 62 workers at 17 home type bakeries in Afyon. Our study was performed in two different seasons and climates, between January 2004 and June 2004. Fungal flora was detected by using Petri-dish method. In the winter, Penicillium was the dominant genus, while Cladosporium was the dominant genus during the summer, in both types of bakeries. The allergenic properties of dominant culturable fungi on workers involved in the bakeries were determined with the skin-prick test. It was found that with workers in the industrial type bakeries, the most common skin test positivity was caused by Penicillium. In the other hand, the skin test positivity, performed on workers in the home type bakeries, was equally caused by Penicillium, Trichophyton and Aspergillus.

Presence of specific IgG antibody to grain dust does not go with respiratory symptoms

A high prevalence of work-related symptoms in relation to grain dust exposure has been reported in grain dust workers, but the role of the specific IgG antibody is unknown. To study the possible role of specific IgG (sIgG) and specific IgG4 (sIgG4) in the development of work-related symptoms, sIgG and sIgG4 subclass antibodies against grain dust antigens were determined by ELISA in sera from 43 workers and 27 non-exposed controls. They were compared with results of specific IgE antibodies, exposure intensity and the presence of respiratory symptoms. SIgG and sIgG4 antibodies were detectable in almost all sera of exposed workers, and the prevalence were significantly higher than those of controls (p<0.05). Higher sIgG4 was noted in workers with specific IgE (p<0.05). The correlation between sIgG and exposure duration was significant (p<0.05). There was no association between the prevalence of sIgG and sIgG4 and the presence of respiratory symptoms, or work stations. In conclusion, these results suggest that the existence of sIgG and sIgG4 might represent a response to grain dust exposure and may unlikely play a role in the etiology of respiratory symptoms.

Sensitization to different species of Aspergillus in bakery workers and general atopic population.

Six species of Aspergillus predominant in the bakery environment--Aspergillus flavus, A. fumigatus, A. nidulans, A. ochraceous, A. sydowi and A. versicolor--were studied for their role in causing Type 1 hypersensitivity among bakery workers and atopic patients from the general population (PGP). Antigenic extracts from the above species were prepared for in vivo and in vitro studies. The IEF, SDS-PAGE, skin test, ELISA and immunoblot techniques were performed to detect the biochemical- and clinico-immunological characteristics of these species. Among those tested, the important fungal sensitizers among the bakery workers and patients from the general population were A. sydowi, A. fumigatus, A. nidulans and A. ochraceous. The protein fractions of different species were in the acidic region (pI 3.0-6.5) and in the molecular weight range of 13.0-91.0 kDa. The protein fraction of 44.0 kDA of A. flavus and 20.0 and 70.0 kDa for A. fumigatus showed IgE binding in the sera of bakery workers only. Significantly, raised IgG antibodies to different species were recorded among the bakery workers as compared to the PGP group. The study showed that different species of Aspergillus are of potential allergenic significance in bakery workers and the general atopic population.

Role of specific IgE, IgG and IgG4 antibodies to corn dust in exposed workers

BACKGROUND AND METHODS: To evaluate the role of specific antibodies to corn dust (CD) and their relationship to respiratory dysfunction, we detected serum specific IgE(slgE) and IgG4(slgG4) antibodies by ELISA in 42 employees working in the animal feed industry and 27 unexposed controls. RESULTS: Our survey revealed that 15 (34.9%) subjects had work-related respiratory dysfunction associated with or without nasal symptoms. Among these subjects, eight had airway hyper-responsiveness to methacholine. Significant differences were noted in slgE and slgG4 between exposed and unexposed groups (p = 0.04, p = 0.00 respectively), but no difference was noted in slgG (p = 0.1). Although there was no significant differences in the prevalence of specific IgE antibody between symptomatic (29%) and asymptomatic groups (19%, p = 0.55), the specific IgE levels were significantly higher in symptomatic workers than in asymptomatic workers (p = 0.03). Specific IgG antibody was detected in 1 (6%) symptomatic and 4 (15%) asymptomatic workers (p = 0.46). Specific IgG4 antibody was detected in 11 (73%) of symptomatic and 21 (78%) of asymptomatic workers (p = 0.90). The higher prevalence of slgG4 antibody was noted in workers with slgE antibody (p = 0.001). The correlation between slgG and exposure duration was significant (r = 0.36, p = 0.02). There was no association between the prevalence of slgE, slgG, and slgG4 to exposure intensity, smoking or atopic status. CONCLUSION: These results suggested that the existence of slgG and slgG4 might represent a response to CD exposure, and that some unexposed subjects had slgG to CD. Specific IgE might play a role in the development of respiratory symptoms.

Sero-prevalence of brucellosis among abattoir personnel of Delhi.

A total of 165 serum samples of abattoir personnel of Delhi were tested by Rose Bengal Plate test (RBPT), Standard tube agglutination test (STAT), Complement fixation test (CFT) and Dot-Enzyme linked immunosorbent assay (Dot-ElISA). The Seroprevalence was 20.60, 12.75, 50.30 and 25.45 percent, respectively on the basis of RBPT, STAT, CFT and Dot-ELISA. Seroprevalence was highest among blood collectors (99.77%) followed by miscellaneous group (72%), animal handlers (68.96%), butchers (68.00%) and sweepers (57.14%). Among veterinarians, Seroprevalance was 28.57%. The Seroprevalence was more among persons of higher age group. The study indicates that abattoir personnel are at high risk to infection with brucellosis.

Differences in hepatitis B markers between clinical and preclinical health care personnel.

Hepatitis B virus (HBV) infection is an occupational risk for health care personnel (HCP). Vaccination is an important preventive measure but high cost of vaccination limits the feasibility of giving vaccine to all HCP. To find an optimum approach for vaccination we conducted a study on HCP in Maulana Azad Medical College and associated LNJPN hospital. A total of 162 subjects were screened. Eight were excluded because of prior vaccination against HBV. Two groups of subjects were selected namely preclinical and clinical. The preclinical group comprised first year medical students and the clinical group comprised of HCP who have been exposed to clinical departments. The subjects were screened for HBsAg, anti HBs and anti HBc viral markers. 86 subjects were screened in the preclinical group. Two (2.3%) were positive for HBsAG; 16 (18%) and 9 (10.4%) were positive for anti HBs and anti HBc respectively. In the clinical group a total of 68 subjects were screened. Amongst them 1.4% were positive for HBsAg; 47 (69%) and 38 (55%) were positive for anti HBs and anti HBc respectively. The study revealed that there was a significant difference in the titre of the viral markers in the preclinical group as compared to the clinical group. Seventy (82%) of preclinical subjects were at high risk for the infection as they moved into clinical departments. Few subjects will be excluded from the vaccination schedule based on anti HBs screening and hence screening prior to vaccination is not cost effective. However in the clinical group 69% will be excluded from the vaccination schedule based on anti HBs positivity and screening will save up to 60% of cost involved in vaccination.

Relaciones entre asma hiperirritabilidad bronquial y alergia / Relation between asthma, bronchial hyperreactivity and allergy

Se estudiaron 50 personas con asma y 50 personas sanas, para establecer: 1) la proporción de hiperreactividad a la metacolina en los asmáticos y en los normales. 2) la presencia de sensibilidad alérgica cutánea en los asmáticos y en los normales. 3) la correlación entre sensibilidad alérgica cutánea e hiperreactividad bronquial en los asmáticos y en los normales. 4) si el grado de reactividad cutánea a la histamina es diferente entre pacientes asmáticos y no asmáticos. Personas asmáticas: 29/50 (58 por ciento) mujeres) y 21/50 (42 por ciento) hombres. Personas normales: 32/50 mujeres (64 por ciento) y 18/50 (36 por ciento) hombres, (X2=0,17, p--0,68). El promedio de edades respectivo fue de 38,6 + 13,76 y 35,1 ñ 13,05 años (F=1,22 p=0,27). Métodos: a - Reacción a la provocación con metacolina midiendo el VEF1 y el FMF 25 por ciento 50 por ciento y asignando a los valores obtenidos, un puntaje creado por los autores. b - Prueba por punción, (prick test) para estudiar la sensibilidad alérgica cutánea aplicándoles también un puntaje creado por los autores. c - Reacción cutánea a la histamina. Resultados: 1 - Porcentaje de hiperreactivos bronquiales a la metacolina entre asmáticos, 96 por ciento (IC 95 por ciento = 78-97 por ciento), y entre no asmáticos 10 por ciento (IC 95 por ciento 3-22 por ciento) (X2=78,22-p<0,001). 2 - Sensibilidad alérgica en el 70 por ciento de los asmáticos (IC 95 por ciento = 55-82 por ciento), versus 92 por ciento entre los no asmáticos (IC 95 por ciento 2-19 por ciento), (X2=21-p<0,001). 3 - Coeficiente de Spearman=0,673, Pearson=0,572, (p<0,001 en ambos). 4 - La reactividad cutánea a la histamina fue similar entre pacientes asmáticos y las personas no asmáticas (F=0,72-p=0,40). Comentarios: la sensibilidad a la prueba de la metacolina fue para el VEF1 de 0,92 (IC 95 por ciento, 0,78-0,79) y para el FMF 25 por ciento-75 por ciento de 0,94 (IC 95 por ciento, 0,89-0,99). La especificidad para el VEF1 fue de 1 (IC 95 por ciento; 0,93-1) y para el FMF 25 por ciento-75 por ciento de 0,94 (IC 95 por ciento 0,83-0,99)_. La prueba de la metacolina con esta metodología arrojó una alta sensibilidad y especificidad y por lo tanto es de gran valor para detectar a posibles asmáticos...

Enfermedad ocupacional en un servicio de alergia / Occupational disease in an allergy service

Se realizó un estudio prospectivo en una población de 26 enfermeras, que tenían como edad promerio 37.2 años. Del total de ellas 14 participaron en la aplicación y preparación de alergenos de 3 a 60 meses. Doce participaron como grupo control. Se determinó la existencia de atopia, síntomas clínicos y se realizó cuantificación de IgE y EMN, pruebas cutáneas con antígenos glicerinados, control positivo y negativo. En los resultados del estudio se concluye que en las enfermedades asignadas al servicio de alergia ocurre sensibilizacíon alérgica, particularmente en quienes tienen carga genética para atopia.

Hepatitis B antibody levels in health-care workers of a large general hospital in Barbados

In order to assess the immune status to Hepatitis B in a general hospital population in the Caribbean, we studied the antibody level to Hepatitis B surface antigen (anti HBs) and to core antigen (anti HBc) in 90 health-care workers aat the Queen Elizabeth Hospital in Berbados, West Indies. There was one asymptomatic carrier with Hepatitis B antigen (HBsAg). Therteen (14.6%) of the remaining 89 possessed anti ABs; 10 of these (11.2%) were considered to be immune, and three non-immune. The 10 immune sujects were also positive for anti HBc wereas the other three "non-immune" positives were not. One person in the studey had strong anti HBc immunity but was negative for anti HBs. There appeared to be no relationship between immunity and age, sex, profession or duration of work years. From the study, 76 individuals (84%) were easily identified as being susceptible to Hepatitis B and were candidates for HBV vaccine