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IntroductionThe issues related to return-to-work (RTW) after COVID-19, and the impact of long-COVID on workers' health engaged in different occupations are far to be fully acknowledged. Occupational Physicians (OPs) represent an important and competent source for the evaluation of these issues in workplaces, scant considered in research up now.Material And MethodsA literature search was performed to develop a questionnaire targeting the Italian OPs. The survey collects data on COVID-19 related RTW issues and on long-COVID symptoms occurrence in workers of Emilia-Romagna region (Italy).ResultsThe questionnaire involves three sections. The first with general information on the OPs activity (industrial sector and types of companies followed, main occupational hazards, health surveillance programs carried out). The second section is about long-COVID, defined according to the World Health Organization and the U.S. Centers for Disease Control and Prevention. A list of 22 symptoms based on a systematic search in MedLine has been developed asthenia;air hunger;chest tightness;memory/concentration problems;mental confusion;joint/muscle pain;sleep disorders;heart palpitations;dizziness;tingling/dysesthesia;gastrointestinal problems;depression and/or anxiety;tinnitus;inappetence;low-grade fever;high-grade fever;cough;headache;sore-throat;changes in smell/taste;skin rashes;other symptoms (to be specified). The main characteristics of the workers with long-COVID (age, gender, concomitant diseases, vaccination, smoking habit, body weight and previous infections etc.) and the frequency of the long-COVID symptoms are collected. The last section investigates RTW issues, to quantify the impact of the phenomenon in terms of workers involved, main characteristics of subjects with RTW problems, and implications for their work-ability.ConclusionsUsing the OPs direct experience as source of information, the study is aimed to develop new knowledge on the long-term impacts of the SARS-CoV-2 pandemic on workers' health, specifically considering RTW issues and the occurrence of long-COVID symptoms.
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The aim of this ecological study is to evaluate correlations between the number of COVID-19 vaccine doses administered in three Italian provinces-one in the south, one in the center and one in the north of the country-and the registered numbers of COVID-19 cases in the same areas. The period of January 2021-September 2022 was considered, with specific analysis for fractions of times corresponding to the spread in Italy of the different SARS-CoV-2 variants. The results confirm the reduction of the effectiveness of the vaccines in preventing new COVID-19 cases in Italy, regardless of latitude, after the appearance of the first omicron variants. The new variants omicron 4 and 5 showed an extremely high spread during the Italian summer months; fortunately, the effects of the vaccinations in preventing new cases was improved compared to the previous omicron variants, showing a negative correlation between the new COVID-19 cases and the number of vaccine doses administered.
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The titer of the anti-SARS-CoV-2 antibodies produced after vaccination shows a relevant decay over time, as demonstrated in several studies. However, less is known on the possible factors affecting the entity of this decay. The aim of this study is to analyze a group of individual factors which are possibly associated with anti-SARS-CoV-2 antibody titer decay six months after the second vaccine dose. We report here the results of a follow-up serological analysis and a questionnaire-based evaluation of a sample of workers from an Italian nursing home, vaccinated with two doses of BNT162b2 vaccine in early 2021. The baseline data were collected one month after the vaccine, while in the present analysis we report the data collected six months later. Our data show a relevant decay of the neutralizing antibody titer, even if for all the workers a largely positive response was detected. Moreover, our results demonstrate a possible association between younger age and the absence of previous COVID-19 infection, and a higher decay rate of the anti-SARS-CoV-2 antibodies titer.
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BACKGROUND: The research aimed to investigate the incidence of SARS-CoV-2 breakthrough infections and their determinants in a large European cohort of more than 60,000 health workers. METHODS: A multicentric retrospective cohort study, involving 12 European centers, was carried out within the ORCHESTRA project, collecting data up to 18 November 2021 on fully vaccinated health workers. The cumulative incidence of SARS-CoV-2 breakthrough infections was investigated with its association with occupational and social-demographic characteristics (age, sex, job title, previous SARS-CoV-2 infection, antibody titer levels, and time from the vaccination course completion). RESULTS: Among 64,172 health workers from 12 European health centers, 797 breakthrough infections were observed (cumulative incidence of 1.2%). The primary analysis using individual data on 8 out of 12 centers showed that age and previous infection significantly modified breakthrough infection rates. In the meta-analysis of aggregated data from all centers, previous SARS-CoV-2 infection and the standardized antibody titer were inversely related to the risk of breakthrough infection (p = 0.008 and p = 0.007, respectively). CONCLUSION: The inverse correlation of antibody titer with the risk of breakthrough infection supports the evidence that vaccination plays a primary role in infection prevention, especially in health workers. Cellular immunity, previous clinical conditions, and vaccination timing should be further investigated.
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Occupational exposure to solar ultraviolet (UV) radiation is a recognized work-related risk, as is associated with the induction of long-term adverse health effects such as Non-Melanoma Skin Cancers and cataracts. Recent research provided new data suggesting an increased risk of specific forms of malignant melanoma, i.e., Lentigo Maligna Melanoma, for outdoor workers, while the relation of cumulative exposure to solar radiation with ocular diseases, such as uveal melanoma and macular degeneration, is still debated. Nowadays, one of the main focuses of prevention activities is the organization of multicomponent sun safety initiatives, which are proved to be effective, particularly when including technologies that are able to directly interact with individuals, such as phone apps, such as the recently released SunSmart Global UV App. Nevertheless, we should not forget that we are living in an era of profound changes, and phenomena such as climate change and the COVID-19 pandemic have an impact on all aspects of our lives, including how and when we perform, as well as the perception of, outdoor activities. In the future, this may result in possible changes in the scenario of occupational and leisure-time solar radiation exposure-related health risks.
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Italy was the first Western European country to be severely hit by the COVID-19 pandemic. Variations in seroprevalence rates were reported according to geographical and temporal differences of previous surveys, as well as depending on demographic and occupational factors. In this cross-sectional study, we evaluated the prevalence of anti-SARS-CoV-2 antibodies in a population of the Emilia-Romagna region in Northern Italy after the first wave in the period from 26 September 2020-26 March 2021. We included 5128 subjects who voluntarily underwent serological tests to determine anti-SARS-CoV-2 antibody positivity, including both self-referred individuals (24.2%) and workers adhering to company screening programs (76.8%). Overall, seroprevalence was 11.3%, higher in self-referred (13.8%) than employed-referred (10.5%) individuals. A slightly higher seroprevalence emerged in women compared to men (12.3% and 10.7%), as well as in the extreme age categories (18.6% for 60-69 years, 18.0% for ≥70 years, and 17.1% for <20 years compared to 7.6% for 20-39 years). Healthcare professionals showed the highest prevalence of seropositivity (22.9%), followed by workers in direct contact with customers, such as the communication, finance, and tourism sectors (15.7%). Overall subgroups seroprevalence increased compared to the first wave data but the trends agreed between the first and subsequent waves, except for an increase in the younger age group and in the sector in direct contact with customers. Among the occupational categories, our study confirms that healthcare workers and workers in the sports sector were at high risk of exposure to SARS-CoV-2.
Subject(s)
COVID-19 , Pandemics , Aged , Antibodies, Viral , COVID-19/epidemiology , Cross-Sectional Studies , Female , Health Personnel , Humans , Italy/epidemiology , Male , Middle Aged , SARS-CoV-2 , Seroepidemiologic StudiesABSTRACT
Globally, there has been a high burden of COVID-19-related mortality amongst physicians and other healthcare workers during the ongoing SARS-CoV-2 pandemic. Fortunately, anti-COVID-19 vaccination campaigns have helped to protect frontline workers and reduce COVID-19-related mortality amongst this occupational group. We analyzed COVID-19-related mortality data for doctors in Italy and compared the crude mortality rate between March-May 2020 (i.e., the beginning of the pandemic in Italy, with the highest rates of COVID-19-related deaths) and the same time period in March-May 2021 (high vaccination coverage amongst Italian physicians). The mortality rate was 12 times higher in March-May 2020 compared to the same time period after the start of the Italian vaccination campaign. Moreover, there was a strong inverse correlation between the number of deaths and the cumulative number of vaccine doses administered in the Italian population. Although non-pharmaceutical interventions, virus evolution and environmental factors probably had an effect, our analysis clearly supports the hypothesis that the vaccination campaign helped to protect Italian physicians and reduce COVID-19-related mortality. The latest available death trends from September to October 2021 for both physicians and the general population are also in favor of the need for the third vaccine dose, currently underway for the majority of the population at risk.
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BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) have produced the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates). For these, systematic reviews of studies estimating the prevalence of exposure to selected occupational risk factors have been conducted to provide input data for estimations of the number of exposed workers. A critical part of systematic review methodology is to assess the quality of evidence across studies. In this article, we present the approach applied in these WHO/ILO systematic reviews for performing such assessments on studies of prevalence of exposure. It is called the Quality of Evidence in Studies estimating Prevalence of Exposure to Occupational risk factors (QoE-SPEO) approach. We describe QoE-SPEO's development to date, demonstrate its feasibility reporting results from pilot testing and case studies, note its strengths and limitations, and suggest how QoE-SPEO should be tested and developed further. METHODS: Following a comprehensive literature review, and using expert opinion, selected existing quality of evidence assessment approaches used in environmental and occupational health were reviewed and analysed for their relevance to prevalence studies. Relevant steps and components from the existing approaches were adopted or adapted for QoE-SPEO. New steps and components were developed. We elicited feedback from other systematic review methodologists and exposure scientists and reached consensus on the QoE-SPEO approach. Ten individual experts pilot-tested QoE-SPEO. To assess inter-rater agreement, we counted ratings of expected (actual and non-spurious) heterogeneity and quality of evidence and calculated a raw measure of agreement (Pi) between individual raters and rater teams for the downgrade domains. Pi ranged between 0.00 (no two pilot testers selected the same rating) and 1.00 (all pilot testers selected the same rating). Case studies were conducted of experiences of QoE-SPEO's use in two WHO/ILO systematic reviews. RESULTS: We found no existing quality of evidence assessment approach for occupational exposure prevalence studies. We identified three relevant, existing approaches for environmental and occupational health studies of the effect of exposures. Assessments using QoE-SPEO comprise three steps: (1) judge the level of expected heterogeneity (defined as non-spurious variability that can be expected in exposure prevalence, within or between individual persons, because exposure may change over space and/or time), (2) assess downgrade domains, and (3) reach a final rating on the quality of evidence. Assessments are conducted using the same five downgrade domains as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach: (a) risk of bias, (b) indirectness, (c) inconsistency, (d) imprecision, and (e) publication bias. For downgrade domains (c) and (d), the assessment varies depending on the level of expected heterogeneity. There are no upgrade domains. The QoE-SPEO's ratings are "very low", "low", "moderate", and "high". To arrive at a final decision on the overall quality of evidence, the assessor starts at "high" quality of evidence and for each domain downgrades by one or two levels for serious concerns or very serious concerns, respectively. In pilot tests, there was reasonable agreement in ratings for expected heterogeneity; 70% of raters selected the same rating. Inter-rater agreement ranged considerably between downgrade domains, both for individual rater pairs (range Pi: 0.36-1.00) and rater teams (0.20-1.00). Sparse data prevented rigorous assessment of inter-rater agreement in quality of evidence ratings. CONCLUSIONS: We present QoE-SPEO as an approach for assessing quality of evidence in prevalence studies of exposure to occupational risk factors. It has been developed to its current version (as presented here), has undergone pilot testing, and was applied in the systematic reviews for the WHO/ILO Joint Estimates. While the approach requires further testing and development, it makes steps towards filling an identified gap, and progress made so far can be used to inform future work in this area.
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Occupational Diseases , Occupational Exposure , Cost of Illness , Humans , Occupational Diseases/epidemiology , Occupational Diseases/etiology , Prevalence , Review Literature as Topic , World Health OrganizationABSTRACT
We report the results of a study on the cumulative incidence of SARS-CoV-2 infections in about 6000 workers of the University Hospital of Modena, Northern Italy, in the period March 2020-January 2021, and the relations with some individual and occupational factors. Overall, in healthcare workers (HCW) the cumulative incidence of COVID-19 during the period was 13.8%. Results confirm the role of overweight and obesity as significant risk factors for SARS-CoV-2 infection. Chronic respiratory diseases, including asthma, also proved to be significantly associated with the infection rate. Considering occupational factors, the COVID-19 risk was about threefold (OR: 2.7; 95% CI 1.7-4.5) greater in nurses and nurse aides than in non-HCW, and about double (OR: 1.9; 95% CI 1.2-3.2) in physicians. Interestingly, an association was also observed between infection risk and nightshifts at work (OR: 1.8; 95% CI 1.4-2.3), significantly related to the total number of shifts in the whole eleven-month period. Even if the vaccination campaign has now greatly modified the scenario of SARS-CoV-2 infections among HCW, the results of this study can be useful for further development of health and policy strategies to mitigate the occupational risk related to the new variants of coronavirus, and therefore the evolution of the pandemic.
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OBJECTIVES: The COVID-19 pandemic is due to SARS-CoV-2 coronavirus infections. It swept across the world in the spring of 2020, and so far it has caused a huge number of hospitalizations and deaths. In the present study, the authors investigated serum anti-SARS-CoV-2 antibody prevalence in the period of June 1-September 25, 2020, in 7561 subjects in Modena, Northern Italy. MATERIAL AND METHODS: The study population included 5454 workers referred to testing by their companies, and 2107 residents in the Modena area who accessed testing through self-referral. RESULTS: The authors found the overall seroprevalence to be 4.7% (95% confidence interval [CI] 4.2-5.2%), which was higher in women (5.4%, 95% CI: 4.5-6.2%) than in men (4.3%, 95% CI: 3.7-4.9%), and in the oldest age groups (7.3%, 95% CI: 5.2-9.3% for persons aged 60-69 years, and 11.8%, 95% CI: 8.6-15.1%, for persons aged ≥70 years). Among the occupational categories, the highest seroprevalence was found in healthcare workers (8.8%, 95% CI: 7.0-10.5%), dealers and vehicle repairers (5.2%, 95% CI: 2.9-7.6%), and workers in the sports sector (4.0%, 95% CI: 1.8-6.1%), while there was little or no such evidence for those employed in sectors such as transport and storage, accommodation and restaurant services, and the school system. CONCLUSIONS: These results have allowed, for the first time, to assess population seroprevalence in this area of Italy severely hit by the epidemic, while at the same time identifying the subgroups at a higher risk of exposure to SARS-CoV-2. Int J Occup Med Environ Health. 2022;35(1):63-74.
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COVID-19 , Aged , Antibodies, Viral , Female , Health Personnel , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , SARS-CoV-2 , Seroepidemiologic StudiesABSTRACT
The results of a voluntary screening campaign for the presence of anti-SARS-CoV-2 serum antibodies are presented, performed on workers in the highly industrialized province of Modena in northern Italy in the period 18 May-5 October 2020. The employment activities of the subjects that tested positive for anti-SARS-CoV-2 IgM and/or IgG antibodies were determined and classified using the International Standard Industrial Classification of All Economic Activities (ISIC). The distribution across different sectors was compared to the proportion of workers employed in the same sectors in the province of Modena as a whole. Workers with anti-SARS-CoV-2 serum antibodies were mainly employed in manufacturing (60%), trade (12%), transportation (9%), scientific and technical activities (5%), and arts, entertainment and recreation activities (4.5%). Within the manufacturing sector, a cluster of workers with positive serological tests was observed in the meat processing sector, confirming recent data showing a possible increased risk of SARS-CoV-2 infection in these workers.
Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , Humans , Immunoglobulin M , Italy/epidemiologyABSTRACT
BACKGROUND: The immunization of healthcare workers (HCWs) plays a recognized key role in prevention in the COVID-19 pandemic: in Italy, the vaccination campaign began at the end of December 2020. A better knowledge of the on-field immune response in HCWs, of adverse effects and of the main factors involved is fundamental. METHODS: We performed a study on workers at a nursing home in Northern Italy, vaccinated in January-February 2021 with two doses of the BNT162b2 vaccine four weeks apart, instead of the three weeks provided for in the original manufacturer protocol. One month after the second dose, the serological titer of IgG-neutralizing anti-RBD antibodies of the subunit S1 of the spike protein of SARS-CoV-2 was determined. The socio-demographic and clinical characteristics of the subjects and adverse effects of vaccination were collected by questionnaire. RESULTS: In all of the workers, high antibody titer, ranging between 20 and 760 times the minimum protective level were observed. Titers were significantly higher in subjects with a previous COVID-19 diagnosis. Adverse effects after the vaccine were more frequent after the second dose, but no severe adverse effects were observed. CONCLUSIONS: The two doses of the BNT162b2 vaccine, even if administered four weeks apart, induced high titers of anti-SARS-CoV-2 neutralizing IgG in all the operators included in the study.
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To date, data on COVID-19-related death cases among physicians from different medical specialties are incomplete and scattered. In Italy, available data highlight that general practitioners (GPs) are, apparently, the most heavily affected group. Indeed, they currently represent 44.1% of the total COVID-19 related death cases occurred among physicians, whereas they constitute about 15% of the total number of doctors. This high proportion is most likely the consequence of a work-related contagion happening especially during the first weeks of the epidemic, and persisting also in the following weeks, after the national lockdown. There are various reasons for these higher contagion rates: GPs perform a lot of medical examinations daily, usually in close contact with patients. Especially at the beginning of the epidemic, GPs might have had scant information on the specific safety procedures for the prevention of SARS-CoV-2 transmission (e.g., there was limited knowledge on the possibility of contagions deriving from asymptomatic patients) and, moreover, the availability of personal protective equipment was insufficient. Furthermore, the risk of infection is highly increased by the virus' characteristics, like its survival for several hours/days on different surfaces and its persistence in the air after an aerosolization process, with possibilities to be transmitted over distances longer than two meters. Following these observations, and considering the high cost in term of GPs' lives, the COVID-19 pandemic will probably revolutionize the approach to patients in general practice. Clear and effective guidelines are absolutely and urgently needed for the refinement of adequate measures to prevent SARS-CoV-2 infections among GPs.