Safety of a mRNA COVID-19 vaccine in patients with indolent systemic mastocytosis

Background: The development of vaccines against coronavirus disease 2019 (COVID-19) and the report of associated allergic reactions has led to growing concern about their safety, especially in populations at risk for anaphylaxis such as patients with systemic mastocytosis. Method(s): We conducted a retrospective descriptive analysis of patients with systemic mastocytosis referred to our Allergy and Clinical Immunology Department, between June 2021 and February 2022, for COVID-19 vaccination. Patients were divided into two groups according to their risk of allergic reaction: low/moderate-risk (no history of severe allergic reaction, with or without a history of allergic disease) and high-risk (history of any severe allergic reaction). All patients were premedicated with 60 mg of oral prednisolone 24 hours and 1 hour prior inoculation, and with an oral antihistamine 1 hour before vaccine administration. Low/moderate-risk patients were monitored for 30 minutes after vaccine inoculation. High-risk patients got a peripheral venous access and remained under medical surveillance for 60 minutes. Result(s): A total of 45 patients were included in the analysis: 62.2% females, with a mean age of 48.8 years (range: 22-85). All patients had indolent systemic mastocytosis subtype, with a median tryptase level of 15.6 ng/mL (range: 4.3-185 ng/mL);11 (24.4%) were in the high-risk group (8 with history of anaphylaxis to hymenoptera venom and 3 with prior drug anaphylaxis). Low/moderate-risk and high-risk groups had similar median levels of serum tryptase (15.5 vs. 16.6 ng/ mL, p = 0.932). All patients received BNT162b2 mRNA COVID-19 vaccine and a total of 118 doses were administered (24.6% in the high risk group). No adverse events, including allergic reactions, after vaccine inoculation were recorded during the surveillance period. Conclusion(s): To our knowledge, this is the largest series reporting safety of a mRNA COVID-19 vaccine in patients with systemic mastocytosis. Our data reinforce the fact that even patients with increased risk for allergic reactions can be safely vaccinated against COVID-19, and that earlier concerns should be abandoned so a widespread immunization can be achieved.

Threats to operating room personnel's occupational safety and health: a qualitative study

Background & Objective: Every operating room has been associated with a variety of occupational hazards, but not many studies have been conducted to assess and address these hazards. We used a qualitative approach to explore operating room personnel's experiences of workplace hazards and how these hazards threaten their occupational safety and health (OSH). Methodology: This qualitative study was conducted in five teaching hospitals in the south-west of Iran from February 2019 to March 2021. The sample was 24 operating room personnel who were selected under convenient sampling technique. Data were collected using semi-structured, individual interviews, document review and non-participant observation. The collected data were analyzed according to the qualitative content analysis method using MAXQDA v. 2020. Results: After prolonged analysis of the data, the researchers extracted 644 codes, 13 subcategories, 4 categories, and 1 main theme. The main theme of the study was working in a context of occupational hazards. Conclusions: Operating rooms are full of potential dangers, which, when combined with the personnel's negligence and management inefficiencies, increase the risk of occupational health and safety. Therefore, making working conditions safe by providing adequate personal protective equipment (PPE), in-service training, and identifying and managing the causes of personnel negligence are recommended. Moreover, strategies should be introduced to manage stress and conflicts among the healthcare personnel, thus controlling psychological hazards.

Clinical and epidemiological characteristics of workers diagnosed with COVID-19 in the setting of an external occupational safety and health service in Lima-Peru

Objective: To describe the clinical and epidemiological characteristics of workers kept under occupational medical surveillance conducted by an occupational safety and health service. Materials and methods: An observational, descriptive, retrospective, longitudinal study of a group of workers diagnosed with COVID-19 kept under occupational medical surveillance from March 18 to July 31, 2020. The data was analyzed using the Stata Statistical Software: Release 15. Results: Males were more severely affected than females (77.16 %), among which the 20- to 39-year-old age group prevailed (63.30 %). On the other hand, study subjects with no comorbidities accounted for 81.11 %. However, the remaining 18.9 % presented one or more comorbidities, with obesity being the most frequent one (61.95 %), followed by asthma (11.09 %). Sore throat and cough were the most common symptoms with 20.67 % and 19.78 %, respectively. Conclusions: The study population mainly consisted of young male adults with no comorbidities, who neither showed predominant symptoms nor required hospitalization.

Occupational Health Services in Peru

Occupational Health Services (OHS) aim to monitor the health of workers, which is technically managed by specialized physician for Occupational Health. Peru with 32.6 million inhabitants has 17 million working population in mostly informal sector and 7.9 million wage earners with Social Security. Since 1922 the large mining companies have had medical services and hospitals for the care of their workers and families. Over time, they have become well-organized OHS. However, in 1997, the Complementary Risk Work Insurance was created, recognizing 21 sectors required to take out additional insurance for the care of Work Accidents (WA) and Occupational Diseases (OD). In 2011, the Occupational Health and Safety Law was enacted and the procedure for Medical Examinations for workers was regulated. Currently, only large and risky companies have their own OHS, 80% since 2010. 76% of them are paid by employers and 56% of them depend on their Safety Departments. Medium sized companies that do not have OHS hire companies that perform this function;some of them have occupational doctors or nurses. The main functions of OHS are: Medical Surveillance, Prevention of OD, Follow-up of workers with common illnesses, and response to emergency situation. COVID-19 has brought changes such as business closures, work suspension and remote work with strict return-to-work procedures for both workers who have suffered COVID-19 and those who have not. Companies that did not have OHS have hired doctors or nurses to comply with the laws and then implement OHS. The situation is similar in Latin America.

Protecting the Unprotected – Occupational health and safety among informal workers in Southern Africa

The International Labour Organisation (ILO) estimates that approximately 2 billion people, about 61% of all globally employed people, are in the informal economy. This statistic is substantially higher for continental Africa (approximately 86%), and varies across the continent: 31.5% in South Africa, and exceeding 95% in Mozambique, Democratic Republic of Congo and Chad. The informal sector is characterised by vulnerabilities in income, job security, occupational risks and access to healthcare. The ILO, in addressing these challenges, developed Recommendation 204, the “Transition from the Informal to the Formal Economy Recommendation, 2015”. This provides a policy framework that requires a transition that provides adequate social and labour protection, extends legal coverage and protection and ensures compliance with laws. While this transition is necessary, its character particularly with regard to occupational health and safety, needs to be shaped in accordance with needs of workers, harnessing resources from the formal economy and structuring legal frameworks that prioritise health and social protection. Informal work environments vary from extractive, manufacturing, food preparation, commercial, social and retail. Hazardous exposures vary, with workers having little or no resources to introduce controls or to protect their health. Most lack the knowledge about the risks posed by their exposures. Access to medical surveillance is non-existent. While workplace exposures are important factors, social contexts further drive health outcomes: lack of health facilities close to working environments reduce primary health care access, lack of childcare facilities result in child exposures and precarious conditions increase gender and xenophobic violence. Numerous interventions have been piloted and proposed for protecting the health of workers in this sector, including the ILO initiatives such as Work Improvements in Small Enterprises (WISE). However, the success of any intervention is dependent on the multi-stakeholder context. The SARS-CoV-2 pandemic brought into sharp focus the vulnerability of the informal sector – both in terms of economic stability as well as health protection. In South Africa alone, approximately 1.5 million informal sector jobs were lost in the first quarter of 2020. The nature of work has meant that the risk for transmission of infection is extremely high, thus return to work is likely to have resulted in disproportionately higher rates of hospitalisation and death compared to formal workers – but few countries have collected data to better understand the epidemic-related risk of informal work. The growth in the informal economy is a direct result of neo-liberal economic policies championed by government and big-business. The policy infrastructure that encourages the growth in this sector excludes the protection of the health of these workers. All tiers of government should be obliged to commit to policy frameworks, local infrastructure for informal work activity and provision of resources for hazard control and medical surveillance. It is the responsibility of the state to ensure that these workers enjoy the rights to safe and healthy workplaces.

Socio-occupational inequalities in potential work-related exposure to SARS-COV-2

Introduction The risk of contracting COVID-19 is not uniform across occupations. Certain workers, exposed to diseases/infections, interfacing with the public/colleagues, unable to work from home, and without appropriate personal protective equipment are likely to experience higher workplace exposure to SARS-CoV-2. Objective To describe the proportion of workers potentially exposed to coronavirus in each occupation under 'routine' working conditions, as well as a baseline socio-demographic profile of these workers in France. Methods We combined two French cross-sectional population-based surveys: 'Working Conditions' (CT-2013) and 'Medical Surveillance of Occupational Risk Exposure' (Sumer-2017) to quantify 'exposure to infectious agents', 'face-to-face contact with the public' and 'working with colleagues'. We then identified the most exposed occupations before the first lockdown and built an exposure matrix. Finally, we described other socio-demographic characteristics (age, sex, occupational group, educational level, income level, origin) of the workers with the highest potential exposure to COVID-19. Results Before the first lockdown, 42% (11 million) of French workers were exposed to at least two COVID-19 occupational exposure factors. While most exposed workers are in the health care sector, other occupations such as social workers, hotel/restaurant employees, army/police officers, firefighters, hairdressers, and teachers also have a high proportion of exposed workers. Middle age participants, females, unskilled employees, those with post-secondary non-tertiary education, those with lower income level, French-born in overseas departments, and descendants of non-European immigrants faced a greater risk of occupational exposure to coronavirus before the first lockdown. Conclusions Our exposure matrix can now be used as an input in ongoing French cohorts to attribute a baseline level of work-related exposure and adjust it based on actual working arrangements during the epidemic. Surveillance of occupational exposure to coronavirus and the socio-demographic characteristics of the workers vulnerable to this virus is key to the implementation of occupation-specific public health response to Covid-19.