ABSTRACT
BACKGROUND: Benefits using the 13-valent pneumococcal conjugate vaccine (PCV13) in adults are controversial. This study investigated clinical effectiveness of PCV13 vaccination in preventing hospitalisation from pneumonia among middle-aged and older adults. METHODS: Population-based cohort study involving 2,025,730 individuals ≥50 years in Catalonia, Spain, who were prospectively followed from 01/01/2015 to 31/12/2015. Primary outcomes were hospitalisation for pneumococcal or all-cause pneumonia and death from any cause. Cox regression models were used to evaluate the association between PCV13 vaccination and the risk of each outcome, adjusting for age, sex and major comorbidities/underlying risk conditions. RESULTS: Cohort members were observed for a total of 1,990,701 person-years, of which 6912 person-years were PCV13 vaccinated. Overall, crude incidence rates (per 100,000 person-years) were 82.8 (95% confidence interval [CI]: 77.7-88.1) for pneumococcal pneumonia, 637.9 (95% CI: 599.0-678.7) for all-cause pneumonia and 2367.2 (95% CI: 2222.8-2518.7) for all-cause death. After multivariable adjustments we found that the PCV13 vaccination did not alter significantly the risk of pneumococcal pneumonia (multivariable-adjusted hazard ratio [mHR]: 1.17; 95% CI: 0.75-1.83; p = 0.493) and all-cause death (mHR: 1.07; 95% CI: 0.97-1.18; p = 0.190), although it remained significantly associated with an increased risk of all-cause pneumonia (mHR: 1.69; 95% CI: 1.48-1.94; p < 0.001). In stratified analyses focused on middle-aged or elderly persons and immunocompromised or immunocompetent subjects, PCV13 vaccination did not appear effective either. CONCLUSION: Our data does not support clinical benefits of PCV13 vaccination against pneumonia among adults in Catalonia. It must be closely monitored in future studies involving more vaccinated person-time at-observation.
Subject(s)
Pneumococcal Vaccines/immunology , Pneumonia, Pneumococcal/prevention & control , Aged , Aged, 80 and over , Cohort Studies , Female , Hospitalization , Humans , Immunocompromised Host , Male , Middle Aged , Pneumonia, Pneumococcal/epidemiology , Pneumonia, Pneumococcal/mortality , Proportional Hazards Models , Spain/epidemiology , Streptococcus pneumoniae/immunology , Survival Analysis , Treatment Outcome , Vaccines, Conjugate/immunologyABSTRACT
OBJECTIVE: To investigate hospitalizations from pneumococcal pneumonia in older adults with specific underlying chronic conditions, evaluating the influence of these conditions in developing pneumonia. METHODS: Population-based cohort study involving 27,204 individuals ≥ 60 years old in Southern Catalonia, Spain. All cases of hospitalization from pneumococcal pneumonia (bacteremic and nonbacteremic) were collected since 01/12/2008 until 30/11/2011. Cox regression was used to calculate hazards ratio (HR) and estimate the association between baseline conditions and the risk of developing pneumococcal pneumonia. RESULTS: Maximum incidences (per 1000 person-years) appeared among patients with history of prior pneumonia (14.6), nursing home residents (12.8), persons with immunodeficiency/asplenia (7.7) and patients with chronic pulmonary disease (7.6). In multivariable analysis, age (HR: 1.05), nursing home residence (HR: 4.59), history of prior pneumonia (HR: 3.58), stroke (HR: 2.50), chronic heart disease (HR: 1.53), chronic pulmonary disease (HR: 4.09), diabetes mellitus (HR: 1.66), smoking (HR: 1.69) and immunosuppressive medication (HR: 1.87) appeared significantly associated with an increased risk of pneumococcal pneumonia. CONCLUSION: Our data support that nursing home residence, chronic pulmonary disease and immunocompromising conditions are the underlying conditions most strongly associated with an increasing risk of pneumococcal pneumonia in older adults. This data underline the need for better prevention strategies among these persons.
Subject(s)
Pneumonia, Pneumococcal/epidemiology , Aged , Aged, 80 and over , Chronic Disease , Comorbidity , Female , Hospitalization , Humans , Immunocompromised Host , Incidence , Male , Middle Aged , Nursing Homes , Prospective Studies , Risk Factors , Spain/epidemiologyABSTRACT
BACKGROUND: The purpose of this study was to assess the relationships between rhinitis, exposure to workplace air contaminants, and occupational characteristics in greenhouse flower and ornamental plant (OP) growers. METHODS: A random sample of growers cultivating such crops and participating in the European Farmers' Study was selected for a cross-sectional assessment of (1) rhinitis in the last year, (2) sensitization to workplace allergens, and (3) occupation characteristics. Associations between variables were assessed through univariate and multivariate analyses. RESULTS: Thirty-nine greenhouse flower and OP growers participated in the study (mean, 48.6; SD, 10.2 years; 35 men). Rhinitis was reported by 12 (31%) of them and was significantly related to sensitization to workplace allergens (odds ratio [OR], 13.20; 95% confidence interval [CI], 2.59-67.23) and pesticide application by hand pump (OR, 12.50; 95% CI, 2.00-78.05). After adjustment for these variables rhinitis emerged as significantly related to number of hours worked inside the greenhouse per day (OR, 1.85; 95% CI, 1.05-3.23). CONCLUSION: Rhinitis is often reported by greenhouse flower and OP growers and is related to sensitization to workplace allergens and pesticide application by hand pump. The disease shows a dose-response relationship with the number of hours spent inside the greenhouse per day, a finding supporting a causal link with greenhouse exposure.
Subject(s)
Allergens/adverse effects , Flowers/adverse effects , Gardening , Occupational Diseases/etiology , Occupational Exposure/adverse effects , Plants/adverse effects , Rhinitis, Allergic, Perennial/etiology , Europe/epidemiology , Female , Humans , Male , Middle Aged , Morbidity , Occupational Diseases/epidemiology , Pesticides/adverse effects , Rhinitis, Allergic, Perennial/epidemiology , Risk Factors , Surveys and QuestionnairesABSTRACT
BACKGROUND: In animal farming, respiratory disease has been associated with indoor air contaminants and an excess in FEV1 decline. Our aim was to determine the characteristics and risk factors for chronic obstructive pulmonary disease (COPD) in never-smoking European farmers working inside animal confinement buildings. METHODS: A sample of participants in the European Farmers' Study was selected for a cross-sectional study assessing lung function and air contaminants. Dose-response relationships were assessed using logistic regression models. RESULTS: COPD was found in 18 of 105 farmers (45.1 SD 11.7 years) (17.1%); 8 cases (7.6%) with moderate and 3 cases (2.9%) with severe disease. Dust and endotoxin showed a dose-response relationship with COPD, with the highest prevalence of COPD in subjects with high dust (low=7.9%/high=31.6%) and endotoxin exposure (low=10.5%/high=20.0%). This association was statistically significant for dust in the multivariate analysis (OR 6.60, 95% CI 1.10-39.54). CONCLUSION: COPD in never-smoking animal farmers working inside confinement buildings is related to indoor dust exposure and may become severe.
Subject(s)
Air Pollution, Indoor/adverse effects , Occupational Exposure/adverse effects , Pulmonary Disease, Chronic Obstructive/etiology , Adult , Air Pollution, Indoor/analysis , Ammonia/analysis , Animal Husbandry , Animals , Animals, Domestic , Cross-Sectional Studies , Dust/analysis , Endotoxins/analysis , Europe , Female , Humans , Lung/physiopathology , Male , Middle Aged , Respiratory Function Tests , Surveys and QuestionnairesABSTRACT
The objective of this study was to determine the prevalence of occupational asthma and sensitization to workplace allergens in greenhouse flower and/or ornamental plant growers. A random sample of 40 growers who cultivated such crops and had participated in the European Farmers' Study was selected for a cross-sectional study that included (1) greenhouse characteristics and air contaminants (dust, endotoxin, and microorganisms), (2) respiratory symptoms, (3) occupational asthma diagnosed by bronchial provocation challenge, and (4) sensitization to workplace flowers or molds. Associations among respiratory symptoms, sensitization, greenhouse characteristics, and air contaminants were analyzed by logistic regression modeling. Thirty-nine growers agreed to participate (response rate, 97.5%). Bronchial provocation challenge confirmed occupational asthma in three workers (7.7%), all of them sensitized to workplace flowers or molds. No cases of occupational asthma were found among nonsensitized growers. Poor ventilation proved to be a marginal risk factor for wheezing (air velocity: odds ratio, 0.11; 95% confidence interval, 0.01-1.04). Sensitization to flowers or molds was found in 13 of 38 growers (34.2%) but was not related to greenhouse characteristics. We conclude that one-fourth of greenhouse flower and/or ornamental plant growers sensitized to workplace flowers or molds have occupational asthma, a disease that is suffered by 8% of the growers who cultivate these crops.
Subject(s)
Asthma/etiology , Occupational Diseases/etiology , Plants/adverse effects , Air Pollutants, Occupational/analysis , Allergens , Asthma/diagnosis , Asthma/epidemiology , Cross-Sectional Studies , Europe/epidemiology , Female , Forced Expiratory Volume , Fungi/immunology , Humans , Male , Middle Aged , Occupational Diseases/diagnosis , Occupational Diseases/epidemiology , Skin Tests , SpirometryABSTRACT
BACKGROUND: A high prevalence of asthma has been reported in poultry farmers. Our aim was to determine air contaminants in poultry confinement buildings and the prevalence of occupational asthma in these workers. PATIENTS AND METHOD: Spanish poultry farmers who participated in the European Study Prevalence and Risk Factors for Airway Obstruction in Farmers, who worked inside confinement buildings, were enrolled in a cross-sectional study that included the measurement of air contaminants (ammonia, total dust, endotoxin and microorganisms), symptoms, skin testing with common and poultry-related allergens, and a specific bronchial challenge. The Spearman correlation coefficient was used to assess the correlation between air contaminants. RESULTS: 14/15 poultry farmers participated in the study (response index: 93.3%). Concentrations of air contaminants in the confinement buildings [median (interquartile range)] were: 7.5 (5-20) ppm for ammonia, 2.6 (1.8-4.6) mg/m3 for total dust, 137.1 (58.6-243.9) ng/m3 for endotoxin and 7,600 (907-27,750) colony-forming units/m3 * 103 for bacteria. Endotoxin correlated with bacterial concentration (r = 0.69, p < 0.01). 5/14 poultry farmers reported wheezing and/or asthma within the last year (35.7%), and in 2 of them spirometry demonstrated current asthma (14.3%). Specific bronchial provocation confirmed the diagnosis of occupational asthma in one subject with current asthma sensitized to the storage mite Lepidoglyphos destructor (7.1%). CONCLUSIONS: One third of poultry farmers working inside confinement buildings reported wheezing, that is partly attributable to occupational asthma caused by storage mites.
Subject(s)
Agricultural Workers' Diseases/epidemiology , Air Pollution, Indoor/adverse effects , Animal Husbandry , Asthma/epidemiology , Adult , Agricultural Workers' Diseases/immunology , Agricultural Workers' Diseases/physiopathology , Air Pollution, Indoor/analysis , Asthma/immunology , Asthma/physiopathology , Cross-Sectional Studies , Female , Humans , Male , Prevalence , Respiratory Function Tests , Respiratory Sounds , Spain/epidemiologyABSTRACT
FUNDAMENTO: La prevalencia de asma en los avicultores es más elevada que en el resto de ganaderos. El objetivo del estudio fue definir los contaminantes ambientales a los que está expuesto el trabajador avícola y determinar la prevalencia de asma ocupacional en ese colectivo. PACIENTES Y MÉTODO: Estudio transversal de una muestra de los avicultores de España que trabajaban en el interior de edificios de confinamiento y participaron en el Estudio Europeo de Salud Respiratoria en la Agricultura y la Ganadería, a los que se realizaron mediciones de contaminantes ambientales (amoníaco, polvo total, endotoxina y microorganismos), síntomas, pruebas cutáneas con alergenos comunes y alergenos relacionados con la avicultura, y pruebas de provocación bronquial específica. Se utilizó el coeficiente de Spearman para estimar la correlación entre contaminantes ambientales. RESULTADOS: Un total de 14 de 15 avicultores participaron en el estudio (índice de respuesta: del 93,3 por ciento). La concentración (mediana [rango intercuartil]) de contaminantes en los edificios de confinamiento fue de 7,5 (5-20) ppm para el amoníaco, 2,6 (1,8-4,6) mg/m3 para el polvo total, 137,1 (58,6-243,9) ng/m3 para la endotoxina y 7.600 (907-27.750) × 103 unidades formadoras de colonias/m3 para las bacterias. La concentración de endotoxina se correlacionó con la concentración bacteriana (r = 0,69, p < 0,01). Un total de 5/14 sujetos refirieron haber tenido sibilancias y/o asma el último año (35,7 por ciento), en dos de los cuales la espirometría mostró asma actual (14,3 por ciento). La prueba de provocación bronquial específica confirmó el diagnóstico de asma ocupacional en un avicultor con asma actual, sensibilizado al ácaro de almacenamiento Lepidoglyphos destructor (7,1 por ciento). CONCLUSIONES: Una tercera parte de los avicultores que trabajan en edificios de confinamiento tiene sibilancias , y esta sintomatología en parte es atribuible a asma ocupacional por sensibilización a ácaros de almacenamiento (AU)
Subject(s)
Adult , Male , Female , Humans , Animal Husbandry , Spain , Prevalence , Respiratory Sounds , Asthma , Cross-Sectional Studies , Agricultural Workers' Diseases , Air Pollution, Indoor , Respiratory Function TestsABSTRACT
Fundamento: Se presenta un estudio transversal de prevalencia de síntomas respiratorios en agricultores y/o ganaderos, con análisis de los factores de riesgo laborales para la existencia de sintomatología. Métodos: Un cuestionario sobre síntomas respiratorios y características de la ocupación fue remitido a una muestra de 1.191 agricultores y/o ganaderos, efectuándose un análisis descriptivo y multivariante por regresión logística de los datos obtenidos. Resultados: Respondieron al cuestionario 1.164 trabajadores (índice de respuesta 98,2 por ciento), de los que 808 fueron incluidos en el estudio después de descartar a los trabajadores sin exposición. En la ganadería, los trabajadores avícolas mostraron las prevalencias más elevadas de síntomas de asma (39,2 por ciento) y de alergia nasal (31,6 por ciento) (p < 0,01, *2) y los expuestos a ganado ovino, las mayores prevalencias de expectoración crónica (38,5 por ciento), de síntomas durante el trabajo (53,9 por ciento) y de síndrome tóxico por polvo orgánico (STPO) (35,9 por ciento) (p < 0,005, *2). En el análisis multivariante realizado, ajustando para edad, sexo, tabaquismo y otras exposiciones laborales, se encontraron, como factores de riesgo significativos, la avicultura para los síntomas de asma (odds ratio [OR]: 2,1; intervalo de confianza [IC] del 95 por ciento: 1,2-3,8) y de alergia nasal (OR: 2,3; IC del 95 por ciento: 1,3-4,2), y el trabajo con ganado bovino para la expectoración crónica (OR: 1,8; IC del 95 por ciento: 1,1-2,9). La agricultura no supuso factor de riesgo para síntomas respiratorios. Conclusiones: En este estudio los principales factores de riesgo de sintomatología respiratoria en la agricultura y/o la ganadería son el trabajo con aves o con ganado bovino. (AU)
