Introduction/Objective Although exposure to metal fumes is known to increase the risk of pneumococcal disease, published outbreaks has been quite rare. However, during nine weeks in 2019, 20 confirmed and probable cases of disease were identified among 1.900 shipyard workers at one shipyard in Norway.

Method/Results The local hospitals initially detected the outbreak. The affected workers were of different European nationalities, most of them employed by different subcontractors. Sixteen were hospitalized. Isolates were available for serotyping for 17 cases, all isolates belonged to serotype 4. The same strain was found in a similar outbreak in Northern Ireland in 2015. Onsite inspection found a crowded shipyard in the process of finishing a new cruise ship. Many tasks were carried out in the same workspace; like welding, cutting, painting, and finishing on surfaces. The labour inspectorate ordered immediate occupational hygiene measures with short notification. Regulations on tobacco smoking, air quality improvements, and the use of personal protective equipment were all implemented. There were also given advice on measures for improving general hygiene at the yard. The National Institute of Public Health recommended vaccination for the involved workers. Around 1.500 of the 1.900 workers present at the shipyard were vaccinated by the shipyard’s occupational health services. After onsite occupational hygiene measures and vaccination, no new cases were identified. There are published information on a similar outbreak in Finland later the same year, and also in France early in 2020.

Conclusion This outbreak indicates that the occupational risk of severe pneumococcal disease is multifactorial, and that metal fume exposure not only is limited to the occupational category welders. In Norway, vaccination with the pneumococcal is recommended for welders after risk assessment. Recommendation of pneumococcal vaccination to broader occupational groups exposed to metal fumes should be considered, and the working and living conditions.