Objective The purpose of this systematic review is to provide an overview of the published evidence on the role of infectious diseases in occupational health, focusing on occupations other than health care workers. We started from a key systematic review from 2009, extending it up to November 2019.

Methods The subqueries of the review were translated into Embase/Medline/Cochrane queries, and the adequacy of these translations was checked. Studies were screened in two rounds. In the first, title and abstract were compared to the inclusion criteria. These were based on the previous review, adding ‘Immune-related and respiratory conditions after exposure to bioaerosols’ . In the second round, title, abstract and full text were assessed. Quality assessment was applied using published guidelines: SIGN for case-control and cohort studies, STROBE for cross-sectional studies, ORION for outbreak reports and CARE for case series.

Results 3353 unique results were yielded; 214 eligible studies were included. 44 occupations with in total 89 infectious disease exposures were found, some of which were overlapping between occupations. The occupations most frequently reported were armed forces (n=32 pathogens), garbage/recycling collectors (n=13), livestock/dairy producers (n=12), female sex workers (n=9); and forestry and wastewater workers (n=8). Exposure to bioaerosols was mentioned in various occupations: wastewater/garbage workers, biotechnology workers, poultry/abattoir workers, construction workers, public transport workers, greenhouse workers, hotel workers, firefighters, services for homeless, cash collectors, television crew, compost/greenhouse workers, grain and animal feed production.

Discussion Two general classes of biological agents could be recognized. The first comprised infectious diseases, including but not limited to zoonotic infections. The second class comprised organisms resulting in the production of bioaerosols, thus increasing the occupational risk of immune-related and respiratory conditions. Some occupations (e.g. mine work and welding) might increase susceptibility of workers to infection, without increasing the exposure to this pathogen.