The Health Surveillance in Occupational Medicine was defined in the 1980s as: "the periodic medical-physiological evaluation of exposed workers with the aim of protecting health and preventing work-related diseases." This activity is carried out through the Occupational Physician and is based on the clinical assessment, which turns out, however, to be only the final act of a much more complex procedure, represented both by the analysis of each individual phase of the work process and, by the assessment of the health risks, to which a worker is exposed, by virtue of the particular work activity performed, better known, in medical jargon, as specific work task.
The objective of Health Surveillance is, therefore, to prevent occupational diseases, i.e., those diseases related to a specific work activity and, caused by it, also keeping well in mind that the aforementioned occupational diseases, since they can be generated by work, are still diseases, like all those known in the other infinite fields of medicine, not differentiating in any way. It follows that, further and essential tasks of the Occupational Physician are those, in primis, to establish the real existence of a "Causality Link" between exposure to certain injurious agents and, in secundis, the related development of a pathology, excluding that it may have causes different from the only work activity performed. To give an explanatory example of the above, it can be said that Bronchial Asthma, a very well known and widespread pathology in the general population, has nothing different from the same disease that may occur in a subject, due to exposure to injurious agents, with which he or she may come in contact during work. It turns out, therefore, to be of utmost importance to understand the origin of a disease and, above all, to be able to detect early and, possibly in the preclinical phase, that is, before the obvious physical manifestations, the alterations in the state of health, all in order to prevent the same from causing permanent and disabling damage in the exposed worker.
The disease is a disease that can be caused by the exposure of the worker.
It can therefore be stated with certainty that Health Surveillance, in Occupational Medicine, first and foremost follows a methodology primarily aimed at prevention, which is why, depending on the type of medical examination to be performed, preventive, periodic, at the worker's request, for change of job or pre-employment, it follows different criteria having slightly different purposes.
In fact, in the pre-employment phase, but also in the case of a change of job duties, it is oriented to verify the absence of individual conditions for which the specific work could be harmful for the worker under consideration, in which case, the medical examinations aim at the analysis of the main organs and apparatuses, with particular regard to those that could be subject to exposure. For example, in the case of known exposure to agents potentially harmful to the respiratory system, the functionality and initial state of that apparatus must be comprehensively and prioritized.
In the periodic visit phase, Health Surveillance must, on the other hand, verify the maintenance of the exposed worker's health status, focusing on the search for any and early alterations of an organ or apparatus, related to occupational exposure. The periodicity depends strictly on the assessment of specific risks and is usually annual, if not otherwise indicated by the regulations, or at different intervals and identified, in a discretionary manner, by the Competent Doctor based on the findings of the examination and investigations performed.
In the case of a medical examination at the request of the worker, the purpose of health surveillance is to verify the presence or absence of a causal link between an illness, suffered by the requesting worker, and the specific work activity performed by him. In Medico-legal terms, by cause is meant that factor which is necessary and sufficient for the production of an event (specific risk present in the work environment), which is at the same time antecedent to the event itself (the manifestation of the occupational disease). It is clear, however, that the cause, to be such, cannot intervene after the event and that it must represent the necessary moment without which the event itself could not occur. The cause must also possess the requirements of sufficiency, that is, by itself have etiological efficacy this, in summary, means that, in order to be able to speak of an occupational disease, the Competent Doctor must be certain that a given disease may have been generated by exposure, on the occasion of work, to injurious agents and that without such exposure, in all probability the worker would not have fallen ill. In this regard, it is worthwhile to represent that, with regard to occupational diseases, there are reference tables (entered into force on September 27, 2014, the new list of occupational diseases subject to the obligation of complaint/reporting by physicians, pursuant to Article 139 of the Consolidated Text) in which have been collected and associated, to a particular exposure, all diseases for which it is probable or possible the occurrence due to the specific work activity. For these pathologies there is already a legal presumption of a cause-and-effect relationship, i.e., of the causal link, about their work origin, and this list is exhaustive, unlike the "non tabulated diseases," i.e., all those diseases for which a causal link with exposure to a specific injurious agent has not been identified; in such a case, since there is no legal presumption of a causal relationship, the burden of proof is on the employee who requests it, i.e., it is up to him to prove that the pathology suffered was caused by exposure to a certain risk, exclusively or primarily on the occasion of the work activity performed.
In this perspective of prevention it is up to the Occupational Physician to draw up a Health Surveillance Plan, which is the set of medical examinations and procedures deemed appropriate to assess the health status of the worker, according to the specific risks and taking into account the most advanced scientific guidelines (Legislative Decree 81/2008, art 25, paragraph 2). Thus, it lists the types of health checks, to which each worker should be subjected according to the work task he/she is called to perform and the periodicity of the same.
This protocol must be drawn up specifically and punctually for each individual Company, providing in very many cases also for the identification and execution of vaccination coverage, which may be in some cases compulsory, with particular reference to tetanus antitetanus and in others, instead, strongly recommended depending on the exposure to biological/zoonotic risks, with reference, in this case, to vaccines against hepatitis B, A, rabies, and so on and so forth. It is the responsibility of the Medical Officer both to administer the appropriate vaccines, and any booster shots where deemed necessary and/or recommended.
From what we are living in this very important historical period, which sees the entire world population engaged in the fight against the SARS CoV-2 Virus, one can easily guess the importance of the prevention of all diseases, with particular reference to those that are serious, disabling and, moreover, potentially fatal, that is why, within the framework of Health Surveillance in Occupational Medicine, preventive vaccination plays an essential role, with respect to exposed workers, at least for all those known diseases, for which the vaccine represents a source of protection absolutely not to be neglected but to be put in the foreground.
