Document NG3bqzn8D9Jg6dqQ4QKBKqZnp

Voijpft .. oe 'JSpim>`- ile :vMVsi ^iQg Ht HjTfefTf ' f &'j^>^s i .u'* Brasa? SiiS m ' /7 Health Survey of Dioxin-Exposed Nitro, West ^.rginia Workers /at Monsanto `*-**C*>.*.-**~Z$vi.my* / ' -*vrT*<i*rV^7*ti < V; , '{ 1-cT' IJL ,-''' tir :>4 ' Chemical Company in"'-h^i-.- i.-..JI Marion MJkes t M.D., Ruth Lilis, M.D. , Irving J. Selikoff, M.D., David Bickers, M tD.*, and Robert Lovelace, M.D.** .- **#vu'k*'~r~ 'Z Z J& t'- " - iit .-j ' 5i*tnf7T v^ ,f T 3 ^ ^ * * > >r* TX`*3 Problem t^.- -vC*<- 2.4.5- T was manufactured by the Monsanto Chemical Company at their Nitro,'`*^3*'. West Virg inia p i a n t from October 1948 to September 1969. In M arch, 1949 an explosion occurred in the reaction vessel where totrachloro.benze.ne7 'I methanol and caustTc were being mixed to make trjchi orophenol. A large amount of the reactor contents was released t.hougbout the building as well as being dispersed to the surrounding area. It is known that such acci dents release large amounts of the very toxic chemical 2,3,7,8-tetra- chlorodibenzo-p-dioxTn (TCDD). This same dioxin is also found during the manufacture of trichlorophenol and is an unwanted and undesirable contain- iH. inant of the 2,4,5-T made from it. The amounts formed during manufacture, .~ however, are much lower than those found in an explosion as the formation . of the dioxin is temperature and pressure dependent. -j */?** Workers exposed to TCDD often develop chloracne as .well as other systemic manifestations of dioxin toxicity. The number of workers who suffered from chloracne and other toxic effects related to the explosion at Monsanto was reported to be 218. It is also known that chloracne had continued to be a problem among *workers at the plant during the time 2.4.5- T was manufactured there. The effects of dioxin on humans are well known because of ^experience with numerous accidents and other over-exposures. Systems affected are the skin" nervous system, liver, lipid metabolism, general metabolic s7tate and most likely, the cardiovascular systems, blood-forming organs, Ind the-v: immune syste m . * Chloracne, characterized by comedones, cysts, pustules and inflammatory skin changes of varying degrees of severity, is commonly found with expo sure to TCDD. It is often very refractory to treatment and may involve almost the entire body. Hyperpigmentation and hypertrichosis may accom pany the chloracne in seveFe cases. The chloracne usually appears within four to six weeks of exposure and in some cases may persist for many years. Chloracne can also occur in family contacts of workers exposed to - the toxic agent who carry it home on their clothing. "; and symptoms of peripheral neuropathy have often b e e n r e p o r t e d . 1 d Signs cr Mitvii -vi *1 rCase Western Reserve School of Medicine, Cleveland, Ohio Columbia University College of Physicians and Surgeons, New York CCiittyy-- > *TZ3OtC*m.k,-V*.+'". # * weakness iny the lower extremities often accompanied by difficulty in walking 3nd coordinating the lower limbs are frequent symptoms. Objective ' measures Vf motor and sensory nerve conductidn testrmg-have co"nirrhed that 1 nerve^ damage exists^ Hyperirritabilitv. sleep disturbances, insomnia^, hypersumnla, loss oT~ vigor and drive, decreased libido and impotence alee reported complaints. ~ " ~^ Effects on the liver range from abnormalities in liver enzymes to toxic hepatitis. Porphyria cutanea tarda has also been reported. In cases where liver biopsies h a v e b e e n done, results have shown abnormalities. Elevated serum lipids have been reported. Very few toxic substances in the industrial environment have been shown to affect such a wide range of body systems and none is biologically active in animal studies at such low levels. Moreover, there are numerous ex perimental studies that reveal significant effects on the immune system in animals. TCDD is a teraTogen and a carcinogen in experimental animals at /"very Tow doses.~~ There are no available adequatetong-term human studies that would allow quantitation of risk to humans of cancer and birth de fects related to exposure to TCDD. Monsanto has been in continuous operation at this site since 1929. The majority of the chemicals manufactured at this plant are rubber additives, accelerators, antioxidants, etc. Workers at the plant were known to'be exposed to the human bladder carcinogen, para-amino-biphenyl, for several years in the 1950's. The organophosphate pesticide parathion, was also manufactured here for several years. Production was stopped when eight workers died in an explosion in the pesticide building in 1957. In April, 1979 , at the request __of the TTm'tpd-- Sfpplworkers of America, AFL-CIO, a health survey was conducted to determine if long-term adverse health" effects" from exposure to dioxin could be demonstrated in the workers. Materials and Methods All active workers identified by union and company records as having had exposure to 2,4,5-T in manufacturing or processing were invited to parti cipate in the survey. A sample of the remainder of the active work force not so identified as having had exposure to 2,4,5-T was also invited. All retirees, identified by union and company records, were invited to parti cipate. Two hundred and thirty five persons participated in the survey and two hundred thirty completed it. Age distribution and work status of these 230 are shown in Tables 1 and 2. Number of years of employment at Monsanto ig shown in Table 3, and the year of hire in Table 4. A Occupational, past medical, dermatological and reproductive histories as well as review of symptoms and physical examination were done. Special dermatological examination was performed on all participants by two derma tologists expert in chloracne. A special detailed neurological evaluation by a neurologist was performed of 91 (40%) of the participants. This evaluation included nerve conduction velocity measurements of motor and sensory nerves, as well as neurobehavioral performance testing. i Fatty tissue was aspirated from the upper outer quadrant of the buttocks under local anesthesia in 122 (53%) of the study participants. Laboratory tests included SMA-18 as well as GGT, triglycerides, complete urinalysis i and total urinary porphyrins. All study subjects had a chest x-ray and pulmonary function testing. A small number of participants also had immunological evaluation of T and B cell function as well as antipyrine drug metabolism studies done. Results Amount of exposure to 2,4,5-T is shown in Table 5. Chloracne findings are presented in Table 6. Analysis of the survey data is currently being completed. Significance Information will be available concerning the long-term status of a group of individuals exposed to TCDD. This work was supported by grant ES 00928 from the NIEHS. 564 Table 1. Age distribution of Nitro survey participants. Age 15-24 25-34 35-44 45-54 55-64 65-74 >75 Number 3 12 45 49 65 49 7 230 Percent of total 1.3 5.2 19.6 21.3 28.3 21.3 3.0 100.0 Table 2. Status of Nitro survey participants Active Retired Number 145 85 230 Percent 63.0 37.0 100.0 Table 3. Number of years worked for Monsanto of Nitro survey participants. Years 0-9 10-19 20-29 30-39 40-49 Number 17 63 53 90 7 230 Percent 7.4 27.4 23.0 39.1 3.0 . 99.9 565 i..* V;:: I Table 4. Year of hire by Monsanto of Nitro survey participants. Year 1925-34 1935-44 1945-54 1955-64 1965-74 1975-79 Number 8 61 82 33 39 7 230 Percent 3.5 26.5 35.7 14.3 17.0 3.0 100.0 Table 5. Amount of exposure to 2,4,5-T by Nitro survey participants. ExDOSure Number Percent None Minimal Moderate Heavy 35 46 57 92* 15.2 20.0 24.8 40.0 230 100.0 *25 workers in this group were directly involved in 1949 explosion. Table 6. Chloracne status of Nitro survey participants. Status Number Percent Chloracne currently present Chloracne present in past Never had chloracne 71 48 109 31.0 21.0 47.8 228* 99.8 * information unavailable for two participants. 566