Document NGaV4JE2QxzBn10KY6qKNXK6y

* V == Vol. 24. No. 29 g WEEKLY g REPORT EE For = Week Ending = July 19, 1975 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE DATE OF RELEASE: JULY 25, 1975 - ATLANTA, GEORGIA 30333 EPIDEMIOLOGIC NOTES AND REPORTS VINYL CHLORIDE AND CONGENITAL MALFORMATIONS - Ohio In March 1975 the Ohio Department of Health reported a significantly increased rate of central nervous system (CNS) malformations in 3 Ohio communities where polyvinyl chlo ride O'VC) polymerization plants are located (/); the increase was not uniform and appeared most prominent in Painesville, Ohio. The birth defect rates were computed from birth certi ficate data for 1970-73 and were compared to similar data for the entire state of Ohio. This study suggested a relationship between the increased rates ofCNS malformations an J the in creased risk of exposure to vinyl chloride (VC) in these com munities. Data available through the CDC Birth Defects Moni- CONTENTS Epidemiologic Notes and Reports Vinyl Chloride and Congenital Malformations -- Ohio.................................................... 245 Follow-Up on Outbreak of Gastrointestinal Illness at Crater Lake National Park -- Oregon.........................246 Trichinosis Outbreak -- Illinois...........................................251 Current Trends Primary and Secondary Syphilis -- United States, May 1975 . . . ............................................................ 251 toring Program (BDMP) (2) provided an opportunity to fur ther examine this suggested relationship. Two hospitals that participate in'the BDMP are located in cities with PVC poly merization plants: one in Pennsylvania, the other in Paines ville, Ohio. CNS malformation rates-for these 2 hospitals in 1970-74 were compared with the rates in their respective TABLE 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES (Cumulative totals include revised anti delayed reports through previous weeks) DISEASE 29th WEEK ENDING July 19. July 20. 1975 1974 MEDIAN 1970-1974 CUMULATIVE. FIRST 29 WEEKS 1975 1974 MEDIAN 1970-1974 . Encephalitis | Post-Infectious.......................... Typhus, tick borne (Rky. Mt. spotted fever) . . . Venereal Diseases: Conorrliea |^Iilj{3ry............................................ Syphilis, primary and secondary ^ vtilitiTrv Rabies in animals.................................................... 84 940 5 17 10 240 624 161 31 35S 32 31 1 574 27 79 4 659 4 9 46 20.410 585 387 9 60 84 6 928 6 19 215 823 106 11 199 20 20 530 46 122 600 6 7 34 18.067 625 507 10 52 172 5 1 34 11 175 i } 1,014 21 271 19 26 698 185 1 6 7 32 ----_ 63 1,320 118 113,682 203 386 18S 6,218 19,508 4,494 210 20,074 930 909 21 44,264 714 14*263 44 18,503 63 166 394 527,957 16362 14,013 191 1.370 1,210 91 96,940 154 468 152 5,814 23,859 4,657 101 18,835 845 822 23 42,245 767 9,015 35 16,933 79 206 418 480,767 16,088 13 >07 255 1,637 1,334 91 107 640 177 4,734 1 / 30,925 623 25,764 938 914 35 53,831 25,166 55 79 173 244 ___ 2,068 TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY Cum. Cum. Botulism: . . ...................................................................................... Congenital rubella syndrome: ......................................................... Hague: Utah 1.................. ................ 13 12 103 20 7 Psittacosis Calif. 1, Texas 1............................................................ Tvphujs. murine: . Texas 2............................................................ 1 1 22 1 SO 17 r.. <.y- l$ :\ SPI-15941 t 246 - -` .Morbidity and Mortality Wet-kJv Keporl VINYL CHLORIDE - Continue*! states. No rate increase was seep. m\ the Return hani. hospital, but an increase, primarily in the categories of niu-nccphultts and spina bifida, was noted in the Painesvillr hospital {1 ul*!v i). Tabic 1 Number of Casns and hr Anencef.haUr* am! Spina Biftda in the State of Ohio and the Painesvill*. Ohio, Hospital, l>y Year. I970-1974 Ancit crpii-ft'.' Hcupu*! M:*\' No. Year C:U0< N\ Cues Kate 1^70 ioii w; !.)>: 1 *' *4 Ur` c> (0) 0.0 in; 5 * n '4 0.3 t .'M < i.;d iD u'.:> n ; (.' 1*1 V;c "4 i*m 14.! (U41 `*.7 Spin:. IttSJ.. Hosptl.'l Muir No. C.i\rs K;ite No. ( aws Rate i '*) h . IVM in l.'t M)o t t *1 S.S (01 0 u M7l n.n i-'; .>.*> (<>) 9.2 in 1 - 1 C'i M* CM :i.: U24) S.9 Rates per UkOOO total while births. 1Tie BDMP hospital data for Paincsville. Ohio, were com pared with the birth certificate data from the Ohio Depart ment of Health and I additional case not included in the BDMP report was added to the ease group (total of 15). f or each case, 2 controls were selected from the hospital birth registry. Medical records for cases and controls were rmiewed to confirm the diagnosis and obtain pertinent dcniographic data, including parental occupation and residence at time of the infant's birth. In addition, parents of 14 of the affected children were interviewed concerning past occupations and residences. Results of the study indicated that none of the inter viewed parents ever worked at either of the 2 PVC polymeri zation plants in Painesville M set of parents could not be lo cated, but records show They did not work at these* plants at the time of their infant's btiill); 2 fathers among the parents >1 the .10 controls were working at 1 of these plants at the time ol their infant-/ births. None of the parents in either group lived within 2 jpiJc:. of the 2 plants. Statistical an;d><t's comparing the distances from home and workplace to me PVC plants showed no differences between the parents of vases and controls. (Reported by the Cancer ard Birth Defects Division, Bureau of Epidemiology. CDC. in cooperation with che Oiii(' S j "j Ih'.dth Depu>'iinchf } Edit-mat Note Vinyl chloiidc is n known carcinogen (.?), and concern ha ; arise/i over i'* pnv'Mc teratogenic effects This concern inns horn re out studie'' which hjvp shown alar; incr-uo- m mutagenicity in bacterial assay system'; (4), and hj increa/*:! ihinin-.-MUiuI r:*.'.ikugo in PVT' polymerization wotkcr.s (.; The Ohio Depaitmeni of Health study (/> js the only report where VC lias hem suggested as causing birth defects in hu mans Although the follow-up study reported here confirmed a moderate increase inCNSmalforrnations in Paincsville, Ohio, it could not establish any association between cases and vinyl chloride exposure. This study clearly does not rule out the possibility that VC may also be teratogenic; other studies are currently underway tu evaluate the incidence of birth de fects among children of parents highly exposed to PVC. References 1. Infante P: Oncogenic and mutagenic risk ir. communities with poly vinyl chloride production facilities. In Program of the Conference on Occupational Can biogenesis at the New York Academy of Science, 25 March J975. New York City. March 1975. Proceedings of the New York Academy of Sciences (in press) 2. Center for Disease Control: Congenital Malformations Surveillance, Annual Summary 1974. Atlanta. CDC. July 1975 3. (enter for Disease ( ontrol' .Morbidity and Mortality Weekly Rep 23lh):19-50. " February 1974 4. Rannug U, Johnnsson A. Kernel C, Wachmeister CA: The mutageni city of vinyl chloride after nr.'Jah'ihc activation. Ambto 3:194,jy74 5. FmKvCuswu* l . La-.'ibcr. B. Lir.dsier. 3. et al: Chromosome aber rations in workers exposed to \ m\ 1 chloride. Lancer 1:459, 1975 FOLLOW-UP ON OUTBREAK OF GASTROINTESTINAL ILLNESS AT CRATER LAKE NATIONAL PARK - Oregon No etiologic agent has yet been demonstrated as ihc cause of the intestinal illness,as.ocijtod with sewage-contami nated water, that occurred among persons at Crater I :i!:e Na tional Park (MMWR. Vol. 22. No. 2S). Rectal swabs and stool specimens from 30 acutely ill persons were negative lor s.dmonellne, shigellae. vibrios. Yerdnia entcmcofinui, and orbivirus. Tests for toxigenic Escherichia colt and enteric viruses are in progress. Three persons with hepatitis who became ill shortly af ter visiting the park were probably inoukatim* the disease jt the time of their visit: 2 of these 3 wore reported to have used the park toilet facilities. Surveillance of the exposed popula tion lor hepatitis has been initiated by State and Territorial Epidemiologists and by CDC. No definite pu-dexposure eases of hepatitis among the persons exposed to the water at Crater Lake during the outbreak have been identified. If any persons develop hepatitis between 2 to (> weeks after exposure nr Crater Luke National Park, They are asked to report their ill ness to their state health departments and to CDC. (Reported by members of the Oregon State Health Division and the Cafifomi i Stare Department of Health; and an F.IS OtW i'T. ) Addendum The following persons who contributed to the investi gation of this outbreak wore inadvertently omitted from the list of persons mentioned in last week's MMWR: Mary Mur phy, RN. Nurse Epidemiologist and Monroe Holmes. DVM, Buhhc Health Veterinarian. Oregon State Health Division. SPI-15942