Document R268QJVDn3rRvjOE83YmyMKkE

CENTER FOR DISEASE CONTROL aaoL w V&sjp V'\uc+ Vol.26, No. 8 l ft nit] WEEKLY m REPORT KtSISM- VC'WflS')- is For , = Week Ending = February 28,1976 U.S. DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE v PUBLIC HEALTH SERVICE DATE OF RELEASE; MARCH S, 1976 - ATLANTA. GEORGIA 30333 EPIDEMIOLOGIC NOTES AND REPORTS ANGIOSARCOMA OF THE LIVER - Wisconsin In the period lone 1973*November 1975. 4 cases of angiosarcoma or the liver (A:)L) ^ere diagnosed at the Marsh field Clinic, Marshfield, Wisconsin. One was based on hepatic arteriography and 3 on tissue findings later confirmed by pathologic review at the National Cancer Institute (NCI). An additional 6 cases, confirmed on pamoiogic review at NCI and identified through a national ASL case surveil lance project initiated at CDC in 1974, have been diagnosed since 1964 in Wisconsin residents. This total of 10 cases is roughly twice as large as might be expected (5.5 cases), based on CDC surveillance estimates of crude ASL incidence for the entire United States. (Five additional cases had been re CONTENTS Epidemiologic Notes end Reports Angiosarcoma of the Liver -- Wisconsin ...... Possible Lassa Fever -- Washington, D.C............... Current Trends Influenza -- Worldwide ................ .. International Nous Sa/mOnelU typtumutium -- Car.ary Islands, Finland, and die Fcdoial of Cc.'rr.zr.,* 63 64 I ported for Wisconsin; 4 w?rc not confirmed, and 1 was in a resident of another stare.) In view of this relative frequency of cases, together with the recent succession of cases at the Marshfield Clinic, epi' demiologie information concerning each of these It; cases TABLE 1. CASES OF SPECIFIED NOTIFIABLE DISEASES. UNITED STATES (Cumulative totals include revised and delayed reports through previous weeks I DISEASE WEEK ENDING February 2H 1976 February 22 1975 MEDIAN I97M97J CUMULATIVE, FIRST K February 28 1976 February 23 1975 WTFKS M LIMAN 1971*19/5 Aseptic meningitis........................................ .. . Brucellosis.............................. ........................... Oiicktripox ............................................. . . . . Diphtheria .............................. . Encephalitis j^Mnfcctioua' '. Type B.............................. Hepatitu, Viral Type A.............................. I Type unspecified.......... .. . Malaria . ........................................... .. Measles (rubeola) ......................... ................. Meningococcal infections, coiaJ.................... Civilian.............................. ........................ Military....................................................... Mumps ............................................................ Pertussis ............... .......................................... Rubella (German measles) ........................ . Tetanus............................................................ tuberculosis .... . Tularemia ......................... .......................... .. Typhoid fever.................... ............................. Typhus, tick-borne (Rky. Mt. spotted fever) Venereal Diseases: _ . (Civilian................................... Gonorrhea |IMiljiUta| ry.................... Civlian Syphilis, primary and sect ndary Military Rabies in animals ........................... 26 7 5,764 4 13 4 242 72 c 133 3 605 53 53 1.366 22 449 2 570 1 3 - 16 i 313 562 526 6 39 35 2 4. 311 14 17 7 210 707 150 6 578 41 41 1.425 24 265 - 5C5 1 2 * 17,273 419 5 21 3 45 33 2 --6 15 5 172 ) 6 62 2 41 4C i 1*692 --645 --- 1 4 - -__ --- --56 307 36 39 ,286 62 129 32 1*935 5 *409 l 13c5 43 4 .318 284 261 3 9,266 194 1 .870 6 4 ,572 21 58 3 151#746 4 ,708 4,132 64 249 292 21 29 ,693 64 96 33 1 .568 5.528 1.123 52 2 ,668 270 263 7 11*136 201 1 .837 9 4,105 d 29 10 141,256 4 ,776 3 *938 52 264 292 15 -- 23 120 33 1.315 \ 7*619 52 4, 767 270 263 9 14,246 3, 534 8 i3 37 9 -__ -- 448 TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY Cum Cum. Anthrax: ................................ Botulism:.............................. Congenital rubelli syndrome: Leprosy: Pa. i,c*ir. 2 ...... . Leptospirosis:...................... Hague: ................................ Delayed Repun (or week ending Z/ - I /7& 2 Poliomyelitis, total...................................................................................... 4 Panlytic: h.Y.C. 1................................................................................... 5 I PsitUcoris: Ohiu 1, edit 3........................................................................... 7 Trichinosis: nj. i............................................................... - Typhua, munne; l'e\. 1............ ... ............................................. ... 2 2 19 33 2 R&S 026851 R&S 026852 PEMU.AKV 31. \V,l ANGIOSARCOMA -- Continued hai been itiemblcd through medical record review and family interview (Table 1). Particular attention has been given to potential occupational or environmental exposure to cnermotli known to induct ASL (vinyl chloride, arsenic, and thorium dioxide). Most cases (7 of 10) were diagnosed since 1970. prob ably reflecting better case ascertainment in recent years. Ages ranged from 36-71 (mean age 58 years). All but 1 pa tient were male, ind all but 1 were white. Places of usual residence for all cases were widely scattered across the state, roughly corresponding with the state's population (Figure 1). One patient had a history of prior thorium dioxide ex posure. For none of the remaining cases was tumor etiology obvious. Occupations and histories of exposure to potential environmental toxins differed widely, with no more than 1 case associated with any particular industry or mode of exposure. In several instances, however, individual patient occupations or exposures were suggestive of possible onco genicity (Table 1). Patient 10 had had exposure to a vinyl compound; he had worked in paper and plywood products with potential contact with various chermcais, including poly vinyl acetate. Two other patients gave histories of possible exposure to arsenic: patient 9, who had exposure to insecti cides while farming, and patient 8. who worked with wood probably treated with arsenic preservatives in the manu facture of bleachers. All but 3 of the 10 patients were known to have lived on farms during their lifetimes, 2 for all of their lives (Table 1). (Reported by J Fkchtner, MD. C Reyes. MD. Marshfield Clinic; K Rcnlmesster, MPH. HG Skinner. MD. State Epi demiologist, Wisconsin State Dept of Health and Social Serv ices; Office of Extramural Coordination and Special Pro/ecls. National Institute of Safety and Health; and the Cancer and Birth Defects Div, Bur of Epidemiology, CDC.) Editorial Note These data indicate no obvious common-source origins among recent cases of ASL in Wisconsin, The marked male preponderance among cases, however, suggests occupational Figure 1 GEOGRAPHIC DISTRIBUTION OF CONFIRMED CASES OF ANGIOSARCOMA OF THE LIVER IN WISCONSIN RESIDENTS. 1964-1975. BY PLACE OF USUAL RESIDENCE exposure as the potential origin for at least some c-:' the cases. Anecdotal histories of occupational and environmental exposures in several of the cases may warrant further investi gation. particularly in relation to contact with arsenic. Al though at present only vinyl chldvide monomer (/). thorium dioxide (2), and arsenic (3.4) are clearly implicated as causes of ASL, investigations such as the one described here may well provide useful leads in defining further causes. References 1. Creech JL, Johnion MN: Angiosarcoma of liver in ihe minufieiurc of polyvinyl chloride, J Occup Med 16.150-151, 1974 2. MacNiahon HE, Murphy AS, Bates Ml: Endoihcha]-cell sarcoma of li-cr following Thorotrast injection. Am J Paihol 23:585-595. 1947 3. Lender JJ, Stanly RJ, Sumner HW, el at. Angiosarcoma of the bver assocV.ed wnh Fowler's solution (potassium arsemte). Gastroenterology 68:1582-1586,1475 4. Roih F: The sequela of chronic arsenic poisoning in Moselle vintcra. Get Med Mon 2.172-175, 1957 Table 1 Cases of ASL in Wisconsin Resident] 1964-1975 Case Month an d Year Usual Town Age at Number Diagnosis Death Of Residence Diagnosis 1 4/64 2/65 Shcybogan 71 2 2/67 2/67 Oshkosh 61 3 6/67 6/67 Necedah 36 4 7/71 7/71 Milwaukee 68 5 4/72 4/72 Milwaukee 64 6 4/74 6/74 Brown Deer 40 7 7/74 7/74 Wausau 57 8 9/74 9/74 Waupun 46 9 8/74 8/74 Stratford 10 11/75 11/75 Marshfield 66 65 Race W W W B w w w w w w Sex Occupation Comments Farm Residence M University Teacher Lived near a chemical eompanx Youth which made plastics and resin M Foundry Welder Exposure to welding materials Nore and resins F Secretary Infectious hepatitis in childhood, Youth moiiier and sistC* had live,- d:>C4sc M Hog Scalder None M Unknown M Lutheran Pastor Exposure to thorium dioxide Unknown Lived near 5 paper mill. I955-195'3 Youth M Rock Crusher;Glue- Exposure to silica dust, rubber Youth Liner for rubber cement raincoats. 1940s M Postal Mail Carrier Contact with lumber, paints, wood Lifetime formerly emplo>cd preservatives, (ammoniacaK'opper* by company that arsenate wood preservative) (?) made bleachers M Retired Farmer No tissue diagnosis: ASL diagnosed Lifetime by hepatic arteriography M Press operator for Contact with wood, plywood, paper and plywood glues, polyvinyl acetate, others Youth company (23 years) |4 1