Document RJor4d3NgD73Lx06bRqGZKDrV

i ** *. A ^OCA.T10N ' Medical, A2SA March 28, 1974 TO Dr. William Nessell 1870 Dear Bill: Enclosed are the NIOSH recommendations. it is worth mentioning that OSHA may or may not follow these recommendations. I would suspect that the liver function screen will be about as listed but it could well happen that OSHA will not follow the interpretations as listed in the NIOSH recommendations. If X have any great thoughts on a course of action other than changing your profile to he recommended, I will let you know with alacrity. GR/ln / Copied by MCA 3/25/74 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE CENTER FOR DISEASE CONTROL ATLANTA. GEORGIA 30333 TELEPHONE: (404) MJ-JJIJ March 22, 1974 Kenneth D. Johnson, Ph.D Secretary, Technical Task Group on Vinyl Chloride Research Manufacturing Chemists Association 1825 Connecticut Avenue, N.W. Washington, D.C. 20009 Rear Dr. Johnson: Enclosed is the final draft of medical screening recommendations stemming from our meeting of March 2 concerning vinyl chloride liver disease. In composing these recommendations, we have tried as far as possible to take into account both the discussion which took place at the meeting and the written recommendations submitted thereafter. This material will now be incorporated into the recommendations being presented by NIOSH to the labor Departr-ent*s Occupational Safety and Health Administration for fur ther action. Thank you very much for your help in developing these recommendations. Sincerely yours Enclosure Clark W. Heath, Jr., M.D., Chief Cancer and Birth Defects Division Bureau of Epidemiology pcvrw^'-nT h. Medical Surveillance The following recommendations are directed primarily at medical screening to detect liver disease and/or hepatic tumor. They should be considered in the context of routine health screening for any general employee health problems, including non-hepatic health conditions po tentially related to vinyl chloride monomer exposure. Routine health screening should include at time of initial employment the recording of past medical history and the performance both of a general physical examination and certain basic laboratory procedures (e.g. complete blood count, urinalysis, chest x-ray); provisipns should also be made for rou tine periodic health followup examinations. Employees covered by the following specific recommendations shall encompass all persons engaged in vinyl chloride monomer production and polymerization, including personnel peripherally involved such as in clerical and management assignments. The recommendations shall be applied both as a pre-employment requirement and as part of periodic health follow up. Screening priority should be given to current employees with prolonged and close potential exposure to vinyl chloride monomer, whether in present or past work settings. (i) At time of initial employment, or upoii institution of screen ing, physical examination shall be performed with specific attention to detecting enlargement of liver or spleen by abdominal palpation. (ii) At time of initial employment, or upon institution of screen ing and annually thereafter, a medical history check-list shall be com pleted by the employee. This list shall include questions concerning: (a) alcohol intake (b) past history of hepatitis (c) past exposure to potential hepatotoxic agents, including drugs and chemicals. (d) past history of blood transfusions (e) past history of hospitalizations Completed medical check-lists shall be reviewed by a physician and should be acted upon as medically indicated for each individual employee. '(ill) At time of Initial employment, or upon institution of screening, a serum specimen shall be obtained for screening with respect to the following five bio-chemical determinations of liver function: (a) total bilirubin (b) alkaline phosphatase (c) serum glutamic oxalacetic transaminase (SGOT) ,(d) serum glutamic pyruvic transaminase ,(SGPT) (e) gamma glutamyl transpeptidase (GGTP) RSV0025234 2 Additional tests that may optionally be'considered for use in screening include lactic dehydrogenase (LDH), serum Drotein determinations, serum orotein electrophoresis, and platelet count. Laboratory analyses shall be performed in laboratories accredited by the College of American Patho logists or licensed in accordance with the provisions of the Clinical Laboratories Improvement Act of 1967. (iv) If results of laboratory screening are normal, screening shall be repeated on an annual basis. If the person beine screened has been em ployed directly in vinyl chloride monomer production or polymerization for 10 years or loneer, screening shall be repeated every 6 months. (v) If one or more liver function tests are abnormal, serum test ing shall be repeated as soon as possible, preferably within 2 to 4 weeks. If .no abnormalities are present upon rescreening, testing should be repeated in 3 months. Cvi) If abnormalities persist on rescreening, the employee shall be removed from contact with vinyl chloride monomer operations and individualized medical workun shall be instituted. Suggested as initial steps in medical workup are a complete Physical examination and various special orocedures such as hepatitis B antigen determination and liver scanning. If liver function abnormalities are determined/ to be unrelated to liver disease (e.g,, elevated alkaline phosphatase in a young, physically active man or elevated bilirubin in Gilbert's syndrome) or *to be transient (e.g., due to recent hepatitis or recent alcohol intake), the employee may be per mitted to return to vinyl chloride-related employment, subject to individual medical evaluation. (viii) In view of the preliminary results of animal toxicology studies it is recommended that no woman who is pregnant or who expects to become preg nant should be employed directly in vinyl chloride monomer operations.. RSV0025235 ~ -"! rtr,t rrota the detk l G. M. ELISWWTH > z-turs*^ f) if* * v <?al - v \Ay-^ r,C$. AT^7 f* L^s t^yv-4 RSV0025236 ,' NADERUNITDISPUTED Parts of Oregon Idaho. OHtAfl&EBAZARBS -Exempt on V' ' Shift ,VX wWiyf ` V'* I WASHINGTON, Jan, 5 (AP) ; WASHINGTO. Jam- S -- A memberTM of the Federal ConsumerProductr Safety C">- (UPI) -- Claude S. Brinegar, the. Secretary of Transporta- , tio^ -Rfgnted a . ttuqporary mansion ?ha*` accused a Ralph : exetopSonyesterday from the Nader group ^"-presenting Emergency Daylight Saving yorthless, calciflatioos "r,K . Time Act to several counties intended to inflame rather than In Oregon and Idaho and re Inform" the. public about pos drew the time zone boundary sible lead rppisoniqg, hazards from certain .candles. in Kentucky. Mr. Brinegar1s action will permit legislators in those tfFhe^Heeilth Research Group states to consider action to 'drawn either, with permanently exempt : the ah|^ifi^|^norance of^^wnenj zmms from year-round day- tary physical science, colossal intent to deceive theipufeHc or Ai-The Set. will take-effect at bolh," Commissicmer Lawrence M.Kushner wrote to Dr. Ski* ji'AM Sunday as part of the national effort to conserve enci gy. , / ney M. Wolfe, director of the Hawaii, Arizona, Puerto NMb& organization. ' Ripe, the Virgin Islands and. in the peti- parts of Indiana voted eaPcs t^W^pos^eiconcentradons tier to exempt themselves of lead, hi air which might re- . from daylight time, and will. not be affectd by the change sult feom huming such candles were based on assumptions over. that are physically impossible and the results ofjthese calcu Dec. 21 that it would nOt im lations were then used to infer mediately ban the candles. a degree of hazard totally in Dr. Wolfe said Wednesday consistent with reality " -wrote .that the group's petition stated the commissioner; who;, has that tire lead concentrations it a doctorate in physical chemis rated as possible from burning try from Princeton. a- candles with lead-core wicks 1 The commission announced were purely..hypothetical. RSV0025237 (JUemicai jM.arKen.ng Keporier jifiarch 11, 1974 lojf* P.r'A IfOH Vr'?qr'r^.r f3!tarvr>ft in P awn ftV iai u J W l * v* 3 Lidtta'^OwfiSiC'.aLji'ixwLT y^-wi v? .-n$$od Reports circulated in European labor ci CMR for details, Dynamit Nobel officials rcles that titty-three out of ICO workers in were unavailable for comment. However, it a German polyvinyl chloride plant had con is understood that the company's board of tracted angiosarcoma, a rare liver cancer, directors was convened last week to discuss were apparently exaggerated. the story (CMR. 4/11/73,Pg, 5) and issue a The illness has since been identified as formal statement. As o( the end of last acroosteolysis, a less serious attliclion that week no statement had been received. was spotted in this country in the 1950`s and According to health officials in the US, arrested by improved work practices. who attempted to trace the story through Details about the origin of Ihe reports European sources, the information first have been difficult to acquire, but it has began to circulate following publication of a been learned that there has been a recent research paper last November by the Skin pattern of work-related illnesses at the Clinic of the University of Bonn on illnesses plant operated by Dynamit Nobel in Trois- suffered by workers st the Dynamit Nobel dorf, Germany. plant. The study was reportedly commis Contacted by the European editor of sioned by Nobel officials themselves. Xerox copy: J. R. Belschwender P. E. Bureau R. L. Bourget W. E. Nessell i Apparently the company becarn cerned as worker illnesses (of spleen, and bones) became inpreasj quent and proceeded to introducj of safetv measures and finally as university study. In the meantime, the companyiiCPiltimieU to improve its facilities. The M Health was informed and apparenHy^began' a stilt-active superintcndance of the-sAfety measures. The ministry is said to tied with the progress being made. The company, has apparently met with-P' the plant's workers' council to discuss the problem. Soitrccs said that thequolod num ber of fifty three sick workers was probably inflated and that the figure of twenty nine attributed to the number of incapacitated workers is probably close to the actual number of workers showing any symptoms \^ ' . OSHA OPTIONS There is the possibility that OSHA will promulgate a temporary emergency stan- ' dard which is the only mechanism by which the agency can put mandatory regulations at all. There are said to have been no new cases uncovered since the fall of 1973 and that many of those victims suffering finger bone deterioration (acroosteolysis) had begun to show signs of bone regeneration. It is said that no angiosarcoma was ever uncovered at the facility. CMR has eeen unable to confirm this story, nor to examine the University of Bonn study. However, if these'events are in fact the soucc of the circulated cancer re ports, then the Dynamit Nobel situation does not represent the significant new de velopment that the stories implied. Regard less of the facts of the Nobel situation, how- ever, there seems to bo a growing body of evidence in Europe and more recently in the US, that VCM presents a potentially se rious health threat, and may be carcinogen ic. In response to that evidence, much of it presented at hearings conducted by the Oc cupational Safely dt Health Administration of the Department of Labor in mid-Febru ary, OSHA is expected to issue new work practice standards soon for all VCM and PVC facilities. These standards are being designed by the Nationaf Institute of Occupational Safe into effect immediately. However, the ex pectation is lhal the agency will issue addi tional voluntary standards, perhaps along the lines of work practice standards issued at the end of January on fourteen other al leged carcinogenic industrial chemicals, pending completion of the regular rulemaking procedure, (which could lake sever al months). J$any people havp called for the estab lishment of a standard of no exposure, in ef fect a "closed system", at all plants deal ing with VCM, including Anthony Ma?.:.ochi an official of the Oil, Chemical & Atomic V/orkers International Union, and Dr '-ving Sclikoff, Director of Environment,; cnccs of the Mt. Sinai School of Medicine . New York. Dr. Sclikoff warned against "wild" reac tions, last week, such as ``removing plastic ashtrays from the table." But he tola CMR that, while scientific evidence is still sket chy. there is enough information available to conclude that ``urgent control measures arc already required." On May 10, the New York Academy of .'Sciences will hold a meeting of "concerned experts" in an attempt to improve the state of knowledge about VCM and pathology- ty & Health (NIOSH) of HEW. It was not clear last week what the new standards would be. . i..' -w. RSV0025238