Document gE2oxj9Qn4D6y2d1dX7mQvGBL

TO _______J. W- Gressler FROM ________H. W. Dietz. M.D. SUEUECT FIELD POINT OR DEPT. & BLDG. NO. Avon Lake G.C. FIELD POINT OR DEPT. & BLDG. NO. Akron - D/Q020, 5-H DAI? DATE this lLTtib 6-9-32_ Dr- Guyton passed to me the list of individuals who have, or di<*d of ischemic heart disease/ together with your concerns. I have analyzed the numbers and do not believe you have a problem. Heart disease is still the leading cause of death in this country? recent statistics show a death rate of 330/100,000/year from ischemic heart disease. Using your list of deaths and the year of death, together with plant population, I calculated death rates for all years in which deaths occurred. These ranged from 142 to 416/100,000/year, with only one exceeding 344. When you consider there were several yo^ra with no deaths, these rates are not excessive and overall there ia probably- a deficit of deaths. At the end of 1981 you indicate 15 active employees with a plant , population of 692 or 2.17 cases per hundred employees. In 1974, national survey indicated approximately 2 out of every 100 indi viduals were to some extent disabled by ischemic heart disease?. This is not a significant difference. Additionally, we have used the BFG Medical Surveillance System to compare Avon Lake ischemic heart disease with the rest of the company and find an overall deficit at Avon Lake. I hope this answers the questions you have on this subject. v BFG-4956-E 11/80 LITHO IN U.S.A. ccno CO o c I BFG50763 '0076CSZ CENTER FOR DISEASE CONTROL ~ Vol.24.No.29' WEEKLY j REPORT ==j For S 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 (PVC) polymerization plants are located (/); tire 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 and 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 end 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..............................................25t 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 I. CASFS OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES (Cumulative totals include revised and delayed reports through previous wceKS) DISEASE Encephalitis {Post-Infectious........................... Typhus, tick-borne (Rky. Mt. spotted fever) . . . 29th WEEK ENDING July 19, I97S July 20, 1974 S4 5 940 5 17 10 240 624 161 31 358 32 31 1 574 27 79 4 659 4 9 46 ' 84 6 928 6 19 S 215 823 106 11 199 20 20 530 46 122 600 6 7 34 MEDIAN 197Q-1974 172 s 1 34 If 175 } 1.014 21 271 19 26 698 185 1 6 7 32 CUMULATIVE, FIRST 29 WEEKS 1975 1974 MEDIAN 1970-1974 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 uio 91 96,940 154 468 152 5314 23359 4,657 101 18335 845 822 23 42345 767 9,015 35 16333 79 206 418 1,334 91 107 640 177 4,734 } 30325 623 25,764 938 914 3S 53331 25.166 --55 79 173 244 Gonorrhea .............................................. Syphilis, primary and secondary j Mj1inry Rabies in animals...................................................... 20,410 58S 387 9 60 18,067 625 507 10 52 -- ___ __ ______ 63 527,957 16,362 14,013 191 1370 - 480,767 16,088 13,907 255 1,637 ----- -- -- ------ -- 2.068 TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY Cum. Cum. Ptague: Utah l.................................................................................... 13 12 103 20 7 Typhus, murine: . Texas 2 .............................................................. 1 1 22 ! 50 17 BFG50764 246 Morbidity and Mortality Weekly Report JULY 19.1975 VINYL CHLORIDE - Continued states. No rate increase was seen in the Pennsylvania hospital, but an increase, primarily in the categories of ancncephalus and spina bifida, was noted in the PainesvjHe hospital (Table 1). Table 1 Number of Cases and Rates for Anencephalus and Spina Bifida in the State of Ohio and the Psinesville, Ohio, Hospital, by Year. 1970-1974 Anencephalus Hospital State No. No. Year Cases Rate* Cases Rate 1970 (0) 0.0 (26) 5.0 1971 0) 10.3 (38) 7J 1972 (3) 35.6 (31) 6.3 1973 (2) 24.9 (27) 5.4 .1974 (0) 1970- 0.0 (22) 4.5 1974 (6) 14.1 (144) 5.7 Spina Bifida Hospital No. Cases Rate State No. Cases Rate (3) 31.2 (58) 11.1 (3) 30.9 (44) 8.5 (0) 0.0 (47) 9.6 (2) 24.9 (46) 9.2 (1) 15.) (29) 6.0 CO 21.2 (224) 8.9 Rates per 10.000 total white births. The BDMP hospital data for Painesville, Ohio, were com pared with the birth certificate data from the Ohio Depart ment of Health and 1 additional case not included in the BDMP report was added to the case group (total of 15). For each case, 2 controls were selected from the hospital birth registry. Medical records for cases and controls were reviewed to confirm the diagnosis and obtain pertinent demographic 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 (1 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 birth); 2 fathers among the parents of the 30 controls were working at 1 of these plants at the time of their infants' births. None of the parents in either group lived within 2 miles of the 2 plants, Statistical analyses comparing the distances from home and workplace to the PVC plants showed no differences between the parents of cases and controls. (Reported by the Cancer and Birth Defects Division. Bureau of Epidemiology, CDC, in cooperation with the Ohio State Health Department.) Editorial Note Vinyl chloride is a known carcinogen {.?), and concern has arisen over its possible teratogenic effects. This concern stems from recent studies which have shown a) an increase in mutagenicity in bacterial assay systems (4), and b) increased chromosomal breakage in PVC polymerization workers (5). The Ohio Department of Health study (]) is the only report where VC has been suggested as causing birth defects in hu mans. Although the follow-up study reported here confirmed a moderate increase inCNSmalformationsin Painesville, 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 to evaluate the incidence of birth de fects among children of parents highly exposed to PVC. References 1. Infante P: Oncogenic and mutagenic risk in communities with poly vinyl chloride production facilities. In Progcam of the Conference on Occupational Carcinogenesis at the New York Academy of Science, 25 March 1975. 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. Center for Disease Control: Morbidity and Mortality Weekly Rep 23(6):49-50, 9 February 1974 4. Rannug U, Johansson A, Ramel C, Wachmeister CA: The mutageni city of vinyl chloride after metabolic activation. Ambio 3:194,1974 5. Funes-Cravioto F, Lambert B, Lindsten J, et al: Chromosome aber rations in workers exposed to vinyl chloride. Lancet l ;459,1975 l c c c. FOLLOW-UP ON OUTBREAK OF GASTROINTESTINAL ILLNESS AT CRATER LAKE NATIONAL PARK - Oregon No etiologic agent has yet been demonstrated as the cause of the intestinal illness,associated with sewage-contami nated water, that occurred among persons at Crater Lake Na tional Park (MMWR, Vol. 24, No. 28). Rectal swabs and stool specimens from 30 acutely ill persons were negative for salmoncllae, shigellae, vibrios. Yersinia enterocolitica, and orbivirus. Tests for toxigenic Escherichia colt and enteric viruses arc in progress. Three persons with hepatitis who became ill shortly af ter visiting the park were probably incubating the disease at the time of their visit; 2 of these 3 were reported to have used the park toilet facilities. Surveillance of the exposed popula tion for hepatitis has been initiated by State and Territorial Epidemiologists and by CDC. No definite post-exposure cases 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 6 weeks after exposure at Crater Lake 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 California State Department of Health: and an EfS Officer.) Addendum The following persons who contributed to the investi gation of this outbreak were inadvertently omitted from the list of persons mentioned in last week's MMWR: Mary Mur phy, RN, Nurse Epidemiologist and Monroe Holmes, DVM, Public Health Veterinarian, Oregon State Health Division. BFG50765