Document k6YOJmn5J99w88x5Bwr1GDmwJ
CENTER FOR DISEASE CONTROL 4,
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Vol. 23, No. 6
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For Week Ending
February 9, 1974
U S. DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE
DATE OF RELEASE- FEBRUARY 15, 1974 _ ATLANTA, GEORGIA 30333
____________
EPIDEMIOLOGIC NOTES AND REPORTS ANGIOSARCOMA OF THE LIVER AMONG POLYVINYL CHLORIDE WORKERS - Kentucky
Between September 1467 and December 1973. 4 eases of angiosarcoma of the liver were diagnosed among men em ployed in the polyvinyl chloride polymerization section of a B.F. Goodrich plant near Louisville, Kentucky. This section of the plant began operations in 14.38. It employs about 370 persons and produces polyvinyl chloride as well as a variety of copolymers by polymerization of vinyl chloride monomer. All 4 men had worked continuously in the section for at least 14 years prior to onset of illness fTable 1); all 4 had worked directly in various phases of the polymerization process.
Case I presented in August 1467 with an epigastric mass and thrombocytopenia. An exploratory laparotomy was per-
CONTENTS Epidemiologic Notes end Reports
Angiosarcoma of the Liver Among Polyvinyl Chloride Workers - Keritucky ................ ... 49
Wild Mushroom Poisoning - Pennsylvania ............................. 50 Current Trends
Influenza - United States ........................................................ 55
tormed in September 1967: liver biopsy revealed angiosar coma. Case 3 presented in January 1970 with gastrointesti nal (Gl) bleeding. Recurrent bleeding in May 1970 led to an exploratory laparotomy at which time a diagnosis of angio sarcoma was made on liver biopsy. Case 3 presented in Janu ary 1964 with Gl hleeding which recurred in May 1965 with
TABLE I CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES (Cumulative totals include revised and delayed reports through previous weeks)
DISEASE
hth WEEK ENDING
February 9, 1974
February 10, 1973
MEDIAN 1969-1973
CUMULATIVE. FIRST 6 WEEKS
1974
1973
MEDIAN 1969-1973
Aseptic meningitis................................
...........
Brucellosis . ..............................................................
Chickenpox ....
...................
...........
Diphtheria...........
...................
Encephalitis;
Primary: Arthropod-borne and unspecified
Post-Infectious.....................................................
Hepatitis. Viral:
Type B..........
.....................................
Type A..................................................................
Type unspecified.....................
................
Malaria ...
...................
Measles (rubeola!
...
Meningococcal infections, total.............................
Civilian................................................................
Military..................................................................
Mumps.....................................
Pertussis ,
....
Rubella (German measles)
...
Tetanus
Tuberculosis, new active ........................................
Tularemia...............................................................
Typhoid fever.............................................................
Typhus, tick-home (Rky Ml spotted fever)
Venereal Diseases
Gonorrhea .............................................
Syphilis, primary and secondary.....................
Rabies in animals ,
34 1
3,609 1
19 12
135 871 1S3
6 S21
34 34
1.702 72
258 2
529 T 6
16.810 462 43
29 3
5.305
21 4
120 j 1,027
6 704
34 34
-
2,145
.. _
441 1
5to2 2 4 1
14,259 516 69
35 1
.. 2
18 5
128 | 1,067
39 704
50 49
2,502
_.
823 1 -> 4
67
213 9
18,811 7
86 27
934 4.914
812 18
2,414 156 156
9.148 182
1,098 6
3.040 10 15 12
97.831 2.661 267
238 II
27,061 12
95 20
805
( 5.775
17 3,461
174 166
8
---1-0-.400
2.269 6
3.027 10 22 6
85.951 2.917 327
21b 11
--17
120 26
805 | 6,407
241 3,663
331 307
15 12,594
2,964 6
_ _.
10 26
3
*47
TAULL II NOTIFIABLE DISI ASI-.S OF LOW IKLUUI NCY Cutn
Cum
Botulism1 Wash 2 Congenital rubella syndrome. Ida l,Te\
Leprosy Hawaii 1 Leptospirosis* Hawaii 1. Ida 1 , ,
Plague
.,
..................................... 1
...........................
1 2 7 4 6
-
Paralytic: ...
,, , ,
...
Psittacosis lex 1 .....................
........................................
Rabies in man
.....................................................................
Tnchinnxi, NYU, Okla 1..........................................................
Tvphus, murine Calif l.Vj 1.....................................................
_
2
13
BOR 007218
50
Morbidity and Mortality Wrekly I ort
FKSKLAKY 15. 1974
ANGIOSARCOMA' - Coniinucd
signs of. portal hypertension. A portacaval shunt was per formed, and liver biopsy yielded a diagnosis of etrrliosisRepcat biopsies in October 1970 .md September 1972 con firmed this diagnosis. Autopsy in March 1973 revealed angio sarcoma. Case 4 presented in July 1973 with liepatosplenomcgaly. weight loss, and jaundice. Two liver biopsies were interpreted as showing severe cirrhosis. Autopsy in December 1973 revealed angiosarcoma.
In each case, pathologic material revealed the presence of extensive cirrhosis of a non-alcoholic type in addition to angiosarcoma- In 2 cases, the diagnosis of angiosarcoma was made only at autopsy, cirrhosis having been diagnosed 7
years before in Case 3 and 5 months before in Case 4. None of the patients gave histories of prolonged alcohol use or ex posure to hepatotoxins outside their work place. In particu lar, none had ever had exposure to thorium dioxide or to arsenic. 2 materials known specifically to induce hepatic angiosarcoma in man (1.2) (Reported hy John Creech. M. D . Plant Physician. B F. Good rich Chemical Company. Louisville. Kentucky. Maurice N Johnson. M.D.. Director of environmental Health. B.F. Good rich Chemical Company. Akron, Ohio: Bradford Block, M.D.. Medical Consultant. Kentucky Occupational Safety and Health Administration, Kentucky State Department of Labor; National Institute for Occupational Safety and Health, and the Cancer and Birth Dejects Division. Bureau of Epidemiolo gy. CDC) Editorial Note
Angiosarcoma of the liver is an exceedingly rare tumor. It is estimated that only about 25 such cases occur each year in the United States. Four cases, therefore, among a small number of workers at a single plant is a most unusual event, and one which raises the possibility of some work-related carcinogen, conceivably vinyl chloride itself. Although no data are yet available concerning the occurrence of angiosar coma among workers at other vinyl chloride plants in the United States, it seems distinctly possible that the problem may be industry-wide. Epidemiologic studies have started to
Table t
( iw (if Angiosarcoma of the Liver among Polyvinyl Chloride Workers
B. F. Goodrich Plant Louisville. Kentucky
Case
Arc at illness onset
Illness iMvet
Date tif Diagnosis
1 43 Aug 1lA7 Sept Mi Jan. 1970 M.iy 1970
3 41 Jan l`>i>4 Mur 147.1
4 SH July 1973 IJcc. 1973
Death
Jjn. 7, 10**8 Sept 77, i>7| Mu, .1. 107.1 IX`t. 10. 107.1
Yean worked wuh m: before illness
17 14 14 27
determine the extent of the problem in the United States, with respect both to angiosarcoma of the liver and to its pos sible relationship to post-toxic cirrhosis.
Published data concerning the potential hepato-toxicity and oncogenicity of vinyl chloride arc limited. Studies in Germany have suggested a link between hepatic damage and occupational exposure to vinyl chloride (3). while Italian workers have suggested that vinvl chloride may cause a wide
variety of tumors in animals (4i. The chemical concentrations used in these latter experiments, however, far exceed levels likely lo he encountered in industrial environments. Efforts to confirm such observations and to measure effects at lower dose levels arc now in progress. References 1. da Silva Horta J, Abbati JD. Cayolla da Motta L. Ronz ML: Malig nancy and other late effects following administration of thorotrast. Lancet 2 201-205, 1965 2. Regaison W, Kim U. Ospma J. Holland JF: Hemangioendothelial sarcoma of liver from chronic arsenic intoxication by Fowler's solution. Cancer 21:514.522. 1968 3. Marsteller HJ. Lelbach WK, Muller R, et at: Chronisch-toxische ieberschaden bei Arbeitem in der PVC Produktion. Dtsch Med Wochenschr 98:2311-2314. 1973 4 Viola PL, Bigoiti A. Caputo A: Oncogenic response of ral skin, lungs, and bone 10 vinyl chloride. Cancer Research 31:516-522,. 1971
WILD MUSHROOM POISONING - Pennsylvania
On October 9, 1973, 37 nuns ate their evening meal at a convent in Berks County. Pennsylvania. Between % and 4'4 hours later (median-approximately 2 hours), 17 nuns devel oped an illness characterized by profuse sweating (765c), wat ery diarrhea (76%), chills (58%), and abdominal pain (42%) (Table 2). Six of the nuns were hospitalized: none died.
Food-specific attack rales for foods ingested in the 24 hours before illness strongly implicated mushrooms as the in toxicating food fTahle 3). Stool specimens from 4 of the ill nuns and baclcriologic cultures of the remaining mushrooms yielded no enteric pathogens Remnants of the mushrooms were identified as Chtoevhe sp and Lcpiotasp. Some species of the former genus are known to contain muscarine, which produces parasympathomimetic effects.
The mushrooms had been picked on the grounds of the convent on the altcrnoon of the outbreak. For several years, the nuns had eaten these mushrooms at meals, and no appar ent illness had occurred. On October 9, however, Ihe nun who
Table 2 Symptoms in 17 III Nuns Berks County Convent - October 9, 1973
Symptom
Diarrhea Sweating Chilis Abdominal pain Nausea Vomiting Excessive salivation Feverish feeling Dry mouth Blurred vision Headache Weakness Faint feeling
Percent with Symptom
76 76 58 42 35 23 23 18 12 12
6 6 6
(Continued on page 55)
BOR 007219