Document ppeXMDwRLNkr7XvdNvMYv1zpj

f/ccs) R&S 026903 Vinvl Chloride: Its Impact on Occupational Medicine Practice in Iran Jehangir Aryanpur, M,D. Upon the establishment of a positive relationship between occupational exposure to VCM and angiosarcoma of the liver, Strict precautionary measures for the protection of VCM ex posed employees in the Abadan Petrochemical Company have been instituted. All such workers have been required to have pre-employment and annual medical examinations with em phasis on liver functions, Among 43 such employees who have undergone regular medical evaluation in the past three years, no instance of liver dysfunction or angiosarcoma has been discovered. The Iranian Standards Institute reviewing occupational health data and local conditions provisionally set in 1976 a TlV of VCM of 25 ppm TWA for 8 hours with revision foreseen for 1977. I! is believed that such precautionary measures should be revised and improved according to available data and knowl edge and that variations in other environmental and local fac tors which may well play an important role in the potential pathogenicity of the exposure should be carefully considered in determining the extent of the precautionary measures and standards in each locality. A bombshell hit tin* petroc hemical industry worldwide when ev idem e in the USA w as reported in 1l)7 4 linking angiosarc oma ot the liver and exposure to vinvl chloride monomer (VCM) and polwinyl chloride 'PVOT This was further supported bv experi mental and epidemiologic studies/ leading to the development ot m-.v standards arid work practices * The suddenness ot the identitu anon of VCM ,s a i arc inogen and its potential adverse etiet t on tlie health nt llv workers, on tlx* health ot the community m whir h the plant is located and on the users ot the* produc l .iad a pmtound eftec l in Iran Technical measures were imrm-diatelv taken at the Ahadan Petros henec al Company 'APO to improve f(nm t>if Hmi| <i' M.'.itlh \ /)< < l ).l ( mniMnv f'O ftu tHM IrhM'i li.io MnJi it Sr/vn . S,ll">*l ll If 1"` I iourna! of Occupational Medictne/Vol 19, No 10/Or'ctcf 1977 the vs or king \ < mdun no in its V( M and PVT units A new medic a! monitoring program was established iur 111** workers in these units More important perhaps was the further realization hv the in dustrial phvsu ians in the National Iranian Oil Company that they kid a v ,lil role ti , plav in tin* vs ell being ot their c ornpan v T hree problems had to he addressed arid while all have not In-on ontirelv resolv**d ea< h li.is been examined thoroughly 1 What 11 V tor v m v I < hloritie should he adopted m Iran * The 1 ppm TlV adopted -w the OM1A USA standard might not be uppin able to the spec tin geoguplm al and lo< al c ondilions ot Iran J What should be the dei on regarding the VCM entrained m the manutar ture ot PVC' In the Western countries PVC contain ing more than a * ertain amount ot \'C M w ould have to he treated as a i at i nv >gen \ Is our PVC plant improper Iv located' PVC munutac ture and .ill supporting chemical |>im r^"' are near a residential urea. 1 he puipi ise "1 th-s atle ts to desi 1 the the me<lu al prntec live measures taken to uinl'n the ki/.trd during tile manutac ture ot PVC and to *-xam,ne the unpai t > : this new *c c ufMlion.fi hazard on the practice ot i i upat:`fi.t' medicine tn Iran History cjf the Problem Ivideni'- ot viml c blond*-/ toxn `tv has been note<l tor many years In l`HH when commercial prorfucfion ot PVC was begun bv B T Coodrst h Company ,>s per intents showed that VCM used at the plant was dangerous m .mimals * A 1940 Russian report show ed tkit VCM i .msed noemalignant liver damage m 1 S out ot 4H w ofkers exposed to the c hemic aJ ' Surveys m the other fumpeun i ountnes over the next dev ade and a halt tonlirmod tlie above /e'at ronshrp ' A 11 winei Mon between V(\M and c am er was nrsl made' n CT l bv Viola et al `it die Umversitv ol Rome, who lound tumors in tlx1 lungs skm anti hones ot rats exposed to high concentrations fit the gas ' In lanu.uv ll"i B f (.oodne ii Company reported that srni e in") three men who worked m its I ouisville Kv , PVC manu tac luting plant had died ot angiosarc nrna ot the liver ' get ause ot the estreuielv low im idem e ot this disease estimated to fie ap- 689 Tibl I. -- Roportod (Uut of Anflowreofna of I bo Llvtr Amortf Vinyl Chlorld* Polymerisation Worker! (Up to February 1977) Cvfldtry Cwli Cn^iosiotf^tj Fdrif R-T Gprnuny fddetil R^H CMfrurj Fiance Gieji 6n:an Italy htian Sweden Untied Soles United States Yugoslavia Total No, of Cam A| it Dta|ftotlb 10 (Awaiting Defatl&t 2 40 A 46 (431 5 36 to 49 (42$) 2 (Awaiting Details) 7 38 to 63 (46 4) ? 37 A 71 (54> 2 43 A 55 (49) 1 52 1 56 I 43 17 37 to 61 (482) 4 (Awaiting Details) 7 42 59 (50 5) 56 37 to 7h (54 . madtan) Yf (tom lit E10 to Dta Total Yft Eip 15 A 16 (155) 15 A 16 0551 1! to 17 (14 2) 11 to 17 (II 6) 10 to 2U (20 81 9 A 26 1175) 15 A 72 (185) 2? ?? 19 1? to 32 (704) 10 ic 79 (1941 4 A 70 (12) 6 A 7) (135) 21 18 4 rn 32 (17 9) 20 A 23 (21 51 9 to 32 (20 5 median) 16 A 20 (19) 4 to 32 U8 madun) 01 l1** Vi rases Uv`*e d'* 36 tmifii 4 ]6 iA,)i|irv <1i`UiK fi,'ijri-, in lirj'k..*?' N.ihonJl InSI'Uilf n* (W uMl'Orut S**><u .j-vt Health l drut WpH.lTP C"> infill On*-) nf Hedlih prnximalely 20 to JO deaths per year in lln* United Slates the ap* pearanc i* of tour c ases in .i live-year period in one plan! led to tlv> conclusion that a new occupational cancer -- aruinsar< nin.i nt (lie liver -- had been disc overed,' This was buttressed bv the animal work f0 Pmtessor Cesare M.iUoni,H who demonstrated induction nt umunsarc (inu < >i tinliver and other organs, as well as the produc turn of other t anc ers m rats exposed to vinyl < blonde, latei, I\;hershaw and Ci.ittoy released their mduslrx'-xx ide epi demiologic al siudv nt vmvl chloride workers which siu^ested in creased numbers ot malignant neoplasms at ndier bodv sites ' Up In ttie present tmu^ a total ol lb identitiable cases oi angio sarcoma ot the liver have been uncovered thruc^hout the world with at least K> deaths'1 .see Table* 1) Description of Plant and Operation the manulac lure ot PVC tn Iran started in tbbb bv the APC as a |omt venture ot tin* National Iranian Petrochemical Companv with tlie li f, Goodrich Company I lie initial annual production rose* trom 20,000 tons tn (>0,000 toils by the* end ot 107b 1 he plant eniplovs approximately GijO people, ot whom 4 1 are emploxed m VCM and f'VC production At the APC tlie manulacUm* ot PVC is a totally contained opei at (oil I hat is, < bin rule is I list produc ed h\ (lie elei trolvsis < >1 salt Tlie*n elhvlene die blonde* (CH-'C! ( M:C I1 is made1 bv the reac lion ot the* ^ases ethvlem* and chlorine Ithxlene die blonde is translormed to vmvl chloride monomer <-CH.'-U ICO*1 m special re.U tois I he VCM passes by pipe* to the1 polvmen/aliun plant where it is mixed with walei, an emulsiiier and a c italvst and roae led under pressure* in an auloelase n*ai ton In poultice a slurrs ni pnlx x myl chloride This slunv is then dried and lufthef pm-, esM*d in produe e PVC pnw cier PVC pnw der is pat kac;ed and Mipolied to other l.ie tOM*\ w lu*re it is used lor the* manutae t are ot PVl pipes, e able coveralls. tloor coverings, shoe's e*te A s-mple 690 f..,-, f rr." :,l- V r; JTtit L/'' b:,r Simplified (ton chart pi PVC production at Abadan Petrochemical Company lied tl>as ri.itl ot tin- processes us*d at Oh* APC is shoxvn in the lii;ure Control Measures J he possibility or a relationship between ,inc;iisjn oma `it the li\er ,md < m e U[at mn.it exposure (<> vmvl < hlonde drew llv at tention nt r*-sporisible rnananement limn tin* very be^innin^ Inv meduteK .m*-f |he m e-ipt nt the* reie-xant inlnrm.ibon urgent and ini|>niUnl steps xxere taken to sa)ei>uard the health and s.tN*tv ot e-mplovees m th* Abadan PVC manutae tunni; plants The* follow* uu; areas ot i nntrnl haxi* beer, establish'd ttamiru* area monitor* tnt; personnel mumtonni; restricting entry into regulated areas 'these beinn areas the! hax e a potentiaI to i aus** exposure to VCM m i-\( ess nt the permissible limits rujid medical surveillance ol emplnvees exposed tn VfM and t umprehenstxe maintenance ot emplc>v*'i- /<' ords Details nl die pini;ram are \i-rs' similar to those* presinlie'd b\ the <)SH*\ M*mjlalions Medical Surveillance Program. TM btnee* 1')7I b">0 etuploxees oi the APC hax** bivn sulijee led to periodic medic a! sc rcviimi* Xm<e l1)"4 the 4 1 eni[)lo\ec*s or the Vl M and PVC units have been suhjec ted to .i < ntuplele annual merju al examination rerjuir* me; tlie tollnwme* steps- ] \(edn al history 2* Occupational history M Phvsu .11 examination and '4 l .ilioratorx tests or COC, uonalysis sMA-12, i best x-mv and \-rav ot the* hands In addition the pre-emplnxment and [i*norlic examination ot these* eniplox...... must include u; PIv.sk al examination methods to delec l derases ot the lixer or spleen I) lli-tui\ oi ak oholic in take he|Mbtis exposure* to hepatotuxic agents hlood transtusions and previous hospitali/alion fhirtN 'ti>ur ol tliese* emploxees are 2b to H years old mm* are U> to 40 xears old Ilvdx-mne hive been working *n VCM and PVC manut.u tunni; units since* the < omniissionm^* r>t the emits m and the n-mainim; lour bav* xxorked in pw*se units tor thrc*e ltxe xears The iru ideme ot c u*are(te srtiokmt* is relatixelv low arnotn; these emploxees onlx mm* ol \ \ smoke "> to 20 t iyarettc*s 1 dax - Alcohol i onsuinption is x-erx Iocs onk lixe* cintik a little beer or xodka oc r asionallx' hone has ^ixc*n a pievious ik r upati.mal hislorx ot i-xptisure to an\ knoxxn in*i>aiotoxtc a\*ent C^nlxoni* empi- ix ee c ould re all hax mi* had Itepat it is vne e hepatitis is endemic .n 'h- .nea some u* the otiv-r emploxe**s c an be expei ted to haxe h.H mill} o* subc lirm al i,i->.s in tli*' past lh* aboo- rnenti.mn| annual i bei k*up> have thus tar been rc*peated m !hr-e oiims unci- xears None ol tin* c*mplo\ees haci Vinyl ChlObfWAryanpur R&S 026904 --------- -U ---------- ' ^ Tibi* 2, -- Thrtthgld Limit ValUft (or Vinyl Chferid* Moo*mr in 0iHr*nt Countries. , Tjble 3 -- CnvuonmtnUl M*Alur*mtirt ot TpUl Hydrocarbons in PVC Unit Cdwntry/a. ''l TcfiUrtt Ffi<l Gffmjny . lliljr : Ijqio Swit/wUrtJ United KinjiJom Octdw United State! USSR Yur - ThrMftoW Lnlt V*lu* of Vinrt Chlortd* Monomir 1975 : ' 26 p*m TWA (8 Hours). SO (IS mrnattf 1975 10 pfvn TWA (6 tour*) 25 ppm TWA MS mimml \m S ppm TWA (6 ittjisl 10 ppm TWA MS nv^tni 1975 25 M)m TWA (8 Hours) 1976 10 ppm Personal Mjimjm, 30 ppm ctiiir^ 19*6; 25 ppm TWA (B houn), 50 ppm TWA <| r.*) " , test* in 1977 1975 , Tglut* 50 ppm Twa (8 ikurf) ?S ppm TWA IB hours), SO ppo 1WA MS mirxrln) 1975 25 m|/m'. tporonrrutefv 10 ppm 1975 10 ppm TWA (8 hours) 1975,. 1976 5 ppm TWA (8 hours). 70 ppm TWA (15 mimtesf 1 ppm TWA IB hours), 5 ppm TWA (15 mimaesl 19/i Future .100 com 10 ppm TWA 18 houis) 1975 ' 25 ppm TWA (8 hours). 50 ppm TWA US minutes) 1975 10 ppm Personal TWA 30 ppm ceding 19)5 19/6 25 ppm TWA 115 mmuiesi 1 ppm TWA (B hours) 5 ppm TWA MS m.cvits) -- 30 mg/m', ipcxoiimatfiy 12 ppm $frir<( Iranian 5lAnd<t'ri\ institute tn> i ompl.unt*!. MJc h ts oxtesxive fatigue, sninMolenie, parexthnsia or ,ghes m bonex or joints I hi- phvatal examinations and routine lest* (urinalysis, complete olnud unint .ind other blood chemistries) have revealed no significant abnorniahties liver turn lion tests and radioing examination', have all been within normal limits. No thromboi ytopenia, linger clubbing, or signs or 'wnp toms referable to Kaynaud's phenomenon, at ro-osteolvsis d-i' tabie liver damage or rases of ingiosarcoma of the liver wen* discovered. Threshold Limit Value. -- VCM had br*on identified .is a hepatotosic agent*' ,l' (it is a chlorinated hydrocarbon) and lias been inctiminated m producing the disease at ro-oslec.lysis " Ip TlV (threshold limit value) before 1M74 was set at l>00 ppm In the OSHA (USA) set the emergent v standard ot r>0 ppm tor VCM, and, in 1*375. limited employee VCM exposure to 1 ppm M hours TWA (time* weighted average) and 5 ppm 15 minute TWA bast'd upon its newly found carcinogenic properties Sime 197*1. most ol the countries having PVC manufac tu-mg plants have Icnvered their T|V for VCM The USA and Sweden have lowert'd their TlV for VCM to 1 ppm M hours TWA: Canada West Cermany Netherlands and UK have redut ed this to 10 ppm and Iran and many other countries fuse reduced their TlV tor VrM to 25 ppm tt hours TWA (Table 2 slum's the TlV ot VCM *:i 1-4 different countries i C onsidenng lb* marked diflereiu es whu h exist in various c ountries and PVC manut.u luring plants 'n> differences m climate humidity, prevailing v\ ind plant lot ation and design, ethnu group alcohol intake1, diet, prevalence' ot hepatitis, etc ). it seem* ap prnpnate that in seating the TlV tor VCM, mere s onsideratmn should be given to these geographic, al, ethnu and other da lerent ex Ihe Iranian Standards institute m I97r, set th<* TtV ot VCM provisionally at 25 ppm TWA lor eight hour-, with revision tonsvn icr 1977 1 he ornmillee setting this stamia d xortsisted ol t)n` representatives ot tin* Iranian standards Institute, the ins'ton- < mental Conservation Organization, the Ministry ot Laho* and Journal ol Occupational Medicine/Voi 19 No 10/CctoOcr 1977 LocJtnri o1 the potr pu>Wl.n* Jt'ti SutaTvisw emcees PIS Sx 1 Ih No is fliersl l|* Conlmi rym l`xl rrjntrol W'*-l Maimn PVg m**e-#,v* f '* *.9 '. e Tala! Hrdroct'tan C*achiuiuoa II)--IS com W--30 pen SO torn 14--75 n 30 KT\ 70 prm , . > i'. OVA .'nr*., .*x *r<J* iTf V 1 on Sot ul \t:,iifs fho Mrnistrs ot Health and 5*>i i.il AVeitare anil the Ah.id.in Metro* h"nui al ( ompam I lie i omnut le* had to re.ti h its rei onimendations enlireh enipir.i alh based upon tin* loi al c. onrlito in-. In renewing our ie>ulis and comparing them with (hose ot otlvef i outlines it -.eems !li.tt apart trofn sui h dilleo-mes as ethnu it\ hm ali ohoi consumption the end'-mn nature ot viral hepatite in the a'e.i and low imideme or igarefte smoking dii-tar. hah.;-. max also nl.tv i roie Km e atl* r all i ornpnses a gieatn puM i*i die diet ot tin*"*' workers than o those on standard Western d-et-, I he < Inn,Uu i ouditiohs ot tin- working and living area> are also different ir* *ni tinoe ih most ot the other P\'( p.anls *P the world In Abadan the .werage summer temperature e about 40 ( . i the shade with a maximum m I `Cl ot -19 (` I lie aw*r age humidity is 4()`\, with maximum spells ot MX)'1-, m summer Hie average winter temperature i 1i to 15 (' with a m.mmum m 197 5 *>i I l'C Ihe average v. ind velocilv e 1' knots -Ml work, is car fix'd outdoors Among tlie 4 t employees ot the \'{ M and P\'(* manutai luring plants ot tin- A PC who base had var-.mg degu-es nt exposure to VCM )or a f)er.oil ol eigh" v `.t s no e\ irleru e ol ar ro osteoK sis liver damage or angiosarcoma ol the li\er has been detei ted Taking into ai i ount 'he relatnelv short exposure period ot them emiiln\res three to eight \r,ifs' and the lai t (bit in the USA the average latent period t:.,m last exposure to V( M to diagnosis ot angmxan orna has been about 19 .ears perhaps one .In mid not expect to find angiosarcoma rases m APC at the present time Heme our experience up to tins time cannot be taken .is a on tic ient gmde Continued vigilante with area momtoemg and medual surveillance w'H l>e c arried nut and '-.ported upon at periods m'erx.th Entrained VCM, -- Hi*- present l`VC manutac tun'd at the -\P( is lor use m Ira i Studies are being earned out to determine die amount oi V( M entrained in ifn- At'C oroduc t hut al this time no spec tal ;*-* finipuc s to lima the amount ot VCM m the* nianui.u tuns-l PV( have been instituted It is unlikely that the* entra-ned VCM iiberati d wheel tin- l`\'< is used would exceed the present threshold limit t. >r Iran I his PV( ` is not used lor tin* m.mu'.u tufe ot food containers of wrapping mateiia lor toofj stuff Studies are being planned In monitor workers exposed to PVC dust n\ live rnanufac tur ot the* resin Community Effect*. --- Hu- -Miad m Pein* liemu al Cc>mt>an\ <s liua.tisi near iesnJc*ntial .mil manuiac luring areas As far as is know n then- has been no release* ot -.ubstantial ami Hants of V< *M w hi h might afei t the c c immumf\ I lowexer on a *ew oc c a-unns c hi* rcne tiad h*-en releas**d trom \h** rnanufac turmg t ompfex t .hjs mg ex,*< uat i* *ii *f .f grade si hool at the eefgc* of ;fn- iridustrial ^ ompiex Tne irritation from i hlorine and the re< ogri.tion that VCM R&S 026905 could be lurmful motivated the Ab.uJ.in I'fti'M h.Tim.il Company Jo assist in relocating the grade school in a lor anon al sonir' distance away no longer in die palti ol th<- prevailing wmtls Hie former school site is now usr*d as warehouse with minimal per sonnel. Summary 1. Awareness tint VCM has been demonslraterl to be a car cinogen producing a rare tumor, angiosarr oma. has led the rumpany to tighten its medu_.il monitoring and inchrstn.il hygiene con trols. 2. A temporary TLV has been established tor VCM at 25 ppm consistent with the operating procedures ol the company anti local geographical conditions. 3. Tlse (xitential harm from Industrie rhemitals has stimulated thr' government and die r nmpany to support further control of inplant and outplant environmental lu/ards frotn industrial operations, itrv dti' lo lb* IV vlUw s*f thft 4Mk iwt'futAttrtn w ibi d,U AKo .vl tunun Oil Indutm it* tH*1* t* jn dtit' \o fn\ t tdV\*t;c*`s m AKilLlo It* Op* Rcfcrcr.tes 1 CriH-ih H .ind |*rfiorn MS Arty'rrrvirr *m,t nt dw hw-r in l)* nwntj t.u tun1 <i (mI rw l< hi* 0 yOM 16 IV> lil l`r*4 2 IK and WR MtrfUluv ^*uK nl vmrk*rv tn 0** riunu i.j, mr<- i/i vm\* ihlrKKtc .md iw {h>lvnn*i's l< Af 16 Wi 'OH 1*7I I OSMA S\ml.rr| t<* (< vinyl ililmifld l><l Kf% 39 1fl4 () r.H'Hl, Indav Oil 4 n:4 4 Torkt'IvHt 1H ' )wm> I .10*1 Rnwr Vk Irmtdv <>t \Ulvl rhlirful*' a> ik'li'ttnini'tl | s ri l,itn*.l'*v animats Ann'' Irul 1/ui / 22 >4 V#M 3 inl*ikh ''I T tkh. rm<rtiv M\ lfMn.1 NV. and kst/ltti lA W'Hkm^ i imdiliivvi ,i?vl tlv.i s.irui.iliiiii in Oh* |K'Ii tmn iirtfl unli/a* lutn of viOv' i hUtfuJ^' |>kisbi s in Russian1 <.^r*rr,i S./nr 10 1H V4`1 0 `vpntus *! .nd kanunslv KH \lOSM fnslrv ot vmvl <hlt>nd' O'l.iV'd anUtfjs.wr om.tv SH )SH DMIW Cincinnati Ohio VC' 7 Viola 1*1 Kikoin A .md t ufiwlo A Ofn fi^mi r*sf*inv*' o nil v^n, lun^v and i>/if ti \m\l thlirTHk* <.m<rr kis 31 fUi-Ti22 1*171 H MiihiH i (' and It'ltMti-n*- C, Can uiitU'*tm nv bi<hi\\.ivs oi CliHi-nl n*svills Artn.i/s, \v Vi 24fc 1*1"t-21H 1*1'^ vinyl *1 Swt hi 1 I ,ni V.d.i'-kai M Modv >i dM*a>*`,` iiu\nl Iw vmvl thliKidt* 'n. It.ili.ur \U`*i Ia\.tn SB 2M 271 10 kf.ivn m t C, MuK kirn VV1 IIh* i \irtommi n n>4MvoM*n*nis in# \n s 1*m7 vlifma! and to vim I < hlwi<fc' Anw^ Ind Ifvv / 33 Vi-10 V"2 II WiU-m 1?M Mt CiifiHn l> Wf dtllHHUh i!\M1 4 11 t.\iwnv t I, at>d ('! d II i njutwnvd I'WIA 201 S7"* Vlt 1*H|, 4 Some Words to the Wise on a Search Committee Ik* wary of sdoni phv'.icians. Ruprossions oiupt Uoni within. Bo careful with smiling UH.hmci.ms. Disasivfs lurk undor Ifn- i*nn Consider tl>o partlv di>ahlod. Thoy always sivm oav;or tc> try Bo tool to iho Farmur* and TsihUHl; TIkw mav >ay hollo land j^oixl-byo' Rostst the1 ag^rowivo audacious. Thoir couraRo may onlv hi* loar Take hood of the lucid loquacious. Thoy say what thoy want you to hoar Bow arc* thi1 huroic unkirnod. Tiioy'd rather bo olscwhori! mstoad. lMk out ior ilv sIok I'mnamul. Hx>v mav t.iko .1 hodlo to hod *s**Un t tho oil\tu and ^iiiod Iho ('V will vtvo v'ou tho v luo Can Nomoono bo luri*d or const ript^l, (Jr `s'ho to< ok1 to bo tfuo( Ktvp 'soarthmy, tor vomothmy olusivo, Tk* is^uo tannot b\` rosolvod You must ho com ivoh comlusivo Botofo vou aro otdorod dwstlvod Assiynniont is tinalh iinisiK'ci A candidaK* sooms to oiru*ryo AduMi.il roservos aro dimmtshorl Fart'woll' It is lime to su mor^o -- Ilr>m .t li'TH*r to lH` idlin' by Wi-bd i>.Kk<rs> 1/ Ml) ft Uir S< i\ f'/ /.H.f'nl nf * f* >h <.' J.jU U 1<"7 \ R&S 026906 692 Vinyl Chloride/Aryanpur