Document re9DodKpMVVzMqm2k41RzBEzG

DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE PUBLIC HEALTH SEPVICE C.C- CENTER FOR OISEASE CONTROL ATLANTA, GEORGIA 30333 T(i.(N40*1Ci |*04| UJ-1111 March 22, 1974 & &/ / t < Maurice N. Jchnson, M.D B.F. Goodrich Company 500 South Main Street Akron, Ohio 44311 . Bear Dr. Jolnson: Enclosed is .he final draft of medical screening recommendations sterna/ug from our meeting of March 2 concerning vinyl chloride liver disease, :n composing these recommendations, we have tried as far as possible to take into account both the discussion which took place at the meeting and t! e written recommendations submitted thereafter. This material will now be incorporated into the recommendations being presented by NIOSH to the Labor Department's Occupational Safety and Health Administration for fur ther action. Thank you very much for your help in developing these recommendations. Sincerely y-urs. Enclosure Clark W. Heath, Jr., M.D., Chief Cancer and Birth Defects Division Bureau of Epidemiology 5107001 BFG63188 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.t complete blood..: count, urinalysis, chest x-ray);/provisions 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_inyp.lv.ed such as in clerical and management assignments^ The recommendations shall be applied both as a pre-employment requirement and as jart 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 upon institution of screen ing, physical examination shall be_performed with specific attention to detecting enliTfg"emerif-bf-"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 eachjindividual employee. (iii) 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) (b) (c) . .. .(d) (e) total bilirubin alkaline phosphatase serum glutamic oxalacetic transaminase (SGOT) serum glutamic pyruvic transaminase ..(SGPT) gamma glutamyl transpeptidase (GGTP) tn o BFG63189 W XV t *v- 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. . fiv) 11 results of laboratory screening are normal, screening shall Ibe 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 lomter, screening shall be repeated every 6 months. (v) If one or more liver function cost.*} are abnormal, scrum tent ing shall be repeated as soon as possible, preferably within 2 to 4 weeks. If.no abnormalities are present upon rescree^ing, testing should be repeated in 3 months. (vi). 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 nhysical examination and various soecial 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), th&mployee 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.. " CGO^OTSi *3 ' . BFG63190 I