Document rxK0j7DeMaeV1jnjZn06zbyer

CENTER FOR DISEASE CONTROL MORBIDITY AND MORTALITY WEEKLY REPORT March 24. 1978 7 Vol. 27 7 No. 12 Epidemiologic Hotel and Report* M Polychlorinated Olohanyl Eapoiurt - Indiana * - 109 Pneumonic Tularemia ~ Washington International Notee ' 100 Infant Botulism - England 109 Quarantine Measure* Currant Trends 109 Primary end Secondary Syphilt* - United States, January 1970 Epidemiologic Notes end Reports ~ Polychlorinated Biphenyl Exposure -- Indiana In January 1976, hi0h concentration! of polycholorinated biphenyls (PCB) ware found ai contaminants in muni cipal tawaea studga used by residents of Bloomington, Indi ana, for gardan fertilizer. The source of the PCB wet attri buted to an electrical manufacturing firm in Bloomington, which had used PCB as a dielectric in the production of capacitors and had discharged PCB into the city sewage sys tem. Fourteen sludge samples had a mean PCB concentra tion of 479.1 parts per million (ppm) (range, 0.1-1,700 ppm), end 28 samples of sludge-treated soil had a mean PCB content of 17.1 ppm (range. 0.M07 ppm). To evaluate the possible health effects of PCB exposure, the Monroe County Board of Health and CDC conducted epidemiologic and clinical avaluations on 3 groups: (1) a small group of workers (principally capacitor worker*) ex posed occupationally to PCB. (2) tha workers' families, end (3) community residents who had applied sludge to their gardens. Serum levels of PCB were found to be highest in th 18 workers exposed occupationally to PCB (mean 71.7 parts per billion (ppb); range 16-357 ppb). Previous studiet of population groups 'n the United States {1,2) and in western Europe (3) without occupational or other unusual expo sures to PCB have shown mean serum PCB levels of 6-20 ppb with 99% of values being less than 30 ppb. Nineteen members of workers' families had a mean strum PCB con centration of 33.6 ppb (rang* 12-164 ppb). Ninety-one community residents who had bean exposed to sewage sludge had a mean PCB concantratlon of 17.0 ppb while 23 without sludge exposure hed a mean level of 23.8 ppb. Serum PCB levels showed no correlation with number of yean of studga use, total pounds used, or interval since last usa. Forty-five (49%) of the 91 sludge users evaluated hed applied sludge to their gardens no more than twice. Sinoe heavy consumption of frash water game fish has previously been associated with elevation in serum PCB levels!/), histories of fish consumption were taken; no correlation was noted. Because alteration in hepatocellular function has baen reported in humin and animal studies of PCB expotura |4), e battery of 8 Over function tests was conducted on 43 adult subjects. Strum lavels of the liver enzyme gemma glu tamyl transpeptidase (GGTP) increased significantly with serum PCB concentrations fr--0.21; p<0.05). This correla tion was independent of age in adults 021 years) and was strengthened by the exclusion from analysis of alcohol drinkers (r*0.42; p<0.0001). No correlations were observed between serum PCB levels end the results of other less sensi tive liver function studies. Plasma triglyceride levels have previously been found tc be elevated fn persons exposed to PCB (5). The apparent mechanism for this elevation is a PCB-induced impairment in the hepetie enzymes which regulate remove! of circulat ing lipoprotein from plasma. In this study 10 fasting adults who were found to have triglyceride levels above the 90th percentile for age, sex, and race (mean triglyceride*279.9 mg/100 ml) had a mean serum PCB content of 65.0 ppb. Plasma triglyceride concentrations increased significantly with increases in serum PCB levels (r-0.35; p<0.003). In adults this association was independent of age. Reported by FX McCtoskey. Meyor. Bloontktftott, TO Middleton. MO, ft Schneider. Monroe County Boerd of Hesith; J Von Fleet. MO. WT Foyntor. MO, RO Telle, MO, Stete Bpidemiotofitt. Indiene Stef Booed ot Nootth: CJ Gluock, MD, Unirenity of Cincmneti Modkoi Contor; Dhr of Sunoillonco, Hoolth Effects, end Field Serykm. NtOSH, Tonkotoyy Br. Cfinket Chomktry Die, Bur of Lobar* torko. Special Studiet Br. Chronic Oitooem Die, Bur ot tpidemio/oty. CDC Editorial Note: Both the manufacture and the use of PCB Hi tha United States have decreased sharply in recent years with recognition of the compound's toxicity and potential for long persistence in the environment. Despite this de creased production, persons exposed to PCB deserve evalua tion because the compound, once absorbed, is excretsd and metabolized very slowly end because the delayed effects of exposure to PCB ere still largely unknown. No evidence wee found in this investigation to indicate that exposure to PCB-contaminated sewage sludge, applied ei fertilizer, resulted in Increased absorption of PCB. Never theless, the leek of a demonstrable association in this study between serum PCB levels and exposure to PCB-conteminated sludge must be interpreted cautiously, since the major ity of sludge users in Bloomington hed relatively brief expo sure to PCB. Sewage sludge and wasttwaters. particularly those from industrial sources, have been shown to contain numerous toxic contaminants, among them heavy metals (6), persistent pesticides, and other halogenatcd hydrocar- U.8. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE MOWS 001261 T Polychlorinated Biphenyl Exposure - continued bon>. It ha* been postulated that the repeated application of partially treated towage containing these materials to crop and grazing lands could lead ultimately to the accumulation of toxic chemicals in human foodstuffs {7,8). References 1. Humphrey HEB: Evaluation of changes of levels of potycholorinetetf biphenyl* (PCBI in humans. Pinal report on FDA contract 223* 79-2204. Washington, DC: U.S. Department of Health, Education, and Welfare, Food and Orug Administration, May, 197S 3. FlnkJee J Pretter LE, Creeson JP, et el: Polychlorinated biphsnyl residues In human plasma exposes a major urban pollution prob* lam. Am J Public Health 62:64*451,1972 9. Karppenen E, Kolho L: The concentration of PCB In human Mood and adipose tissue In three different research groups. PCB Conference II. National Swedish Environment Protection Board, Publication* 1973:46,124-127 4. Kimbrough PD: The toxicity of polychlorinated polycyclie eom. pound* and related chemicals. CRC Celt Rev Toxicol 2:44M98 1974 * 5. Smith AB. Gertside PS, Gluech CJ.et el.: Lipid and lipo protein alteration: Occupational exposure to chlorinated biphenyl abstract. Clin Research. In press 6. Tehran HR, Luces JB, Ryan JA, et al: An appraisal of the rela tive health risk* associated with land application of municipal sludge. Presented at the 50th Annual Conference of the Water Pollution Control Federation, Philadelphia, 2-B October 1977 7. Fishbeln GW: New policy emphasises land treatment ol munici pal wastewater. Environmental Health Letter, 15 October 1977 6. National Institute of Environmental Health Sciences: Human Health and tha Environment - Soma Research Needs. Report of Second Task Force for Research Planning In Environmental Health Science IOHBW pub no. 77-1277). Btlhesda, HIH. 1977 pp 197-203 International Notes Infant Botulism -- England England ht reported it* firtt recognized cote of Infant botulism. Clinical and laboratory feature* of the case era I follows. The patient, 5-month-old breast-fed female, had been Introduced to home cooked and commercial solids In Dec* ember. Her development was normal until December 31, 1977, when she had onset of constipation. Over the next 10 days, *ht became Irritable, developing generalized weak ness so that she was unable to suckle and tended to choke when spoon fed. When admitted to the hospital on January 11 she was lethargic and had poor head control, sluggish reflexes, and reduced muscle tone. Cerebrospinal fluid was dear, an electroencephalogram we* norma), and a Tensilon test was negative. Type A botufinal toxin was detected in a 7-gram specimen of facet collected on January 16. Clostri- (continued on pege 105) fkUM^aa Table I. Summary--Caeea of Specified Notifiable Dlsestoa: United States fCUmutattva reran inckjdt nvirnd nd dxtoydrtportt through pravtote makt) BtSIASE it* whk Enema Meabll, 1971 Mu* 11, 1177 f MEDIAN M 1179-1177" cmaetAfivE. Hen n mens Mm* It, 1171 Mat* It, 1177 f MEDIIMI I173-I177n 11 49 95 404 400 14* 29 . 4tH7 *529 4*917 40*447 44*410 57*744 2 2 4 22 12 54 * 7 T \PM-hihctbw ............................. <Tvfe........................................ ibpWW.VM {Track........................................ (TptmpidM ......................... fc.._ .. . > ................... Nmnr.............................................................. Menai .................................................................. Rcfcelb Itmm ixcmIr) ...................................... TyabM, el harm (Mry. ML panel fever) .............. Vmend Plwcici: ` ew^.^^ \Mbaxr u ----- iMMbrr 1 111 MS 144 14 427 54 95 1 440 90 224 ** j* 1 17*224 249 429 9 59 --9 992 490 145 1*754 TT 7? 495 15 1*241 sea ^ '1 17*499 954 4 50 .4 219 ITM 7V2 44 49 1 1*474 *55 .. ------- 25 9*017 5*704 1*741 4 4*424 570 545 5 4*297 490 2*144 444 j 17*499 477 472 4 70 5*944 14 10 141*422 4.2)1 49 441 2) 9.917 7*071 1*474 47 14*49) 501 504 2 4*944 152 5.997 17 149*999 5*741 4694 a) 441 41 . 2*290 } 7.474 41 7*272 191 912 4 14*149 1*445 C **i ' II 5*515 441 Table N. Notifiable Dlaeaeee of low Frequency: United Stataa CUM. CUM _ 15 1 HMtwC new If *>luctr vim 10?T trt to vpxi I(ft year'* nwthly w) evmvlttiw Wall. ttMWtom let OancMw* *a4 SyphHlt ** tetW ox 4*tt to* ISIS- *e? I *D*f*r*e more: ioMNtm: Me- -I |te|; UetwMfb: Mo. -I (19771: Ml*.. Mtan. -1 (1fT7):Ty<Vw. mgtW: NVC-t HONS 001262