Document rxbLmeyjq6DEkbZ6LY5bXMD8G

R&S 112560 BIO-MEDICAL. RESEARCH DOCUMENT DESCRIPTION FORM 63 Duplicate.in all cards:--S> 68 69 76 JfJT\ | 0000379 year as-1961- File number [Right justify [Numeric only] Author(s), as Last Name FS (No Punctuation) and coden for journal as JAMA preceeded by one blank space 1 20 21 y 40 41 ' -----" 77 78 Sub-Index Code 60 61 62 Title of Report; end with space-hyphen-hyphen-space. Follow with Index Terms, separated from each other with comma-space. Avoid other punctuation; do not abbreviate. ,, tfWto# $ 21 22 23 24 Source (Journal, Vol., Number, Pages, Date) 12 [PZ- ftftfj ftft P /ft/o-rw JC/-/S / /j^ ]/, ft' 7 J --------------- ------------- v'ff------------------------------------------------------------------ 1 --y 7--- ----- ----------------------------- ftt 1P# t~T -T r'U/lsi Afty'/lr^c* & '/t r: fa <s-frsrf> 61 62 31 32 Brief Summary 12 10 SUMMARY: 61 62 61 62 63 64 -.* ** "-r-'&l c. 7, ' Ku * i - A 1. tJ?*'* rr... ''Vn v ,t -'< '' \j :/-/H PREELLIIMfllINNAAERY REP.ORT ON THE MEDICAL EXAMINATION pF 288 EMPLOYEES- ^po ** < : **, *-*- , lf% - 1 '"* AT,THE .^1# PVC PLANT, ,4 l _. < * < * - . 4 ;-jvsvav;T` '-V- -v. -*5'..B . 1 -** .- r v .. A -- NORSK HYDRO a.. s , PORSGRUNN FABRIKKER, / % IH by LEIF HILLESTAD J/O - ; * *..'*' " - 0000-375 \ ^ S' . ^INQUIRY. CARRIED OFT AT TI1L HEALTH DEFT., POESGRUNN FABRIKKER,, ' `'j ' * * . - ..vv'1 **, * v RYPTHE COMPANY DOCTOR E: l^kkn, E. THIIS-EVENSEN M.D., AND j''U r-v^-HEALTH DEPT. PERSONNEL IN C'X>PFc-;uTON WITH ST. JOSEPH':S-' >' 'i? ^ HOSPITAL, PORSGRCNN HOSP IT Abe r *r r'v,*> ;> *> ; - ^ R&S 112561 , b1'-, j In .the spring of 1974 , there arose international concern 7p for health hazards in PVC producing industries:. This was .j.;' _ Vprimarily due to the oc^.n '-vrci! of a rare type, of cancer of ^ i 71 **''vi- the,liver. It was soon J i ncov rod that a worker at' the PVC ,n ' * 1*i .plant in Porsgrunn had died of this illness in 1972'. He had ; been- heavily exposed to vinyl chloride during a period1 of ^ *v '* * v *>} '' 'vi 's- iSf*a ^ * v: i many vh years. .' ?'-, }i . ;-. v'-v. V?' a; *** " % 1 t > *,1 - > _ * ^ * V* ^ * t ' ` T* ` ^ 'vikt''1' J-: V*"'* `H -1 Agaiffet'-this background of dramatic events, Dr. E. LgiKen, the' t .* :' Vf - Company Doctor at the Porsgrunn 1'abrikkor, addressed himself . .' r.'H.*' -V to- me on April 2nd of the sa:.',-.- y-'ar. Ho requested the assistance of St. Joseph's Hospital in order to undertake a J. ` hi 1 '.p V> .;. comprehensive examination of 150 employees at the PVC 'plant. ^ ^\4<- -g v ' .* The task, already at this point, aopeared a large one -in rv ' ^ f *. - 4 fc " ' relation to the facilities in our command at the hospital. "' ^ * r.t, ` . ?" ' .K'* However, because of a trudition of good cooperation between - ' v * * ** .. y.' C..the *16cal industries and the Porsgrunn Hospitals and because i - - ^ ' c *1' '\ ' .-' f,. V, * Joseph's Hospital was in a position to carry out the. ,; ^necessary .tests, we accepted the assignment. As the hhoossppi ital r ^^ "; i J' _' f7 r' was in the fortunate possession cf a genetic laboratory, J 1 .also , agreed to undertake chi. most xe analvses uoon a limited number `.''fa ' r-* p* . .. - ' -oof the emoloyees. We had no idea at this rao int of the -impor-' - ' f [i % -.1- -tance these tests would Inter assume. - - r w*. f '' ... ' >.4,<v''L.jThes: very next day, April. 3rd, a letter was sent-from, the hospiltaLy^, -- ''i'... V, : ' .\ . * ' ; , -Pj j top the Health Dept. at. the Porsgrunn Fabrikker, accepting- the ' . *-- y.,..'. - ^.**- v-VVn assignment and -.agreei0g to carry out the necessary ` eexx;aminations - \ " t^vC^i'.inQluding', post ^examinations and Doss-ibi^ -u_ T. R. Torkelson, Sc.D. Occupational Health Associate The Dow Chemical Company 2030 Dow Center Midland, Mich. 48640 Preliminary report on the medical examina tion of 288 employees at the PVC plant, Norsk Hydro a.s., Porsgrunn Fabrikker. Report by The Medical Commission on the Production of PVC. Norsk Hydro a.s. -s n ' R&S 112562 REK:h M* TeZ' March 21, 1975 j. Norsk Hydro Sales Corporation 800 Third Avenue New York, New York 10022 Telephone: 212 688-6606 >--- , v?,*07 I f"** ~ ,. v v i 'V*' 'XV -2 ?- - :. ' ''/' * "'***'. '' mTVhe-- c__oVn- jd.* itijons `faere a more clearly defined work distribution v *7^-. *; ' 'i \.|J ,, - '* V.' - ' ;-r**:'yand that N'drSk Hydro a. s should cover all expenses. All of -''**. i `* * * - T .'T*oui*r c... onditions were met. 'i *> . ..W ^ , `A; *- f ` -v ;'.-., r';>^^^rpurin^. Easter 1974 the necessary preparations were carried 'f?; , -out.'' On April 16th, we announced that we were ready to start, . r *T;, `oVand'the examinations began on April 22nd. The .task was carried ' * .^,V` *% daut as/quickly as possible to allay the understandable anxieties , 1 *% - *, vr {"'! of-the employees' at the.PVC plant. The examinations^-called - " .yV' '. 'for `a great deal of extra work, especially for the laboratory ''K-. `'."I;ig: *^ersohnl during the holidays, entailing a good deal of over- *V't .^time and extra work on weekends. However, because of the 'Tv' >.[' importance of the assignment, for the employees and therefore /f, * - **''' t -4 * ..--ft--- or the whole district, all persons involved worked with `..K\ ^ <v ^h'dmiralDle loyalty. This is a point which I feel is worthy of 4.."-'v* ' being stressed. v-*. .'**"vv- - ' oy&;vifal factor in an experiment of this kind, is naturally "y^. ,H y prompt ' reporting results tq the employees. To satisfy > i-`. "1* -4;i? 'nv' - / ;-r: [ ;i. this .`hded, one day each week was set aside for conferences ' .A.' , y S- ' ;!T;'yj-and evaluation of examination results. Our purpose was to. i c' ,> fepor.t the results as quickly as possible to those involved. i, **v In the course of events, it appeared that the total of those - `7 "yj.;i examined would exceed the original 150 employees.' On-'checking * -with' the Company Doctor at the'Health Dept., I was informed .i X, a. i<m (/) ^n.'the rautumn of 1974 that as far as he could judge, the final - ** _ ,. -riumber would probably be about 238 employees. It was'agreed ^ Ck -ytliat'the report'"would be prepared as soon as the examinations ' " ' <n ? >*' of. all" 288' had been carried out. . S :^v.- . =- ' ** * ,,* -* * -v % / -;p'-SV Ijowever, the number continued to increase so that at the *_ ` `beginning' of January 1975, wc had reached a total of. 349 f - *- ' r , .\I' - r.employees . We are still not sure of whether this represents 'i*v*,; >j-*thr'->T.e' final figure. This report, therefore, should be considered **- >r" - t 'y- ,. 5-'ets ^preliminary. `Ay. y. *.j x -'-Of the 288 examined, 6 were women and 282 were men. Of the TV- ,rr: ... y, 'V - employees under 60, all ago. groups were evenly distributed, v>`' ry~tr.r';-'` . . e.- ;*> " .iv- v `whereas the. number of employees above 60 was small'. * r fV**- KV -3 - hs was to be expected, the length of employment at'the PVC 'plant increased with age, but without direct proportionality. .Many in the relatively young ago groups had comparatively f lengthy employment in the PVC plant, approximately 60% of `.the employees had worked in the PVC plant less than 10 years, .'" while the remaining 40% had worked there from *1.0 to 24 years. Of the 288 examined, 59 persons oi 20,5% required follow-up examinations. In the majority of cases, the abnormal test \ spits were due to mild, passing illnesses. In evaluating *'"* the" examination results of individual cases, the regular ."-.health reports available at the Health Dept., Porsgrunn Fabrikker, were of invaluable help. _4i i ,. r.. In all, 6 persons or 1,7%, required further observation, at ;. the hospital. V,.The final results show that 2 persons died at the PVC plant 'beforef ', *the present*, examination' took# * place. Both cases were directly caused by exposure to vinyl chloride. The first. .death in 1958 was that of a young man, who died of acute .vinyl chloride poisoning. The other case occured as already mentioned in 1972, whore a worker died of angiosarcoma of the liver after lengthy exposure to vinyl chloride. .The death rate at the PVC plant calculated from these cases,, would be 0,7%. . During the present examination cf 288 employees, no cases of 'death have occurred. The morbidity rate, which can be regarded as- caused by vinyl chloride is 0,4%, which is quite low. The morbidity rate from other causes is 2,1%. ,. . v # ** > _1 * . * It is therefore documented that work at the PVC plant in Porsgrunn, as was to be expected, involves health hazards with death and disease. However, the number of diseased persons was, as our present examinations show, relatively low. ef: V. In- addition to the above mentioned clinical examinations, Jv. chromosome analyses were also carried out on a certain* number ' ___________ __________ - ~~ 'C of PVP _ 1 ***** *" ** ------ consideration.because ( i the kind of public and other ' new s - r, ad i ) importance and n]so because of dJ r c- c d in the c: Chromosome analvie., in 'ensuring and have proven to be ol great ip >.n i-he c n.i tviehc from the start it was obvious thr.t .-:u^r ..r, _::arr i .iuricn of alb .the 150 employees as orlg-toaiiy intended., would 3 mpof ,1- ?herefore I recommended that 4.5 amp1 oy.-cs should h-s chosen at-random for r- these examinations. When trio c*ir pi oyer .-; were offered this suggestion, they insists 1 t.i.at campr>'nbie number of persons chosen, by them, accru ding c.j L-iiu^h of emu i cyr.ent, should be added to the number <- persons or.anined. This suggestion was accepted, and with the -addition or other special cases, the number of persons ex-mi red to date has come up to 39. ..-a-,- A total of 101 chromosome tests have h.-or. made on these people. ^ At the same time 29 analyses have been made on a control Wt. ' ^V group of 16 persons. After Dr. Sjelikof at an ICF'mo"ting in Geneva in October 1974 presented results of a chromeseme study of alarming import, the chromosome studios <it St, Joseph's Hospital we re taken up again for rootniuntion. \]1 agreed that the study.should be expanded and that the tempo should be increased.. Norsk Hydro a.s unconditional]y nh.md nil the necessary economic means at our disposal. .r. *T Of the 39 chromejf me ana.] /.-.os which have so far been evaluated, .there are proven drvxuti ins in. 6 persons. These deviations are not large in *<ny of these persons, but %definitely abnormal ' according no intevnation;.llv aroepued criteria and in relation to the control group. Thorn are also 2 proven cases of congenital chromosome anomalicn. Jn addition, there are certain persons who i.n t i.i.-j tn -obior. are borderline oases. However, in many canes pro v it u : ry known disorders explain the findings. Every cast nhowui: d .'inita or possible chromosome abberations will of uoiu.iu ?. oc-L aunqn.ife medical follow-up examinations. ! -'4 / -rf *Tf . Without being able to- pro sea u definite proof, it is.difficulty;. 'a" avoid }conclud-i ti'- *-u~4- ' * are due to exposure to viny] chloride. The important question is which consequences these findings may have. In an attempt to answer this question, the Head of the genetic laboratory at St. Joseph's Hospital has tried to contact intarnational experts to the extent that the work pressure has allowed. Furthermore, exports from Oslo Universitet and Norsk Hydro's Kreftforskningsinstitutt, were called to a meeting at St. Joseph's Hospital January 23rd, 1975. The conclusions which at present can be drawn regarding the observed chromosome changes are as follows: > * R&S 112566 The chances for transferring the proven genetic damage to progeny are minimal. The chance that the proven genetic damage can be the precursor of illness does exist and further medical supervision is therefore necessary. However, there is a chance for reversion or a complete disappearance of the genetic damage, when exposure to vinyl chloride ends or is considerably reduced. \~ r -i * v Based 'on the observations made* at'St. Joseph's Hospital,'which, as far as is known, are the largest and most comprehensive undertaken anywhere in the world up to now, it would appear '-'absolutely, necessary that the genetic studiesare continued. With the modern views on* employee working conditions and . * health, it also appears important to increase the area of study. This is an opportunity to find out to what degree Industrially used chemicals can cause genetic damage and ? what such damage can imply in the long run. Plans for just V* such a genetic study expansion at St. Joseph's Hospital have been di-scussed, but the resources available at the present time are not sufficient. The examination of PVC plant employees will continue until -all employees are examined. Furthermore, total incidence of illness of the regular staff during the past 24 years will --be evaluated more closely on the basis of a control series, j-^e study of the health hazards, which are involved in working in the PVC plant, thus are not concluded. Bearing these reservations in mind, it would appear in order, however, on the -basis of the examinati on rf nwni -------------------------- ---- -T--~ _- - '-T --, H,iu lJUfli) I OW *TT ----- l. I 6 M +v Disease which can be blaned on exposure.to vinyl chloride r . W.-V is proven.in a limited extent. Genetic damage, which might * have been caused by exp >-sure to vinyl chloride is established. f. ,, , The extent of this damage, however , is much more limited !^.*T,than one was led to er.pocr. W the other 2 studies which are . J vf. available at this tim_ The material compiled at St. Joseph's 4- Hospital so far, is the most comprehensive known in the world ^ ,4 * * to-day. . , On the whole, the exam. inaLio:-' show deviations in various i h . u oy laboratory tests of ?7 porsoiv or 7,3% of the total. Many | y . j * * r; have illnesses not rotated i_o vinyl chloride, which can , v* j**-- explain the observed deviation*'. All will be subjected to . ' , adequate follow-up tv un;nations. 4 , .<. N Vs-*' During the course of .his stuuy contact with international * v. experts has been mair.ua iued as far as possible. As studies .. * in other countries aie completed, more light will probably V* be cast on the probl*. .ms in the course of 1975. For the time . ,* being pher^'is a'-lach of internationally accepted rules for, :ii4 Ti ti . 1 'V ** X- among other things, the continuing medical supervision of persons who have fcenn employed in PVC industries. On the basis of the experience ro fai gathered during the examination of the employees at tue Porsgrunn Fabrikker,one can however present the following recommendations: R&S 112567 Until further notice, an cwr. led yearly medical check on the employees of the PVC plane on'--* 11 be undertaken. As the latent period before' .no outbreak-of .illness caused by exposure to vinyl chloride car. be long, this medical check should probably be carried cut over a period of many years. It would r ,! .\ be desirable to simplify these medical examinations. However, so far there is little information on how this could be accomplished. .When taking on new employees, the Health Dept, should not accept those who may bo dispujvv for acquiring vinyl chloride disorders. For a- special group of employees it would be necassarv .in ... accordance with what. has already been mentioned, to carry out particularly thorough examinations. Genetic studies should be continued and expanded. Should it be desirable that the Porsgrunn Hospital continue = this work, it would be necessary to have *a prompt evaluation' of the increased resources/which the Hospital then will require. Porsgrunn, January 31st 1975 Leif Hillestad M.D. (s.) Head of Medical Department St. JoseDh's Hospital, Porsgrunn. 99SZU s *u