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NIOSH Reports Page

NIOSH Case Reports

In, December, 2000, Niosh completed a study... on pages 31-35 they have a table of published case reports, case series, and health hazard evaluations involviing exposure to CCP or CCP components. Follow one of the links and open the Adobe Acrobat file, then go to Section 4 (Pages 31-35).

NIOSH: http://www.cdc.gov/niosh/01-107pd.html

Local: 01-107.pdf (Adobe Acrobat Reader)

Important Note:  NIOSH did not report testing carbonless copy paper from the various manufacturers including Appleton Papers Inc., Moore Business Forms Inc. for the 2000 report.  Instead NIOSH accepted the manufacturers statements on ccp toxicity.  NIOSH's own testing of Englewood HETA 83-313-1534  had formaldehyde levels and aliphatic compounds (C10-C14).  SEE below HAZELTON Laboratories America Inc.  Final Report "A Study To Determine The Potential Emanation Of Formaldehyde Vapor from Carbonless Copy Paper for Appleton Papers Inc. ( a copy can be requested under FOIL from NIOSH Appleton submissions number 000239).

HETA 83-313-1534 The Municipal Court Section, City of Englewood,
in Englewood, Colorado. NIOSH was called in to investigate due to
several employees experiencing various health problems such as
respiratory, eye, skin irritation and low platelet count, drowsiness in
afternoon, sore throats, nasal congestion, blurred vision and sneezing.
The Municipal Court Section consisted of a Judge and seven
employees. The investigation noted, "All forms in this office are on
carbonless copy paper." The court employees used 24 different
forms. The uninsulated pipes for hot water ran in one area of this
office. The hot water pipes created excessive heat in the area during seasonal cooling. NIOSH investigators tested the carbonless copy
paper and also did air sampling. The results were, "from this analysis a variety of chemicals were initially evaluated at the Court building.
These included aliphatic compounds (C10-C14) and aromatic compounds such as alkyl substituted biphenyls, phenyl methyl benzenes, and terphenyl type compounds. Laboratory results also found formaldehyde emitted from the carbonless copy paper tested."
NIOSH concluded, " that a potential health hazard did exist to the employees who worked at the Municipal Court Office in Englewood, Colorado." They based this on the levels of formaldehyde emitted
from the carbonless copy paper. Also, "Environmental results for formaldehyde showed levels slightly higher inside the cabinet than in the room in general. Individuals who sat closest to the forms cabinets recorded more symptoms than those sitting further away." NIOSH stated," A small percentage of the population show a hypersensitivity
to even low levels of formaldehyde which can include both upper and lower airway symptoms."


HETA 85-462-1748 BOISE CASCADE Vancouver, Washington.
"An authorized representative of the Association of Western Pulp and
Paper Workers requested NIOSH do a Health Hazard Evaluation
on diethylene triamine (DETA), hexamethylene diisocyanate (HDI) oe (HMDI) and other chemicals used in the production of carbonless
copy paper." Cited, "Symptoms reported as a result of exposure included voice change, cough (sometimes productive), tightness and soreness in the chest, running nose, and skin rashes." "The airborne concentration results were: hexamethylene diisocyanate (< 0.7 to 14.0 ug/m3); diethylene triamine (< 0.01 to < 0.35 ppm), phenol (< 0.02 to 0.15 ppm), formaldehyde k 0.04 to < 0.08 ppm), biphenyl (0.003 to < 0.02 ppm), butyl biphenyl (0.12 to 0.29 ppm), petroleum solvents (0.7 to 12 mg/0), and one total particulate sample was 2.70 mg/m3." "CF has an odor, is dusty, and has a drying effect. CB application is associated with some irritating vapors and for some people irritation on contact. The maintenance workers have had symptoms associated with exposure to the coating equipment, with the HDI equipment reportedly being the worst offender. Four individuals reported pulmonary symptoms consistent with exposure to diisocyanates."
"A small percentage may experience adverse health effects because of individual susceptibility, a pre-existing medical condition, and/or a hypersensitivity (allergy).` In addition, some hazardous substances may act in combination with other workplace exposures, the general environment, or with medications or personal habits of the workers to produce health effects even if the occupational exposures are controlled at the level set by the evaluation criterion. These combined effects are often not considered in the evaluation criteria. Also, some substances are absorbed by direct contact with the skin and mucous membranes, and thus potentially increase the overall exposure."
"The Machine Operator identified the slimacide as causing considerable eye irritation," "Three workers had headaches and dizziness. Four other workers bad skin problems which seemed to relate to work in the area, including one with acne not present before working here, one who got dry brownish spots on his arms and peeling on the face, one whose hands got extremely red on handling the paper fading to a grayish coloration after exposure ceased, and one who was irritated by some of the dyes. One other worker developed shortness of breath and wheezing which gradually worsened over the months while working and gradually cleared when away from the plant." "Symptoms in the coating area included: a raspy sore throat with voice changes, runny nose and eyes, and chest tightness and cough. One worker reportedly had his asthma aggravated, two others apparently developed wheezing or breathing difficulties after prolonged exposure in the coating area, and one reportedly developed an obstructive decrease in pulmonary function (worse in the evening after exposure) which has improved after removal from exposure in the coating area. On the whole, the millwrights, pipefitters, and-instrument men reported more problems than the other groups of workers. Concern was also expressed about a hard-to-remove residue coating the tools used in the coating area. Currently a set of tools is dedicated to coater work." " Others. 4 other workers were interviewed, including: 2 Starch Makers, a Boiler Tender Helper, and a Lift Truck Driver. One complained of eye irritation, dry throat, and chest tightness while working in the coater area and still notices the eye irritation when going past the open doors. Two others had problems with upper respiratory irritation when exposed to the coater area or its effluent."
"Summary. The CF was identified as having an odor, sometimes sufficient to cause nausea, and was reportedly dusty and drying to the respiratory tract. This was sufficient to aggravate preexisting asthma or bronchitis on occasions." "The coater area caused more irritative problems, particularly to those working on maintaining the equipment. Four of the workers interviewed described pulmonary symptoms consistent with exposure to diisocyanates. There were also complaints of headaches, dizziness, and feeling funny suggestive of solvent exposure. There were skin complaints as well. Several of the components of the CB are known sensitizers. Unless precautions are taken to control exposure, one could expect health problems. Of the components of CB, the HDI could be expected to cause the most problems until it is fully reacted."


HETA 97-0332 Allegheny County Court of Common Pleas, Court
employee contacted NIOSH to do a Health Hazard Evaluation. She
contacted NIOSH after receiving a copy of the " Allegheny County
Health Department's IAQ testing results. Tests showed Benzene
60 ppb, Toluene 100 ppb, m-Xylene 4 ppb, total Hydrocarbons
10,080 ug/m3. Criteria for acceptable indoor air quality Total Hydrocarbons 200 ug/m3. Conclusions/Recommendations: At the time of out investigation, the indoor air quality did not meet ASHRAE
guidelines for acceptable indoor air quality. The levels of total
hydrocarbons determined are such that exposed individuals may begin to experience adverse health effects." The employee worked for
the Judge, her small office lacked ventilation, was full of carbonless
copy paper that she fed into the in-office laser printer. This request was
submitted to NIOSH during their investigation. NIOSH did not advise
the employee of the open investigation, nor do any testing at the
Court.
 

HETA 81-275 General Telephone Company, York, PA "General Telephone Company employees in the Service Department provide services to customers. The employees are engaged in receiving reports of malfunctioning tele- phone service and requests for new services. The employees distribute the reports to their substations which provide the service requested. The assignments come in by teletype machines or phone. Two machines use carbonless paper which is a paper with an encapsulated ink. Previously carbon paper was used and there were no complaints. Following the introduction of carbonless paper, the employees started experiencing health effects such as sinus, skin and respiratory problems, eye itching/burning, headaches and face itching. These problems only occur while hand-ling the carbonless paper. This problem abates when they are away from the joband disappears completely when they do not handle the paper. They also stated that the yellow copy was more irritating than the white copy."

"Local - Formaldehyde gas may cause severe irritation to the mucous membranes of the respiratory tract and eyes. The aqueous solution splashed in the eyes may cause eye burns. Urticaria has been reported following inhalation of gas. Repeated ex-posure to formaldehyde may cause dermatitis from irritation or allergy. Systemic Systemic intoxication is unlikely to occur since intense irritation of upper respiratory passages compels workers to leave areas of exposure. If workers do inhale high concentrations of formaldehyde, coughing, difficulty in breathing and pulmonary edema may occur. Ingestion, although usually not occuring in industrial experience, may cause severe irritation of the mouth, throat, and stomach. NIOSH recommends that formaldehyde be handled as a potential occupational carcinogen and that appropriate controls be used to reduce worker exposure. These recommendations are based primarily on a Chemical Industry Institute of Toxicology (CIIT) study in which laboratory rats and mice exposed to formaldehyde vapor developed nasal cancer, and are supported by a New York University study where rats exposed to a mixture of formaldehyde and hydrochloric acid vapors developed nasal cancer. Formaldehyde has also been shown to be a mutagen in several short-term laboratory studies. The methylene chloride extract of the gloves was qualitatively analyzed. The major peaks identified were diethyl phthalate, dibutyl phthalate and dioctyl adipate. Dibutyl phthalate was also present in the bulk sample of the carbonless paper. Based upon preliminary data, exposure to and handling of carbonless copy paper seemed to be both temporally and physically related to the symptoms."
 

81-0429-1299 Appalachien Laboratory for Occupational safety

The report states,"Health problems due to office environments cannot be
successfully approached utilizing the exposure standards that currently exist.
Workplace environmental standards are based on protection from a chronic disease such as cancer or an acute disease or symptom . They do not consider sensitization, subtle neurotoxicity or the chronic irritation that may result from a continuous low level exposure to a wide variety of chemicals or contaminants."
"TABLE C SOURCES OF "INTERNAL" OFFICE CONTAMINANTS AND OFFICE WORKER ILLNESS16 MACHINES/MATERIALS CHEMICALS/IRRITANTS RECOMMENDATIONS Carbonless Paper Formaldehyde Good general ventilation,
personal hygiene"

HETA Report No. 83-141 EPA CENTRAL REGIONAL LABORATORY, REGION III
ANNAPOLIS, MARYLAND Cites, carbonless forms.
"Formaldehyde is widely used as a bonding agent in the manufacture of myriad products. Formaldehyde as an indoor office air pollutant has been studied at length (10). Generally, "energy-efficient" office buildings allow much less air infiltration -because of tighter construction, and provide less fresh air and lower circulated air rates than buildings built 10 years ago, resulting in higher concentrations of indoor air contaminants, such as formaldehyde, that were not a problem in older less energy-efficient buildings. Possible sources of formaldehyde in the air of office buildings are ........., and carbonless forms (11) if present in abundance. "The ventilation system of a building may also enhance buildup of contaminants by designs which provide poor mixing (11)." 11. Gockel, D. L., S. W. Horstman, and C. M. Scott, Formaldehyde Emission from Carbonless Copy Paper-Forms. Amer. Ind. Hyg. Assn.J., 42:474-476 (1981).

HETA 84-065-1519 Southern Oregon State College Ashland, Oregon "1 CIn December 1983 the National Institute for Occupational Safety and Health (NIOSH) received a request to determine the cause of skin rashes experienced by several bookstore employees at the Southern Oregon State College, Ashland, Oregon. " "NI0SH conducted an initial survey in December 1983 and environmental sampling in April and May 1984. The medical records of the workers were reviewed by a NIOSH physician and two of the three currently affected workers were patch tested by a local dermatologist. Eight of thirteen No-Carbon-Required paper forms used in the bookstore contained from 100 to 880 ppm latent formaldehyde; formaldehyde was not detected in the other 5 forms. Airborne formaldehyde concentrations ranged from 0.01 to 0.02 ppm. Measurements of the ventilation system indicated that the supply air volumes were adequate. Due to the lack of a humidifier in the HVAC, the room humidity could be very low in the colder winter months when the skin rashes tend to occur." "Two of the affected workers were patch tested for sensitivity to a variety of potential allergens, including wipe samples of dust from the door jamb, filing cabinet, and supply air vents. One worker who was patch tested, exhibited a 3-plus reaction to 2% formaldehyde at 72 hours. The affected workers were seen by a dermatologist during the time they were experiencing a skin rash.440` The diagnosis made by the dermatologist was acne rosacea."

"On the basis of this investigation, NIOSH investigators could not conclusively identify the cause of the skin rashes experienced by seven former and current Southern State College bookstore employees. Handling NCR paper containing formaldehyde and exposure to low humidity in the winter may have caused and/or contributed to the rash in one or more of the individuals. Recommendations are presented in Section VII of this report."         ** "Table 1

Formaldehyde Concentrations in No Carbon Required (NCR) Paper used in SOSC

HETA 88-314 Luthern Medical Center Brooklyn, NY

"C. Qualitative/ quantitative screening for volatile organic chemicals. General-area air samples collected for qualitative screening for volatile organic chemicals showed that all samples contained toluene, xylenes, isopropanol, some C5 - C6 alkanes, and a series of various aliphatic hydrocarbons, mostly branched alkanes in the C,,) - C13 range. 14 C Additionally, one sample collected in Room 2044 (Patient Accounts) contained trichloroethylene, 1,1,1-trichloroethane, limonene, and small amounts of C16Hl, isomers such as phenylxylethanes (compounds often found in carbonless copy papers)." "Based on the results of the qualitative screenings for volatile organic chemicals, 23 quantitative samples were analyzed for isopropanol, 1,1,1-trichloroethane, trichloroethylene, toluene, xylenes, limonene, and total hydrocarbons. The results of the quantitative analyses showed detectable concentrations of toluene on all full-shift samples collected, but only one sample had a quantifiable concentration, and was less than 1% of the NIOSH REL. Xylene was detected on 15 samples, but only three samples showed quantifiable concentrations, the highest of which was less than 1% of the NIOSH REL. Isopropanol was detected 96fon seven samples and the highest concentration found was less than 1% of the NIOSH REL. Trichloroethylene was detected on two samples and 1,1,1,-trichloroethane was detected on three samples. Both substances were found only in Room 2044 (Patient Accounts) and Room 2046 (Medical Records) in concentrations less than 1% of the NIOSH REL. The highest concentrations of total hydrocarbons and xylenes were found at the Nurses Station 4A and Nurses Substation 4A."
 

Submitted to NIOSH in the 1987 Investigations:

APPLETON PAPERS INC. Carbonless Copy Paper Study done by "HAZELTON Laboratories America Inc.  Final Report "A Study To Determine The Potential Emanation Of Formaldehyde Vapor from Carbonless Copy Paper for Appleton Papers Inc. March 11, 1985"  " Executive Summary" pages made the following statements." Those products containing black ink produced substantially higher formaldehyde concentrations than those with blue ink."  " Evaluation of the data presented in Table 13 and in Graphs 1 through 3 indicated form marking may result in a higher chamber formaldehyde maximum concentration.......  Since the greatest amount of work involving carbonless copy paper would be the separating and collating of forms, the initial emission rate may provide the greatest impact on the office formaldehyde concentration.  It would therefore be prudent to use the initial emission rate to make any predictions regarding carbonless copy paper formaldehyde emissions."     Some of the formaldehyde readings 0.880, 0.717, 0.527, 0.542, 0.673, 0.754, 0.653, 0.6930.585.

** We suggest Plaintiff's attorney subpoena the original and make comparisons.

Appleton paid study #238 Hill Top Research, Inc. 10/17/83 Report 83-0965-70 Safety Study Of Paper Samples (carbonless papers) "25 panelists, double-blind study to determine the irritation potential of four paper samples." "Only eight of the final 24 did not exhibit or report any of the response" "The complete report submitted to NIOSH on 11/2/88 and used by DSDTT for analysis."

Hill Top Research, Inc. 3/28/73 72-128-21 Acute Toxicity and irritation Studies of TS 021673, 2-2619 (CF Systems), 50% Slurry "grayish-white liquid with slight odor" "Four of the rats exhibited slight diarrhea stains." "Throughout remainder of study three exhibited alopecia around the anus." "3. Patch Test for Primary irritation and Corrosivity-Rabbits" "Irritative effects were confined to very slight or well-defined erythema at five intact and five abraded sites" "Acute Oral Administration -Rats" "On the first post-dosage day, all rats appeared depressed, and exhibited depressed righting and placement reflexes." "All the rats were found dead on day two."

Monsanto 7/7/81

"90-Day Feeding Study With MCS-1918 (Santasol 150) in the Rat." (Solvent CB Internal Phase) "Compound related gross and microscopic changes were observed in the kidneys and livers of the high dosage and occasionally mild-dosage animals."

We will be adding more of the studies.