Introduction: Chronic health effects of occupational exposure to dust, gases and vapours are not well recognised by health professionals and neglected by public authorities and employers, leading to missed diagnoses and putting employees in danger. In 2012 an employee of a chocolate products plant was diagnosed with talcosis. Talc (magnesium silicate) is often used in the food industry. Although talc is considered to be safe by oral route, inhalation of talc is a well known cause of granulomatous lung disease and fibrosis. The company was not aware of this risk. Objectives: To identify exposed workers at risk of talcosis and to define control measures. Methods: Exposure assessment consisted of semi-quantitative evaluation for all job titles with potential talc exposed tasks. In addition, personal respirable talc measurements were performed. Medical evaluation in 111 workers consisted of a questionnaire on occupational history and respiratory symptoms. Cumulative exposure was estimated as the product of the total number of days worked and job title with relevant talc exposure as dummy variable. Based on estimated cumulative exposure workers were referred for clinical investigation including a HRCT scan of the thorax. Results: Full shift personal respirable talc exposure varied between job titles (range TWA 0.05- 0.54 mg/m3) and were often close to or exceeding the Dutch OEL of 0.25 mg/m3. During some tasks high peak exposures occurred, e.g. up to 9 mg/m3 respirable talc during filling the talc storage box. HRCT scan was performed in 18 highest exposed workers with 8-40 work years. In addition to the index case, for one worker with NSIP on the HRCT talcosis was confirmed by lung biopsy. In another worker HRCT showed a nodular pattern. Several control measures have effectively reduced exposure. Discussion: Once an index-case has been diagnosed, further actions depend on many players and factors. In the Netherlands, limitations may occur on every level, both at expertise in occupational medicine, multidisciplinary team work, executing and financing a surveillance. Alternatively, tools for early identification of health risks of occupational exposure to agents aimed at primary prevention is even more challenging. Conclusion: Inhaled talc was an unidentified hazard in this food processing plant. This may apply to other industries as well. This study showed that comprehensive surveillance programmes including exposure assessment and structured medical evaluation are the keystone of prevention and contribute to a safe and healthy workplace.
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