Quyết định 167-BYT/QD

DECISION

ON ADDITIONAL ISSUANCE OF OCCUPATIONAL DISEASES IN THE LIST OF COVERED OCCUPATIONAL DISEASES

MINISTER OF HEALTH

Pursuant to Article 106 of the Labor Code on the issuance of the list of occupational diseases;

Pursuant to Decree No. 68 dated October 11,1993 of the Government stipulating functions, duties and powers of the organizational structure of the Ministry of Health;

Pursuant to official dispatch No. 334/LDTBXH-BHLD dated January 29, 1997 of the Ministry of Labour - Invalids and Social Affairs authorizing the Ministry of Health to sign the decision on addition of 5 occupational diseases to the list of covered occupational diseases 1997;

After obtaining the consent of Vietnam General Federation of Labor in the official dispatch No.1592/TLD dated December 31, 1996;

DECIDES

Article 1. Additional issuance of 5 occupational diseases to the list of covered occupational diseases (attached annexes)

1. Occupational arsenic and arsenic compound intoxication disease (Annex 1).

2. Occupational nicotine intoxication disease (Annex 2).

3. Occupational pesticide intoxication disease (Annex 3).

4. Occupational caisson disease (Annex 4).

5. Occupational chronic bronchitis (Annex 5).

Article 2. The laborers who are inspected to suffer from diseases specified in Article 1 of this Decision shall be entitled to the benefits specified in the Labor Code and documents guiding the implementation of this Labor Code.

Article 3. This Decision takes effect from its signing date.

Article 4. Chief of Office, Director of Hygiene and Disease Prevention Department and Departments under the Ministry of Health, Head of units directly under the Ministry of Health, Director of Service of Health of provinces and centrally-affiliated cities, head of health sector and heads of relevant units are liable to execute this Decision.

ANNEX 1

OCCUPATIONAL ARSENIC AND ARSENIC COMPOUND INTOXICATION DISEASE
(Issued together with Decision No. 167 dated February 04, 1997)

I. MAIN OCCUPATIONS AND JOBS MAY CAUSE DISEASE

All jobs with exposure to or breath of arsenic dust or vapor and arsenic compounds.

- Arsenic ore processing.

- Production and use of arsenic chemical pesticides.

- Ore processing in arsenic non-ferrous metallurgy

- Use of arsenic compounds and inorganic substance in leather processing, production of glass, electronic parts…

II. DIAGNOSIS INSTRUCTION:

1. Diagnosed subject:

Diagnosed subject are laborers working in the environment with arsenic dust, vapor or arsenic inorganic compounds.

2. Exposure time:

Determined by the concentration of exposure and disease;

. Acute disease: typically short duration of exposure with high concentrations.

. Chronic disease: with concentration lower than the permit standard but long duration of exposure may also be affected.

3. Sub-clinical signs:

Urinary arsenic amount: The arsenic amount in urine must be greater than or equal to 100 † g / l (or †g creatinine) (it is necessary to get the urine for every 24 hours).

Eating fish and sea food shall increase the urinary arsenic amount. Thus, the subjects diagnosed must avoid eating sea food at least for 2 days before collecting urine for determination of arsenic amount .

4. Clinical signs and symptoms:

4.1. Acute intoxication:

- Nausea and diarrhea

- Severe abdominal pain

- Little urination

- Reduction in body temperature and blood pressure

- Cramp and convulsion.

For acute intoxication due to AsH3, there are signs as follows:

- Urination with hemoglobin

- Jaundice and thrombolysis

- Plasma proteins in nephritis

- Central nervous system toxicity (coma)

4.2. Chronic intoxication:

. Initial symptoms: irritability, abdominal pain, itching, pain in joints and asthenia.

. Signs: Diarrhea or constipation, rash, gauntness, swelling of lower eyelid, mucosal lesion, gingivitis, pharyngitis, upper respiratory inflammation (runny nose, hoarseness, cough ...) and combined membrane inflammation.

. Neurological symptoms: Feeling of numbness, skin burning, tingling or itching accompanied with tremor, muscle twitching, muscle atrophy, limb paralysis. Inflammation of many nerves is a primary sign.

. Skin and mucous membrane lesion: Inflammation, ulcer, palmoplantar keratodermas

. Skin darkening and hair loss

. Hepatic impairment

. Nephritis and kidney failure

4.3. Cancer: Cancer of the skin, lungs, ethmoid bone, malignant warts.

III. INSPECTION INSTRUCTION

Note:

When being intoxicated with arsen and acute arsenic compounds, first aid and treatment must be performed until stable, if any new Sequelae occurs, it should be inspected by the Medical Evaluation Board.

. When the disease recurs, it must be treated until stable and then re-inspected.

Persons suffering from diseases mentioned above (defined in recruitment dossier) shall not have medical inspection to determine occupational diseases.

ANNEX 2

OCCUPATIONAL NICOTINE INTOXICATION DISEASE
(Issued together with Decision No. 167 dated February 04, 1997)

I. MAIN OCCUPATIONS AND JOBS MAY CAUSE DISEASE

All jobs with exposure to or breath of cigarette and nicotine dust such as:

. The work during the process of cigarette production: tobacco stemming, drying, screening, material coating, julienne, cigarette rolling, bagging ...

. Tobacco harvesting, packing, shipping ...

II. DIAGNOSIS INSTRUCTION:

1. Diagnosed subjects: are persons working in environment with cigarette and nicotine dust.

2. Exposure time:

Determined by the concentration of exposure and disease;

. Acute disease: typically short duration of exposure with high concentrations.

. Chronic disease: with concentration lower than the permit standard but long duration of exposure may also be affected.

3. Sub-clinical signs:

Urinary nicotine amount:

- For non-smokers: the urinary nicotine amount is more than 0.3 mg/l.

- For smokers: the urinary nicotine amount is more than 0.3 mg/l.

4. Clinical signs and symptoms:

4.1. Acute intoxication:

- Severe dizziness and headache, pale face.

- Nausea, vomiting, abdominal pain and diarrhea.

- Saliva secretion and cold sweat streaming

- Rapid heartbeat, increased blood pressure, pain in the heart

- Visual and hearing disturbances

- Eyelid vibration, hand tremor and muscle cramp.

4.2. Chronic intoxication:

- Mucosa: with phenomenon of irritability, dry gular and nasal mucosa, stomatitis, conjunctivitis (watery eyes, eye pain, vision loss).

- Skin and nails: atopic dermatitis, thin and brittle nails;

- Cardiovascular: heart attack, heartbeat change, premature ventricular beat, blood pressure change.

- Nerve: headache, poor sleep, decreased memory, easy to forget, decreased hearing and vision, tremor.

- Digestion: nausea, loss of appetite, indigestion, diarrhea, heartburn, epigastric pain.

- Respiration: chronic bronchitis, alveolar expansion, decreased pulmonary ventilation.

III. INSPECTION INSTRUCTION

Note:

. When being intoxicated with nicotine, first aid and treatment must be performed until stable, if any new Sequelae occurs, it should be inspected by the Medical Evaluation Board.

When the disease recurs, it must be stably treated and then re-inspected.

 Persons suffering from diseases mentioned above (defined in recruitment dossier) shall not have medical inspection to determine occupational diseases.

ANNEX 3

OCCUPATIONAL PESTICIDE INTOXICATION DISEASE
(organophosphate, organochlorine, carbamate)
(Issued together with Decision No. 167 dated February 04, 1997)

I. MAIN OCCUPATIONS AND JOBS MAY CAUSE DISEASE

All jobs with exposure to chemical pesticdes:

- Industrial production.

- Packaging

- Transport

- Storage

- Mingling, mixing, spraying, sprinkling, steaming ...

II. DIAGNOSIS INSTRUCTION

1. Diagnosed subjects:

Diagnosed subjects: are persons who are exposed to chemical pesticides.

2. Exposure time:

Determined by the concentration of exposure and disease;

. Acute disease: typically short duration of exposure with high concentrations.

. Chronic disease: with concentration lower than the permit standard but long duration of exposure may also be affected.

3. Sub-clinical signs:

Amount of Acetylcholinesteraza enzyme activity (AChE): The amount of AChE enzyme activity decreases over 25% compared to that before exposure or the constant of AChE enzyme activity in normal person.

4. Clinical signs and symptoms:

4.1. Acute intoxication:

- Vomiting and abdominal pain

- Sweating, watery eye, runny nose, saliva secretion…

- Miosis

- Pulmonary edema

- Muscle twitching and cramping

- Paralysis, coma.

4.2. Chronic intoxication:

- Headache, dizziness

- Fatigue

- Poor sleep

- Loss of appetite

- Hand tremor

- Eyeball twitching

- Light paralysis

- Skin manifestations: rash, eczema ...

- Neurovegetative dysfunction

III. INSPECTION INSTRUCTION

Note:

When being intoxicated with chemical pesticide, first aid and treatment must be performed until stable, if any new sequela occurs, it should be inspected by the Medical Evaluation Board.

When the disease recurs, it must be stably treated and then re-inspected.

Persons suffering from diseases mentioned above (defined in recruitment dossier) shall not have medical inspection to determine occupational diseases.

ANNEX 4

OCCUPATIONAL CAISSON DISEASE
(Issued together with Decision No. 167 dated February 04, 1997)

I. MAIN OCCUPATIONS AND JOBS MAY CAUSE DISEASE

All jobs carried out under conditions of pressure high than atmospheric pressure: divers, working in the sank cage ...

II. DIAGNOSIS INSTRUCTION:

1. Diagnosed subjects:

Diagnosed subjects are persons working in conditions of high pressure or compressed air (divers and person working in sank cage).

2. Exposure time:

Exposure time may vary with disease: acute or chronic.

. Time of apprearance of acute disease may be right after pressure reduction.

. For chronic disease, the exposure time is usually 01 year.

3. Clinical signs and symptoms:

3.1. Acute caisson disease:

- Pain in limbs

- Vomiting, epigastric pain

- Dizziness

- Tingling and numbness in limb tip

- Shortness of breath

- Headache

- Epilepsy

- Visual disturbances, dazzling or scotoma

- Heart attacks, coronary artery disorder, irregular heartbeat.

- Hypotension

3.2. Chronic caisson disease:

- Limb fatigue and pain

- Difficult movement: stiffness, less or much limitation of movement.

- Muscle atrophy

- Hearing loss.

4. Sub-clinical signs (chronic decompression)

4.1. X-ray signs: detection of bone changes:

- Calcium disorders: mineral loss

- Bone structure: bone cavity

- Dissolution of bone

- Periosteal reaction (spine, thick bone)

Change of bone found in the limb root: shoulders, groin. As seen in the upper and lower end of femur, tibia, in the upper end and shaf of humerus bone.

4.2. Audiometry: to identify hearing loss

III. INSPECTION INSTRUCTION

Note:

The working complications in high-pressure must have first aid and treatment until stable, if any new Sequelae occurs, it should be inspected by the Medical Evaluation Board.

When the disease recurs, it must be stably treated and then re-inspected.

Persons suffering from diseases mentioned above (defined in recruitment dossier) shall not have medical inspection to determine occupational diseases.

ANNEX 5

OCCUPATIONAL CHRONIC BRONCHITIS
(Issued together with Decision No. 167 dated February 04, 1997)

I. MAIN OCCUPATIONS AND JOBS MAY CAUSE DISEASE

All jobs with exposure to organic and inorganic dust or toxic gas such as CO, SO2, H2S, C1, HCL etc. ..

II. DIAGNOSIS INSTRUCTION:

1. Diagnosed subjects

Diagnosed subjects are persons who are exposed to some kinds of dust or toxic gas such as SO2, H2S etc. ..

2. Exposure time: The prescribed exposure time is 3 years.

3. Clinical signs and symptoms:

Coughing and spitting sputum for over 2 months in a year and over 2 consecutive years.

4. Sub-clinical signs:

Measurement of respiratory function: maximum expiratory volume / second (FEV1) declines.

III. INSPECTION INSTRUCTION

Note:

The persons who are given inspection of occupational chronic bronchitis must have the result of measurement of respiratory function in normal physiological limit at least 3 years before

TABLE 1

TABLE OF PERCENTAGE OF LOSS OF WORKING CAPACITY DUE TO VISION LOSS BECAUSE OF LESION OF VISUAL ORGAN

TABLE 2

VI. GROUP OF NEUROPATHY

TABLE 3

CARDIOVASCULAR CLASSIFICATION ACCORDING TO NYHA
(NEW YORK HEART ASSOCIATION)
(Currently applied by the World Health Organization)

Type I: No symptom (shortness of breath, chest pain, palpitation) at rest or exertion.

Type II: No symptom (as above) at rest, but symptoms do appear upon performance of daily work.

Type III: No symptoms at rest, but symptoms do appear upon performance of a lighter job than the daily one.

Type IV: The symptoms do appear even at rest and only moving very slightly.

TABLE 4

CLASSIFICATION OF DEGREE OF HYPERTENSION DISEASE
(According to WHO)

I. CLASSIFICATION

Stage I:

Patient has no objective signs of any physical injury (see below).

Stage II:

Patient has at least one of signs of physical injury as follows:

+ Left ventricular hypertrophy can been seen upon clinical examination or electric ray, ECG, ultrasound cardiogram etc. ..

+ Widespread or localized narrow retinal arteries.

+ Proteinuria and / or serum creatinine increasing slightly.

Stage III:

Hypertension disease has caused injury to various organs, represented by the functional symptoms and physical signs as follows:

+ Heart: left ventricular failure.

+ In the brain: Hemorrhage of cerebrum, cerebellum or brainstem, hypertensive cecaphalopathy

+ Ocular fundus: retinal hemorrhages and exudation, with or without papilledema. These signs represent the progressive malignant stage.

Also in stage III hypertension or even other unclear signs which are the direct result of hypertension with these above signs, such as:

+ Heart: angina pectoris and myocardial infarction.

+ Brain: intracranial arterial thrombosis

+ Blood vessels: dissequant anevrysme (anevrysme dissequant) arterial inflammation.

+ Kidney: renal failure

II. SEVERITY CLASSIFICATION OF HYPERTENSION NUMBER

 (Measuring 03 times for every 02 weeks)