NIOSH Report on Carbonless Copy Paper Reviews Data, Suggests Ways to Reduce Symptoms

Contact: Fred Blosser (202) 401-3749
January 5, 2001

In a new report, the Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) reviews current scientific information on health effects associated with occupational exposure to carbonless copy paper, and recommends ways to reduce or eliminate symptoms.

According to available data, exposure to certain types of carbonless copy paper or its components has resulted, under some conditions, in mild to moderate symptoms of skin irritation and irritation of the mucosal membranes of the eyes and upper respiratory tract, NIOSH said in the report, “NIOSH Hazard Review: Carbonless Copy Paper.”

In most cases, good industrial hygiene and work practices should be adequate to reduce or eliminate symptoms, NIOSH suggested. These include adequate ventilation, humidity, and temperature controls; proper housekeeping; minimal hand-to-mouth and hand-to-eye contact; and periodic cleansing of hands. These recommendations are similar to ones that have been made by other researchers, programs, and agencies in the U.S. and abroad, according to the report.

Data also indicate that exposure to carbonless copy paper or its components has been associated in rare cases with allergic contact dermatitis. NIOSH also noted two case reports of various reactions in three individuals, including shortness of breath and hives; those cases were reported more than 10 years ago, and there is no evidence, given a lack of similar reports in more recent literature, that current CCP exposures present a risk for these effects. Data are insufficient to evaluate claims of other adverse health effects, such as neurologic effects or reports of multiple chemical sensitivity, the report found. NIOSH also offered these recommendations:

• NIOSH encourages carbonless copy paper manufacturers and their suppliers to follow professionally established “best practices” for product management, such as the American Chemistry Council’s Product Stewardship Code of Management Practices. Manufacturers and suppliers also should consider enhancing their product guidance to reflect that published studies indicate that symptoms of irritation appear to increase with increasing exposure to CCP.
• Carbonless copy paper manufacturers and their suppliers should consider how test procedures for assessing safety from skin contact can be modified to reflect exposures from high use of the paper. Current practices in product testing may not be sensitive enough to identify mild skin irritants.
• As part of ongoing monitoring to identify potential work-related health effects in workers under general occupational safety and health programs, carbonless copy paper manufacturers and their suppliers may want to evaluate the frequency and severity of irritation in workers using carbonless copy paper.

NIOSH initially evaluated the issue of potential health effects from occupational exposure to carbonless copy paper in 1987, at the request of the Occupational Safety and Health Administration. NIOSH issued a public notice for information in 1987. The review of the then-available data found that no strong conclusion could be reached concerning a consistent link between carbonless copy paper and health effects.

In 1997, as a result of continuing public interest in this issue, NIOSH issued a second notice to solicit new information available since 1987. The new NIOSH report is based on a review of the published, peer-reviewed scientific literature, and on more than 14,000 pages of information submitted in response to the NIOSH public notices in 1987 and 1997.

The new report is the most comprehensive scientific document available on issues relating to health concerns from exposure to carbonless copy paper. It includes extensive information about the components of carbonless copy paper, production processes, published and unpublished scientific data, and historical recommendations for preventing or reducing exposure to carbonless copy paper.

“NIOSH Hazard Review: Carbonless Copy Paper,” DHHS (NIOSH) Publication No. 2001-107, is available by calling the toll-free NIOSH information number at 1-800-35-NIOSH (1-800-356-4674). The report, along with other information on NIOSH research, also is available on the NIOSH site.