Attachment 1 , ftige 11 
Follow-up Evaluation of Illness - A biotechnology worker who develops 
Illness or Is absent from work for 48 hours without explanation should be 
actively evaluated. The importance of such active pursuit cannot be 
overemphasized. The evaluation of such illness should consider (a) whether 
the symptoms are in any way relatable to the microorganisms or products in the 
worker's place of employment, (b) whether an accident has occurred in the 
facility; and whether the ill worker was involved in the accident; and (c) 
whether any illnesses have occurred in co-workers. 
Epidemiological and Other Long-Term Follow-up Studies - The likelihood 
that epidemiologic evaluations of workers engaged in rONA applications will in 
the near term produce useful results is slight, given the relatively small 
mmbers of exposed workers and the long induction- latency periods which may 
need to elapse between beginning of exposure and appearance of any disease. 
In the longer term, however, epidemiologic studies may be extremely useful as 
a health surveillance tool. Specific follow-up studies intended to evaluate 
specific outcomes will be the most cost-effective form of epidemiologic 
follow-up. Among the outcomes to be considered for long-term surveillance 
might be Increases in cancer Incidence or mortality rates. Increased rates of 
endocrine disorders, and elevated rates of immunologic diseases. Surveillance 
might also be directed to the occurrence of adverse reproductive outcomes in 
the offspring of male or female workers. Many such studies might require the 
concommitant evaluation of appropriate control groups. With further 
development of such sophisticated biochemical indicators of genetic alteration 
as protein profile testing, it may be possible to couple such indices with 
epidemiologic follow-up studies. 
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