Parkinson ’ s disease in occupational exposure to joss paper , a report of two cases

We report two genetically unrelated ethnic Chinese women, aged 63 and 60 years, who developed Parkinson’s disease at the age of 55 and 53 years respectively. Both cases were working in the same joss paper shop for 15 years prior to the onset of Parkinson’s disease. There was no family history of Parkinson’s disease and exposure to other chemical or toxic agents. Biochemical analysis of joss papers revealed the presence of heavy metals such as lead, copper, zinc, and mercury, which has been implicated in the pathogenesis of Parkinson’s disease. The Parkinson’s disease in these two cases was attributed to occupational exposure to joss paper. Joss paper has not been associated with the development of Parkinson’s disease previously. Neurol J Southeast Asia 2003; 8 : 117 – 120 Address correspondence to: Dr NK Chew, Department of Medicine, Faculty of Medicine, University of Malaya 50603 Kuala Lumpur, Malaysia INTRODUCTION Joss paper is a ceremonial paper used in China and other parts of Asia. It is burned during religious ceremony to pay respect to the ancestors. It consists of thin, rough, usually rice paper, often with metallic leaf attached. There are two main types of joss paper. The first type (Figure 1) has metallic leaf in the centre of the page with orange colouring that makes the metal leaf look like gold. Printed over the leaf is a red block print with Chinese writing and patterns. The second type (Figure 2) has two pieces of metallic leaf on both sides of the page. One side has the orange colouring that makes the metal leaf look like gold. The other side is left uncoloured so that the leaf is silver in colour. Previously, joss paper commonly used in Malaysia was manufactured locally. Since 1990, with rising import from China, the local production of joss paper had ceased. Until today, the tradition of burning joss paper is still widely practiced by the ethnic Chinese in Malaysia. Despite this, there have been no previous reports of health problems associated with joss papers in the literature. We present two genetically unrelated cases of Parkinson’s disease with occupational exposure to joss paper.