Gulf War and Health Updated Literature Review of Sarin (2004) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-12
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Although most Gulf War veterans resumed their normal activities, many soon began reporting a variety of nonexplained health problems that they attributed to their participation in the Gulf War, including chrome fatigue, muscle and joint pain, loss of concentration, forgetfulness, headache, and rash. Because of concerns about the veterans' health problems, the Department of Veterans Affairs (VA)
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CHARGE TO THE PRESENT COMMITTEE The present committee was charged to review the peer-reviewed literature published since earlier IOM reports on health effects associated with exposure to sarin and related compounds, including relevant epidemiologic studies. With regard to the toxicologic literature, the committee used review articles to obtain and present a broad overview of the toxicology of sarin and cyclosarin, and to assess biologic plausibility with respect to the compounds in question and health effects; individual toxicologic research papers were evaluated as wa ranted.
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Modeling has bt en conducted to determine potential exposures of US troops. According to model estimates, no troops were exposed to doses greater than would cause "first noticeable effects", which would set off chemical alarms and cause visible signs of the acute cholinergic syndrome.
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Changes persisted for I year after sarin administration, although the changes did not appear to have any behavioral or psychologic significance. Similar effects were not seen in marmosets or in guinea pigs except when they were exposed to doses that caused the acute cholinergic syndrome.
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The results of one study suggested that low PONI activity due to the polymom, hism might be a risk factor for illness m Gulf War veteran s, but another study did not find an y differences m PON I activity between symptomatic and asymptomatic Gulf War veterans. HUMAN HEALTH OUTCOME DATA Four populations have been studied in large epidemiologic studies after exposure to sarm: milita y volunteers who were exposed several decades ago to nonlethal doses of sarm and other chemical-warfare agents, mdustrial workers with documented acute exposure to sarm, victims of the SaTm terrorist attacks m Matsumoto City m 1994 and Tokyo m 1995, and Gulf War veterans Studies of Gulf War veterans include studies of veterans potentially exposed to sann after demolition of rockets at Khamisiyah and a number of studies on Gulf War veterms that evaluate the relationship between symptoms and possible exposures on
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Three years after the Matsumoto attack, fatigue, headache, and the visual disturb~mces asthenopia, blurred vision, and na rowmg of visual field were more common among people who reported signs of the acute cholinergic syndrome than among those who lived near the sann release site who did not have signs of the syndrome. An English-language abstract also showed visual-field constriction and abnormal BEG 45 months after the attacks.
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has been seen in survivors of the Matsumoto and Tokyo sarin terrorist attacks and to British veterans who reported either wearing "nuclear, biological, and chemical warfare suits", hearing chemical alarms, or having a "chemicaVnerve gas attack". Other studies, however, found no relationship between PTSD and "wearing chemical protective gear or hearing alarms sounding", and PTSD was not more common among Khamisiyahexposed than nonexposed Gulf War veterans.
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The prevalence of multiple chemical sensitivity was also associated with hearing chemical alarms and self-reports of havmg a chemical or nerve-gas attack; and chronic fatigue syndrome was associated with hearing chemical ala -113 m a study of British soldiers. In all those studies, the exposure assessment is not a reliable indicator of actual SaTm or cyclosarin exposures.
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Far example. several high-quality studies repart eanHDrent pasinve aDDaciahanD and the studies are suffieientlyfree af bias inHuding adequate eantralfar eanfaunding Limited/Suggestive Eridenee ef an ADDeeiRoen Evideneefram available studies suggests an assoeiahan between expasure ta a speeifie agent and a speeifie health auteame in human stu&e~ but the bady af evidence i~ limited by the inability ta rule aut ehanee and bias inelu&ng eanfam &ng with eanfidenee Far example at least ane high-quality2 study repart~ a paHhve a~aciahan that i~ ~uffieiently free af bias inHu&ng adequate can tral far eanfaund ing Other earrabarahng stu&es pravide ~upparifar the a~aciahan but they are nat suffieientlyfree af bias inHu&ng eanfam &ng Allernatively ~everal stu&es af less quality shaw eansistent pasinve assoeiahans and the results are prabably nat3 due ta bias including eanfaunding.
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Other kinds of eftorts ctm obtain sensinve meastnes of exposure, such as use of occupanonal m envimmmental monitoring data, use of more extensive industrial hygiene assessment3, use of imerview techniques dhat help to minimige recall hias (for example, photos of products tmd home tmd workplace walkunoughs)
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From page 11... ...
, asthenia, shoulder stflnsss, and symptoms of PTSD Sarin sxporiurs he r ill m Followed by abnommal test results, of unknown clinical signifi canes, on the digit symbol testof psychomotor performance, EEG records of sloop, ovont-rslrflod potential, visual evoked potent al, and computerized posturography Persistent Neurological Effects Following Low-Lewl Exposures Thenr is inadequatrvinsuflicient evidence to detemmine whether an association does or does not exist between exposure to saris at bw doses insu flicient to cause acute cholinergic signs and symptoms and subsequent longterm s r ye rr e neurobgicAI hearth effects In the absence of carefully designed human studies express y of sann or cyclosarin's long-tsmm health Exacts at doses that do not produce acute signs and symptoms, the committes concludes that the data remain inadequate or insufl cent to dstsrmins whether such sflscts exist Pensistent Cardiovascular Effects Following Low-Level Exposures Thenr is inadequatrvinsuflicient evidence to detemmine whether an association does or does not exist between exposure to sarin and subsequent longterm cardiovascular effects Studies of persistent cardiovascular sflscts aflvr sann sxporiurs have ~ -M inconsistent Therefore, the committes concluded that the data are inadequate or insufficisnt to dstsrmins whether an r~socia90n existri
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