Gulf War and Health Volume 1: Depleted Uranium, Sarin, Pyridostigmine Bromide, and Vaccines (2000) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-26
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, depleted uranium (DU) , anthrax and botulinum toxoid vaccinations, and infectious diseases, in addition to psychological and other physiological stress.
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Following meetings with representatives of different veterans' organizations, the committee decided to study the following compounds: depleted uranium, chemical warfare agents (sarin and cyclosarin) , pyridostigmine bromide, and vaccines (anthrax and botulinum toxoid)
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. By studying health effects in these populations, the committee could decide, in some cases, whether the putative agents could be associated with adverse health outcomes.
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Evidence is sufficient to conclude that a causal relationship exists between the exposure to a specific agent and a health outcome in humans. The evidence fulfills the criteria for sufficient evidence of an association (below)
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There are several adequate studies covering the full range of levels of exposure that humans are known to encounter that are mutually consistent in not showing a positive association between exposure to a specific agent and a health outcome at any level of exposure. A conclusion of no association is inevitably limited to the conditions, levels of exposure, and length of observation covered by the available studies.
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Finally, no studies had reliable information about cigarette smoking, which may also-confound outcomes of lung cancer. However, these cohorts of uranium processing workers are an important resource, and the committee encourages further studies that will provide progressively longer follow-up, improvements in exposure estimation, and more sophisticated statistical analyses.
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The committee concludes that there is limited/suggestive evidence of no association between exposure to uranium and lung cancer at cumulative internal dose levels lower than 200 mSv or 25 cGy. However, there is inadequate/insufficient evidence to determine whether an association does or does not exist between exposure to uranium and lung cancer at higher levels of cumulative exposure.
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While the studies did not suggest that uranium has adverse health effects, the studies were of insufficient quality, consistency, or statistical power to permit a conclusion regarding the presence or absence of an association in humans. The committee concludes that there is inadequate/insufficient evidence to determine whether an association does or does not exist between exposure to uranium and the following health outcomes: lymphatic cancer; bone cancer; nervous system disease; nonmalignant respiratory disease; or other health outcomes ((gastrointestinal disease, immune-mediated disease, effects on hematological parameters, reproductive or developmental dysfunction, genotoxic effects, cardiovascular effects, hepatic disease.
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The committee concludes that there is sufficient evidence of a causal relationship between exposure to sarin and a dose-dependent acute cholinergic syndrome that is evident seconds to hours subsequent to sarin exposure and resolves in days to months. In humans, exposure to high doses of sarin produces a well-characterized acute cholinergic syndrome.
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The committee concludes that there is limited/suggestive evidence of an association between exposure to sarin at doses sufficient to cause acute cholinergic signs and symptoms and subsequent long-term health effects. After sarin exposure, many health effects are reported to persist (e.g., fatigue; headache; visual disturbances such as asthenopia, blurred vision, and narrowing of the visual field; asthenia; shoulder stiffness; symptoms of posttraumatic stress disorder; and abnormal test results, of unknown clinical significance, on the digit symbol test of psychomotor performance, electroencephalogram records of sleep, event-related potential, visual evoked potential, and computerized posturography)
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Side effects of PB are generally related to the large doses given to myasthenics; in surgical patients, adverse reactions are controlled by simultaneous administration of atropine (Williams, 1984~. The acute cholinergic side effects of PB are due to stimulation of muscarinic or nicotinic receptors by increased acetylcholine (ACh)
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The effects were self-limited and were well tolerated. The most extensive information available on the acute effects of PB comes from studies of its use for diagnosis of growth hormone deficiency and its therapeutic use for myasthenia gravis.
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The committee concludes that there is sufficient evidence of an association between PB and transient acute cholinergic effects in doses normally used in treatment andfor diagnostic purposes. Since unexplained Gulf War-related illnesses have been chronic, possible long-term effects of PB are of great interest.
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were sent to the war theatre to protect military personnel against potential exposures to biological threats (Committee on Veterans' Affairs, 1998~. Concerns about Iraq's offensive biological warfare capabilities led to the decision that available vaccines should be utilized as preventive measures against biological warfare agents.
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conducted the only randomized clinical trial of vaccination with a protective antigen anthrax vaccine.6 The clinical Dial was conducted among eligible workers at four goat hair processing mills in which some raw materials were contaminated by anthrax bacilli. Participants were examined 24 and 48 hours following each vaccination to assess both local and systemic reactions to the vaccine.
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Studies of the botulinum toxoid vaccine have not used active surveillance to systematically evaluate long-term health outcomes. This situation is unfortunately typical for all but a few vaccines.
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The committee concludes that there is inadequate/insufficient evidence to determine whether an association does or does not exist between botulinum toxoid vaccination and long-term adverse health effects. Multiple Vaccinations 17 Military personnel often receive several vaccinations as they prepare for service in an environment with many endemic diseases.
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Thus, the committee could not determine the TABLE 1 Summary of Findings Sufficient Evidence of a Causal Relationship Evidence is sufficient to conclude that a causal relationship exists between the exposure to a specific agent and a health outcome in humans. The evidence fulfills the criteria for sufficient evidence of an association (below)
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. · Exposure to uranium and lymphatic cancer; bone cancer; nervous system disease; nonmalignant respiratory disease; or other health outcomes (gastrointestinal disease, immune-mediated disease, effects on hematological parameters, reproductive or developmental dysfunction, genotoxic effects, cardiovascular effects, hepatic disease, dermal effects, ocular effects, or musculoskeletal effects)
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Finally, this report takes its place alongside several other recent IOM reports on the health of Gulf War veterans. Although the conclusions and recommendations presented here will not end the controversy surrounding Gulf War veterans' illnesses, this report will provide a scientific basis for consideration by the Department of Veterans Affairs as they develop a compensation program for veterans.
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· Long-term systematic research to examine potential adverse effects of anthrax and botulinum toxoid vaccination in multiple species and strains of animals. · Careful study of current symptoms, functional status, and disease status in cohorts of Gulf War veterans and Gulf War-era veterans for whom vaccination records exist.
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1995. Uranium dust exposure and lung cancer risk in four uranium processing operations.
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1990c. A new test for the diagnosis of growth hormone deficiency due to primary pituitary impairment: Combined administration of pyridostigmine and growth hormone-releasing hormone.
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2000. Health effects of depleted uranium on exposed Gulf War veterans.
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1999. Radiation exposure and cancer mortality in uranium processing workers.
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CONTENTS ADDRESSING GULF WAR HEALTH ISSUES........................................... Past and Current Efforts, 28 Complexities in Resolving Gulf War Health Issues, 29 Multiple Exposures and Chemical Interactions, 29 Limitations of Exposure Information, 31 Individual Variability, 31 Unexplained Symptoms, 32 28 THE GULF WAR SETTING 32 Deployment, 32 Living Conditions, 33 Environmental and Chemical Exposures, 33 Threat of Chemical and Biological Warfare, 34 SCOPE OF THE REPORT 35 ORGANIZATION OF THE REPORT 36 REFERENCES 36
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