Dioxin in Viet Nam 40 Years after the American War€¦ · Dioxin analysis Congener pattern is...
Transcript of Dioxin in Viet Nam 40 Years after the American War€¦ · Dioxin analysis Congener pattern is...
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Dioxin in Viet Nam 40 Years
after the American War
Daniel Robie, Department of Chemistry, York College, CUNY
Jean Grassman, Health & Nutrition Sciences/CUNY School of Public Health
April 10, 2014
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Dioxin
What is dioxin?
Why should we care about it?
◦ From exposure to health effects
Seeking chemical justice for Vietnam
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Dioxins are a class of compounds
with two aromatic rings.
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Properties of TCDD
Molar mass 322 g/mol
Melting point 305C
Boiling point Decomposes
Saturated vapor pressure ~1 ntorr
Water solubility 20 ng/L
Octanol-water partition ratio 107
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2 + 2HCl
How TCDD is made
Pentachlorophenol is a fungicide for wood. Since 1872 it has been known that it dimerizes with loss of HCl to OCDD.
2,4,5-trichlorophenol dimerizes with loss of HCl to TCDD, as shown in 1957.
2,4,5-trichlorophenol 2,3,7,8-tetrachlorodibenzo-p-dioxin
(TCDD)
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How TCDD is made
• Minor product in manufacture of
2,4,5-trichlorophenoxyacetic acid (2,4,5-T).
• Originally 60 ppm, then reduced to .005 ppm
through temperature control.
2,4,5-trichlorophenoxyacetic acid
(2,4,5-T)
2,3,7,8-tetrachlorodibenzo-p-dioxin
(TCDD)
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Small amounts of dibenzodioxins and
dibenzofurans are generated in nearly
all low-temperature combustion
systems that have C, H, O, and Cl. (E.g.,
polyvinyl chloride combustion.) It’s
ubiquitous.
In the dark, it’s not very reactive. • At water surface, 1/2 = 21 hr in summer
• Underground, 1/2 = 12 yr
• No bacterial degradation.
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Dioxin analysis
Congener pattern is characteristic of source. (Agent Orange has mostly TCDD.)
Method must be extremely sensitive; therefore easy to overwhelm; limit of detection must be ~1 fg/g (.001 parts per trillion). Maximum contaminant level in dirt from EPA is .03 ppt. Human blood TCDD is usually <10 ppt.
Depends on matrix: blood, tissue, water, soil, dust, herbicide
GC separation followed by isotope dilution MS with 13C12
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Mass spectrum of TCDD from Agilent 6890/5973
50 pg/g = 50 ppt
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Famous cases
Agent Orange in Vietnam, 1961-71
Seveso, Italy in 1976: explosion in ICMESA
plant
Vienna, Austria poisonings in 1997
Yushchenko poisoning in Ukraine, 2004
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Dioxin
What is it?
Why should we care about dioxin? ◦ Environmental contamination: US/Vietnam
◦ Exposure
◦ Health effects
Seeking chemical justice in Vietnam
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municipal solid waste incineration
backyard barrel burning
medical waste incineration
secondary copper smelting
Dioxin releases have declined
USA: Sources of dioxins
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Vietnam-Volume of herbicide used
(1961-1971)
Units are liter/grid (~1.2 km2)
Agent Orange Agent White Agent Blue
Stellman et al., 2003
~~77 million liters (20 million gallons) of herbicides, including 49.3 million
liters (13 million gallons) of Agent Orange
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http://ehp.niehs.nih.gov/docs/1998/106-2/focus.html
Global circulation of POPs
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http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/D/DDT_chain.gif
Biomagnification
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Dioxin exposure pathway for humans: Most exposure comes from dietary animal fats
jan.ucc.nau.edu/
Global distribution Formation/release Biomagnification Consumption
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The good news/bad news about dioxin metabolism in humans
The bad news is humans have limited capacity for
metabolism: TCDD ½=7-10 years
The good news is because of the long half life, it is
possible to detect long term accumulation of dose:
Measure TCDD/dioxins in blood lipids.
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Patterson et al., 2005
USA: Dioxin body burdens as Total TEQ:
Age specific 90th percentiles
Age range (years) Dioxin TEQ (ppt)
15-29 14
30-44 21
45-59 30
>60 73
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TCDD ppt Lipid adjusted
Bien Hoa
n=43
North
n=5
<10 7 (16%) 5 (100%)
10 to <50 10 (23%)
50 to <100 11 (26%)
100 to <200 10 (23%)
>200 to 413 5 (12%)
Vietnam: Serum TCDD levels in adults as
measured in 1999-2001
Schecter et al., 2002 JOEM 44: 218-220
Compare with age specific 90th percentile of 70 ppt
amongst US residents > 60 years old
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Dioxin Reassessment USEPA http://cfpub.epa.gov/ncea/CFM/nceaQFind.cfm?keyword=Dioxin
Adults
1-3 pg/kg-day
Breast-fed infants
~70 pg/kg-day
USA: Estimated intake of TCDD
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EPA TCDD Reference Dose
0.7 pg/kg-day!
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0.7 pg/kg-day!
Adults
1-3 pg/kg-day
Breast-fed infants
~70 pg/kg-day
EPA TCDD Reference Dose
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Schecter et al., Dioxin 2008 An update on Agent Orange: Vietnamese and US Collaboration
TCDD in breast milk
1970 location n TCDD ppt
Dong Nai Village 1 1,832
Dong Nai Village 1 1,465
Can Gio Village 1 732
Sai Gon Village 1 257
Boston, MA, USA 1 BDL (29 ppt)
1980s
USA NY & LA 42 x = 3.3
Hanoi 28 x = 2.2
Ho Chi Minh City 38 x = 7.1
• Developed countries: 10-35 pg/g milk fat
• Developing countries: <10 pg/g milk fat
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TCDD
adapted from http://dir.niehs.nih.gov/dirlcbra/mechanism.gif
TCDD alters transcription
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Epidemiology provides evidence that TCDD
is a carcinogen
Ranch Hand update by Michalek and Pavuk (2008)
• Diabetes and cancer: Based on stratification by years of spraying and time spent in Southeast Asia
New Zealand Vietnam vets cohort follow-up 1988-2008 by McBride, et al. (2013)
• Significantly increased incidence of chronic lymphocytic leukemia
• Non-significantly increased incidence of all cancer, prostate cancer, lung cancer, multiple myeloma, Hodgkin Disease, etc.
Boehringer-Ingelheim cohort follow-up through 2007 by Manuwald, et al. (2012) • 1,589 workers, with TCDD measurements
• Increased all-cause and all-cancer (SMR=1.37; 95% CI 1.21-1.56) mortality
• Increased respiratory, esophageal and other cancer deaths in males
• Increased breast cancer (SMR=1.86; 95% CI 1.12-2.91) in female workers
• Significant trend with increasing TCDD levels
Adapted from Richard Clapp, 2013
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Seveso twenty-year cancer incidence update by Pesatori, et al.
(2009)
• Excess lymphatic and hematopoietic cancer in Zones A and B
• Excess breast cancer in Zone A (RR=1.43; 95% CI 0.71-2.87)
Seveso Women’s Health Study second follow-up by Warner, et al.
(2011)
• All cancer HR was 1.80 (95% CI 1.29-2.52) for each 10-fold increase in
serum TCDD
• Breast cancer HR was 1.44 (95% CI 0.89-2.33)
Adapted from Richard Clapp, 2013
Epidemiology provides evidence that TCDD
is a carcinogen
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What is known about the
developmental effects with--- 1) Maternal exposure in animal models--
• Biochemical, immunological, and endocrine abnormalities
2) Prenatal and/or breast milk exposure due to maternal environmental
exposure
• alterations in play behavior in Japan (Nakajima et al., 2006)
• delayed breast development in Belgium (Leijs et al., 2008)
• significant decline in growth measures over 3 years with increasing TEQ
in Chapaevsk, Russia boys (Burns, et al. 2009, 2011)
3) Maternal exposure to an accidental release in Seveso, Italy
• persistent alteration in thyroid function (Baccarelli et al., 2008)
4) Exposure during adolescence in Seveso, Italy
• Alterations in sperm count and motility upon maturation (Mocarelli et al., 2008)
5) Vietnam-Perinatal/paternal/maternal exposure after exposure to Agent Orange
• congenital abnormalities (during the war) (Phuong et al., 1989)
• altered growth and neurodevelopment with contemporary exposure
(Nishijo et al., 2012)
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Evidence of developmental effects
6) Transgenerational impact of dioxins (Manikkam et al., 2012)
• changes to germ line inherited in absence of direct exposure
• Differential epimutations in 50 promoter regions
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Evidence of developmental effects 5) Transgenerational impact of dioxins (Manikkam et al., 2012)
• changes to germ line inherited in absence of direct exposure
• differential epimutations in 50 promoter regions
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Dioxin
What is it?
Why should we care about it?
◦ Health effects
◦ Widespread environmental contaminant
◦ Intentional use in Vietnam
◦ Exposure
Seeking chemical justice in Vietnam
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Public Health/Science Committee
Vietnam Agent Orange Relief & Responsibility Campaign
Dr. Michael McGarvey
Ms. Marie Elivert
Dr. Franklin Mirer
Dr. Carole Baraldi
Ms. Susan Schnall
Dr. Daniel Robie
Dr. Jean Grassman
With Dr. Tran Ngoc Tam
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Thai Binh
Hue A Luoi Danang
Ho Chi Minh City
Hanoi
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Exposure scenarios that may result
in health effects from Agent Orange
1) Exposure during the conflict due to aerial spraying
2) Contemporary exposures from residual and ongoing contamination
3) Contemporary manifestation of exposure sustained during the war due
to transgenerational effects of dioxins
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Questions that emerged:
1) Contemporary exposure: Is the populace exposed to dioxins
due to sites that remain contaminated?
2) Health impact of past exposure: Has the health of the populace
been affected by the historical spraying of Agent Orange?
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Questions that emerged:
1) Contemporary exposure: Is the populace exposed to dioxins
due to sites that remain contaminated?
Observation of contaminated sites
2) Health impact of past exposure: Has the health of the populace
been affected by the historical spraying of Agent Orange?
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Danang
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Reference
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A Luoi–site of former airbase
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A Luoi today
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Questions that emerged:
1) Contemporary exposure: Is the populace exposed to dioxins
due to sites that remain contaminated?
2) Health impact of past exposure: Has the health of the populace
been affected by the historical spraying of Agent Orange?
Investigated evidence of chronic illness & developmental effects
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Visits to the homes of affected veterans….
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And affected children….
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Peace Village in
Ho Chi Minh City
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Children’s home in Danang
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Friendship Village in Danang
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Discussions with medical and public
health practitioners
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Dr. Phuong
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Remediation of contaminated sites
$77 million appropriated for remediation and health care up to 2012, mostly since 2007.
U.S. agreement with Viet Nam 12/30/09 for remediation at Da Nang
Vietnamese target of 150 ppt, between the USEPA’s preliminary remediation goals of 50 ppt for residential areas and 664 ppt for industrial areas
Dioxin mass to be removed between 150 and 0.1 kg.
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In Pile Thermal Desorption
(IPTD®) 77000 m3 of dirt moved, heated under
vacuum; will remove between 0.1 and 150 kg dioxins
Must remove water to get to 335C
Capture of vapor on activated carbon and porous polymer. Effluent into the air.
We saw some evidence of preliminary work in June 2012.
Construction and dirt accumulation completed. Heating begins April 2014.
Project to complete by December 2016.
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H.R. 2519
Victims of Agent Orange Relief Act of 2013
Introduced to the U.S. House of Representatives on June 26, 2013 by Congresswoman Barbara Lee for herself and 7 others.
This act will:
◦ Provide medical assistance and disability benefits to affected children of American Vietnam veterans
◦ Provide health care and social services for affected Vietnamese
◦ Provide health care for affected Vietnamese Americans and their offspring, and
◦ Clean up the lands and restore the ecosystems contaminated by dioxins in Vietnam
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Veterans and Agent Orange:
Update 2010
Limited or Suggestive Evidence of an Association
Laryngeal cancer
Cancer of the lung, bronchus, or trachea
Prostate cancer
Multiple myeloma
AL amyloidosis
Early-onset peripheral neuropathy
Parkinson disease
Porphyria cutanea tarda
Hypertension
Ischemic heart disease
Type 2 diabetes (mellitus)
Spina bifida in offspring of exposed people
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Veterans and Agent Orange:
Update 2010 Eighth biennial review since 1994, published by National
Academies Press (2011)
Confirmed “Sufficient Evidence of an Association” for soft tissue sarcoma, non-Hodgkin lymphoma, chronic lymphocytic leukemia, Hodgkin lymphoma and chloracne
Confirmed “Limited or Suggestive Evidence of an Association” for several other cancers, early-onset peripheral neuropathy, Parkinson disease, diabetes, spina bifida in offspring, and other diseases (see www.books.nap.edu)
Adapted from Richard Clapp, 2013
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Conclusions • The health impact of dioxins is well-documented; possibility of
transgenerational effects.
• Everyone is exposed, but some are exposed more than others.
• Long half life enables assessment for years after the release of dioxins.
• Some areas of Vietnam are still contaminated with dioxins. • Desirable contaminated sites (Danang airbase, Bien Hoa) will be remediated while other
sites (A Luoi) have received relatively little attention
• We observed children with severe congenital anomalies.
• Variety of anomalies; cannot comment on causation
• Hazard exists and the population merits further support and monitoring
for the impact of Agent Orange/dioxin. • Little is known about paternal exposure and possible transgenerational effects.
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References
Collins, et al. AJE, 2009
Baccarelli, et al., PLOS, 2008
Burns, et al., EHP, 2009 and 2011
Pesatori, et al., Env Health, 2009
McBride, et al., OEM, 2013
Michalek and Pavuk, JOEM, 2008
Warner, et al., EHP, 2011
Manuwald, et al., OEM, 2012
Mocarelli, et al., EHP, 2008
National Academies Press, 2011
Adapted from Richard Clapp, 2013
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