Early dioxin exposure and later health effects

Early dioxin exposure and later health effects

Gavin W. ten Tusscher, M.D., Ph.D., paediatrician

Department of Paediatrics and Neonatology

Westfriesgasthuis, Hoorn, Netherlands

Proof of evidence: Ringaskiddy-Indaver Pleanala Hearing

Cork, 12-05-2009 Gavin W. ten Tusscher 2

Overview

– Introduction

– Background exposures

– Accidents

– Final thoughts


Why dioxins?

– Numerous chemicals potentially harmful, however …

– Dioxins are well studied

– Much data available on health effects

– Personal area of experience

– Dioxins are almost exclusively waste-products


What are Dioxins and PCBs?

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Dioxins

– Are of the most toxic substances known

– Colourless crystals or solids in pure form

– Not intentionally produced except for small quantities for research


Why a healthhazard?

– Extremely difficult to break down (metabolise), thus accumulating, long half-life

– Stored in fat (adipose) tissue

– Exposure via placenta and breast milk

– Europe has high background exposure levels


What is background exposure?

– Concentrations we are exposed to in our daily lives

– WHO recommendations as a result of extreme toxicity and potential for enormous health effects

– EU intake limit currently: 14 ng/kg BW/week


Accidents

– Yusho, Japan, 1968

– Yucheng, Taiwan, 1978

– Seveso, Italy, 1976

– Agent Orange, Vietnam War


Vietnam

– Agent Orange was dioxin contaminated defoliant used on large scale in South East Asia during Vietnam War

– Data is beginning to emerge of large scale • birth defects• illnesses• Cancers

– These effects are also seen in second and even third generations!


Birth Defects

– Increase in hypospadias, phimosis, cryptorchidism, SGA, spontaneous abortions in polluted part of Russia

Revich et al. Gig Sanit 2002; (1): 8-13

– Increased miscarriages and premature birth; 60% congenital malformations after Agent Orange

Le et al. Reprod Health Matters 2001; 9(18): 156-64

– Increase in orofacial clefts

ten Tusscher et al. Chemosphere 2000; 40: 1263-70

– Other birth defects?


Zeeburg

– 1960s large scale incinerations of various chemicals in largely unknown quantities in open air

– Seven-fold increase in cleft lips/palates

N on-syndrom al orofacial clefts: trend of incidence for 1960 -1969

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per 1000 births (live + stillborn)

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Miscarriages,prematurity

Increased miscarriages and premature birth; 60% congenital malformations after Agent Orange

Le et al. Reprod Health Matters 2001; 9(18): 156-64


Infant deaths

Increase in infant deaths and infant deaths with congenital disorders near solid waste incinerator

Tango et al. J Epidemiol. 2004 May; 14(3): 83-93


Infancy and later childhood

Disruption immune systemPluim et al. Acta Paediatr 1994; 83(6): 583-7

Weisglas-Kuperus et al. Pediatric Res 1995; 38(3): 404-10Nagayama et al. Chemosphere 1998; 37(9-12): 1781-7

ten Tusscher et al. 2003; 111(12): 1519-23

Reduced platelet counts (necessary for coagulation), persistent effect

Pluim et al. Acta Paediatr 1994; 83(6): 583-7ten Tusscher et al. 2003; 111(12): 1519-23

Chickenpox at a younger ageMore middle-ear infectionsLess asthma

Weisglas-Kuperus et al. Environ Health Perspect 2000; 108(12): 1203-7


Thyroid, liver

Disregulation of thyroid function

Pluim et al. Lancet 1992; 339: 1303, Environ Health Perspect 1993; 101(6): 504-8Koopman-Esseboom et al. Pediatr Res 1994; 36(4): 468-73

Liver damage

Pluim et al. Acta Paediatr 1994; 83(6): 583-7


Pulmonary problems

– Decreasing lung function with increasing prenatal exposure (p=0.045)

– Decreasing lung function with increasing postnatal exposure (p=0.0002)

– Increase in asthmatic complaints with increasing exposure (n=4)

– ten Tusscher et al. Acta Paediatr 2001; 90(11): 1292-8


Italy

– Lichen very sensitive to SO2 concentrations

– SO2 good indicator of air pollution


Lichen biodiversity determined in 662 places in Northern Italy (2 425 samples)

Lung cancer mortality 1981-1988

Cislaghi C & Nimis PL. Nature 1997; 387:463-4


Biodiversity and lung cancer r = 0.95, P < 0.001


Psychology, neurology

Precocious neuromotor developmentIlsen et al. Chemosphere 1996; 33(7): 1317-26

Increase in social problems & aggression in two environments (home and school) with dioxins

ten Tusscher et al. Thesis 2002

In boys less masculine play, in girls more masculine play, with increasing prenatal PCBs

Vreugdenhil et al. Env Health Perspect 2002; 110(10): A593-8


Brain Development– Ultra modern and

sensitive testing (MEG)

– Retardation in brain development of on average 3½ y

– Possible relation with behavioural problems


Teeth

More dental defects (caries and enamel)Alaluusua et al. Eur J Oral Sci 1996; 104(5-6): 493-7


Puberty, fertility

Retardation in initiation breast developmentLeijs et al. Chemosphere 2008; 73(6): 999-1004

Delay in genital and breast development in boys and girls with dioxins

Den Hond et al. Health Perspect 2002; 110: 771-6

Possibly increase in endometriosis with dioxinsDe Felip et al. Toxicol Lett 2004: 150(2): 203-9


Malignancy

Increased incidence of non-Hodgkin lymphoma (RR 2.3) in vicinity of municipal solid waste incinerator

Floret et al. Epidemiology 2003; 14(4): 392-8

Adolescent colorectal cancer and dioxin?Pratt et al. Lancet 1987; 2(8562): 803

Increased risk of sarcoma (RR 3.3) in vicinity of municipal solid waste incineratorsZambon et al. Environ Health 2007; 6: 19

Childhood cancer/leukaemia births are associated with high atmospheric emissions from combustion processes

Knox EG. Childhood cancers and atmospheric carcinogens. J Epidemiol Community Health 2005; 59: 101-5


Summarising

• Birth defects

• Hormone disruption

• Decreased lung function

• Reduced production blood platelets

• Immunity interference

• Increased cancer risk

• Influence on the thyroid

• Liver damage

• Dental problems

• Behavioural problems

• Retardation sexual development

• Retardation in brain development


Accidents

– Often argued that risk of accident in incineration plant is small

– The last years have shown numerous accidents at waste incinerators and by-product storage facilities, resulting in high local exposures


Quick media search1993 Explosion in vinyl chloride monomer works

1994 Incinerator in Duiven exceeds dioxin emission norm

1995 explosion in incinerator for non-industrial wastes

1996 Fire in waste incinerator in Holland, high dioxin emissions

1997 Incinerator in Rotterdam exceeds dioxin emission norm

1999 Increased incidence of serious diseases, incinerator link

2001 Toxic cloud emission from incinerator

2002 Elbe floods storage depot for dioxins (by-products of incinerations)

2002 Incinerator explosion Japan, 10 injured

2004 Explosion at hazardous waste incinerator, Argentina

2004 Dioxin emissions following faulty filters

2005 Fire at hazardous waste incineration, US, requiring evacuation 1,500 people

2007 Explosion in incinerator, US

2008 Toxic waste catches fire, India

2009 Radiation-tainted waste leaks during truck transport


Final thoughts

Is the Ringaskiddy area a coastal area at risk for flooding?

According to the World Health Organisation this would be an important reason to exclude the proposed site. Should flooding occur, the risk for human health effects would increase dramatically


Final thoughts

How much local experience is there in monitoring environmentally related health effects in children?

Probably limited, meaning that the population is extra at risk


Final thoughts

What biomonitoring needs to be performed in order to have a complete picture of possible environmental exposure?

Sampling of a number of index (key) substances is most probably not sufficient. All possible chemical exposures and their interactions upon each other first need to be assessed in order to have a baseline for comparison during biomonitoring


Final thoughts

What outcomes of biomonitoring and health monitoring will be considered relevant?

Why not others?


Final thoughts

What would Indaver and governmental institutions consider “acceptable” mortality and morbidity figures?

How many environmentally-related deaths and illnesses would be considered the threshold for cessation of activities?


Final thoughts

With whom does the financial responsibility for (possible) environmentally-related disease lie?

Bearing in mind the generally very long period of time between exposure and negative health effects, would Indaver be compelled to set aside monies in a fund for future victims?


Concluding

– Our children are already being exposed to concentrations that are too high – don’t increase it further!

– Any increase in this exposure, for instance in the case of an accident, only increases the damage done to them

– Dioxins and PCBs (POPs) remain in our bodies for many years

– It is not wise to risk the health and development of our children

Documents

Early dioxin exposure and later health effects