Early dioxin exposure and later health effects

1
Early dioxin exposure and later health effects

• Proof of evidence Ringaskiddy-Indaver Pleanala
  Hearing

Gavin W. ten Tusscher, M.D., Ph.D.,
paediatrician Department of Paediatrics and
Neonatology Westfriesgasthuis, Hoorn, Netherlands
2
Overview

• Introduction
• Background exposures
• Accidents
• Final thoughts

3
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

4
What are Dioxins and PCBs?
 


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
5
Dioxins

• Are of the most toxic substances known
• Colourless crystals or solids in pure form
• Not intentionally produced except for small
  quantities for research

6
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

7
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

8
Accidents

• Yusho, Japan, 1968
• Yucheng, Taiwan, 1978
• Seveso, Italy, 1976
• Agent Orange, Vietnam War

9
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!

10
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?

11
Zeeburg

• 1960s large scale incinerations of various
  chemicals in largely unknown quantities in open
  air
• Seven-fold increase in cleft lips/palates

12
Miscarriages,prematurity

• Increased miscarriages and premature birth 60
  congenital malformations after Agent Orange
• Le et al. Reprod Health Matters 2001 9(18)
  156-64

13
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

14
Infancy and later childhood

• Disruption immune system
• Pluim et al. Acta Paediatr 1994 83(6) 583-7
• Weisglas-Kuperus et al. Pediatric Res 1995
  38(3) 404-10
• Nagayama 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) 583-7
• ten Tusscher et al. 2003 111(12) 1519-23
• Chickenpox at a younger age
• More middle-ear infections
• Less asthma
• Weisglas-Kuperus et al. Environ Health Perspect
  2000 108(12) 1203-7

15
Thyroid, liver

• Disregulation of thyroid function
• Pluim et al. Lancet 1992 339 1303, Environ
  Health Perspect 1993 101(6) 504-8
• Koopman-Esseboom et al. Pediatr Res 1994 36(4)
  468-73
• Liver damage
• Pluim et al. Acta Paediatr 1994 83(6) 583-7

16
Pulmonary problems

• Decreasing lung function with increasing prenatal
  exposure (p0.045)
• Decreasing lung function with increasing
  postnatal exposure (p0.0002)
• Increase in asthmatic complaints with increasing
  exposure (n4)
• ten Tusscher et al. Acta Paediatr 2001 90(11)
  1292-8

17
Italy

• Lichen very sensitive to SO2 concentrations
• SO2 good indicator of air pollution

18
Lichen biodiversity determined in 662 places in
Northern Italy (2 425 samples) Lung cancer
mortality 1981-1988 Cislaghi C Nimis PL.
Nature 1997 387463-4
19
Biodiversity and lung cancer r 0.95, P lt 0.001
20
Psychology, neurology

• Precocious neuromotor development
• Ilsen 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

21
Brain Development

• Ultra modern and sensitive testing (MEG)
• Retardation in brain development of on average 3½
  y
• Possible relation with behavioural problems

22
Teeth

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

23
Puberty, fertility

• Retardation in initiation breast development
• Leijs 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 dioxins
• De Felip et al. Toxicol Lett 2004 150(2) 203-9

24
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 incinerators
• Zambon 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

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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

26
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

27
Quick media search
1993 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
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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

29
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

30
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

31
Final thoughts

• What outcomes of biomonitoring and health
  monitoring will be considered relevant?
• Why not others?

32
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?

33
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?

34
Concluding

• Our children are already being exposed to
  concentrations that are too high dont 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