Information Paper Pesticides Some Gulf War veterans have reported unexplained illnesses some suspect are related to exposure to pesticides during the war. The Office of the Special Assistant conducted a health-risk assessment whose results suggest some veterans may have been exposed to certain pesticides at concentrations above those recognized as safe. During the Gulf War, preventive medicine personnel anticipated the need to control regional pests-especially sand flies and mosquitoes-which carry several infectious diseases, including leishmaniasis, sand fly fever, and malaria. Because sand fly fever had been widespread in Iran and Iraq during World War II, US health officials viewed it as one of the most serious infectious disease threats. Of the 697,000 US servicemembers deployed during the Gulf War, only 40 cases of insect-borne infectious diseases were reported. Military analysts attributed this low incidence to the establishment of a comprehensive preventive medicine structure, favorable weather, dry desert locations for most units, and pesticide use. During the Gulf War, US forces had available for use at least 64 pesticide and repellant products, including sprays, powders, baits, pest strips, and flypaper. These products were of five major formulations: organophosphorus pesticides, such as malathion and chlorpyrifos; carbamate pesticides, such as bendiocarb; one organochlorine, lindane; pyrethroid pesticides, such as permethrin; and insect repellents, such as DEET. Investigators focused on 12 active ingredients contained in 15 pesticides of potential concern investigators believed posed the greatest potential hazard to US servicemembers based on prevalence and manner of use and toxicity. The Environmental Protection Agency (EPA) and the Food and Drug Administration had approved the lindane dust used to delouse enemy prisoners of war. EPA had approved all other pesticides and repellents supplied by the military during the Gulf War and did not consider them harmful when used according to instructions. Since then, the EPA has directed phasing out two-diazinon and chlorpyrifos-for general use and has also proposed to eliminate most uses of dichlorvos-containing pest strips. Some pesticides used in the Gulf War were purchased locally by authorized personnel for unit use, or by individuals for their personal use, and may not have been registered with the EPA. Based on a preliminary review, we found in Gulf War hospital and personnel medical records only one documented case of acute health problems from pesticide exposure. A recent follow-up interview with this veteran revealed he currently does not suffer from any adverse health effects associated with the exposure. When other records are fully cataloged in an automated system, other evidence of acute exposures and related symptoms may emerge. Servicemembers most likely to have experienced the highest risk for pesticide overexposure included trained, certified pesticide applicators, field sanitation teams, and military police who conducted delousing. Some of the general military population also may have been overexposed. For example, 7 percent of servicemembers may have been exposed to pest strips hung in various indoor locations to control flying insects. Even when pest strips were used as directed, because servicemembers spent long times in areas where pest strips were hung, some exposures may have been higher than recommended amounts. Approximately 30,500 servicemembers may have been at greater risk for short-term health effects from exposure to pest strips. Fly baits, purchased locally and issued by the military, may have been used in many areas where personnel worked, ate, and slept and often were placed in open containers inside and outside buildings and tents or spread on the ground. Military guidance and labels on EPA-registered products authorized outdoor use only. Besides trained pesticide applicators, other Gulf War veterans could have been at higher-than-typical risk of pesticide overexposure, including those exposed to pest strips and fly bait used improperly indoors and those whose duties were expanded to applying pesticides but who lacked sufficient training or protective equipment. Some veterans also reported they wore flea and tick collars designed for use on pets. Some reported local skin reactions. However, because of the slow release of the active ingredients and small amount of skin exposure, it is unlikely anyone absorbed large amounts of the active ingredients through their skin. The RAND Corporation reviewed independent scientific literature on pesticides' possible health effects. The review suggests but does not conclude pesticides, specifically acetylcholinesterase inhibitors such as organophosphates and carbamates, could be among the potential contributing agents to some of Gulf War veterans' reported undiagnosed illnesses. Some literature suggests unless individuals had symptoms of serious pesticide poisoning or toxicity from organophosphate and carbamate pesticides when initially exposed, health effects months or years later are unlikely. RAND concludes from its literature review short-term symptoms do not necessarily indicate long-term effects. Some people are more susceptible to pesticides' effects than others, due perhaps to several factors, including genetic makeup. For example, some people may be more efficient than others at detoxifying and clearing pesticides from their bodies. Gulf War veterans are eligible for a free, comprehensive medical evaluation. The Department of Defense established the Comprehensive Clinical Evaluation Program (CCEP) for Gulf War veterans still on active duty, serving in the National Guard or Reserves, or retired from military service. To schedule a CCEP evaluation call (800) 796-8631. The Department of Veterans Affairs administers a similar program for veterans no longer in the military. To schedule a VA evaluation, call (800) 749-8387. More detailed information on pesticides and other research projects of the Office of the Special Assistant is available on the Internet at GulfLINK. |
