ENVIRONMENTAL EXPOSURE REPORT
The Office of the Special Assistant for Gulf War Illnesses (OSAGWI) has published an interim report on the results of an investigation into pesticide use and exposure during the Gulf War. The OSAGWI report is about the pesticides that were used, how they were used, and it addresses the known health effects that may have been experienced by individuals who were exposed to pesticides during their deployment in Operations Desert Shield/Desert Storm. In pursuing each of these issues the investigators attempted to determine the role pesticides might have played in the undiagnosed illnesses reported by some Gulf War veterans. A secondary goal was to examine issues surrounding pesticide use as part of the continuing efforts to advance force health protection issues especially those involving the handling and use of pesticides. The information provided in this document summarizes the findings and conclusions reached during the course of that investigation.
The requirement for pesticide use in the Kuwait Theater of Operation (KTO) arose due to the prevalence of pests such as filth flies, sand flies, mosquitoes, fleas, and lice indigenous to this part of the Middle East. These insects carry several infectious diseases, including leishmaniasis, sand fly fever, malaria, and typhus. Unabated, these diseases were believed to be capable of incapacitating a large number of the US and Coalition fighting force.
To combat this threat more than 60 different pesticide products and formulations were used during the Gulf War. This total includes a variety of products that include sprays, powders, baits, pest strips, and flypaper. Depending on its intended use and the pest it was formulated to target, most of the pesticide products consisted of at least one active ingredient and one or more inert ingredients. A complete analysis of all pesticides used during the Gulf War was not practical. Therefore, we applied a series of carefully selected screening criteria to reduce the number to those considered to have the greatest potential to cause adverse health effects those that were considered to be the pesticides of potential concern (POPCs). Precautions in the development of the screening factors were taken to ensure the significance or potential threat of any pesticide was not trivialized and that pesticides that have historically been associated with disease in humans were included in the investigation.
Based on a thorough analysis of the available data, OSAGWI investigators focused on 15 POPCs containing 12 active ingredients. The compounds consist of five organophosphate pesticides (azamethiphos, chlorpyrifos, diazinon, dichlorvos and malathion); three carbamate pesticides (bendiocarb, methomyl, and propoxur); two pyrethroid pesticides (permethrin and d-phenothrin); one organochlorine pesticide (lindane); and one repellent (DEET). Investigators believe these active ingredients posed the greatest potential hazard to US servicemembers due to manner of use, prevalence of use, and toxicity.
Some pesticide products containing these active ingredients were used only on a limited basis, and some were used by only a very small number of US service members. Others received widespread use and were largely available to the general military population. All were considered safe at the time for general use under normal application conditions and when applicators followed instructions for use on the packaging labels.
These or similar pesticide products were available for purchase by the general public at local garden and hardware supply stores and, when used during the Gulf War, were approved by the US Environmental Protection Agency (EPA) and/or the US Food and Drug Administration for general use by the US public. However, in recent years, EPA has moved to limit the uses of some of the active ingredients, due mainly to concerns about possible impacts on the health of children. Some pesticide products, such as the fly bait Snip� , were purchased in-theater by authorized personnel for unit use or by individuals for their personal use. Some of these locally purchased products were not registered with the EPA.
Information contained in the OSAGWI report is the result of several key tasks that comprised the overall investigation; these included:
review of various databases on background issues associated with the use and application of pesticides;
review of DoD policies and guidelines on the use and management of pesticides;
literature review, conducted by RAND, of the health affects associated with pesticide exposure;
random survey of more than 2,000 Gulf War veterans, also conducted by RAND, to obtain information on the use of and exposure to pesticides used during the Gulf War;
interviews by OSAGWI investigators with approximately 700 preventive medicine personnel as well as approximately 200 interviews with other personnel to acquire information on pesticide application and management practices; and
an independently reviewed health risk assessment (HRA) developed in conjunction with the US Environmental Protection Agency that estimates the likelihood that exposures to pesticides during the Gulf War may have been connected to acute effects at the time of exposure.
The investigation was hampered by the lack of quantitative data on the amount of pesticides used during the Gulf War, and the levels of pesticides present in the air and on surfaces to which US troops were exposed. The investigation also lacked information from veterans hospital and medical records. Collectively this lack of data resulted in significant uncertainties in the findings and conclusions of the HRA. To reduce these uncertainties and better characterize the risk from pesticide exposure, further research is needed in several key areas, including: the effects of low-level pesticide exposures; pesticide interactions with other chemical compounds, such as pyridostigmine bromide; record searches of more than 28,000 patient records for evidence of pesticide poisoning and overexposure; and epidemiological studies involving pesticide applicators.
In the absence of sampling data and information about actual pesticide application rates that we otherwise would have used, we relied in part on the results of the RAND survey and approximately 700 interviews with preventive medicine personnel to determine exposure levels. Of these interviews, 252 provided specific information related to exposure (e.g., frequency with which a pesticide was applied, application rates, personal protective equipment worn, etc.). An additional 60 provided more general information without specifics relating to issues of exposure. Investigators also interviewed approximately 200 non-preventive medicine personnel regarding lindane use in delousing enemy prisoners of war, and the use of fly baits.
As noted above, information contained in this report refers to the results of two RAND studies. The first study presents the results of a medical and scientific literature review on the health effects associated with pesticide exposure. The literature review reports in detail on the health effects of the 12 POPC active ingredients, identified by OSAGWI, contained in pesticide products used during the Gulf War. The second study presents the results of a survey of 2,005 Gulf War veterans, focusing on how pesticides were used during the Gulf War.
The OSAGWI report is organized into three parts. Part A is the Environmental Exposure Report with information on the background issues associated with pesticide use, handling, management, and training during the Gulf War. Part A also summarizes the recognized health effects associated with exposure to pesticides and contains a non-technical summary of the health risk assessment that was prepared to provide an estimate of the likelihood that various short-term effects occurred during deployment due to exposure to pesticides. Part B is the complete health risk assessment, which is a highly technical report. Part C contains information used to support or expand the discussion of selected topics presented in Parts A and B, including a description of DoD guidance on the use, application, and management of pesticides; additional information on fly baits and delousing operations; procur