Recent dioxin contamination from Agent Orange in residents of a southern Vietnam city

Dioxins: an overview

This review article summarizes what is known about human health following exposure to dioxins. It is meant primarily for health professionals but was also written with the general public in mind. The need for such an article became apparent to the authors following media inquiries at the time the then Ukraine presidential candidate Victor Yushchenko was deliberately poisoned with the most toxic dioxin, tetrachlorodibenzodioxin or TCDD.

Agent Orange, Dioxins, and Other Chemicals of Concern in Vietnam: Update 2006

OBJECTIVE

The objective of this study was to find sites in Vietnam where there was human exposure from Agent Orange herbicide sprayed between 1962 and 1971, as determined by congener-specific measurement of dioxins, including 2,3,7,8-tetrachlorodibenzodioxin (TCDD), the dioxin that contaminated Agent Orange, in blood.

METHODS

Blood was collected from residents of eight heavily sprayed regions in the south of Vietnam and analyzed for TCDD and in some cases the dioxin-like dibenzofurans and dioxin-like PCBs.

RESULTS

Six of the eight newly studied sites did not show substantial or any elevated TCDD in blood. Marked elevation of TCDD in Vietnamese blood was found in one new location with a suggestion of slightly elevated TCDD in a second location.

CONCLUSIONS

In newly studied locations in Vietnam, we found some persons with elevation of TCDD consistent with exposure to dioxin from Agent Orange. In our previous studies, we found PCBs, PCDDs, and PCDFs as well as pesticides in human milk, blood, or in food. Health effects from Agent Orange need to be differentiated from effects caused by chemicals other than TCDD from Agent Orange.

Association between Agent Orange and birth defects: systematic review and meta-analysis

BACKGROUND

The association between parental exposure to Agent Orange or dioxin and birth defects is controversial, due to inconsistent findings in the literature. The principal aim of this study was to conduct a meta-analysis of relevant epidemiological studies that examined this association and to assess the heterogeneity among studies.

METHODS

Relevant studies were identified through a computerized literature search of Medline and Embase from 1966 to 2002; reviewing the reference list of retrieved articles and conference proceedings; and contacting researchers for unpublished studies. A specified protocol was followed to extract data on study details and outcomes. Both fixed-effects and random-effects models were used to synthesize the results of individual studies. The Cochrane Q test and index of heterogeneity (I2) were used to evaluate heterogeneity, and a funnel plot and Egger's test were used to evaluate publication bias.

RESULTS

In total, 22 studies including 13 Vietnamese and nine non-Vietnamese studies were identified. The summary relative risk (RR) of birth defects associated with exposure to Agent Orange was 1.95 [95% confidence interval (95% CI) 1.59-2.39], with substantial heterogeneity across studies. Vietnamese studies showed a higher summary RR (RR = 3.00; 95% CI 2.19-4.12) than non-Vietnamese studies (RR = 1.29; 95% CI 1.04-1.59). Sub-group analyses found that the magnitude of association tended to increase with greater degrees of exposure to Agent Orange, rated on intensity and duration of exposure and dioxin concentrations measured in affected populations.

CONCLUSION

Parental exposure to Agent Orange appears to be associated with an increased risk of birth defects.

The use of potassium dichromate and ethyl alcohol as blood preservatives for analysis of organochlorine contaminants

The "gold standard" for preserving and shipping of human tissue samples for analysis of organochlorine contaminants is freezing. This method can be difficult, costly if using heavy dry ice for shipping, and often unfeasible, especially in less developed countries where electricity and dry ice are frequently rare or absent. Therefore, it is essential that more convenient and practical methods for preservation of blood samples are found. As an alternative to freezing, there have been studies employing potassium dichromate as a preservative for human or cow's milk or ethyl alcohol preservation of blood for dioxin analysis. In this study, four methods were compared to investigate the effectiveness of ethyl alcohol and potassium dichromate as blood preservatives for analysis of dioxins, dibenzofuran, and polychlorinated biphenyl (PCB) congeners. Samples of whole blood from a Dallas, Texas hospital were collected and pooled. Freezing, ethyl alcohol in two concentrations (20% and 40% per volume of sample), and potassium dichromate were used for blood preservation. The blood samples containing potassium dichromate or ethyl alcohol were stored and sent to ERGO laboratory for dioxin analysis and comparison with results from the frozen sample, which was kept frozen at all times until analyzed. This study suggests that potassium dichromate is a suitable alternative to freezing for preservation of whole blood for dioxin, dibenzofuran, and PCB measurements when either lipid or wet weight based results are reported. Potassium dichromate tablets were very easy and convenient to use--two 100 mg tablets (with a dichromate content of about 33 mg each) were added to each bottle containing 65 ml of blood. However, ethyl alcohol at 20% and 40% concentration under the conditions of this pilot study and the analytical method employed did not appear to provide satisfactory preservation when lipid based results are given or when the fat content has to be determined (wet or whole weight). Further research with a larger number of samples, inclusion also of other groups of persistent organic pollutants such as organochlorine pesticides or brominated flame retardants, a longer duration of storage time, and at temperatures greater than US or German room temperature is indicated in order to recommend the routine use of potassium dichromate as preservative for whole blood intended for dioxin, dibenzofuran, and PCB analysis.

Exposure opportunity models for Agent Orange, dioxin, and other military herbicides used in Vietnam, 1961-1971

Nearly 19.5 million gallons of herbicides were sprayed on the Republic of Vietnam between 1961 and 1971 for military purposes. Amounts of spray and patterns of applications are available in an electronic file called HERBS that contains records of 9141 defoliation missions, including detailed coordinates of US Air Force Ranch Hand aircraft flight paths, along with chemical agent and gallonage sprayed. Two classes of models for use in epidemiological and environmental studies that utilize the HERBS data for estimating relative exposure opportunity indices are presented: a discrete "hits" model that counts instances of proximity in time and space to known herbicide applications, and a continuous exposure opportunity index, E4, that takes into account type and amount of herbicide sprayed, distance from spray application, and time interval when exposure may have occurred. Both direct spraying and indirect exposure to herbicide (or dioxin) that may have remained in the local environment are considered, using a conservative first-order model for environmental disappearance. A correction factor for dermal versus respiratory routes of entry has been incorporated. E4 has a log-normal distribution that spans six orders of magnitude, thus providing a substantial amount of discrimination between sprayed and unsprayed areas. The models improve on earlier ones by making full use of the geometry of the HERBS spray flight paths of Ranch Hand aircraft. To the extent possible so many decades after the War, the models have been qualitatively validated by comparison with recent dioxin soil and biota samples from heavily contaminated areas of Vietnam, and quantitatively validated against adipose dioxin obtained in epidemiological studies of Vietnamese. These models are incorporated within a geographic information system (GIS) that may be used, as one would expect, to identify locations such as hamlets, villages, and military installations sprayed by herbicide. In a novel application, the GIS also facilitates quantitative risk assessment in epidemiological and ecological studies by applying the models within a framework of historical reconstruction of exposure history of individuals based upon their location histories.

Legislation with respect to dioxins in the workplace

Legislation of chemicals is complex and doubts have often been expressed as to its effectiveness, but there are many problems involved in regulating chemicals from synthesis and use through to disposal. Using dioxins as an example of a chemical currently with complicating factors surrounding its control, this paper reviews its occupational legislation, chemistry, formation, toxicity, occurrence, and disposal in industrial situations, and sets this information in context by reference to its environmental occurrence and associated legislation. The role and limitations of legislation to control chemicals like dioxins, which are micropollutants and not intentionally produced, are discussed. Dioxins were chosen as the example because they are widespread, exposure occurs through a variety of routes, and they possess a reputation that ensures public concern. Because dioxins are ubiquitous and are predominantly produced by incineration, whether accidental or deliberate, intake is a total of all exposures from diet, environment and occupation. Occupational exposure is only one factor in this total, but this exposure may push total intake above recommended levels. Although overall exposure is reducing, public concern is rising, and this may be a consequence of greater scientific knowledge. Potential workplace exposures have been evaluated, and a sampling survey was recently undertaken in some of these sectors. The legal options are discussed, and the reasons for some decisions explained. Regulators have an unenviable task, and I believe there is only a fine balance between effective control and over-complicated prescriptive legislation.

Dioxin, dibenzofuran, and polychlorinated biphenyl (PCB) levels in food from Agent Orange-sprayed and nonsprayed areas of Laos

During the Vietnam War, a phenoxy-herbicide mixture called Agent Orange, which was contaminated with 2,3,7,8-tetrachlorodibenzodioxin, or TCDD, was used primarily for destruction of forest and other foliage in order to prevent enemy troop movement and protect American and allied troops and military bases in the south of Vietnam. Smaller areas of Laos and Cambodia were also sprayed with Agent Orange between 1962 and 1971 from fixed-wing aircraft. In 2001, 28 food samples consisting of meat, fish, and dairy products were collected in sprayed and nonsprayed areas of Laos and analyzed for dioxins, dioxinlike dibenzofurans, and selected polychlorinated biphenyl (PCB) congeners by high-resolution gas chromatography/high-resolution mass spectrometry at laboratories in Germany and Canada. Low levels of dioxin and other dioxinlike substances were found in Laotian food, similar to levels present in recent exported Vietnamese food to United States. Vietnam is geographically adjacent to Laos. Total dioxin toxic equivalent (TEQ) levels were similar in samples from sprayed and non-sprayed areas, ranging from 0.009 to 0.851 pg/g or parts per trillion (ppt) in sprayed Sepone, and from 0.022 to 0.537 pg/g or ppt wet weight in non sprayed Vientiane. However, the Laotian fish samples from the Agent Orange-sprayed area had, on average, a higher proportion of total TEQ from TCDD (31.7% vs. 9.4%) compared to the nonsprayed area. Some other food items, duck eggs and pork liver from Sepone, also had severalfold higher TCDD levels than similar food samples from Vientiane, 0.029 vs. 0.011 pg/g and 0.070 vs. 0.004 pg/g wet weight, respectively. There were no substantial differences in levels of dibenzofuran and PCB congeners. In general, elevated TCDD levels were not found in Laotian food samples. It is possible that dioxin-contaminated areas, or "hot spots," exist in Laos as they do in Vietnam, although they have not yet been identified.

Are Vietnamese food exports contaminated with dioxin from Agent Orange?

In this study the levels of dioxins and dioxinlike compounds, dibenzofurans, and polychlorinated biphenyls (PCBs) were measured in food exported from Vietnam to the United States. In the past, some Vietnamese fish was found to be contaminated with dioxin, 2,3,7,8-TCDD, or TCDD, from Agent Orange. U.S. commercial catfish farmers recently claimed that exported Vietnamese food, especially catfish, was contaminated with dioxin from Agent Orange and was thus a matter of concern to the U.S. Congress. In 2001, twenty-two exported Vietnamese food samples (mostly fish) were purchased in the United States and Laos to evaluate possible contamination with dioxin from Agent Orange. Dioxin, dibenzofuran, and coplanar PCB congeners were measured by high-resolution gas chromatography-high-resolution mass spectrometry by laboratories in Germany and Canada certified for dioxin analysis by the World Health Organization (WHO). In the current study, only low levels of dioxins and dioxinlike compounds were present in all exported Vietnamese food analyzed, despite recent findings of elevated levels of one dioxin, 2,3,7,8-TCDD, from Agent Orange exposure in some Vietnamese individuals, presumably due to food consumption. It appears unlikely that exported Vietnamese food is, in general, contaminated with large amounts of dioxin (TCDD) from Agent Orange or other sources. Further food sampling from areas of heavy Agent Orange spraying in Vietnam is warranted to map out where the source of TCDD contamination of food may be originating.

Food as a source of dioxin exposure in the residents of Bien Hoa City, Vietnam

Recently, elevated dioxin levels, over 5 parts per trillion (ppt) 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), from Agent Orange was reported in 95% of 43 selected residents of Bien Hoa City, a city in southern Vietnam near a former air base used for Agent Orange-spraying missions. Agent Orange herbicide, contaminated with TCDD, was sprayed in Vietnam between 1962 and 1971 primarily for use as a defoliant. Typical blood TCCD levels are 2 ppt in Vietnamese, but levels are as high as 413 ppt in Bien Hoa City. Elevated TCDD was found in children born many years after Agent Orange spraying ended and in immigrants from non-Agent Orange-sprayed parts of Vietnam, which documented new exposures. Extremely elevated soil TCDD samples, over 1 million ppt, and elevated TCDD in sediment were found in some nearby areas such as Bien Hung Lake. The primary route of intake of almost all dioxins in humans is food. However, in our prior studies in Bien Hoa, food was unavailable for dioxin analysis so the route of intake was not confirmed. In the 1970s, while Agent Orange was still being sprayed, elevated human milk TCDD levels as high as 1850 were detected in milk from Vietnamese people living in Agent Orange-sprayed areas where consumption of fish was high. Furthermore, also in the 1970s, elevated TCDD levels (up to 810 ppt) were found in fish and shrimp from the same area as the milk donors. In the 1980s, we found elevated TCDD and also other organohalogen levels in human tissue, pork, fish, a turtle, and a snake in Southern Vietnam. For these reasons, we recently collected food from Bien Hoa and analyzed it for dioxins, polychlorinated biphenyls (PCBs), DDT and its metabolites, and other organochlorines. We found marked elevation of TCDD, the dioxin characteristic of Agent Orange, in some of the food products, including ducks with 276 ppt and 331 ppt wet weight, chickens from 0.031-15 ppt wet weight, fish from 0.063-65 ppt wet weight, and a toad with 56 ppt wet weight. Usual TCDD levels in food are less than 0.1 ppt. Total TEQ for ducks was from 286-343 ppt wet weight or 536 ppt and 550 ppt lipid; for chickens from 0.35-48 ppt wet weight or 0.95-74 ppt lipid, for fish from 0.19-66 ppt wet weight or 3.2 ppt and 15,349 ppt lipid, and the toad was 80 ppt wet weight and 11,765 ppt lipid. Interestingly, this study did not find elevated levels of TCDD in the pork and beef samples. Clearly, food, including duck, chicken, some fish, and a toad, appears responsible for elevated TCDD in residents of Bien Hoa City, even though the original Agent Orange contamination occurred 30-40 years before sampling. Elevated levels of PCBs and DDT and its metabolites were found in some food samples. Furthermore, measurable levels of hexachlorocyclohexanes (HCH) and hexachlorobenzene (HCB) were found in a wide range of measurable levels. All of the 11 dioxin-like PCBs measured and presented plus 6 dioxins in addition to TCDD and 10 dibenzofurans contributed to the total dioxin toxicity (TEQ). However, when elevated, TCDD frequently contributed most of the TEQ. Thirty-six congeners from 7 classes of chemicals were measured in each of the 16 specimens providing a total of 576 congener levels.

Exposure assessment of residents living near a wood treatment plant

We report the results of environmental sampling and modeling in a neighborhood adjacent to a wood processing plant. This plant used creosote and pentachlorophenol (PCP) to treat wood for over 70 years. Between 1999 and 2001, environmental samples were obtained to quantify the level of environmental contamination from the wood processing plant. Blood from 10 residents was measured for chlorinated dioxins and dibenzofurans. Soil sediment samples from drainage ditches and attic/dust samples from nearby residents' homes were tested for polychlorinated dioxins, furans, and polycyclic aromatic hydrocarbons (PAH). The dioxin congeners analysis of the 10 residents revealed elevated valued for octachlorodibenzo-p-dioxin and heptachlorodibenzo-p-dioxin compatible with PCP as the source. The levels of carcinogenic PAHs were higher than background levels and were similar to soil contamination on wood preserving sites. Wipe sampling in the kitchens of 11 homes revealed that 20 of the 33 samples were positive for octachlorinated dioxins with a mean value of 10.27 ng/m2. The soil, ditch samples, and positive wipe samples from the homes indicate a possible ongoing route of exposure to the contaminants in the homes of these residents. Modeled air exposure estimated for the wood processing waste chemicals indicate some air exposure to combustion products. The estimated air levels for benzo(a)pyrene and tetrachlorodibenzodiozin in this neighborhood exceeded the recommended levels for these compounds in some states. The quantitative data presented suggest a significant contamination of a neighborhood by wood processing waste chemicals. These findings suggest the need for more stringent regulations on waste discharges from wood treatment plants.

Characterization of dioxin exposure in residents of Chapaevsk, Russia

Since 1967, a chemical plant in the town of Chapaevsk (Samara province, Russia) has produced large amounts of chlorinated compounds and is suspected to be a major source of local environmental dioxin contamination. Dioxins have been detected in the local air, soil, drinking water, vegetables, and cow's milk. Human exposure to dioxins is suspected as a factor in the deteriorating local public health. In an effort to characterize nonoccupational dioxin exposure among local residents, during the summer of 1998, 24 volunteers were recruited to donate blood and to provide information about their residence, employment, demographics, medical history, and dietary habits. Selected polychlorinated dibenzodioxins, dibenzofurans, and coplanar biphenyls were measured in blood serum samples. The mean concentration of total dioxin World Health Organization toxic equivalents (WHO-TEQ(98)) based on polychlorinated dibenzo-para-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and coplanar polychlorinated biphenyls (PCBs) was 61.2 (range 16.4-168.1) pg/g lipid. Subjects living in close proximity to the plant (less than 5 km) had significantly higher dioxin levels (mean WHO-TEQ(98), 75.7 pg/g lipid), as compared to subjects living more than 5 km from the plant (mean WHO-TEQ(98), 44.1 pg/g lipid) (P<0.04). Comparisons of the study results with available published data indicate that average blood dioxin levels were substantially higher in Chapaevsk residents than in nonoccupationally exposed populations of other parts of Russia, Europe, and North America. Chronic exposures of such magnitude may have appreciable adverse effects on public health.

Dioxin reservoirs in southern Viet Nam--a legacy of Agent Orange

In the isolated Aluoi Valley of central Viet Nam, very high levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) were measured in soil, fish fat, duck fat, pooled human blood and breast milk samples collected from A So village between 1996 and 1999. The village was situated on a former military base occupied by US Special Forces between 1963 and 1966. TCDD was a contaminant of the herbicide "Agent Orange", aerially sprayed in the valley between 1965 and 1970, and stored at the A So base. Measured levels were lower near the sites of two other former US bases in the valley which had been occupied for shorter periods of time. In areas where Agent Orange had been applied by low-flying aircraft, levels of TCDD in soil, food and human samples were elevated, but lower than those near the three former US bases. We confirm the apparent food chain transfer of TCDD from contaminated soil to cultured fish pond sediments to fish and duck tissues, then to humans as measured in whole blood and breast milk. We theorize that the Aluoi Valley is a microcosm of southern Viet Nam, where numerous reservoirs of TCDD exist in the soil of former military installations south of the former demilitarized zone. Large quantities of Agent Orange were stored at many sites, used in ground and aerial applications, and spilled. TCDD, through various forms of soil disturbance, can be mobilized from these reservoirs after decades below the surface, and subsequently, introduced into the human food chain.

Impact of chemical warfare with agent orange on women's reproductive lives in Vietnam: a pilot study

During the American war in Vietnam, huge quantities of the highly toxic herbicide dioxin ('Agent Orange'), were sprayed over large areas of central and south Vietnam. In addition to polluting the environment and causing cancers and other diseases in those directly exposed to it, dioxin has caused high rates of pregnancy loss, congenital birth defects and other health problems in their children. This paper reports the findings of a pilot study in the year 2000 among 30 Vietnamese women whose husbands and/or who themselves were exposed to Agent Orange. The aim was to develop research in order to explore the impact of chemical warfare on people's lives. Using the reproductive lifeline and semi-structured interviews, information was gathered on both partners' periods of exposure to Agent Orange, pregnancy outcomes, perceived health problems of children and experiences of living with handicapped children. The women had had a high number of miscarriages and premature births. About two-thirds of their children had congenital malformations or developed disabilities within the first years of life. Most of the families were poor, aggravated by impaired health in the men, the burden of caring for disabled children, and feelings of guilt and inferiority. The plight of 'Agent Orange families' is special and should be placed in its historical and political context.