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Early dioxin exposure and later health effects

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. Overview. Introduction Background exposures

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Early dioxin exposure and later health effects

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  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 Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  4. What are Dioxins and PCBs? Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  8. Accidents • Yusho, Japan, 1968 • Yucheng, Taiwan, 1978 • Seveso, Italy, 1976 • Agent Orange, Vietnam War Gavin W. ten Tusscher

  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! Gavin W. ten Tusscher

  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? Gavin W. ten Tusscher

  11. Zeeburg • 1960s large scale incinerations of various chemicals in largely unknown quantities in open air • Seven-fold increase in cleft lips/palates Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  16. 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 Gavin W. ten Tusscher

  17. Italy • Lichen very sensitive to SO2 concentrations • SO2 good indicator of air pollution Gavin W. ten Tusscher

  18. 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 Gavin W. ten Tusscher

  19. Biodiversity and lung cancer r = 0.95, P < 0.001 Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  21. Brain Development • Ultra modern and sensitive testing (MEG) • Retardation in brain development of on average 3½ y • Possible relation with behavioural problems Gavin W. ten Tusscher

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

  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 Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  25. 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 Summarising Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  27. Quick media search Gavin W. ten Tusscher

  28. 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 Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  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 Gavin W. ten Tusscher

  31. Final thoughts What outcomes of biomonitoring and health monitoring will be considered relevant? Why not others? Gavin W. ten Tusscher

  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? Gavin W. ten Tusscher

  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? Gavin W. ten Tusscher

  34. 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 Gavin W. ten Tusscher

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