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Agent Orange 2011

Overview. What is/are dioxin(s)VHA response to Vietnam WarPresumptive conditionsExposures of special groupsThe futureResourcesQuestions. Herbicide (Agent) Orange (1). 1:1 mixture of 2,4-dichlorophenoxy acetic acid (2,4-D, 50%) and 2,4,5-trichlorphenoxyacetic acid (2,4,5-T, 50%) 2,4,5-T was u

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Agent Orange 2011

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    1. Agent Orange 2011 Science, Politics, Policy and Practice

    2. Overview What is/are dioxin(s) VHA response to Vietnam War Presumptive conditions Exposures of special groups The future Resources Questions

    3. Herbicide (Agent) Orange (1) 1:1 mixture of 2,4-dichlorophenoxy acetic acid (2,4-D, 50%) and 2,4,5-trichlorphenoxyacetic acid (2,4,5-T, 50%) 2,4,5-T was used extensively as an herbicide in forestry and agriculture domestically and abroad starting in the 1940s. Shipped to Vietnam in 55-gallon steel drums with an orange stripe around the middle ~12/19x106 gallons used in Vietnam = A.O.

    4. Herbicide (Agent) Orange (2) 2,4-D 2,4,5-T

    5. Other Herbicides Used in Vietnam Picloram Cacodilic Acid Dibenzofurans

    6. Heavily Sprayed Areas - Map Inland forests near the demarcation zone Inland forests at the junction of the borders of Cambodia, Laos, and South Vietnam Inland forests north and northwest of Saigon Mangrove forests on the southernmost peninsula of Vietnam Mangrove forests along major shipping channels southeast of Saigon

    7. Dioxins A group of chlorinated dibenzo-p-dioxins (CDDs) with 75 isomeric forms of 2,3,7,8-tetrachlorobenzo-p-dioxin (TCDD) A condensation reaction occurred during production of 2,4,5-trichlorophenol resulting in the creation of TCDD, a contaminant. (TCDD)c varied by lot: 1-50 ppm Handout

    8. Dioxins - Pharmacology Entry – skin, respiratory and GI tracts Extremely lipophilic – fat, liver. T1/2 – 7 to 10 years Ah (aromatic hydrocarbon) receptor activation in mouse and humans Aryl Hydrocarbon Hydroxylase (AHH) - inducible enzyme Excretion - ?bile or urine

    9. Dioxins - Toxicology Varies by species Involves many systems – skin, endocrine, reproductive (female,) liver, CNS (?) Human toxicity determined variously Chloracne - clinical:dose/response toxicity Lymphoma – domestic agriculture Reproductive – Seveso, Italy et. al. Diabetes - Epidemiology

    10. Politics Congress ordered the end of Herbicide Orange spraying when two studies showed birth defects and other endocrine-related pathology in rats For the purposes of policy re: presumptive conditions, the Department of Veterans Affairs does not require the same order of “proof” of toxicity as do scientists.

    11. Federal Response to Vietnam 1970s - Agent Orange examination and Agent Orange Review 1980s – Epidemiology/Case law/Legislation VHA EES; CDC 1991 – Agent Orange Act 1960s – 2011 – Scientific Study 1980s – Air Force Ranch Hand 1990s et. seq. – NAS/IOM biennial AO Report

    12. Presumptive Conditions (1) Acute and Subacute Peripheral Neuropathy?A nervous system condition that causes numbness, tingling, and motor weakness. Under VA's rating regulations, it must be at least 10% disabling within 1 year of exposure to herbicides and resolve within 2 years after the date it began. AL Amyloidosis?A rare disease caused when an abnormal protein, amyloid, enters tissues or organs. Chloracne (or Similar Acneform Disease)?A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers. Under VA's rating regulations, chloracne (or other acneform disease similar to chloracne) must be at least 10% disabling within 1 year of exposure to herbicides.

    13. Presumptive Conditions (2) Chronic B-cell Leukemias?A type of cancer which affects white blood cells. Diabetes Mellitus (Type 2)?A disease characterized by high blood sugar levels resulting from the body’s inability to respond properly to the hormone insulin. Hodgkin’s Disease?A malignant lymphoma (cancer) characterized by progressive enlargement of the lymph nodes, liver, and spleen, and by progressive anemia.

    14. Presumptive Conditions (3) Ischemic Heart Disease?A disease characterized by a reduced supply of blood to the heart, that leads to chest pain. Multiple Myeloma?A cancer of plasma cells, a type of white blood cell in bone marrow. Non-Hodgkin’s Lymphoma?A group of cancers that affect the lymph glands and other lymphatic tissue.

    15. Presumptive Conditoins (4) Porphyria Cutanea Tarda?A disorder characterized by liver dysfunction and by thinning and blistering of the skin in sun-exposed areas. Under VA's rating regulations, it must be at least 10% disabling within 1 year of exposure to herbicides. Prostate Cancer?Cancer of the prostate; one of the most common cancers among men.

    16. Presumptive Conditions (5) Respiratory Cancers?Cancers of the lung, larynx, trachea, and bronchus. Soft Tissue Sarcoma (other than Osteosarcoma, Chondrosarcoma, Kaposi’s sarcoma, or Mesothelioma)?A group of different types of cancers in body tissues such as muscle, fat, blood and lymph vessels, and connective tissues.

    17. Other Military Exposures Korea Waterways Inland Costal On-shore Blue water* *Requires specific information

    18. Women Veterans and Offspring Am J Ind Med. 2000 Oct;38(4):447-54. Pregnancy outcomes among U.S. women Vietnam veterans. Kang HK, Mahan CM, Lee KY, Magee CA, Mather SH, Matanoski G. A comparison of self-reported pregnancy outcomes for 4,140 women Vietnam veterans with those of 4,140 contemporary women veterans who were not deployed to Vietnam. There was no statistically significant association between military service in Vietnam and index pregnancies resulting in miscarriage or stillbirth, low birth weight, pre-term delivery, or infant death. The risk of having children with "moderate-to-severe" birth defects was significantly elevated among Vietnam veterans (adjusted OR = 1.46, 95% CI = 1.06-2.02).

    19. Covered Birth Defects (1) Achondroplasia Cleft lip and cleft palate Congenital heart disease Congenital talipes equinovarus (clubfoot) Esophageal and intestinal atresia Hallerman-Streiff syndrome

    20. Covered Birth Defects (2) Hip dysplasia Hirschprung's disease (congenital megacolon) Hydrocephalus due to aqueductal stenosis Hypospadias Imperforate anus Neural tube defects

    21. Covered Birth Defects (3) Poland syndrome Pyloric stenosis Syndactyly (fused digits) Tracheoesophageal fistula Undescended testicle Williams syndrome

    22. Death from Agent Orange Surviving spouses, dependent children and dependent parents of Veterans who were exposed to Agent Orange and died as the result of diseases related to Agent Orange exposure may be eligible for survivors' benefits. http://www.publichealth.va.gov/exposures/agentorange/survivors-benefits.asp 

    23. NAS/IOM Veterans and Agent Orange – 2010 Veterans and Agent Orange: Update 2010 Released: September 29, 2011 Veterans Review of the Health Effects in Vietnam Veterans of Exposure to Herbicides (Eighth) Biennial Update

    24. Resources VHA Agent Orange Home Page http://www.publichealth.va.gov/exposures/agentorange Vietnam Veterans of America Home Page http://VVA.org

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