Peter Orris, MD, MPH

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Toxic Waste Incineration Human Health
Waste Not Asia Seoul South Korea June 22 2004

• Peter Orris MD MPH
• Professor Associate Director
• Great Lakes Centers for Environmental
• Occupational Safety and Health
• UIC School of Public Health
• Division of Occupational Medicine
• Cook County Hospital
• A WHO Collaborating Center

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PVC in Medical Products

• IV bags
• Blood bags
• IV and respiratory therapy tubing
• Venodyne sleeves
• Patient ID cards
• Water bed liners

• Rigid packaging trays
• Mattress covers
• X-Ray folder holders
• Shower curtains
• Dialysis bags
• Thermal blankets

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Dioxin
2378 tetrachlorodibenzo-para-dioxin (TCDD)

• No commercial use
• Produced during production or destruction of
  chlorinated organic compounds
• 75 separate dioxin-like compounds

Most research is performed on TCDD because it has
the greatest potency
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Long-Range Atmospheric Transport - An Overview
Thomas M. HolsenDepartment of Civil
Environmental Engineering Clarkson University
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Air shed of the Great Lakes (average wind speed
16 mph)
Thomas M. HolsenDepartment of Civil
Environmental Engineering Clarkson University
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Dioxin and Cancer
In 1977 the International Agency for the
Research on Cancer (IARC) classified TCDD as a
class I (known) human carcinogen. Dioxin has been
linked with

• soft tissue sarcomas
• multiple myeloma
• lymphoma
• lung cancer

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Human development is disrupted at vulnerable
stages by fetal and infant exposure to endocrine
disruptors.
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Effects in Dutch PCB DioxinExposure Children

• In a study of 395 children in the Netherlands
  begun by the Dutch Government in 1989
• Prenatal PCB exposure related to lower birth
  weight lower growth rate lower psychomotor
  scores at 3 months
• Postnatal PCB Dioxin exposure was related to
  lower psychomotor development at 7 months
• At 42 months
• Prenatal PCB exposure associated with lower
  cognitive functioning
• Postnatal (lactation current) PCB Dioxin
  exposure unrelated to cognitive functioning
• PatandinS et al Journal of Pediatrics 134(1)
  Jan 1999

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MERCURY
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Health Effects of Methyl Mercury on Humans
Systemic
Immunologic
Neurologic
Developmental
Cancer
Intermediate
Chronic
Reproductive
Genotoxic
Acute
Death
Inhalation Oral Dermal
Existing Studies (ATSDR 1998)
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Faroe Islands Study

• Faroe Islands located SE of Iceland in the
  Norwegian Sea
• Homogeneous and isolated population of people who
  consume fish (1-3 meals of cod per week) and have
  episodic feasts of pilot whale
• Fish have low mercury content but pilot whale
  meat has a mean content methyl mercury content of
  1.9 ppm

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Faroe Islands Study

• Prospective cohort study of 700 mother infant
  pairs enrolled at birth
• Mean mercury levels in mothers hair 6.8 ppm
  (range 0.5-27 ppm)
• Pilot whales contaminated with PCBs study
  controlled for PCB exposure

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MercuryEffects of Low Dose Prenatal Exposure
Children with high prenatal mercury exposure
Children with low prenatal mercury
exposure
lt 15
30-50
15-30
gt50 µg/l
Children with lowest scores at age 7 years
Figure shows prenatal mercury exposure levels of
Faroese children with scores in the lowest
quartile after adjustment for cofounders. For
each of the five major cognitive functions one
neuropsychological test with a high psychometric
validity was selected.
Source Grandjean et. al. Cognitive Deficit in
7-year-Old Children with Prenatal Exposure to
Methylmercury Neurotoxicology and Teratology
Vol. 19 No. 6 1997
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Seychelles Study

• Equatorial islands in the Indian ocean inhabited
  by a stable cohesive and homogeneous population
• Eat fish frequently (mean 12 fish meals/week)
• Fish have relatively low methyl mercury
  concentrations (lt0.3 ppm)
• No adverse effects

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MERCURY AND THE RISK OF CORONARY HEART DISEASE IN
MENAZUKO YOSHIZAWA SC.D.et al

• Toenail clippings were collected in 1987 from
  33737 cohort members and during five years of
  follow-up we documented 470 cases of coronary
  heart disease (coronary-artery surgery nonfatal
  myocardial infarction and fatal coronary heart
  disease).
• The mercury level was not significantly
  associated with the risk of coronary heart
  disease.
• These findings do not support an association
  between total mercury exposure and the risk of
  coronary heart disease but a weak relation
  cannot be ruled out.
• N Engl J Med 20023471755-60.

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Stack gases
Stack Gas 5-8000 cubic meters per ton
Fly Ash 10-30 kg per ton
Fly ash
Incinerator
Slag 250-350 kg per ton
Scrubber
Bottom ash or slag
Treated effluent
Filter Cake 30 kg per ton
Filter cake
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MOST WIDELY KNOWN INCINERATOR POLLUTANTS OF
CONCERN

• DIOXINS
• PARTICULATE MATTER
• ARSENIC
• BERYLLIUM
• CADMIUM

• CHROMIUM
• LEAD
• MERCURY
• ACIDIC GASES

Source National Research Council 2000. Waste
Incineration and Public Health Washington DC
National Academy Press
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INCINERATOR WORKERS

• Urine and Blood Elevated Concentrations of

• Dioxins
• PCBs
• Hexachlorobenzene
• Chlorophenols
• Mercury
• Nickel

• Benzene
• Toluene
• Xylene
• Arsenic
• Lead

• Gustavsson (1989)

• Kitamura et al.(2000) Schecter et al. (1999)
  Kurttio et al. (1998) Van den Hazel and Frankort
  (1996) Wrbitzky et al. (1995) Papke et al.
  (1993) Malkin et al. (1992) Angerer et al.
  (1992) Schecter et al. (1991).

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Incineration

• Health effects of chronic exposure to dioxins and
  its accumulation on workers of a municipal solid
  waste incinerator
• Osaka Prefecture
• Takata T. Occupational Health Research and
  Development Center Japan Industrial Safety and
  Health Association 5-35-2 Shiba Minato-ku
  Tokyo 108-0014 Japan.
• Concentrations of dioxin among the blood of the
  workers who had engaged in maintenance of the
  furnace the electric dust collector and the wet
  scrubber of the incinerator were higher compared
  with those of residents in surrounding areas.

Ind Health. 2003 Jul41(3)189-96b
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PEOPLE WHO LIVE NEAR INCINERATORS Show Evidence
Of Toxin Absorption

• Elevated dioxins were found in blood samples from
  communities near incinerators in several studies
  but not others
• Miyata (1998) Deml et al. (1996) Van den Hazel
  and Frankort (1996) Startin et al. (1994)

• Dioxin levels in blood increased by 10-25
  percent during the two years following the
  startup of a new incinerator
• Gonzalez et al. (2000)

• PCB levels in the blood of children living near
  a German hazardous waste incinerator were
  elevated
• Holdke et al. (1998)

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Incineration

• Health survey on workers and residents near the
  municipal waste and industrial waste incinerators
  in Korea
• Leem JH Hong YC Lee KH Kwon HJ Chang YS Jang
  JY.Department of Occupational Medicine Inha
  University 7-206 Shin heung dong Jung-gu
  Incheon Republic of Korea.

• The PCDD/F concentrations in residents from the
  area around industrial waste incinerator were
  higher than those in workers and residents from
  the area around MSW incinerator.

Ind Health. 2003 Jul41(3)181-8.
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PEOPLE WHO LIVE NEAR INCINERATORS May Be At
Increased Risk of Cancer

• Though results were not consistent studies have
  found increased rates of deaths from cancer of
• Elliot et al. (2000) Knox (2000) Knox and
  Gilman (1998) Michelozzi et al. (1998) Elliot
  et al. (1996) Biggeri et al. (1996) Babone et
  al. (1994) Elliot et al. (1992) Diggle et al.
  (1990)

• Lung
• Larynx
• Liver
• Stomach
• Rectum
• Childhood Cancers
• All Cancers Combined

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PEOPLE WHO LIVE NEAR INCINERATORS May Be At
Increased Risk of Respiratory Disease

• Several studies found elevated risk of various
  respiratory problems.
• Lee and Shy (1999) Legator et al. (1998) Shy
  et al. (1995) Gray et al. (1994) ATSDR (1993)
  Wang et al. (1992) Zmirou et al. (1984).

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Dioxin Emissions From A Solid Waste Incinerator
And Risk Of Non-Hodgkin Lymphoma
Floret N. Mauny F. Challier B. Arveux P.
Cahn J.-Y. Viel J.-F.

• Our findings support the hypothesis that
  environmental dioxins increase the risk of
  non-Hodgkin lymphoma among the population living
  in the vicinity of a municipal solid waste
  incinerator

Epidemiology 14 392398 2003
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Adverse pregnancy outcomes around incinerators
and crematoriums in Cumbria North West
England195693T J B Dummer H O Dickinson L
Parker

• Results
• Incinerators
• Increased risk of lethal congenital anomaly
• Spina bifida odds ratio 1.17
• Heart defects odds ratio 1.12
• crematoriums
• Increased risk of stillbirth odds ratio 1.04
• Increased anencephalus odds ratio 1.05
• J Epidemiol Community Health 200357456461