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Peter Orris, MD, MPH

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Faroe Islands Study. Faroe Islands located SE of Iceland in the ... Faroe Islands Study. Prospective cohort study of 700 mother infant pairs enrolled at birth ... – PowerPoint PPT presentation

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Title: Peter Orris, MD, MPH


1

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

2
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3
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

4
Dioxin
2,3,7,8 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
5
Long-Range Atmospheric Transport - An Overview
Thomas M. Holsen,Department of Civil
Environmental Engineering, Clarkson University
6
Air shed of the Great Lakes (average wind speed
16 mph)
Thomas M. Holsen,Department of Civil
Environmental Engineering, Clarkson University
7
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8
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

9
Human development is disrupted at vulnerable
stages by fetal and infant exposure to endocrine
disruptors.
10
Effects in Dutch PCB Dioxin Exposure 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
  • Patandin,S et al Journal of Pediatrics, 134(1),
    Jan 1999

11
MERCURY
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14
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)
15
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

16
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

17
Mercury Effects 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
18
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

19
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20
MERCURY AND THE RISK OF CORONARY HEART DISEASE IN
MEN AZUKO YOSHIZAWA, SC.D.,et al
  • Toenail clippings were collected in 1987 from
    33,737 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.

21
Stack gases
Stack Gas 5-8,000 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
22
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
23
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).

24
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
25
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)

26
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.
27
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

28
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).

29
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
30
Adverse pregnancy outcomes around incinerators
and crematoriums in Cumbria, North West
England 195693 T 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
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