Occupational Exposures and Environmental Health Hazards of Military Personnel

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Abstract

Background: Military personnel are frequently exposed to environmental pollutants that can cause a variety of diseases. Methods: This review analyzed publications regarding epidemiological and biomonitoring studies on occupationally-exposed military personnel. Results: The exposures include sulfur mustard, organ chlorines, combustion products, fuel vapors, and ionizing and exciting radiations. Important factors to be considered are the lengths and intensities of exposures, its proximity to the sources of environmental pollutants, as well as confounding factors (cigarette smoke, diet, photo-type, healthy warrior effect, etc.). Assessment of environmental and individual exposures to pollutants is crucial, although often omitted, because soldiers have often been evaluated based on reported health problems rather than on excessive exposure to pollutants. Biomarkers of exposures and effects are tools to explore relationships between exposures and diseases in military personnel. Another observation from this review is a major problem from the lack of suitable control groups. Conclusions: This review indicates that only studies which analyzed epidemiological and molecular biomarkers in both exposed and control groups would provide evidence-based conclusions on exposure and disease risk in military personnel.

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Most cited references 139

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Comparison of early and late toxic effects of sulfur mustard in Iranian veterans.

Mehrdad Hefazi, Mahdi Balali-Mood (2006)

Sulfur mustard is an alkylating agent that reacts with ocular, respiratory, cutaneous, and bone marrow tissues, resulting in early and late toxic effects. We compare these effects based on the experience in Iranian veterans exposed to the agent during the Iran-Iraq conflict (1983-88). The first clinical manifestations of sulfur mustard poisoning occurred in the eyes with a sensation of grittiness, lacrimation, photophobia, blepharospasm, and corneal ulceration. Respiratory effects appeared as rhinorhea, laryngitis, tracheobronchitis, and dyspnoea. Skin lesions varied from erythema to bullous necrotization. Initial leukocytosis and lymphopenia returned to normal within four weeks in recovered patients, but marked cytopenia with bone marrow failure occurred in fatal cases. Late toxic effects of sulfur mustard were most commonly found in lungs, skin and eyes. Main respiratory complications were chronic obstructive pulmonary disease, bronchiectasis, asthma, large airway narrowing, and pulmonary fibrosis. Late skin lesions were hyperpigmentation, dry skin, atrophy, and hypopigmentation. Fifteen of the severely intoxicated patients were diagnosed with delayed keratitis, having corneal vascularization, thinning, and epithelial defect. Respiratory complications exacerbated over time, while cutaneous and ocular lesions decreased or remained constant. Both the severity and frequency of bronchiectatic lesions increased during long-term follow-up. The only deteriorating cutaneous complication was dry skin. The maximum incidence of delayed kaeratitis was observed 15 to 20 years after initial exposure. Being suggested as the main cause ofassociated with malignancies and recurrent infections, natural killer cells were significantly lower 16 to 20 years after intoxication.

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Neuropsychological functioning in military pesticide applicators from the Gulf War: Effects on information processing speed, attention and visual memory.

Kimberly Sullivan, Maxine Krengel, William Bradford … (2017)

1991 Gulf War (GW) veterans continue to experience debilitating cognitive and mood problems more than two decades following their return from deployment. Suspected causes for these cognitive complaints include additive and/or synergistic effects of the varying combinations of exposures to chemicals in theater, including pesticides and pyridostigmine bromide (PB) pills. This study was undertaken to address one of the key recommendations of the US Department of Defense Environmental Exposure Report on Pesticides, which was to conduct an epidemiological study to further evaluate the role of neurotoxicant exposures in the expression of central nervous system symptoms reported by GW veterans. This study evaluated the role of pesticides and/or PB in the development of chronic neuropsychological dysfunction in GW veterans. We examined the associations between self-reported measures of pesticide and PB exposures and performance on neuropsychological tests in a group of 159 GW-deployed preventative medicine personnel who had varying levels of pesticide exposures during their work as pesticide applicators or other preventative medicine roles. These veterans had a unique knowledge of pesticides and their usage during the war. It was hypothesized that pesticide applicator personnel with higher exposures would perform significantly worse on objective cognitive measures than lower-exposed personnel and that multiple chemical exposures (pesticide and PB) would further diminish cognitive functioning and increase mood complaints. Study results showed that the participants with both high pesticide and high PB exposure performed worse on specific measures than the groups with high single exposures or low exposures to both toxicants. High combined exposure was associated with significantly slower information processing reaction times, attentional errors, worse visual memory functioning, and increased mood complaints. In addition, stepwise regression analyses of individual pesticide exposures found that pest strip exposure was associated with slower reaction times and attentional errors, and that fly bait and delouser exposures predicted greater mood complaints.

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Effects of low-level exposure to sarin and cyclosarin during the 1991 Gulf War on brain function and brain structure in US veterans.

Linda Chao, Johannes Rothlind, Valerie Cardenas … (2010)

Potentially more than 100,000 US troops may have been exposed to the organophosphate chemical warfare agents sarin (GB) and cyclosarin (GF) when a munitions dump at Khamisiyah, Iraq was destroyed during the Gulf War (GW) in 1991. Although little is known about the long-term neurobehavioral or neurophysiological effects of low-dose exposure to GB/GF in humans, recent studies of GW veterans from the Devens Cohort suggest decrements in certain cognitive domains and atrophy in brain white matter occur individuals with higher estimated levels of presumed GB/GF exposure. The goal of the current study is to determine the generalizability of these findings in another cohort of GW veterans with suspected GB/GF exposure. Neurobehavioral and imaging data collected in a study on Gulf War Illness between 2002 and 2007 were used in this study. We focused on the data of 40 GW-deployed veterans categorized as having been exposed to GB/GF at Khamisiyah, Iraq and 40 matched controls. Magnetic resonance images (MRI) of the brain were analyzed using automated and semi-automated image processing techniques that produced volumetric measurements of gray matter (GM), white matter (WM), cerebrospinal fluid (CSF) and hippocampus. GW veterans with suspected GB/GF exposure had reduced total GM and hippocampal volumes compared to their unexposed peers (p< or =0.01). Although there were no group differences in measures of cognitive function or total WM volume, there were significant, positive correlations between total WM volume and measures of executive function and visuospatial abilities in veterans with suspected GB/GF exposure. These findings suggest that low-level exposure to GB/GF can have deleterious effects on brain structure and brain function more than decade later. Copyright © 2010 Elsevier Inc. All rights reserved.

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Paul B. Tchounwou: Role: Academic Editor

Journal

Journal ID (nlm-ta): Int J Environ Res Public Health

Journal ID (iso-abbrev): Int J Environ Res Public Health

Journal ID (publisher-id): ijerph

Title: International Journal of Environmental Research and Public Health

Publisher: MDPI

ISSN (Print): 1661-7827

ISSN (Electronic): 1660-4601

Publication date (Electronic): 18 May 2021

Publication date Collection: May 2021

Volume: 18

Issue: 10

Electronic Location Identifier: 5395

Affiliations

[1 ]Department of Experimental Medicine, University of Genoa, 16132 Genoa, Italy; marta_geretto@ 123456hotmail.it

[2 ]Texas Biomedical Research Institute, 8715 W. Military Drive, San Antonio, TX 78227, USA; mferrari@ 123456txbiomed.org

[3 ]Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; roberta.deangelis@ 123456iss.it

[4 ]General Inspectorate of Military Health, 00184 Rome, Italy; consulente@ 123456igesan.difesa.it (F.C.); ispettore@ 123456igesan.difesa.it (N.S.)

[5 ]Department of Health Sciences, University of Genoa,16132 Genoa, Italy; alessandra.pulliero@ 123456unige.it

[6 ]Faculty of Medicine, Pharmacy, Science and Technology University of Medicine, Pharmacy, Science and Technology, 540142 Targu Mures, Romania; wau@ 123456stu.edu.cn

[7 ]Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555, USA

[8 ]IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy

Author notes

[* ]Correspondence: izzotti@ 123456unige.it ; Tel.: +39-010-353-8522

Author information

Alessandra Pulliero https://orcid.org/0000-0001-5378-9517

Alberto Izzotti https://orcid.org/0000-0002-8588-0347

Article

Publisher ID: ijerph-18-05395

DOI: 10.3390/ijerph18105395

PMC ID: 8158372

PubMed ID: 34070145

SO-VID: 6eb39d28-19dc-42e9-b2b5-1bf987a8a164

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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

Occupational Exposures and Environmental Health Hazards of Military Personnel

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Most cited references 139

Comparison of early and late toxic effects of sulfur mustard in Iranian veterans.

Neuropsychological functioning in military pesticide applicators from the Gulf War: Effects on information processing speed, attention and visual memory.

Effects of low-level exposure to sarin and cyclosarin during the 1991 Gulf War on brain function and brain structure in US veterans.

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