Diseases endemic to the region: Leishmaniasis, sandfly fever, pathogenic Escherichia coli, and shigellosis.

Administration of live, “attenuated,” and toxoid vaccines.

In response to VA and Congress, IOM determined that the study would be conducted in phases and that the initial phase would include review of the agents that were of most concern to the veterans. After meetings with Gulf War veterans, the first IOM Gulf War committee (The Committee on Health Effects Associated with Exposure During the Gulf War) decided that its study would focus on depleted uranium, pyridostigmine bromide, sarin, and vaccines (anthrax and botulinum toxoid).

After reviewing IOM’s Gulf War and Health, Volume I (IOM, 2000) the secretary of veterans affairs determined that there was no basis to establish a presumption of a connection between Gulf War exposure to sarin, pyridostigmine bromide, depleted uranium, or anthrax and botulinum toxoid vaccines and various health outcomes (Department of Veterans Affairs, 2001). The conclusions and recommendations from the first report are presented in Appendix B.


This second volume focuses on long-term adverse health outcomes associated with exposure to insecticides and solvents. The IOM committee that was formed to conduct the second study (Gulf War and Health: Literature Review of Pesticides and Solvents) began its work by overseeing extensive searches of the peer-reviewed medical and scientific literature, described in Appendix C and Chapter 2. The searches retrieved about 30,000 potentially relevant references that were considered by the committee and staff. All searches were completed by August 2001; relevant studies published after that date will be reviewed by future IOM committees. After an assessment of those references, the committee focused on approximately 3000 epidemiologic studies that analyzed associations between the relevant insecticides and solvents and long-term adverse health effects in humans.

Although the committee also examined the experimental evidence, animal studies had a limited role in its assessment of association between exposure and health outcome. The animal data were used to make assessments of biologic plausibility for adverse health outcomes. The animal data were not used as part of the weight-of-evidence to determine the likelihood that an exposure to a specific agent might cause a long-term outcome. The animal studies, however, were used as evidence to support the human epidemiologic data.

Information on the specific insecticides and solvents used during the Gulf War was obtained from a variety of sources, including veterans, the Department of Defense (DOD), VA, the RAND Corporation, the Presidential Advisory Commission (Cecchine et al., 2000; PAC, 1996, 1997) and PL 105–277 and PL 105–368. On the basis of those sources, this IOM committee reviewed the literature on the long-term adverse health effects of “insecticides,” the classes of insecticides (such as organophosphorous compounds), and 12 specific insecticides and one insect repellent identified as having been used in the Persian Gulf. Although the committee also reviewed the literature on exposure to pesticides, it did not make conclusions of association on this broad category because it includes herbicides, fungicides, and other agents, known not to have been used during the Gulf War. Similarly,

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