preparation for the Gulf War (Roffey et al. 2002). The comprehensive report of the special adviser to the director of central intelligence on Iraq’s weapons of mass destruction states that “at a meeting of the Iraqi leadership immediately prior to the Gulf War in 1991, Saddam Husayn personally authorized the use of BW weapons against Israel, Saudi Arabia, and US forces” (CIA 2004). No evidence was found that Iraq deployed any weapons containing BW agents (Roffey et al. 2002; Zilinskas 1997).

After the Gulf War, Iraq was supposed to destroy all biologic agents developed for BW purposes. However, the United Nations Special Commission was not able to confirm that the destruction was complete (Zilinskas 1997). The Central Intelligence Agency reports that Iraq probably abandoned its BW program in 1995, although some BW-related seed stocks were discovered by US forces during OIF (CIA 2004).

Of the four BW agents that Iraq reportedly weaponized—aflatoxin, botulinum toxin, Bacillus anthracis, and ricin—only anthrax is a living microorganism and capable of multiplying in infected people. Although it is infectious, Bacillus anthracis has little potential for person-to-person transmission (Cieslak and Eitzen 2000). Aflatoxin, botulinum toxin, and ricin are toxins derived from microorganisms and cannot replicate.

SUMMARY

Al Eskan disease, mycoplasma infection, and exposure to BW agents have long been of concern to veterans of the Gulf War and have been proposed as possible causes of the veterans’ health problems. IAEP and A. baumannii infections have been diagnosed in a number of military personnel serving in OIF and OEF. Having reviewed the data, the committee does not believe that Al Eskan disease and IAEP are caused by infectious organisms. Al Eskan disease might be caused by exposure to silica in the sand; the long-term adverse health outcomes of this disease are unknown. The committee does not expect that people who survive IAEP will experience long-term health outcomes related to that illness. Long-term adverse health outcomes from A. baumannii infections are unlikely to occur, given modern medical and surgical treatments. The evidence does not support mycoplasma infections as a cause of the symptoms reported by Gulf War veterans. No evidence has been found that Iraq deployed anthrax-containing weapons.

REFERENCES

Abbo A, Navon-Venezia S, Hammer-Muntz O, Krichali T, Siegman-Igra Y, Carmeli Y. 2005. Multidrug-resistant Acinetobacter baumannii. Emerging Infectious Diseases 11(1):22-29.

Abussaud MJ. 1996. Incidence of wound infection in three different departments and the antibiotic sensitivity pattern of the isolates in a Saudi Arabian hospital. Acta Microbiologica et Immunologica Hungarica 43(4):301-305.

Akhlaghi F, Aframian-Farnad F. 1997. Management of maxillofacial injuries in the Iran-Iraq War. Journal of Oral and Maxillofacial Surgery 55(9):927-930.

Allen JN, Pacht ER, Gadek JE, Davis WB. 1989. Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. New England Journal of Medicine 321(9):569-574.



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