Index

A

Acetylcholine (ACh), 9

botulinum toxoid vaccines, 288(n.10), 289

pyridostigmine bromide (PB), 11, 12, 13, 207–216 (passim), 224, 227–228

sarin, 18, 19, 21, 169–170, 175, 176, 188, 192, 198

Acetylcholinesterase (AChE)

cyclosarin, 186

organophosphate binding (OP-AChE), 9, 174–175, 177, 178, 180, 186, 208, 210, 366

pyridostigmine bromide binding (PB-AChE), 9, 11, 13, 53, 208, 210–213 (passim), 215, 217, 220, 223, 227–228, 232, 235, 241, 244–245

sarin, 9–10, 21, 169–170, 174–175, 176, 177, 178, 180, 186, 187, 190, 194–195

see also Pyridostigmine bromide

Acute cholinergic symptoms/syndrome, 9–13, 19, 366

sarin, 9–10, 170–172, 173, 188, 190, 192, 193, 196, 198

Acute effects, general, 4, 72, 189

anthrax vaccines, 15, 16, 19, 277–287 (passim), 304, 313

botulinum toxoid vaccines, 17, 19, 290, 291, 293–294, 313

multiple vaccinations, 17, 297, 306

organophosphate toxicity, 13, 213

pyridostigmine bromide (PB), 214, 224, 234, 250–251

sarin, 9, 18, 19, 21, 180, 188, 193–194, 199, 328

squalene, 309, 310, 311

vaccines, 270, 271;

see specific vaccines supra

uranium, 99

see also specific acute symptoms

Adjuvants, vaccines, 270, 271, 274, 276, 279, 280, 290

squalene, 268, 280, 307–312, 340

Adrenal gland, see Hypothalamic-pituitary-adrenal processes

Adenovirus vaccines, 295

Age factors, 41, 43, 74

anticholinesterases, 190

multiple vaccinations, 305

organophosphate pesticides, 371–375

phosphate fertilizer production workers, 130

pyridostigmine bromide, 227, 228, 236, 238, 242, 244, 246–247



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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines Index A Acetylcholine (ACh), 9 botulinum toxoid vaccines, 288(n.10), 289 pyridostigmine bromide (PB), 11, 12, 13, 207–216 (passim), 224, 227–228 sarin, 18, 19, 21, 169–170, 175, 176, 188, 192, 198 Acetylcholinesterase (AChE) cyclosarin, 186 organophosphate binding (OP-AChE), 9, 174–175, 177, 178, 180, 186, 208, 210, 366 pyridostigmine bromide binding (PB-AChE), 9, 11, 13, 53, 208, 210–213 (passim), 215, 217, 220, 223, 227–228, 232, 235, 241, 244–245 sarin, 9–10, 21, 169–170, 174–175, 176, 177, 178, 180, 186, 187, 190, 194–195 see also Pyridostigmine bromide Acute cholinergic symptoms/syndrome, 9–13, 19, 366 sarin, 9–10, 170–172, 173, 188, 190, 192, 193, 196, 198 Acute effects, general, 4, 72, 189 anthrax vaccines, 15, 16, 19, 277–287 (passim), 304, 313 botulinum toxoid vaccines, 17, 19, 290, 291, 293–294, 313 multiple vaccinations, 17, 297, 306 organophosphate toxicity, 13, 213 pyridostigmine bromide (PB), 214, 224, 234, 250–251 sarin, 9, 18, 19, 21, 180, 188, 193–194, 199, 328 squalene, 309, 310, 311 vaccines, 270, 271; see specific vaccines supra uranium, 99 see also specific acute symptoms Adjuvants, vaccines, 270, 271, 274, 276, 279, 280, 290 squalene, 268, 280, 307–312, 340 Adrenal gland, see Hypothalamic-pituitary-adrenal processes Adenovirus vaccines, 295 Age factors, 41, 43, 74 anticholinesterases, 190 multiple vaccinations, 305 organophosphate pesticides, 371–375 phosphate fertilizer production workers, 130 pyridostigmine bromide, 227, 228, 236, 238, 242, 244, 246–247

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines uranium workers, 116–117, 119, 121, 128, 134–135, 138, 149 vaccines, 302, 311–312 Agency for Toxic Substances and Disease Registry (ATSDR), 94, 99, 106 Agent Orange, 29, 334 AIDS, 310, 342, 345 Air Force Technical Applications Center (AFTAC), 173 Alcohol abuse, 45, 49 Alkaline phosphatase (ALP), 150 Aluminum hydroxide adjuvant, 274, 276 Alzheimer’s disease, 213, 227 American College of Rheumatology, 355 American Psychiatric Association, 345, 346, 360 Ammunition depleted uranium, 5, 6, 92–93, 98, 326 sarin, 172 see also Armor Animal studies, 2, 71–72, 80, 99, 351 anthrax vaccines, 21, 277–280, 330 botulinum toxoid vaccines, 21, 288, 289–291, 330 cyclosarin, 186–187 depleted uranium, 99, 100–101, 151, 327 fatigue, 72, 351 multiple vaccinations, 297–299 pain, 72 pyridostigmine bromide (PB), 209, 210–211, 213, 214, 215, 218–219, 220 sarin, 10, 175–176, 177, 178–187, 288 squalene, 308–309 uranium, 21, 96, 97–98, 99–106, 107, 151, 159, 327 vaccines, 271, 272, 277–280, 288, 289–291, 297–299, 308–309, 330 see also Primate equilibrium platform Anthrax Vaccine Expert Committee, 284 Anthrax Vaccine Immunization Program, 15, 274, 330 Anthrax vaccines, vii, 1, 2, 4, 14, 15–16, 19, 21, 28, 268, 272, 274–287, 306, 312–313, 330, 335 acute effects, 15, 16, 19, 277–287 (passim), 304, 313 animal studies, 21, 277–280, 330 antibodies, 279, 285, 306 antigens, general, 15, 54, 274–277 (passim), 279–280 cardiovascular system, 278, 280 cellular processes, general, 272, 276, 301, 302 chronic effects, 19, 287, 312–313 clinical studies, 15–16, 19, 282–283, 284–287, 334 dermal effects, 15, 16, 272(n.3), 279, 281–287 (passim) dose factors, 274–275, 278, 285 edema, 15, 275, 276, 277, 278, 283, 284 exposure routes, 272(n.3), 275 dermal, 272(n.3), 282, 283 ingestion, 272(n.3) inhalation, 272(n.3), 276–277, 282, 283 injection delivery, 15, 279–286 (passim), 297 FDA, 14, 267, 274, 283–284, 287, 313 fever, 16, 277–278, 282, 284, 285, 287 gastrointestinal effects, 272(n.3), 285 gender factors, 286 genetic effects, 280 headaches, 281, 284, 285 historical perspectives, 272, 274, 281, 283–284, 287 hospitalization following administration, 284, 286 immune system pathologies, 279, 284, 285, 290–292, 306 inflammation, 278, 281, 284, 286, 287, 297 live attenuated spore vaccines, 274, 276, 277–279, 281, 297 lymphatic system, 278 mental disorders, 284 mortality, 277, 278 multiple vaccinations, 301, 304 nausea and vomiting, 284, 285 neuromuscular effects, 281, 284, 285, 286 neuropathy, general, 285 number of vaccinations given, 15, 267, 274, 284 pain, 281–282, 284, 285, 286 protective antigen vaccines, 274, 276–277, 279–280, 281, 282 rashes, 284, 285 reproductive system effects, 226

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines research recommendations, 313 respiratory effects, 272(n.3), 276–277, 282, 283 short-term malaise, 15, 281, 283, 284, 285 squalene, 309–310 surveillance, 269 veterans, studies of Gulf War veterans, 285, 286, 293 visual and ocular effects, 286 Antibodies adverse reactions to vaccines, 17, 272, 298 anthrax vaccines, 279, 285, 306 botulinum toxoid vaccines, 288(n.11), 290, 293, 306 lymphocytes, 158, 272, 278, 301, 302 squalene, 309, 311 uranium, 152, 156–157, 312 see also Autoimmune diseases; Vaccines Anticholinesterase, 9, 170, 174, 189, 190, 199, 328, 372 age factors, 190 genetic factors, 31 see also Cyclosarin; Sarin Antidotes cyclosarin, 186 sarin, 170, 179 see also Pyridostigmine bromide Antigens, 271–272, 273 anthrax vaccines, 15, 54, 274–277 (passim), 279–280 botulinum toxoid vaccines, 290 human leukocyte antigen (HLA), 273 toxicity of, 271–272, 273 see also Vaccines Anxiety, 49, 57, 171, 196, 226, 350, 354 Armed Forces Epidemiologic Board, 295 Armor, depleted uranium, 5, 91–92 Army Center for Health Promotion and Preventive Medicine, 93–94 Army Medical Corps, 9 Army Medical Research Institute of Infectious Diseases, 284, 285–286, 292 Arthritis, 299–300, 302, 309 Asbestos, 34, 78, 79 Asthma, 45, 49, 215, 231, 236, 237 Atropine, 11, 208, 228, 237 ATSDR, see Agency for Toxic Substances and Disease Registry Attention deficits, 27, 51 sarin, 171 Autoimmune diseases, 273 arthritis, 299–300, 302, 309 diabetes mellitus, 298–299 fibromyalgia, 45, 46, 48, 49, 62, 343, 352, 355–360 (passim) systemic lupus erythematosus, 157, 284, 311 see also Myasthenia gravis AVIP, see Anthrax Vaccine Immunization Program B Baltimore cohort, Gulf War veterans, 21, 93, 326 Beneficiary Identification and Records Locator Subsystem, 54–55 BEIR, see Committee on the Biological Effects of Ionizing Radiation Biological warfare agents, general, 1, 34, 35, 48, 325 see also Anthrax vaccines; Botulinum toxoid vaccines; Nerve agents; Vaccines Birth defects, 56–57, 61(n.25), 62, 104–105 Bladder, see Genitourinary system and urinalysis Blood, see Cardiovascular system; Hematologic effects Blood-brain barrier pyridostigmine bromide (PB), 11, 207, 219–220 sarin, 177 Bone cancer, 19, 109, 143, 146, 159 Bones, see Musculoskeletal effects Bosnian conflict, 39, 50–51, 250, 303, 304, 358 Botulinum toxoid vaccines, vii, 1, 2, 4, 14, 16–17, 19, 21, 28, 34, 287–294, 297–298, 301, 306 acetylcholine (ACh), 288(n.10), 289 acute effects, 16, 17, 19, 290, 291, 293–294, 313 animal studies, 21, 288, 289–291, 330

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines antibodies, 288(n.11), 290, 293, 306 chronic effects, 19, 294, 313–314 clinical studies, 19, 291–294, 333 cramps, 288 dermal tissue, 290, 292, 294 dose factors, 288, 289, 293 edema, 292 fatigue, 288(n.10) FDA, 16, 288, 293 fever, 288(n.10), 294 genetic factors, 290–291 headaches, 294 hematologic effects, 293 historical perspectives, 16, 288, 291, 293 immune system, impacts on, 290–292 inflammation, 290, 293–294 ingestion, 287–288 injection, 16, 288, 293 neuropathy, general, 288(n.10), 289, 290–291 neuromuscular effects, 288, 289 number of vaccinations given, 268 pain, 288, 292, 293, 294 short-term malaise, 288, 294 surveillance, 269 veterans, studies of Gulf War veterans, 285, 293 Brain Alzheimer’s disease, 213, 227 blood-brain barrier, 11, 177, 207, 219–220 cyclosarin, 186–187 depleted uranium, 103 electroencephalography, 10, 103, 181, 187, 191, 199, 372 pyridostigmine bromide (PB), 11, 207, 217, 219–220, 247 sarin, 10, 175–176, 177, 180, 181, 182, 186–187, 191, 195, 196, 199 see also Neuropsychological effects Britain, see United Kingdom Bronchi pyridostigmine bromide (PB), 11, 12, 208, 214, 215, 225, 230, 237 sarin, 171 Butyrylcholinesterase (BuChE), 21, 53, 177, 178, 186, 214, 218, 220–221, 245, 250, 329 C Canada Gulf War veterans, 39, 45, 46, 48–49, 285, 333, 358 uranium mine workers, 109 Cancer, 55, 79 bone, 19, 109, 143, 146, 159 liver, 79 lung, 6–7, 19, 79, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159 lymphatic, 19, 100, 123, 142–143, 144–145, 159 mortality, 117, 128, 114, 117–118, 126–127, 128, 131 multiple vaccinations, 299 registry data, 42 testicular, 60 uranium, 6–7, 19, 100, 114, 117–118, 121, 126–145 (passim), 159 Carbamates, 34, 169, 207, 210, 213, 219 Cardiovascular system anthrax vaccines, 278, 280 chest pain, 42, 171 cyclosarin, 187 peripheral vascular resistance, 228–229 pyridostigmine bromide (PB), 215–216, 228–229, 230, 235–236, 245, 249 registry data, 42 sarin, 171, 181, 187, 194–195 uranium, 8, 19, 96, 100, 105, 108–109, 126, 158, 160 vaccines, 272 Case-control studies, 43–44, 52–53, 71, 75, 77, 82, 250 organophosphate pesticides, 370 uranium exposure, 108, 121, 127, 138 CDR, see Comprehensive Epidemiology Data Resource (CEDR) Cellular processes, general anthrax vaccines, 272, 276, 301, 302 lymphocytes, 158, 272, 301, 302 lymphomas, 142 pyridostigmine bromide (PB), 219–220 see also Cancer; DNA; Genetic factors; DNA; Immune system; Receptor-mediated actions; Red blood cells; RNA

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines Center for Health Promotion and Preventive Medicine (CHPPM), 93–94 Centers for Disease Control and Prevention (CDC) AIDS, case definition, 345–346 anthrax vaccines, 283, 284 botulinum toxoid vaccines, 288, 293–294 chronic fatigue syndrome, case definition, 354 multiple vaccines, 295, 296, 304, 305–306 vaccine surveillance, 269, 270, 283, 284 Central Intelligence Agency, 172, 173, 196 Central nervous system (CNS) depleted uranium, 99, 103 myasthenia gravis, 224 pyridostigmine bromide (PB), 12, 213, 217, 219–220, 223, 224, 226, 235, 240, 241, 247, 251 sarin, 170, 171, 176–177, 182, 191, 195, 196, 327 squalene, 308 uranium, 99, 102, 103 see also Brain Chemical Abstracts Service, 339–340 Chemical agent-resistant coating, 34 Chemical warfare agents, general, 1, 34, 35, 48, 178, 189–190, 325 see also Antidotes; Cyclosarin; Nerve agents; Sarin Chlorinated hydrocarbons, 34 Cholinergic effects, see Acetylcholine; Acetylcholinesterase; Acute cholinergic symptoms/syndrome; Anticholinesterase; Butyrylcholinesterase; Growth-releasing hormone; Pyridostigmine bromide Cholinesterase (ChE), see Pyridostigmine bromide; Sarin Chronic effects, general, 4, 13, 49, 50, 51, 53, 54, 58(n.21), 59, 61 anthrax vaccines, 19, 287, 312–313 botulinum toxoid vaccines, 19, 294, 313–314 depleted uranium, 102–103 multiple vaccinations, 17, 298–299, 304 pyridostigmine bromide (PB), 13, 14, 214–215, 252–253 sarin, 183, 188, 191–192, 193, 198 squalene, 311 uranium, 100, 102–103 vaccines, 17, 271, 287, 294, 198–199, 303, 304, 311, 312–314, 330 see also Multisymptom illness; specific anatomical and chronic diseases and symptoms Chronic fatigue syndrome (CFS), ix, 27, 45, 48–50 (passim), 62, 342, 343, 350, 354, 356–357, 358, 360, 361 see also Fatigue; Fibromyalgia; Multisymptom illness Clinical studies, 54, 76–77, 82 anthrax vaccines, 15–16, 19, 282–283, 284–287, 334 case definitions, 43–44, 54, 343–361 botulinum toxiod vaccinations, 19, 291–294, 333 fibromyalgia, 355 multiple vaccinations, 17, 305–306 pyridostigmine bromide (PB), 12, 19, 209, 222–231, 249, 329 vaccines, 15–17, 19, 270, 271, 282–283, 284–287, 291–294, 305, 306, 310–311, 333 Cognitive dysfunction, 351, 354, 356, 359 attention deficits, 27, 51, 171 depleted uranium, 153 epidemiological studies, 45–49 (passim), 52, 53, 54, 62, 246, 247–248 memory loss, 1, 27, 39, 40–41, 42, 52, 171, 311, 351 multisymptom illness, 17, 51, 54, 154, 303–306, 342–345 pyridostigmine bromide (PB), 53, 224, 227, 233–235, 236, 242–243, 246, 247–248 sarin, 171, 181, 197 Cohort studies, 13, 44–54, 61, 73–75, 82 depleted uranium, 21, 93, 326–327 organophosphate pesticides, 369 phosphate fertilizer processing workers, 112, 114–115, 130, 131, 132, 148, 152, 159 sarin, 190

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines uranium miners and processing workers, 112–114, 115–121, 122, 123–149, 151–152, 154–157, 158, 159 vaccinations, 17, 274, 281, 291, 299, 300–303, 306, 314 see also Occupational exposure, nonmilitary; Veterans, studies of Gulf War Veterans Colorado Plateau states, uranium millers, 108, 111, 112, 130, 131, 132, 144 Committee on the Biological Effects of Ionizing Radiation, 107, 143 Compensation of veterans, 20, 28 Comprehensive Clinical Evaluation Program, 40 Comprehensive Epidemiology Data Resource (CEDR), 117 Computerized posturography, sarin, 10, 196, 199 Concentration deficits, see Attention deficits Controlled studies, viii–ix, 7, 32, 39, 48–62, 74, 76–77, 82, 358 anthrax vaccines, 278 birth defects, 56 botulinum toxoid vaccines, 288(n.10), 291–293 case-control studies, 43–44, 52–53, 71, 75, 77, 82, 108, 121, 127, 138, 250, 370 fibromyalgia, 356 organophosphate pesticides, 370–375 pyridostigmine bromide (PB), 13, 227, 231–245 (passim) sarin, 10, 181, 193, 327 uranium exposure, 7, 108, 121, 127, 138 vaccines, 270, 278, 288(n.10), 291–293, 301, 301–303 see also Clinical studies Convulsions, sarin, 10, 170, 175, 176, 179, 188, 192, 193 Cost and cost-benefit factors, 2 compensation of veterans, 20, 28 vaccines, 268 Cramps, 51 botulinum toxoid vaccines, 288 pyridostigmine bromide (PB), 11, 12, 214, 223, 226, 251 sarin, 171 uranium exposure, 151 Cross-sectional studies, 45–48, 61, 73, 75–76, 81, 368, 369 multiple vaccinations, 305 pyridostigmine bromide (PB), 247, 248, 250 Cyclosarin, 2, 9, 28, 172, 173–174, 186–187, 198, 340 see also Pyridostigmine bromide; Sarin Cytokines, 272, 275 Czechoslovakia, uranium miners, 109 D Databases, 54–55, 69, 339–341 Death, see Mortality DEET, see N,N-diethyl-m-toluamide Demographic factors, 41, 43, 348 see also Age factors; Gender factors; Racial and ethnic factors; Socioeconomic status Department of Defense (DoD) anthrax vaccines, 284, 285 depleted uranium studies, 91–92, 326 hospitalization studies, 55–56, 189–190 previous research on Gulf War health effects, 30 pyridostigmine bromide (PB), 208, 209 registry programs, 40–43, 77, 357 sarin, 9, 172, 173, 189, 196 squalene, 307 vaccines, 284, 285, 295, 329–330 Department of Energy (DOE), 116, 117 Department of Health and Human Services Agency for Toxic Substances and Disease Registry, 94, 99, 106 Anthrax Vaccine Expert Committee, 284 National Institutes of Health, 30, 114–115, 274, 310 see also Centers for Disease Control and Prevention; Food and Drug Administration Department of Veterans Affairs, 54 committee study, background, vii, 2, 28, 70 compensation of veterans, 20, 28 depleted uranium, 93

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines previous research on Gulf War health effects, 30 registry programs, 40–43, 58, 77, 357, 358 Depleted uranium (DU), vii, viii, 1, 2, 5–8, 28, 34, 83, 90–93, 98–99 ammunition containing, 5, 6, 92–93, 98, 326 animal studies, 99, 100–101, 151, 327 armor, 5, 91–94 chronic effects, general, 102–103 cohort studies, 21, 93, 326–327 developmental and reproductive effects, 8, 19, 104–105, 157 exposure, 6, 31, 92, 93–94, 326 gastrointestinal effects, 8, 19, 104 genetic factors, 8, 19, 158 hematologic effects, 8, 19, 99 historical perspectives, 91–92 ingestion, 6, 93, 96, 98–99 inhalation, 6, 93 injection, 99 musculoskeletal effects, 8, 99 neuropathy, 99, 103, 151, 153 renal effects, 7–8, 99, 150 research recommendations, 21, 326–327 respiratory effects, 98 tantalum (Ta), 98–99, 100, 101, 103 wounds, 93, 102–103 see also Uranium Depression, 350, 354, 355 epidemiologic studies, 45, 46, 48, 49, 52, 62 organophosphate pesticides, 370 pyridostigmine bromide (PB), 233, 245 see also Chronic fatigue syndrome; Posttraumatic stress disorder Dermal exposure anthrax, 272(n.3), 282, 283 sarin, 8, 169, 176 uranium, 96, 151, 156 see also Injection delivery Dermal tissue, other, 47, 51 anthrax, 272(n.3), 282, 283 anthrax vaccines, 15, 16, 272(n.3), 279, 281–287 (passim) botulinum toxoid vaccines, 290, 292, 294 pyridostigmine bromide (PB), 215 registry data, 42 sand, blown, 33 uranium, 19, 105, 158 see also Injection delivery; Perspiration; Rashes Developmental effects birth defects, 56–57, 61(n.25), 62, 104–105 depleted uranium, 8, 19, 104–105, 157 sarin, 186, 187 uranium, 8, 19, 104–105, 157, 158 Diabetes mellitus, 298–299 Diagnosis, vii, 43–44, 56 case definitions, 43–44, 54, 343–361 chronic fatigue syndrome, 354, 356–357, 358–359 Diagnostic and Statistical Manual of Mental Disorders, 58, 346, 360 electrocardiography (EKG), 158, 235, 244 electroencephalography (EEG), 10, 103, 181, 187, 191, 199, 372 electromyography (EMG), 190, 232, 233, 249 International Classification of Diseases, 56, 346, 360 multisymptom illness, 17, 51, 54, 154, 303–306, 342–365 posttraumatic stress disorder, 57, 58, 342 posturography, 10, 196, 199 pyridostigmine bromide (PB) effects, 12, 223 registry data, 40–43 symptom clustering, 43, 44, 48, 49, 50–51, 349 see also specific symptoms (e.g., Pain) Diagnostic and Statistical Manual of Mental Disorders, 58, 346, 360 Diarrhea, 60 registry data, 42 pyridostigmine bromide (PB), 11, 208, 214, 226, 230, 251 uranium, 156 Diet, 33, 307–308 Digestive system, see Gastrointestinal effects Diphtheria-tetanus-pertussis vaccines, 268, 295, 296, 299, 300, 301 DNA anthrax vaccines, 280

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines pyridostigmine bromide (PB), 220 sarin, 183 uranium effects, 157 Dose and dose-response, viii, 78–79, 83, 357 anthrax vaccines, 274–275, 278, 285 botulism toxin, 288, 289, 293 committee study methodology, 4, 18, 78 cyclosarin, 186 depleted uranium, 103 multiple exposures and varying doses, 29, 79 pyridostigmine bromide (PB), 11, 12, 14, 208–209, 210–211, 214, 215, 218, 219, 223–238 (passim), 247–248, 251, 252, 329 sarin, 9, 10, 18, 19, 173, 176, 178–183, 186, 188, 192, 199, 288, 327 squalene, 308, 312 uranium, 7, 90, 91, 103, 108, 115–116, 117–118, 120, 121, 123, 125, 128, 130, 135–140, 141, 142, 159 vaccines, general, 272 see also Exposure; Multiple vaccinations DSM-III, see Diagnostic and Statistical Manual of Mental Disorders DTP, see Diphtheria-tetanus-pertussis vaccines Drug delivery, see Injection delivery Dysarthria, pyridostigmine bromide (PB), 12, 223, 251 E Edema anthrax vaccines, 15, 275, 276, 277, 278, 283, 284 botulinum toxoid vaccines, 292 sarin, 171 see also Inflammation Electrocardiography (EKG), 158, 235, 244 Electroencephalography (EEG) depleted uranium, 103 organophosphate pesticides, 372 sarin, 10, 181, 187, 191, 199 Electromyography (EMG), 190, 232, 233, 249 Emotional effects, see Anxiety; Depression; Malaise, short-term, Mental disorders; Mood disorders; Neuropsychological effects; Psychological factors Employment, see terms beginning “Occupational” Encephalitis vaccines, 295 Enzyme-linked immunosorbent assay (ELISA), 311 Eosinophils, 158, 342 Epidemiology, general, 32, 40, 43–62, 71, 72–76, 82, 83, 84–85, 357–358 birth defects, 56–57, 61(n.25), 62, 104–105 case definitions, 43–44, 54, 343–361 committee study methodology/agenda, 4–5, 18–19, 333 cognitive dysfunction, 45–49 (passim), 52, 53, 54, 62, 246, 247–248 depression, 45, 46, 48, 49, 52, 62 evidence, assessment criteria, 4–5, 18–19, 78–81, 82; see also “case definitions” supra fatigue, 45–49 (passim), 54, 62, 357–358 fibromyalgia, 45, 46, 48, 49, 62, 343, 352, 355–360 (passim) infectious diseases, general, 59, 72 injuries, 48, 49, 55 general health status, 43–54 hospitalizations, 55–57, 60, 61, 188, 189–190, 193–195, 284, 286, 311, 368 limitations of, 60–62, 73, 74–76, 82, 83, 84–85, 123–128, 130, 140–142, 143, 252 multiple vaccinations, 305 musculoskeletal effects, 40–41, 42, 45, 46, 48, 49 organophosphate pesticides, 53, 366–377 population-based studies, vii, 3–4, 6, 10, 13, 18, 21, 32, 35, 44–51, 191–193; see also Registry programs posttraumatic stress disorder (PTSD), 45, 46, 48, 49, 57–59, 62, 246 pyridostigmine bromide (PB), 13–14, 21, 48, 71, 209, 245–250, 252, 329 sarin, 4, 71, 188, 189–192, 193–195

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines specific health endpoints, 54–60 stress-related disorders, 46, 49, 51, 57–59, 57–59, 123 symptom clustering, 43, 44, 48, 49, 50–51, 349 multisymptom illness, 17, 51, 54, 154, 303–306, 342–365 uranium-induced lung cancer, 6–7, 19, 100, 114, 117–118, 126–127, 128–130, 132–142 uranium, 106–121; see also "uranium” under Occupational exposure, non-military see also Case-control studies; Cohort studies; Cross-sectional studies; Mortality; Occupational exposure, noncombat military personnel; Occupational exposure, non-military; Recordkeeping; Registry programs; Statistical techniques Erythrocytes, see Red blood cells Estrogen contraceptive pills, 273 vaccines, response to, 273 Ethnicity, see Racial and ethnic factors Event-related potential (ERP) sarin, 10, 195, 196, 199, 327 see also Visual evoked potential Experimental allergic encephalomyelitis, 309 Exposure, 18–19, 43, 49, 51, 71, 72, 73–77, 81–85, 99, 360 case definition, 348 community study, methodology/agenda, viii, 2–3, 4–5, 18, 29, 35, 335 depleted uranium, 6, 31, 92, 93–94, 326 duration, 29, 31, 71, 72, 76 uranium, 71, 116–117, 121, 126, 130 multiple exposures and chemical interactions, 29, 31, 79, 298–299; see also Interactions, chemical multiple chemical sensitivity (MCS), 46, 49, 350, 352, 356–357, 358, 359 organophosphate pesticides, long-term, 366–377 phosphate fertilizer production workers, 112, 114–115, 130, 132, 148, 152, 159 registry programs, 40 routes, 71, 80, 94–96; see also Dermal exposure; Ingestion; Inhalation; Injection delivery anthrax, 15, 272(n.3), 275, 276–277, 279–286 (passim), 282, 283, 297 botulinum toxoid vaccines, 268 sarin, 9, 18, 19, 31, 170–173, 178, 182–183, 188 terrorism, viii, 3, 10, 70, 177–178, 188 smoke, 1, 27–28, 33–34, 48 depleted uranium, 6, 93 oil-well fires, 1, 27, 31, 33 uranium, depleted uranium, 6, 31, 92, 93–94, 326 occupational exposure, 6–7, 19, 31, 108, 111, 113, 114, 115–117, 120, 121, 123–129, 130, 134, 135, 138, 140–141, 142, 149, 159 see also Dose and dose-response; Dermal exposure; Epidemiology; Ingestion; Inhalation Eyes, see Visual and ocular effects; Visual evoked potential F Fatigue, 1, 27, 32, 39, 343, 350–360 (passim) animal studies, 72, 351 botulinum toxoid vaccines, 288(n.10) epidemiological studies, 45–49 (passim), 54, 62, 357–358 fibromyalgia, 45, 46, 48, 49, 62, 343, 352, 355–360 (passim) multiple vaccinations, 304, 306, 314 pesticides, organophosphate, 367–375 pyridostigmine bromide (PB), 211, 226, 230, 233, 236, 245, 329 registry data, 40–41, 42 myasthenia gravis, 3, 11, 12, 70, 71, 207, 208, 209, 224–225, 227–228, 230, 231, 250–251 sarin, 171, 189, 193, 194, 195, 198, 199, 327, 328 squalene, 311 see also Chronic fatigue syndrome

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines Federal government, 28–29, 39 see also Legislation; Regulatory factors; specific departments and agencies Fernald Feed Materials Production Center, 117–118, 121, 122, 135, 137 Fertilizers, see Phosphate fertilizers Fever anthrax vaccines, 16, 277–278, 282, 284, 285, 287 botulinum toxoid vaccines, 288(n.10), 294 yellow fever vaccines, 295, 296, 301 Fibromyalgia, 45, 46, 48, 49, 62, 343, 352, 355–360 (passim) Fires, see Smoke Follicle-stimulating hormone (FSH), 157 Food, see Diet Food and Drug Administration (FDA) anthrax vaccines, 14, 267, 274, 283–284, 287, 313 Investigational New Drug (IND) status, anthrax vaccines, 274, 283–284 botulinum toxoid vaccines, 16, 288, 293 pyridostigmine bromide (PB), 208 pyridostigmine bromide (PB), 11, 207, 208 squalene, 307, 309 vaccine surveillance, 269 Formaldehyde, 274, 288, 289–290, 292 Fort Bragg Booster Study, 285, 293 Fort Detrick Studies, 17, 274, 281, 291, 299, 300–303, 306, 314 Freedom of Information Act (FOIA), 283 G Gamma-aminobutyric acid (GABA), 175 Gamma-glutamyltransferase (GGT), 150 Gas chromatograph-mass spectroscopy (GC-MS), 191, 194 Gastrointestinal effects, 47, 51, 60 anthrax, 272(n.3) anthrax vaccines, 285 depleted uranium, 8, 19, 104 infections, 59–60 pyridostigmine bromide (PB), 11, 12, 208. 209, 214, 223, 225–226, 230, 236, 242, 251 registry data, 42 sarin, 171, 180 uranium, 8, 19, 104, 156, 158, 160 see also Diarrhea; Ingestion; Nausea and vomiting; Salivation Gender factors, 41, 43, 74 anthrax vaccines, 286 organophosphate pesticides, 371–375 phosphate fertilizer production workers, 115 pyridostigmine bromide, 226, 231, 239, 244 sarin, 196, 197 testicular cancer, 60 uranium processing workers/miners, 117, 118, 119, 121, 149, 157 women, symptoms specific to, 51–52 see also Sexual functioning General Accounting Office (GAO) anthrax vaccines, 283 squalene, 307 Genetic factors, 71–72 anthrax vaccines, 280 botulinum toxoid vaccines, 290–291 depleted uranium, 8, 19, 158 individual variability, 31, 197–198, 220–222, 244–245, 272, 334 multiple vaccines, 298 organophosphates, 31, 53 pyridostigmine bromide, 21, 220–222, 244–245, 328, 329 research recommendations, 21, 328, 329 sarin, 21, 53, 183, 187, 197–198, 328 uranium, 8, 19, 100–101, 157, 158 vaccines, 272, 273, 280, 290–291 see also DNA; RNA Genitourinary system and urinalysis, 47, 54 depleted uranium, 158 pyridostigmine bromide (PB), 12, 208, 225–226 registry data, 42 sarin, 171, 177–178 uranium, 97, 100–101, 119, 123, 124, 150 see also Renal effects; Sexual functioning Germany, sarin development, 8 GGT, see Gamma-glutamyltransferase

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines GH-releasing hormone (GHRH), 222–223, 224 Growth hormone, pyridostigmine bromide (PB), 12, 209, 220, 222–224, 251, 334 Guillain-Barré syndrome, 284 Gulf War, background and setting, 1, 9, 27, 32, 172–174, 209 see also Veterans, studies of Gulf War veterans H Haemophilus influenzae type B (HIB), 296 Headaches, 1, 39, 350, 351, 354 anthrax vaccines, 281, 284, 285 botulinum toxoid vaccines, 294 pyridostigmine bromide (PB), 236 registry data, 40–41, 42 sarin, 10, 171, 193, 194, 198 Heat, 33, 235, 243 see also Thermoregulation Hematologic effects, 54 botulinum toxoid vaccines, 293 depleted uranium, 8, 19, 99 lymphocytes, 158, 272, 301, 302 multiple vaccines, 301–302 pyridostigmine bromide (PB), 11, 208, 244 rheumatoid factor, 299–300, 302 sarin, 177, 178, 188, 192, 194–195 squalene, 311 uranium, 8, 19, 96, 97, 99, 105–106, 109, 157–158 see also Cardiovascular system; Red blood cells Hepatic effects, 79 pyridostigmine bromide (PB), 210 sarin, 177 squalene, 308 uranium, 19, 97, 100, 104, 108–109, 158 Hepatitis vaccines, 295, 296 Herpes simplex virus, 310 HIAA, see 5-hydroxyindoleacetic acid HIB, see Haemophilus influenzae type B Histocompatibility, 273 Historical perspectives, 28–29, 30, 339, 343 AIDS, 345–346 anthrax vaccines, 272, 274, 281, 283–284, 287 Bosnian conflict, 39, 50–51, 250, 303, 304, 358 botulinum toxoid vaccines, 16, 288, 291, 293 chemical warfare agents, testing of military volunteers, 189 depleted uranium, 91–92 fatigue syndrome, 354 Kurdish/Iraqi conflict, 34 Operation Desert Storm, significant dates, 1, 9, 27, 32, 172–174, 209 organophosphates, general, 182 pyridostigmine bromide (PB), 207, 225 sarin, 8, 191 Japan, terrorist attack, 3, 10, 177–178, 188, 191–196, 199 squalene, 307 vaccines, general, 267, 268, 294, 295, 300–303; see also specific vaccines supra HIV, see AIDS Hoffman-La Roche, 207 Hormones, 230, 244, 244 contraceptives, 230 follicle-stimulating hormone, 157 GH-releasing hormone (GHRH), 222–223, 224 growth hormone, 12, 209, 220, 222–224, 251, 334 hypothalamic-pituitary-adrenal processes, 354, 360 pyridostigmine bromide (PB), 209, 220, 223, 250–251 luteinizing hormone (LH), 157 pineal gland, 220 vaccines, response to, 273 Hospitalization, 39, 55–57, 60, 61 anthrax vaccines, 284, 286 influenza vaccines, 311 organophosphate insecticides, 368 sarin, 188, 189–190, 193–195 HPA, see Hypothalamic-pituitary-adrenal Human leukocyte antigen (HLA), 273 Humoral immune response, 276–277 HSV, see Herpes simplex virus 5-hydroxyindoleacetic acid, 176 5-hydroxytryptamine, see Serotonin

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines multisymptom illness, 17, 51, 54, 154, 303–306, 342–365 myasthenia gravis, 3, 11, 12, 70, 71, 207, 208, 209, 224–225, 227–228, 230, 231, 250–251 pain, muscle and joint, 27, 39, 40, 42, 45, 46, 48, 49, 72, 193. 194, 198, 281, 284, 285, 286, 288, 293–294, 350, 351, 354, 355 pyridostigmine bromide (PB), 11, 12, 211–213, 220–221, 223, 226, 230, 232–233, 246, 248, 251 registry data, 40–41, 42 sarin, 9, 10, 171, 173, 179–180, 187, 190, 193, 194, 197, 327 uranium, 72, 105, 123, 158, 160 see also Chronic fatigue syndrome; Fatigue; Psychomotor effects Neuropathy, general, 46, 47, 52 Alzheimer’s disease, 213, 227 anthrax vaccine, 285 botulinum toxoid vaccines, 288(n.10), 289, 290–291 cyclosarin, 186–187 depleted uranium, 99, 103, 151, 153 genetic factors, 53 pyridostigmine bromide, 21, 220–222, 244–245, 328, 329 sarin, 21, 53, 183, 187, 197–198, 328 insecticides, 53 myasthenia gravis, 3, 11, 12, 70, 71, 207, 208, 209, 224–225, 227–228, 230, 231, 250–251 organophosphate-induced delayed neuropathy (OPIDN), 181–182, 183, 192, 197, 213, 217, 218, 248, 249, 252, 328 organophosphates, general, 367–368, 371–375 pyridostigmine bromide (PB), 11, 12, 13, 53, 219–220, 247–249, 252, 328 registry data, 42 sarin, 9–10, 175–176, 180–185, 186–187, 190, 192, 193, 194, 197, 327–328 convulsions, 10, 170, 175, 176, 179, 188, 192, 193 squalene, 308, 309 uranium, 19, 99, 102–103, 123, 151–153 vestibular nerve, 52, 197, 327 see also Acetylcholine; Acetylcholinesterase; Acute cholinergic symptoms/syndrome; Anticholinesterase; Brain; Butyrylcholinesterase; Central nervous system; Chronic fatigue syndrome; Convulsions; Cyclosarin; Nerve agents; Neuromuscular effects; Pain; Peripheral nervous system; Psychomotor effects Neuropathy target esterase (NTE), 181, 182, 183, 187 Neuropsychological effects, 47, 51, 351 anxiety, 49, 57, 171, 196, 226, 350, 354 attention deficits, 27, 51, 171 malaise, anthrax vaccines, 15, 281, 283, 284, 285 botulinum toxoid vaccines, 288, 294 organophosphates, general, 367–375 pyridostigmine bromide (PB), 13, 213–214, 227, 233–235, 236, 242–244, 252 sarin, 171, 175, 180, 188, 195, 195, 197, 328 uranium exposure, 151 see also Cognitive dysfunction; Mental disorders; Psychological effects Nicotinic effects pyridostigmine bromide (PB), 11, 208, 211, 223, 226, 230, 237, 240, 251 sarin, 170, 171, 175 N,N-diethyl-m-toluamide (DEET), 217, 218, 248, 334 Nuclear Regulatory Commission, 90, 92 Nutrition, see Diet O Oak Ridge, Tennessee, uranium processing workers, 7, 118–121, 122, 131–148 (passim), 152, 159 Occupational exposure, noncombat military personnel, 1, 27, 34 anthrax vaccines, 284–285 botulinum toxoid vaccines, 291–292 Occupational exposure, non-military, 74–75, 80 anthrax vaccines, 272, 282

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines botulinum toxoid vaccines, 16, 288 multiple vaccinations, 17 organophosphates, 188, 191, 199 phosphate fertilizer production workers, 112, 114–115, 130, 132, 152 sarin, 188, 191 uranium miners/processors, viii, 3, 6–7, 19, 21, 71, 89, 98, 106, 107–121, 122, 123–152, 154–159, 340–341 age factors, 116–117, 119, 121, 128, 134–135, 138, 149 bone cancer, 19, 109, 143, 146, 159 cardiovascular effects, 108–109, 126, 158, 160 cancer, general, 6–7, 19, 114, 117–118, 126–127, 128, 131, 135 dermal effects, 158, 160 gastrointestinal effects, 156, 158, 160 gender factors, 117, 118, 119, 121, 149, 157 genitourinary effects, 119, 123, 124, 150 genotoxicity, 158, 160 hematological effects, 109, 157–158, 160 hepatic effects, 19, 108–109, 158 immunologic effects, 154, 156–157, 158, 160 lung cancer, 6–7, 19, 79, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159 lymphatic cancer, 19, 100, 123, 142–143, 144–145, 159 mortality, see “uranium workers” under Mortality musculoskeletal effects, 123, 158, 160 neuropathy, 151–152, 160 ocular effects, 158, 160 race/ethnicity, 112, 113, 116, 119, 121 renal disease, 19, 115, 123, 147–151, 159 reproductive/developmental effects, 157, 158, 160 respiratory effects, 19, 108–109, 153–156, 159, 160; see also “lung cancer” supra socioeconomic status, 7, 117, 121, 138, 141 vaccines, 15, 16, 272, 282, 288, 294–295 Ocular effects, see Visual and ocular effects; Visual evoked potential Office of Technology Assessment, 30 Office of the Special Assistant for Gulf War Illnesses, 268 Oil well fires, 1, 27, 31, 33 OP-AChE bond, 9, 174–175, 177, 178, 180, 186, 210, 366 Oral delivery, see Ingestion Ordnance, see Ammunition Organophosphate-induced delayed neuropathy (OPIDN), 181–182, 183, 192, 196, 197, 212–213, 217, 218–219, 248, 249, 252, 328 Organophosphates, general, 1, 13, 28, 34, 53, 175, 182–183, 188, 213, 328, 330, 340, 369 acute effects of toxicity, 13, 213 age factors, 371–375 animal studies, 10 depression, 370 epidemiologic studies, 53, 366–377 fatigue, 367–375 genetic factors, 31, 53 neuropathy, 367–368, 371–375 organophosphate-induced delayed neuropathy (OPIDN), 181–182, 183, 192, 197, 213, 217, 218, 248, 249, 252, 328 occupational exposure, non-military, 188, 191, 199 organophosphate binding (OP-AChE), 9, 174–175, 177, 178, 180, 186, 208, 210, 366 psychological effects, 367–375 sexual function, 370 smoking and, 371 see also Cyclosarin; Pyridostigmine bromide; Sarin P Pain, 48, 49 animal studies, 72

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines anthrax vaccines, 281–282, 284, 285, 286 botulinum toxoid vaccines, 288, 292, 293, 294 chest, 42, 171 muscle and joint, 27, 39, 40, 42, 45, 46, 48, 49, 72, 193. 194, 198, 281, 284, 285, 286, 288, 293–294, 350, 351, 354, 355 pyridostigmine bromide (PB), 11, 12, 236 registry data, 40, 41, 42 sarin, 10, 171, 171, 193, 194, 198 uranium, 151, 156 see also Cramps; Headaches; Nausea and vomiting Paints, 1, 27, 34 Paraoxonase/arylesterase 1 (PON1), 221–222, 250, 328, 329 PB, see Pyridostigmine bromide PB-AChE bond, 9, 11, 13, 53, 208, 210–213 (passim), 215, 217, 220, 223, 235, 241, 244–245 Peer review anthrax vaccines, 15, 280, 286, 287, 312, 313 botulinum toxoid vaccines, 291 committee study methodology, 3, 18, 35, 61(n.26), 70 sarin, 173 uranium, 94 PEP, see Primate equilibrium platform Peripheral nervous system, 50 pyridostigmine bromide (PB), 213, 247 sarin, 170 squalene, 308 uranium, 151 Peripheral vascular resistance, 228–229 Persian Gulf Registry and Uniform Protocol, 40 Persian Gulf War Veterans Act, 2, 28 Perspiration pyridostigmine bromide (PB), 11, 12, 225 sarin, 171 see also Thermoregulation Pesticides, see Insecticides and insect repellants Petroleum and petrochemical products, 1, 14, 27–28, 30, 34, 48 oil well fires, 1, 27 Pharmacodynamics, pyridostigmine bromide (PB), 217–219, 230, 244 Pharmacokinetics pyridostigmine bromide (PB), 244 uranium, 94–99 Phosphate fertilizers, worker exposure, 112, 114–115, 130, 131, 132, 148, 152, 159 Pituitary gland, see Hypothalamic-pituitary-adrenal processes Plague vaccines, 295 Polio virus, 226 vaccines, 268, 296 POM, see Pro-opiomelanocortin PON1, see Paraoxonase/arylesterase 1 Population-based studies, vii, 3–4, 6, 10, 13, 18, 21, 32, 35, 44–62, 70 see also Occupational exposures, military personnel; Occupational exposures, nonmilitary; Registry programs Portsmouth Uranium Enrichment Facility, 115–116, 131, 132, 134, 145, 148, 152, 159 Posttraumatic stress disorder (PTSD), 342 diagnosis, 57, 58, 342 epidemiologic studies, 45, 46, 48, 49, 57–59, 62, 246 multiple vaccinations, 304, 305 pyridostigmine bromide (PB), 246 sarin, 10, 195–196, 198 Posturography, see Computerized posturography Presidential Advisory Committee, 172 Primate equilibrium platform, sarin, 180 Prolactin (PL), 156, 157 Pro-opiomelanocortin (POM), 213 Protective antigen vaccines, 274, 276–277, 279–280, 281, 282 Psychological factors, 46 anxiety, 49, 57, 171, 196, 226, 350, 354 malaise, anthrax vaccines, 15, 281, 283, 284, 285 botulinum toxoid vaccines, 288, 294 individual variability, 31 multiple vaccinations, 304 sarin, other, 171, 175, 180, 188, 197, 328

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines see also Mental disorders; Neuropsychological effects; Posttraumatic stress disorder; Stress, general Psychomotor effects depleted uranium, 103 dysarthria, 12, 223, 251 pyridostigmine (PB), 11, 12, 227, 223, 233, 240, 241, 242, 251 sarin, 10, 171, 175, 180, 196, 199 see also Convulsions; Musculoskeletal effects Public Law 103–446, 61 Pyrethroids, 34 Pyridostigmine bromide (PB), vii, viii, 1, 2, 3, 4, 8–9, 11–14, 19, 28, 34, 207–264, 330, 340 acetylcholine (ACh), 11, 12, 13, 207–216 (passim), 224, 227–228 Acetylcholinesterase (AChE), PB binding, 9, 11, 13, 53, 208, 210–213 (passim), 215, 217, 220, 223, 227–228, 232, 235, 241, 244–245 acute effects, 214, 224, 234, 250–251 age factors, 227, 228, 236, 238, 242, 244, 246–247 animal studies, 209, 210–211, 213, 214, 215, 218–219, 220 brain, 11, 207, 217, 219–220, 247 central nervous system, general, 12, 213, 217, 219–220, 223, 224, 226, 235, 240, 241, 247, 251 chronic effects, general, 13, 14, 214–215, 252–253 clinical studies, 12, 19, 209, 222–231, 249, 329 cognitive effects, general, 53, 224, 227, 233–235, 236, 242–243, 246, 247–248 cramps, 11, 12, 214, 223, 226, 251 dermal tissue, 215 depression, 233, 245 diagnosis of effects, 12, 223 dose factors, 11, 12, 14, 208–209, 210–211, 214, 215, 218, 219, 223–238 (passim), 247–248, 251, 252, 329 dysarthria, 12, 223, 251 epidemiological studies, 13–14, 21, 48, 71, 209, 245–250, 252, 329 fatigue, 211, 226, 230, 233, 236, 245, 329 FDA status, 11, 207, 208 gastrointestinal effects, 11, 12, 208. 209, 214, 223, 225–226, 230, 236, 242, 251 nausea and vomiting, 11, 12, 208, 214, 226, 245, 251 salivation, 11, 12, 208, 214, 225, 226, 242, 251 gender factors, 226, 231, 239, 244 genetic factors, 21, 220–222, 244–245, 328, 329 genitourinary system and urinalysis, 12, 208, 225–226 growth hormone, 12, 209, 220, 222–224, 251, 334 headaches, 236 hematologic effects, 11, 208, 210, 211–212, 244–245, 244 hepatic effects, 210 historical perspectives, 207, 225 hypothalamic-pituitary-adrenal processes, 209, 220, 223, 250–251 ingestion, 11, 12, 207–209, 210–211, 214, 223, 225, 234, 236, 237, 238, 240, 251 injection, 11, 207, 231, 236–237 interactions, chemical, 187, 209, 217–220, 229–230, 235, 248, 328, 328, 330, 334 lungs, 231, 237 mood disorders, 246 myasthenia gravis, 3, 11, 12, 70, 71, 207, 208, 209, 224–225, 227–228, 230, 231, 250–251 nausea and vomiting, 11, 12, 208, 214, 226, 245, 251 neuromuscular effects, 11, 12, 211–213, 220–221, 223, 226, 230, 232–233, 246, 248, 251 neuropathy, general, 11, 12, 13, 53, 219–220, 247–249, 252, 328 nicotinic effects, 11, 208, 211, 223, 226, 230, 237, 240, 251 pain, 11, 12, 236 peripheral nervous system, 213, 247 perspiration, 11, 12, 225 pharmacodynamics, 217–219, 230, 244 posttraumatic stress disorder, 246

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines psychological effects, 13, 213–214, 227, 233–235, 236, 242–244, 252 psychomotor effects, 11, 12, 227, 223, 233, 240, 241, 242, 251 rashes, 215, 225 red blood cells, 210, 211–212, 244–245 renal effects, 11, 208, 210 reproductive effects, 215, 226 research methodology, issues, 6–7, 11, 13, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159, 231, 237 research recommendations, 21, 328–329 respiratory effects, 11, 12, 208, 214, 215, 221, 225, 230–231, 235, 236–237 salivation, 11, 12, 208, 214, 225, 226, 242, 251 sleep disturbance, 226 stress, general, 226, 243–244, 328 thermoregulation, 216–217, 237–240 perspiration, 11, 12, 225 veterans, studies of Gulf War veterans, 209, 225–226, 245, 246–250, 252 visual and ocular effects, 11, 12, 208, 225, 233, 240–242, 248, 249 R Rabies vaccines, 295 Racial and ethnic factors, 41, 43, 60, 74 phosphate fertilizer production workers, 115 uranium workers, 112, 113, 116, 119, 121 Radiation effects, 48, 49 see also Depleted uranium; Uranium Rank of personnel, 41, 305 Rashes, 1, 27, 51, 52, 351 anthrax vaccines, 284, 285 pyridostigmine bromide (PB), 215, 225 registry data, 39, 40, 42 Receptor-mediated actions anthrax vaccines, 275 botulinum toxoid vaccines, 289 organophosphate binding (OP-AChE), 9, 174–175, 177, 178, 180, 186, 210, 366 pyridostigmine bromide binding (PB-AChE), 9, 11, 13, 53, 208, 210–213 (passim), 215, 217, 220, 223, 235, 241, 244–245 sarin, 9, 169–170, 175, 176 uranium, 96 see also Nicotinic effects; terms listed under Cholinergic effects Recordkeeping, viii–ix, 55(n.17), 61–62 anthrax vaccines, 284 botulinum toxoid vaccines, 268 phosphate fertilizer production workers, exposure, 130 uranium workers, exposure, 124 vaccines, 21, 268, 269, 270, 284, 330 Red blood cells (RBCs) pyridostigmine bromide (PB), 210, 211–212, 244–245 sarin, 177, 178, 190, 191 uranium, 96 Registry programs, 39, 40–43, 58, 77, 357, 358, 368 uranium, 94, 99, 106, 114, 149 Regulatory factors uranium, 90, 92 vaccines, 294 see also Food and Drug Administration; Legislation Renal effects depleted uranium, 7–8, 99, 150 pyridostigmine bromide (PB), 11, 208, 210 sarin, 177 uranium, 7–8, 19, 72, 97, 99, 100, 101–102, 115, 123, 147–151, 159 see also Genitourinary system and urinalysis Reproductive system, 52, 56–57, 61(n.25) anthrax vaccines, 226 birth defects, 56–57, 61(n.25), 62, 104–105 depleted uranium, 8, 19, 104–105, 157 pyridostigmine bromide (PB), 215, 226 sarin, 186, 187, 197 sexual functioning, 48, 49, 197, 370 uranium, 104–105, 157, 158, 160 Research methodology, viii–ix, 69–85, 334, 335, 342–365 clinical case definitions, 43–44, 54, 343–361

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines committee study, viii, 2–5, 18, 28, 32, 34–35, 40, 69–71, 78, 325, 339–341 disease classification, 342–365 dose factors, 4, 18, 78 evidence, assessment criteria, 4–5, 18–19, 78–81, 82–84 exposure, 69–70, 123–125 posttraumatic stress disorder, 58 pyridostigmine bromide (PB), 6–7, 11, 13, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159, 231, 237 sarin, 173 uranium effects, 123–128, 153, 159 vaccine studies, 269–271 see also Animal studies; Clinical studies; Cohort studies; Epidemiology; Peer review; Recordkeeping; Statistical techniques Research recommendations, 20, 325–330 anthrax vaccines, 21, 330 botulinum toxoid vaccines, 21, 330 depleted uranium, 21, 326–327 genetic factors, 21, 328, 329 interactions, chemical, 21, 325, 328 pyridostigmine bromide, 21, 328–329 sarin, 21, 327–328 vaccines, 21, 329–330 Respiratory effects, 46, 49, 52, 351, 356 anthrax, 272(n.3), 276–277 anthrax vaccine, 282, 283 asthma, 45, 49, 215, 231, 236, 237 botulinum toxoid vaccines, 289 bronchi, 11, 12, 171, 208, 214, 215, 225, 230, 237 depleted uranium, 98 infections, 59 macrophages, respiratory, 154, 272, 275 pyridostigmine bromide (PB), 11, 12, 208, 214, 215, 221, 225, 230–231, 235, 236–237 sarin, 171, 173, 174, 179–180, 188, 190, 193, 194 shortness of breath, 42 uranium, 19, 94–96, 97–98, 99, 100, 108–109, 153–156, 159 lung cancer, 6–7, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159 lungs, other, 96, 97–98, 99, 100, 108–109, 114, 117, 121, 123, 154–156 see also Inhalation; Lung cancer; Lungs Rheumatoid factor, 299–300, 302 Rubella, see Measles-mumps-rubella S Salivation pyridostigmine bromide (PB), 11, 12, 208, 214, 225, 226, 242, 251 sarin, 171 Sand, 1, 27, 33, 34 Sarin, vii, 2, 4, 8–10, 28, 169–204, 340 acetylcholine (ACh), 18, 19, 21, 169–170, 175, 176, 188, 192, 198 acetylcholinesterase (AChE), 9–10, 21, 169–170, 174–175, 176, 177, 178, 180, 186, 187, 190, 194–195 acute effects, 9, 18, 19, 21, 180, 188, 193–194, 199, 328 animal studies, 10, 175–176, 177, 178–187, 288 antidotes, 170, 179 brain, 10, 175–176, 177, 180, 181, 182, 186–187, 191, 195, 196, 199 central nervous system, general, 170, 171, 176–177, 182, 191, 195, 196, 327 chronic effects, general, 183, 188, 191–192, 193, 198 cognitive effects, general, 171, 181, 197 convulsions, 10, 170, 175, 176, 179, 188, 192, 193 cramps, 171 dermal exposure, 8, 169, 176 developmental effects, 186, 187 dose factors, 9, 10, 18, 19, 173, 176, 178–183, 186, 188, 192, 199, 288, 327 edema, 171 exposure, general, 9, 18, 19, 31, 170–173, 178, 182–183, 188 terrorist attacks, viii, 3, 10, 70, 177–178, 188 fatigue, 171, 189, 193, 194, 195, 198, 199, 327, 328 gastrointestinal effects, 171, 180

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines gender factors, 196, 197 genetic factors, 21, 53, 183, 187, 197–198, 328 genitourinary system and urinalysis, 171, 177–178 headaches, 10, 171, 193, 194, 198 hematologic effects, 177, 178, 188, 190, 191, 192, 194–195 hepatic effects, 177 historical perspectives, 8, 191 Japan, terrorist attack, 3, 10, 177–178, 188, 191–196, 199 hospitalizations, 188, 189–190, 193–195 ingestion, 176 inhalation, 169, 174, 176, 189 Japan, terrorist attack, 3, 10, 177–178, 188, 191–196, 199 injection, 176, 186, 189 insecticides and, 8, 10, 188, 328 interactions, chemical, 181, 187, 328 insecticides and, 8, 10, 188, 328 lungs, 171, 174 memory loss, 171 mood disorders, 195, 197, 199 mortality, 179, 188, 190 nausea and vomiting, 171 neuromuscular effects, 9, 10, 171, 173, 179–180, 187, 190, 193, 194, 197, 327 neuropathy, 9–10, 175–176, 180–185, 186–187, 190, 192, 193, 194, 197, 327–328 convulsions, 10, 170, 175, 176, 179, 188, 192, 193 nicotinic effects, 170, 171, 175 pain, 10, 171, 171, 193, 194, 198; see also “headaches” supra peripheral nervous system, 170 perspiration, 171 posttraumatic stress disorder, 10, 195–196, 198 posturography, 10, 196, 199 psychological effects, 171, 175, 180, 188, 195, 195, 197, 328 psychomotor effects, 10, 171, 175, 180, 196, 199 receptor-mediated actions, general, 9, 169–170, 175, 176 red blood cells, 177, 178, 190, 191 renal effects, 177 reproductive system effects, 186, 187, 197 research recommendations, 21, 327–328 respiratory effects, 171, 173, 174, 179–180, 188, 190, 193, 194 salivation, 171 sexual functioning, 197 sleep disturbance, 10, 171, 191, 194, 195, 199 stress, general, 176 terrorists attacks, viii, 3, 10, 70, 177–178, 188 toxicokinetics, 176–178 veterans, studies of Gulf War veterans, 172–174, 187–190, 196–197 visual and ocular effects, 10, 195, 196, 199, 171, 173, 174, 175, 188, 192, 193, 194, 195, 196, 199, 327 see also Cyclosarin; Pyridostigmine bromide Serotonin, 176 Sex-based differences, see Gender factors Sexual functioning, 48, 49 organophosphate pesticides, 370 sarin, 197 Skeletal effects, see Musculoskeletal effects Skin, see Dermal exposure; Dermal tissue, other; Injection delivery; Perspiration; Rashes SLE, see Systemic lupus erythematosus Sleep disturbance, 52, 351, 355 pyridostigmine bromide, 226 registry data, 42 sarin, 10, 171, 191, 194, 195, 199 Smoke, 1, 27–28, 33–34, 48 depleted uranium, 6, 93 oil well fires, 1, 27, 31, 33 Smoking, tobacco, 75, 81 organophosphate pesticides, 371 sarin exposure and difficulty in, 194 uranium miners/processors, 6, 7, 107, 108, 114, 120, 121, 127, 130, 135, 137, 138, 139, 141–142, 154, 156, 159 Social factors disease classification, 343, 348, 349 individual variability, 31 living conditions, 33, 35

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines Social Security Administration, 114–115, 116, 119 Socioeconomic status organophosphate pesticides, 371 uranium workers, 7, 117, 121, 138, 141 Solvents, 1, 27, 34, 48 Soviet Union, 281 Special Immunization Safety Study, 284–285 Speech, see Dysarthria Squalene, 268, 280, 307–312, 340 Statistical techniques, 4, 7, 8, 55(n.12), 79, 82 aggregation of data, 44 clinical classifications, 347 factor analysis, 44, 52, 53–54, 246, 347 uranium effects, 125–127, 159 vaccine studies, 270–271 see also Epidemiology; Multivariate analysis Stool, see Feces Stress, general, 1, 21, 28, 35, 46, 49, 51, 57–59, 334 living conditions, 33, 35 multiple vaccinations, 305 pyridostigmine bromide, 226, 243–244, 328 sarin and, 176 see also Posttraumatic stress disorder Subcutaneous drug delivery, see Injection delivery Sweating, see Perspiration Swelling, see Edema; Inflammation Symptom clustering, 43, 44, 48, 49, 50–51, 349 multisymptom illness, 17, 51, 54, 154, 303–306, 342–365 Systemic lupus erythematosus, 157, 284, 311 T Tanks, military assault vehicles depleted uranium, 5, 92–94 Tantalum (Ta), 98–99, 100, 101, 103 Tennessee Eastman Corporation, Oak Ridge plant uranium processing workers, 7, 118–121, 122, 123, 131–148 (passim), 152, 159 Terrorist attacks, sarin, viii, 3, 10, 70, 177–178, 188 Testicular cancer, 60 Thermoregulation, 33, 216–217, 235, 237–240 see also Perspiration Tobacco use, see Smoking Tokyo, Japan, see Sarin Toxicokinetics anthrax vaccines, 275 antigens, general, 271–272, 273 botulinum toxoid vaccines, 289–291 genetic factors, 31, 63 multiple vaccines, 296–299 organophosphates, 31 pyridostigmine bromide (PB), 210 sarin, 176–178 uranium, 94–99, 327 see also Pharmacokinetics Toxicological Profile for Uranium, 94 Trauma, injury, see Injuries Tri-o-cresyl phosphate (TOCP), 182 Tripler Army Medical Center Survey, 286 Tumor necrosis factor (TNF), 275 Typhoid vaccines, 295, 301 U Union Carbide, Oak Ridge plant uranium processing workers, 7, 118–121, 122, 131–148 (passim), 152, 159 United Kingdom, personnel, 39, 45, 46, 50–51, 356, 357, 358 anthrax vaccines, 274, 281 birth defects, 56–57 multiple vaccines, 303–305, 314 pyridostigmine bromide (PB), 250, 252 registry program, 41 sarin, 190 United Nations Special Commission on Iraq, 9, 172, 268 United Nuclear Corporation, 111, 114 Uranium, 90–167 acute effects, 99 animal studies, 21, 96, 97–98, 99–106, 107, 151, 159, 327 antibodies, 152, 156–157, 312 cancer, 113, 117–118, 121, 123, 128–142, 159

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines cardiovascular effects, 8, 19, 96, 100, 105, 108–109, 126, 158, 160 case-control studies, 108, 121, 127, 138 central nervous system, general, 99, 102, 103 chronic effects, general, 100, 102–103 cohort studies, 112–114, 115–121, 122, 123–149, 151–152, 154–157, 158, 159 cramps, 151 Department of Energy (DOE), 116, 117 dermal effects, 19, 105, 158 dermal exposure, 96, 151, 156 developmental effects, 8, 19, 104–105, 157, 158 dose factors, 7, 90, 91, 103, 108, 115–116, 117–118, 120, 121, 123, 125, 128, 130, 135–140, 141, 142, 159 exposure, general, depleted uranium, 6, 31, 92, 93–94, 326 occupational exposure, see also “uranium miners/processors” under Occupational exposure, nonmilitary gastrointestinal effects, 8, 19, 104, 156, 158, 160 genetic factors, 8, 19, 100–101, 157, 158 genitourinary system and urinalysis, 97, 100–101, 119, 123, 124, 150 hematologic effects, 8, 19, 96, 97, 99, 105–106, 109, 157–158 hepatic effects, 19, 97, 100, 104, 108–109, 158 immune system, 8, 154, 156–157, 158 ingestion, 6, 93, 96, 98–99, 100, 105, 123, 147, 149–150, 151 inhalation, 93, 94–96, 97, 97–98, 99, 100, 105, 106, 115, 118–120, 121, 123, 142–143, 154, 156, 158 injection, 99, 144 interactions, chemical, 154, 159 lung cancer, 6–7, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159 mood disorders, 109, 151 neuromuscular effects, 72, 105, 123, 158, 160 neuropathy, general, 19, 99, 102–103, 123, 151–153 occupational exposures, miners and processors, see also “uranium miners/processors” under Occupational exposure, non-military pain, 151, 156 peripheral nervous system, 151 pharmacokinetics, 94–99 phosphate fertilizer production workers, 112, 114–115, 130, 132, 148, 152, 159 psychological effects, 151 registry programs, 94, 99, 106, 114, 149 regulatory issues, 90, 92; see also Nuclear Regulatory Commission renal effects, 7–8, 19, 72, 97, 99, 100, 101–102, 115, 123, 147–151, 159 reproductive system effects, 104–105, 157, 158, 160 research methodology issues, 123–128, 153, 159 respiratory system, 19, 94–96, 97–98, 99, 100, 108–109, 153–156, 159 lung cancer, 6–7, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159 lungs, other, 96, 97–98, 99, 100, 108–109, 114, 117, 121, 123, 154–156 smoking tobacco, 6, 7, 75, 81, 107, 108, 114, 120, 121, 127, 130, 135, 137, 138, 141–142, 154, 156, 159 visual and ocular effects, 8, 105, 158 see also Depleted uranium Urinary system, see Genitourinary system and urinalysis U.S., Uranium Registry, 149 V VA, see Department of Veterans Affairs Vaccine Adverse Events Reporting System (VAERS), 269, 270, 284, 296 Vaccines, viii, 4, 14–18, 19, 49, 51, 267–324 acute effects, general, 270, 271 antibodies, adverse reactions, 17, 272, 298

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines adjuvants, vaccines, 270, 271, 274, 276, 279, 280, 290 squalene, 268, 280, 307–312, 340 age factors, 302, 311–312 animal studies, 271, 272, 277–280, 297–299, 330 cardiovascular effects, general, 272 chronic effects, general, 17, 271, 287, 294, 198–199, 303, 304, 311, 312–314, 330 clinical studies, 15–17, 19, 270, 271, 282–283, 284–287, 291–294, 305, 306, 310–311, 333 cohort studies, 17, 274, 281, 291, 299, 300–303, 306, 314 dose factors, 272 genetic factors, 272, 273, 280, 290–291 hepatitis virus, 295, 296 herpes simplex virus, 310 historical perspectives, general, 267, 268, 294, 295, 300–303 HIV, 310 hormonal effects, 273 immune system response, 17, 271–272, 273, 278, 284, 288, 290, 296, 297, 298–299 influenza, 295, 310–311 insecticides and, 305 interactions, chemical, 272, 296, 330 insecticides and, 305 see also Multiple vaccinations meningitis, 284, 295, 296 mortality, 302–303, 311 number of military doses delivered, 14, 267, 268, 269 occupational exposures, non-military, 15, 16, 272, 282, 288, 294–295 polio, 268, 296 recordkeeping, 21, 268, 269, 270, 284, 330 research methodology issues, 269–271 research recommendations, 21, 329–330 regulatory factors, 294; see also Food and Drug Administration squalene, 268, 280, 307–312, 340 surveillance and reporting, 269, 270 typhoid, 295, 301 veterans studies, Gulf War, 285, 286, 293, 299–300, 303–305, 311–312, 329, 330 visual and ocular effects, 286, 288(n.10), 294 yellow fever, 295, 296, 301 see also Anthrax vaccines; Botulinum toxoid vaccines; Centers for Disease Control and Prevention; Multiple vaccinations VAERS, see Vaccine Adverse Events Reporting System Varicella vaccines, 295 VEP, see Visual evoked potential Vestibular nerve, 52, 197, 327 Veterans Administration, see Department of Veterans Affairs Veterans, studies of Gulf War veterans, 43–62, 325 anthrax vaccines, 285, 286, 293 botulinum toxoid vaccines, 285, 293 clinical definitions, 43–44, 54, 347–348, 349–361 Canadian, 39, 45, 46, 48–49, 285, 333, 358 Iowa Persian Gulf study, 45, 46, 48, 49, 52, 57, 60, 62, 358, 333, 358 multiple vaccinations, 299–300 multisymptom illness, 17, 51, 54, 154, 303–304 pyridostigmine bromide (PB), 209, 225–226, 245, 246–250, 252 sarin, 172–174, 187–190, 196–197 squalene, 311–312 United Kingdom, 39, 41, 45, 46, 50–51, 56–57, 190, 250, 252, 274, 281, 303–305, 314, 356, 357, 358 uranium, see Depleted uranium vaccines, 285, 286, 293, 299–300, 303–305, 311–312, 329, 330 Veterans Programs Enhancement Act, 2, 28 Vietnam War herbicides, 3, 29, 334 Vinyl chloride, 79 Visual and ocular effects anthrax vaccines, 286 botulinum toxoid vaccines, 288(n.10), 294 miosis, 11, 12, 171, 174, 188, 208, 240, 241, 248, 249 pyridostigmine bromide (PB), 11, 12, 208, 225, 233, 240–242, 248, 249

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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines sand, 33 sarin, 10, 195, 196, 199, 327, 171, 173, 174, 175, 188, 192, 193, 194, 195, 196, 199, 327 uranium, 8, 105, 158 visual evoked potential (VEP), pyridostigmine bromide (PB), 240, 248, 249 sarin, 10, 195, 196, 199, 327 Vomiting, see Nausea and vomiting W Weather, 33, 235, 243 Weight loss, 52, 245 White blood cells, see Lymphocytes Women, see Gender factors World Health Organization, 346, 360 Wounds, depleted uranium, 93, 102–103 Y Yellow fever vaccines, 295, 296, 301