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
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
anticholinesterases, 190
multiple vaccinations, 305
organophosphate pesticides, 371–375
phosphate fertilizer production workers, 130
pyridostigmine bromide, 227, 228, 236, 238, 242, 244, 246–247
uranium workers, 116–117, 119, 121, 128, 134–135, 138, 149
Agency for Toxic Substances and Disease Registry (ATSDR), 94, 99, 106
Air Force Technical Applications Center (AFTAC), 173
Alkaline phosphatase (ALP), 150
Aluminum hydroxide adjuvant, 274, 276
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
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
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
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
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
multiple vaccinations, 301, 304
neuromuscular effects, 281, 284, 285, 286
neuropathy, general, 285
number of vaccinations given, 15, 267, 274, 284
protective antigen vaccines, 274, 276–277, 279–280, 281, 282
reproductive system effects, 226
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
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
see also Pyridostigmine bromide
anthrax vaccines, 15, 54, 274–277 (passim), 279–280
botulinum toxoid vaccines, 290
human leukocyte antigen (HLA), 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
Asthma, 45, 49, 215, 231, 236, 237
ATSDR, see Agency for Toxic Substances and Disease Registry
sarin, 171
Autoimmune diseases, 273
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
antibodies, 288(n.11), 290, 293, 306
chronic effects, 19, 294, 313–314
clinical studies, 19, 291–294, 333
cramps, 288
edema, 292
fatigue, 288(n.10)
genetic factors, 290–291
headaches, 294
hematologic effects, 293
historical perspectives, 16, 288, 291, 293
immune system, impacts on, 290–292
ingestion, 287–288
neuropathy, general, 288(n.10), 289, 290–291
neuromuscular effects, 288, 289
number of vaccinations given, 268
surveillance, 269
veterans, studies of Gulf War veterans, 285, 293
Brain
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
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
cyclosarin, 187
peripheral vascular resistance, 228–229
pyridostigmine bromide (PB), 215–216, 228–229, 230, 235–236, 245, 249
registry data, 42
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
Center for Health Promotion and Preventive Medicine (CHPPM), 93–94
Centers for Disease Control and Prevention (CDC)
AIDS, case definition, 345–346
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)
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
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
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
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
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)
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
Czechoslovakia, uranium miners, 109
D
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)
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
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
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
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
hematologic effects, 8, 19, 99
historical perspectives, 91–92
injection, 99
musculoskeletal effects, 8, 99
research recommendations, 21, 326–327
respiratory effects, 98
tantalum (Ta), 98–99, 100, 101, 103
see also Uranium
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
see also Injection delivery
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
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
uranium, 8, 19, 104–105, 157, 158
Diabetes mellitus, 298–299
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
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
Digestive system, see Gastrointestinal effects
Diphtheria-tetanus-pertussis vaccines, 268, 295, 296, 299, 300, 301
DNA
anthrax vaccines, 280
pyridostigmine bromide (PB), 220
sarin, 183
uranium effects, 157
Dose and dose-response, viii, 78–79, 83, 357
anthrax vaccines, 274–275, 278, 285
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
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
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
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
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
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)
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
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
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
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)
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
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
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
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
infections, 59–60
pyridostigmine bromide (PB), 11, 12, 208. 209, 214, 223, 225–226, 230, 236, 242, 251
registry data, 42
uranium, 8, 19, 104, 156, 158, 160
see also Diarrhea;
Ingestion;
Nausea and vomiting;
Salivation
anthrax vaccines, 286
organophosphate pesticides, 371–375
phosphate fertilizer production workers, 115
pyridostigmine bromide, 226, 231, 239, 244
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
individual variability, 31, 197–198, 220–222, 244–245, 272, 334
multiple vaccines, 298
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
uranium, 97, 100–101, 119, 123, 124, 150
see also Renal effects;
Sexual functioning
Germany, sarin development, 8
GGT, see Gamma-glutamyltransferase
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
see also Thermoregulation
Hematologic effects, 54
botulinum toxoid vaccines, 293
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
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
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
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
influenza vaccines, 311
organophosphate insecticides, 368
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
Hypersensitivity, immune response, 31, 49, 82, 218, 236, 271, 272, 278, 284, 288, 290, 297, 298–299
Hypothalamic-pituitary-adrenal processes, 354, 360
pyridostigmine bromide (PB), 209, 220, 223, 250–251
I
IC, see Immunoconglutinin
ICRP, see International Commission on Radiological Protection
Iminodipropionitrile (IDNP), 213
anthrax vaccine, impacts on, 279, 284, 285, 290–292, 306
botulinum toxoid vaccines, pathological response to, 290–292
histocompatibility, 273
humoral immune response, 276–277
hypersensitivity, 31, 49, 82, 218, 236, 271, 272, 278, 284, 288, 290, 297, 298–299
macrophages, respiratory, 154, 272, 275
multiple vaccines, 17, 296, 297–298
myasthenia gravis, 3, 11, 12, 70, 71, 207, 208, 209, 224–225, 227–228, 230, 231, 250–251
vaccines, response to, 17, 271–272, 273, 278, 284, 288, 290, 296, 297, 298–299
see also Antibodies;
Antigens;
Inflammation
Immunizations, see Vaccines
Immunoconglutinin (IC), 299–300
Immunoglobulin, 311
Infectious diseases, 342
gastrointestinal, 59–60
registry data, 42
see also Anthrax vaccines;
Biological warfare agents, general;
Botulinum toxoid vaccines;
Measles-mumps-rubella;
Vaccines
anthrax vaccines, 278, 281, 284, 286, 287, 297
botulinum toxoid vaccines, 290, 293–294
multiple vaccinations, 17, 297, 306
squalene, 309
see also Edema
Influenza vaccines, 295, 310–311
Ingestion
anthrax, 272(n.3)
botulism, 287–288
contraceptive pills, 230
depleted uranium, 6, 93, 96, 98–99
polio vaccines, oral, 268, 296
pyridostigmine bromide (PB), 11, 12, 207–209, 210–211, 214, 223, 225, 234, 236, 237, 238, 240, 251
sarin, 176
uranium, 6, 93, 96, 98–99, 100, 105, 123, 147, 149–150, 151
see also Gastrointestinal effects
Inhalation
anthrax, 272(n.3), 276–277, 282, 283
Japan, terrorist attack, 3, 10, 177–178, 188, 191–196, 199
uranium, 93, 94–96, 97, 97–98, 99, 100, 105, 106, 115, 118–120, 121, 123, 142–143, 154, 156, 158
see also Lung cancer;
Lungs;
Respiratory system;
Smoke;
Smoking, tobacco
Injection delivery
anthrax vaccines, 15, 279–286 (passim), 297
botulinum toxoid vaccines, 16, 288, 293
depleted uranium, 99
multiple vaccines, 295–296, 297
pyridostigmine bromide (PB), 11, 207, 231, 236–237
Injuries
registry data, 42
uranium exposure, accidental deaths, 109
wounds, depleted uranium, 93, 102–103
Insecticides and insect repellants, 1, 21, 34, 48, 53, 247, 340, 366–377
fatigue, 367–375
gender factors, 371–375
genetic factors, 53
N,N-diethyl-m-toluamide (DEET), 217, 218, 248
vaccines and, 305
see also Organophosphates
Interactions, chemical, 29, 46, 71–72, 78, 334
multiple chemical sensitivity (MCS), 46, 49, 350, 352, 356–357, 358, 359
phosphate fertilizer production workers, 130
pyridostigmine bromide (PB), 187, 209, 217–220, 229–230, 235, 248, 328, 328, 330, 334
research recommendations, 21, 325, 328
sarin, 175–178 (passim), 181, 187, 328
insecticides and, 8, 10, 188, 328
insecticides and, 305
multiple vaccinations, 14, 17–18, 19, 21, 51, 270, 285, 295–306, 314
Internal Revenue Service, 114–115, 116
International Atomic Energy Agency, 268
International Classification of Diseases (ICD), 56, 346, 360
International Commission on Radiological Protection, 89
Intravenous injections, see Injection delivery
Investigational New Drug (IND) status
anthrax vaccines, 274, 283–284
botulinum toxoid vaccines, 16, 288, 293
pyridostigmine bromide (PB), 208
anthrax vaccines, 275
Iowa Persian Gulf study, 45, 46, 48, 49, 52, 57, 60, 62, 333, 358
Iran–Iraq conflict, sarin, 8
Isopropyl methylphosphonoflouridate, see Sarin
J
Japan, sarin terrorist attacks, 3, 10, 177–178, 188, 191–196, 199, 327
K
Kidneys, see Renal effects
L
Lactate dehydrogenase (LDH), 101, 150, 187, 214–215
Leishmaniasis, 59
Legislation
Freedom of Information Act, 283
Persian Gulf War Veterans Act, 2, 28
Veterans Programs Enhancement Act, 2, 28
see also Regulatory factors
LH, see Luteinizing hormone
Linde Air Products Company, 116–117, 134
Live attenuated spore vaccines, 274, 276, 277–279, 281, 297
Liver, see Hepatic effects
Longitudinal studies, see Cohort studies;
Epidemiology
Lung cancer, 79
uranium, 6–7, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159
Lungs, 142
pyridostigmine bromide (PB), 231, 237
uranium, 96, 97–98, 99, 100, 108–109, 114, 117, 121, 123, 154–156
see also Inhalation
Lupus, see Systemic lupus erythematosus
Luteinizing hormone (LH), 157
Lymphatic system
anthrax vaccines, 278
cancer, 19, 100, 123, 142–143, 144–145, 159
uranium, 6, 95, 100, 106, 109, 123, 135, 142–143
Lymphocytes, 158, 272, 301, 302
anthrax vaccines, 278
M
Macrophages, respiratory, 154, 272, 275
Malaise, short-term, 354
anthrax vaccines, 15, 281, 283, 284, 285
botulinum toxoid vaccines, 288, 294
Malaria, 230
Mallinckrodt Chemical Works, 118–119. 121, 122
Mass spectroscopy, 119
Gas chromatograph-mass spectroscopy (GC-MS), 191, 194
Matsumoto, Japan, see Sarin
MCS, see Multiple chemical sensitivity
Measles-mumps-rubella vaccines, 268, 295, 296, 300
Memory loss, 1, 27, 39, 52, 351
sarin, 171
Men, see Gender factors
Mental disorders, 46, 47, 48, 50
anthrax vaccines, bipolar disorder, 284
mood disorders, general, 50, 54, 195;
see also Multisymptom illness
organophosphates, 367
pyridostigmine bromide (PB), 246
registry data, 41–42
see also Attention deficits;
Depression;
Memory loss;
Posttraumatic stress disorder
Mestinon bromide, see Pyridostigmine bromide
Methodology, see Research methodology
Methylphosphonic acid, 177–178
Minority groups, see Racial and ethnic factors
Miosis
pyridostigmine bromide (PB), 11, 12, 208, 240, 241, 248, 249
MMR, see Measles-mumps-rubella
Monitoring System for Adverse Events Following Immunization, 296
see also Depression;
Multisymptom illness
Mortality, 39, 40, 54–55, 74, 82
anticholinesterases, 190
cancer, 6–7, 108–109, 117, 128, 114, 117–118, 126–130, 128, 131–142
influenza vaccines, 311
multiple vaccines, 302–303
phosphate fertilizer production workers, 112, 114–115, 130, 132, 148, 152, 159
uranium workers, 112–118, 119–120, 125–127, 129, 151
bone cancer, 143
cancer, general, 117, 128, 114, 117–118, 126–127, 128, 131
cardiovascular factors, 158
lung cancer, 6–7, 108–109, 113, 117–118, 128–130, 132–142
lymphatic cancer, 142–143, 144–145
neuropathy, 151–152
respiratory disease, nonmalignant, 159
Motor functions, see Convulsions;
Psychomotor effects
MPA, see Methylphosphonic acid
Multiple chemical sensitivity (MCS), 46, 49, 350, 352, 356–357, 358, 359
see also Interactions, chemical
Multiple vaccinations, 14, 17–18, 19, 21, 51, 270, 285, 295–306, 314
age factors, 305
animal studies, 297–299
anthrax vaccine as part of, 301, 304
cancer and, 299
Centers for Disease Control and Prevention (CDC), 295, 296, 304, 305–306
chronic effects, general, 17, 298–299, 304
diphtheria-tetanus-pertussis vaccines, 268, 295, 296, 299, 300, 301
genetic factors, 298
hematologic effects, 301–302
immune system response, 17, 296, 297–298
measles-mumps-rubella vaccines, 268, 295, 296
mortality, 302–303
posttraumatic stress disorder, 304, 305
prescribed for military personnel, list, 295
psychological factors, 304
socioeconomic status, 305
veterans, studies of Gulf War veterans, 299–300
Multisymptom illness, 17, 51, 54, 154, 303–306, 342–365
symptom clustering, 43, 44, 48, 49, 50–51, 349
veterans, studies of Gulf War veterans, 17, 51, 54, 154, 303–304
see also Posttraumatic stress disorder
Multivariate analysis, 7, 108, 114
sarin-induced effects, 191
uranium-induced effects, 7, 126, 138, 140–141
Mumps, see Measles-mumps-rubella
Munitions, see Ammunition
Musculoskeletal effects, 47
anthrax vaccines, 281, 284, 285, 286
bone cancer, 19, 109, 143, 146, 159
botulinum toxoid vaccines, 288, 289
electromyography (EMG), 190, 232, 233, 249
epidemiological studies, general, 40–41, 42, 45, 46, 48, 49
fibromyalgia, 45, 46, 48, 49, 62, 343, 352, 355–360 (passim)
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, 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
sarin, 9, 10, 171, 173, 179–180, 187, 190, 193, 194, 197, 327
uranium, 72, 105, 123, 158, 160
see also Chronic fatigue syndrome;
Cramps;
Fatigue;
Psychomotor effects
Myasthenia gravis, 3, 11, 12, 70, 71, 207, 208, 209, 224–225, 227–228, 230, 231, 250–251
N
National Center for Toxicological Research, 183
National Death Index, 117
National Institute of Allergy and Infectious Diseases, 310
National Institute for Occupational Safety and Health, 114–115
National Institutes of Health, 30, 274
National Library of Medicine, 341
National Occupational Safety and Health Administration, 114–115
National Technical Information Service, 341
National Vaccine Injury Compensation Program, 269
Nausea and vomiting
pyridostigmine bromide (PB), 11, 12, 208, 214, 226, 245, 251
sarin, 171
see also Antidotes;
Central nervous system;
Cyclosarin;
Pyridostigmine bromide;
Sarin
Neuromuscular effects, 52
anthrax vaccines, 281, 284, 285, 286
botulinum toxoid vaccines, 289, 290
electromyography (EMG), 190, 232, 233, 249
epidemiological studies, general, 40–41, 42, 45, 46, 48, 49
fibromyalgia, 45, 46, 48, 49, 62, 343, 352, 355–360 (passim)
Guillain-Barré syndrome, 284
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
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
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
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
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
botulinum toxoid vaccines, 16, 288
multiple vaccinations, 17
organophosphates, 188, 191, 199
phosphate fertilizer production workers, 112, 114–115, 130, 132, 152
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
gastrointestinal effects, 156, 158, 160
gender factors, 117, 118, 119, 121, 149, 157
genitourinary effects, 119, 123, 124, 150
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
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
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
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
animal studies, 72
anthrax vaccines, 281–282, 284, 285, 286
botulinum toxoid vaccines, 288, 292, 293, 294
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
sarin, 10, 171, 171, 193, 194, 198
see also Cramps;
Headaches;
Nausea and vomiting
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
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
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
epidemiologic studies, 45, 46, 48, 49, 57–59, 62, 246
multiple vaccinations, 304, 305
pyridostigmine bromide (PB), 246
Posturography, see Computerized posturography
Presidential Advisory Committee, 172
Primate equilibrium platform, sarin, 180
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
see also Mental disorders;
Neuropsychological effects;
Posttraumatic stress disorder;
Stress, general
Psychomotor effects
depleted uranium, 103
pyridostigmine (PB), 11, 12, 227, 223, 233, 240, 241, 242, 251
sarin, 10, 171, 175, 180, 196, 199
see also Convulsions;
Musculoskeletal effects
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
dose factors, 11, 12, 14, 208–209, 210–211, 214, 215, 218, 219, 223–238 (passim), 247–248, 251, 252, 329
epidemiological studies, 13–14, 21, 48, 71, 209, 245–250, 252, 329
fatigue, 211, 226, 230, 233, 236, 245, 329
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
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
peripheral nervous system, 213, 247
pharmacodynamics, 217–219, 230, 244
posttraumatic stress disorder, 246
psychological effects, 13, 213–214, 227, 233–235, 236, 242–244, 252
psychomotor effects, 11, 12, 227, 223, 233, 240, 241, 242, 251
red blood cells, 210, 211–212, 244–245
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
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
see also Depleted uranium;
Uranium
pyridostigmine bromide (PB), 215, 225
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
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
uranium, 96
Registry programs, 39, 40–43, 58, 77, 357, 358, 368
uranium, 94, 99, 106, 114, 149
Regulatory factors
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
sexual functioning, 48, 49, 197, 370
uranium, 104–105, 157, 158, 160
committee study, viii, 2–5, 18, 28, 32, 34–35, 40, 69–71, 78, 325, 339–341
disease classification, 342–365
evidence, assessment criteria, 4–5, 18–19, 78–81, 82–84
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
botulinum toxoid vaccines, 21, 330
interactions, chemical, 21, 325, 328
pyridostigmine bromide, 21, 328–329
Respiratory effects, 46, 49, 52, 351, 356
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
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
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
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
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
insecticides and, 8, 10, 188, 328
interactions, chemical, 181, 187, 328
insecticides and, 8, 10, 188, 328
memory loss, 171
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
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
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
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
Social Security Administration, 114–115, 116, 119
Socioeconomic status
organophosphate pesticides, 371
uranium workers, 7, 117, 121, 138, 141
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
vaccine studies, 270–271
see also Epidemiology;
Multivariate analysis
Stool, see Feces
Stress, general, 1, 21, 28, 35, 46, 49, 51, 57–59, 334
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
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
multiple vaccines, 296–299
organophosphates, 31
pyridostigmine bromide (PB), 210
sarin, 176–178
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
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
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
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
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
interactions, chemical, 154, 159
lung cancer, 6–7, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159
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
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
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
adjuvants, vaccines, 270, 271, 274, 276, 279, 280, 290
squalene, 268, 280, 307–312, 340
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
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
insecticides and, 305
interactions, chemical, 272, 296, 330
insecticides and, 305
see also Multiple vaccinations
number of military doses delivered, 14, 267, 268, 269
occupational exposures, non-military, 15, 16, 272, 282, 288, 294–295
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
veterans studies, Gulf War, 285, 286, 293, 299–300, 303–305, 311–312, 329, 330
visual and ocular effects, 286, 288(n.10), 294
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
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
sand, 33
sarin, 10, 195, 196, 199, 327, 171, 173, 174, 175, 188, 192, 193, 194, 195, 196, 199, 327
visual evoked potential (VEP),
pyridostigmine bromide (PB), 240, 248, 249
Vomiting, see Nausea and vomiting
W
White blood cells, see Lymphocytes
Women, see Gender factors
World Health Organization, 346, 360
Wounds, depleted uranium, 93, 102–103
Y