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Suggested Citation:"Appendix D: Environmental Chemicals." National Academies of Sciences, Engineering, and Medicine. 2020. An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies. Washington, DC: The National Academies Press. doi: 10.17226/25889.
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D

Environmental Chemicals

Environmental chemicals reported to be associated with signs and symptoms similar to the chronic signs and symptoms observed in Havana patients (pesticides are in italics).

Symptoms Chemicals Associated with Symptom
Ototoxicity, vestibulotoxicity, tinnitus, vertigo
  • Organic solvents (benzene-based and aliphatic hydrocarbons, 1,2-dinitrobenzene, toluene, trichloroethylene, xylene)
  • Nitriles, carbon disulfide, asphyxiants (CO), metals
  • Organophosphorus pesticides (OPs) and other phosphate-based chemicals (acute and chronic exposures)
  • Acute pyrethroid exposure
  • Quinine (chronic exposure)
Sensorimotor function
  • Bismuth
  • Brevetoxins
  • Pyrethroids
  • Organophosphorus pesticides (OPs)
  • Metals (Pb, Cd, thallium)
Vision
  • Acute OP exposures
  • Chlordecone (kepone)
  • Carbon tetrachloride, carbon disulfide, 2,5-hexanedione, methanol (formate)
  • Quinine
Motor dysfunction (incoordination, muscle weakness)
  • Acute and chronic OP exposures
  • B-N-methylamino-L-alanine (BMAA), domoic acid, tetanus toxin
  • MPTP, ethanol, 3-nitropropionic acid
  • Carbon monoxide, carbon disulfide, toluene
  • Metals (Pb, Mn, Hg, As)
Concentration/memory deficits
  • Acute and chronic OP exposures
  • Many pesticides that target neuronal signaling molecules
  • Metals (Pb, Mn, Hg)
  • Solvents
Headaches, fatigue, insomnia
  • OPs and pyrethroids

SOURCES: Alcaras et al., 2013; Anger et al., 2020; Ashok Murthy and Visweswara Reddy, 2014; Campo et al., 2007; Chen et al., 1991; Choochouy et al., 2019; Crawford et al., 2008; Dassanayake et al., 2007, 2008, 2009; Dundar et al., 2016; Edwards and Tchounwou, 2005; Fuente and McPherson, 2012; London et al., 1998; Mont’Alverne et al., 2016; Müller-Mohnssen,

Suggested Citation:"Appendix D: Environmental Chemicals." National Academies of Sciences, Engineering, and Medicine. 2020. An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies. Washington, DC: The National Academies Press. doi: 10.17226/25889.
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1999; Pham et al., 2016; Richter et al., 1992; Rohlman et al., 2011; Roldan-Tapia et al., 2006; Ross et al., 2013; Spencer et al., 2000; Teixeira et al., 2002; Zeigelboim et al., 2019.

REFERENCES

Alcaras, P. A., A. B. Larcerda, and J. M. Marques. 2013. Study of evoked otoacoustic emissions and suppression effect on workers exposed to pesticides and noise. Codas 25(6):527-533.

Anger, W. K., F. M. Farahat, P. J. Lein, M. R. Lasarev, J. R. Olson, T. M. Farahat, and D. S. Rohlman. 2020. Magnitude of behavioral deficits varies with job-related chlorpyrifos exposure levels among egyptian pesticide workers. Neurotoxicology 77:216-230.

Ashok Murthy, V., and Y. J. Visweswara Reddy. 2014. Audiological assessment in organophosphorus compound poisoning. Indian Journal of Otolaryngology and Head and Neck Surgergy 66(1):22-25.

Campo, P., K. Maguin, and R. Lataye. 2007. Effects of aromatic solvents on acoustic reflexes mediated by central auditory pathways. Toxicological Sciences 99(2):582-590.

Chen, S. Y., Z. W. Zhang, F. S. He, P. P. Yao, Y. Q. Wu, J. X. Sun, L. H. Liu, and Q. G. Li. 1991. An epidemiological study on occupational acute pyrethroid poisoning in cotton farmers. British Journal of Industrial Medicine 48(2):77-81.

Choochouy, N., P. Kongtip, S. Chantanakul, N. Nankongnab, D. Sujirarat, and S. R. Woskie. 2019. Hearing loss in agricultural workers exposed to pesticides and noise. Annals of Work Exposure and Health 63(7):707-718.

Crawford, J. M., J. A. Hoppin, M. C. Alavanja, A. Blair, D. P. Sandler, and F. Kamel. 2008. Hearing loss among licensed pesticide applicators in the agricultural health study. Journal of Occupational and Environmental Medicine 50(7):817-826.

Dassanayake, T., I. B. Gawarammana, V. Weerasinghe, P. S. Dissanayake, S. Pragaash, A. Dawson, and N. Senanayake. 2009. Auditory event-related potential changes in chronic occupational exposure to organophosphate pesticides. Clinical Neurophysiology 120(9):1693-1698.

Dassanayake, T., V. Weerasinghe, U. Dangahadeniya, K. Kularatne, A. Dawson, L. Karalliedde, and N. Senanayake. 2007. Cognitive processing of visual stimuli in patients with organophosphate insecticide poisoning. Neurology 68(23):2027-2030.

Dassanayake, T., V. Weerasinghe, U. Dangahadeniya, K. Kularatne, A. Dawson, L. Karalliedde, and N. Senanayake. 2008. Long-term event-related potential changes following organophosphorus insecticide poisoning. Clinical Neurophysiology 119(1):144-150.

Dundar, M. A., S. Derin, M. Aricigil, and M. A. Eryilmaz. 2016. Sudden bilateral hearing loss after organophosphate inhalation. Turkish Journal of Emergency Medicine 16(4):171-172.

Edwards, F. L., and P. B. Tchounwou. 2005. Environmental toxicology and health effects associated with methyl parathion exposure--a scientific review. International Journal of Environmental Research and Public Health 2(3-4):430-441.

Fuente, A., and B. McPherson. 2012. Occupational chemical-induced hearing loss. In Hearing loss, edited by S. Naz. Intech Open. Pp. 171-190.

London, L., V. Nell, M. L. Thompson, and J. E. Myers. 1998. Effects of long-term organophosphate exposures on neurological symptoms, vibration sense and tremor among south african farm workers. Scandanavian Journal of Work, Environment, & Health 24(1):18-29.

Mont’Alverne, L. R., A. P. Corona, and M. A. Vasconcelos Rego. 2016. Hearing loss associated with organic solvent exposure: A systematic review. Revista Brasileira de Saude Ocupacional 41:e10.

Müller-Mohnssen, H. 1999. Chronic sequelae and irreversible injuries following acute pyrethroid intoxication. Toxicology Letters 107(1-3):161-176.

Pham, H., M. D. Lingao, A. Ganesh, J. E. Capasso, R. Keep, K. A. Sadagopan, and A. V. Levin. 2016. Organophosphate retinopathy. Oman Journal of Ophthalmology 9(1):49-51.

Suggested Citation:"Appendix D: Environmental Chemicals." National Academies of Sciences, Engineering, and Medicine. 2020. An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies. Washington, DC: The National Academies Press. doi: 10.17226/25889.
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Richter, E. D., P. Chuwers, Y. Levy, M. Gordon, F. Grauer, J. Marzouk, S. Levy, S. Barron, and N. Gruener. 1992. Health effects from exposure to organophosphate pesticides in workers and residents in Israel. Israel Journal of Medical Sciences 28(8-9):584-598.

Rohlman, D. S., W. K. Anger, and P. J. Lein. 2011. Correlating neurobehavioral performance with biomarkers of organophosphorous pesticide exposure. Neurotoxicology 32(2):268-276.

Roldan-Tapia, L., F. A. Nieto-Escamez, E. M. del Aguila, F. Laynez, T. Parron, and F. Sanchez-Santed. 2006. Neuropsychological sequelae from acute poisoning and long-term exposure to carbamate and organophosphate pesticides. Neurotoxicology and Teratology 28(6):694-703.

Ross, S. M., I. C. McManus, V. Harrison, and O. Mason. 2013. Neurobehavioral problems following low-level exposure to organophosphate pesticides: A systematic and meta-analytic review. Critical Reviews in Toxicology 43(1):21-44.

Spencer, P. S., H. H. Schaumburg, and A. C. Ludolph. 2000. Experimental and clinical neurotoxicology. 2nd ed. New York: Oxford University Press.

Teixeira, C. F., L. Giraldo Da Silva Augusto, and T. C. Morata. 2002. Occupational exposure to insecticides and their effects on the auditory system. Noise Health 4(14):31-39.

Zeigelboim, B. S., J. S. Malisky, M. R. D. Rosa, A. B. M. Lacerda, P. S. Alcaraz, and V. R. Fonseca. 2019. The importance of otoneurological evaluation in Brazilian workers exposed to pesticides: A preliminary study. International Archives of Otorhinolaryngology 23(4):e389-e395.

Suggested Citation:"Appendix D: Environmental Chemicals." National Academies of Sciences, Engineering, and Medicine. 2020. An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies. Washington, DC: The National Academies Press. doi: 10.17226/25889.
×
Page 62
Suggested Citation:"Appendix D: Environmental Chemicals." National Academies of Sciences, Engineering, and Medicine. 2020. An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies. Washington, DC: The National Academies Press. doi: 10.17226/25889.
×
Page 63
Suggested Citation:"Appendix D: Environmental Chemicals." National Academies of Sciences, Engineering, and Medicine. 2020. An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies. Washington, DC: The National Academies Press. doi: 10.17226/25889.
×
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In late 2016, U.S. Embassy personnel in Havana, Cuba, began to report the development of an unusual set of symptoms and clinical signs. For some of these patients, their case began with the sudden onset of a loud noise, perceived to have directional features, and accompanied by pain in one or both ears or across a broad region of the head, and in some cases, a sensation of head pressure or vibration, dizziness, followed in some cases by tinnitus, visual problems, vertigo, and cognitive difficulties. Other personnel attached to the U.S. Consulate in Guangzhou, China, reported similar symptoms and signs to varying degrees, beginning in the following year. As of June 2020, many of these personnel continue to suffer from these and/or other health problems. Multiple hypotheses and mechanisms have been proposed to explain these clinical cases, but evidence has been lacking, no hypothesis has been proven, and the circumstances remain unclear.

The Department of State asked the National Academies to review the cases, their clinical features and management, epidemiologic investigations, and scientific evidence in support of possible causes, and advise on approaches for the investigation of potential future cases. In An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies, the committee identifies distinctive clinical features, considers possible causes, evaluates plausible mechanisms and rehabilitation efforts, and offers recommendations for future planning and responses.

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