Occupational Exposures and Environmental Health Hazards of Military Personnel
Abstract
:1. Introduction
2. Methods
2.1. Literature Search
2.2. Inclusion and Exclusion Criteria
2.3. Identification and Selection of Studies
3. Sulfur Mustard
4. Sarin and Cyclosarin
5. Organochlorinates
5.1. Herbicides
5.2. Pesticides
5.3. Cs Gas (Tear Gas)
6. Combustion Products
6.1. Oil Combustion
6.2. Cooking Oil Fumes
6.3. Open Pit Burning
7. Fuel
7.1. Jet Fuel
7.2. Submarine Fuel
8. Firing Ranges
9. Sunlight Exposure
10. Electromagnetic Fields
11. Ionizing Radiations
12. Discussion
13. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Pollutant | Sample Size | Time after Exposure | Solider Nationality | Exposure Site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Sulfur Mustard | 236 | 2–28 months | Iran | Iran/Iraq border | - | - | - | Respiratory tract, central nervous system, skin, eyes. | - | [17] | ||
75 | 16–20 years | Iran | Khorasan (Iran) | - | Immunity | WBC, RBC, hematocrit, IgM, C3, monocytes, and CD3+ lymphocytes CD16+. | - | Complications in the lungs, peripheral nerves, skin, and eyes. | [19] | |||
134 | 17–22 years | Iran | Fars (Iran) | - | - | - | - | Complications in lung, skin, and eyes. | [20] | |||
43 | 12–17 years | Iran | Khorasan (Iran) | - | - | - | - | Complications in lungs, peripheral nerves, skin, eyes, head, and neck. | [21] | |||
12 | 6–8 days | Iran | Majnoun Island and Persian Gulf | - | - | - | Eye, throat, lung, and gastro-intestinal symptoms | - | [12] | |||
372 | 20 years | Iran | Sardasht (Azerbaijan) | - | Immunity | Chemokines, citokines, and inflammatory markers | - | Respiratory function | [15,16] | |||
40 | 16–20 years | Iran | Khorasan (Iran) | - | - | - | - | COPD, bronchiectasis, asthma, large airway narrowing, pulmonary fibrosis, simple chronic bronchitis. | [23] | |||
43 | 20–25 years | Iran | Iran/Iraq border | - | - | - | - | Dysphonia, post-nasal discharge, lower larynx position, limitation of vocal cords, inflammation of larynx mucosa, COPD, asthma, large-airway narrowing, pulmonary fibrosis, simple chronic bronchitis. | [24] | |||
43 | 25 years | Iran | Iran/Iraq border | - | - | - | - | Bronchiectasis, pulmonary fibrosis, and ground-glass attenuation. | [22] | |||
75 | 16–20 years | Iran | Khorasan (Iran) | - | Immunity | WBC, RBC, Hct, monocytes, CD3+T-lymphocytes, CD16+56 positive cells, IgM and C3 levels. | - | Increased risk of infections and tumors. | [27] | |||
200 | - | Iran | Iran | - | - | - | - | Increased prevalence of oral candidiasis. | [28] | |||
11 | 25 years | Iran | Iran | - | Gene expression | Peroxiredoxins (PRDXS) and sulfiredoxin-1 (SRXN1), oxidative stress responsive kinase-1 (OXSR1), forkhead box M1 (FOXM1), glutathione peroxidase-2 (GPX2), aldehyde oxidase 1 (AOX1), myeloperoxidase (MPO), dual oxidase 1 and 2 (DUOX1, DUOX2), thyroid peroxidase (TPO), eosinophil peroxidase (EPO), metallothionein-3 (MT3), and glutathione reductase. | - | - | [29,30,31] | |||
268 | 25 years | Iran | Iran | - | Oxidative stress, gene expression, cellular senescence | Lipid peroxidation derivative malondialdehyde (MDA), 8-oxo-dG, OGG1, and p16INK4a mRNA. | - | DNA damage and immune system subjected to cellular senescence. | [33] | |||
80 | - | Iran | Iran | - | Oxidative stress | Prostaglandin-like compound 8-isoprostane F2- alpha | - | - | [34] | |||
75 | 25 years | Iran | Khorasan (Iran) | - | DNA damage | DNA repair proteins (MRE11, NBS1, RAD51, and XPA), phosphor-H2AX. | - | Long-term health problems. | [18] | |||
81 | - | Iran | Iran | - | microRNA expression | miR-589-3p, miR-365a-3p, miR-143-3p, miR-200a-3p, miR-663a. | - | - | [35] | |||
34,000 | 18-23 years | Iran | Iran | - | - | - | Lesions of the lungs, eyes and skin | [36] |
Pollutant | Sample Size | Time after Exposure | Solider Nationality | Exposure site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References |
---|---|---|---|---|---|---|---|---|---|---|
Sarin and Cyclosarin | 349,291 | - | United States | Khamisiyah (Iraq) | - | - | - | - | Suffering postwar morbidity. | [37] |
1,368,150 | 7 years | United States | Khamisiyah (Iraq) | - | - | - | - | Cause-specific mortality. | [38] | |
80 | 11-16 years | United States | Khamisiyah (Iraq) | - | - | - | - | Reduced total gray matter volume. | [40] | |
128 | 14–19 years | United States | Khamisiyah (Iraq) | - | - | - | - | Reduced gray matter and white matter volumes. | [41] | |
118 | 14–19 years | United States | Khamisiyah (Iraq) | - | - | - | - | Increased axial diffusivity throughout the brain. | [42] | |
170 | 23–26 years | United States | Khamisiyah (Iraq) | - | - | - | - | Smaller hippocampal volumes. | [43] | |
351,041 | 10 years | United States | Khamisiyah (Iraq) | - | - | - | - | Increased risk of brain cancer death. | [39] | |
26 | - | United States | Khamisiyah (Iraq) | - | - | - | - | White matter reduction and ventricles volume increase. | [44] | |
140 | 4–5 years | United States | Khamisiyah (Iraq) | High exposure: 0.072 mg min/m3; Moderate exposure: from 0.035 to 0.144 mg min/m3 but no more than 0.072 mg min/m3 | - | - | - | Neuropsychological task performances for psycho-motor dexterity and visuospatial abilities. | [45] |
Pollutant. | Sample Size | Time after Exposure | Solider Nationality | Exposure Site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References |
---|---|---|---|---|---|---|---|---|---|---|
Agent Orange | - | - | United States | Vietnam | Inner aircraft concentrations ranged from 11.49 to 13.2–27.0 pg/m3 | - | - | - | - | [48] |
- | - | United States | Vietnam | Exposure estimated using a software | - | - | - | - | [49] | |
5609 | - | United States | Vietnam/ Non-Vietnam | - | - | - | - | COPD mortality. | [50] | |
111,726 | - | Korea | Vietnam | Exposure indexes based on the proximity of the veterans’ military unit to an Agent Orange-sprayed area. | - | - | - | Diabetes mellitus, thyroid, pituitary gland, and neurologic disorders. | [51] | |
180,639 | 30 years | Korea | Vietnam | Exposure indexes based on the proximity of the veterans’ military unit to an Agent Orange-sprayed area. | - | - | - | Cancers of the stomach, small intestine, liver, larynx, lung, bladder, and thyroid gland, chronic myeloid leukemia. | [52] |
Pollutant | Sample Size | Time after Exposure | Solider Nationality | Exposure Site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References |
---|---|---|---|---|---|---|---|---|---|---|
Pesticides | 187 | Day 0, 14, and 28 of the wearing period, and 28 days after termination | Germany | Germany | Permethrin concentration in uniforms: 1300 mg/m2 | Exposure biomarker in urines | Permethrin metabolites: cis-3-(2,2-dichlorovinyl)-2,2-dimethyl-(1-cyclopropane) carboxylic acid (cis-DCCA), trans-3-(2,2-dichlorovinyl)-2,2-dimethyl-(1-cyclopropane) carboxylic acid (trans-DCCA), and 3-phenoxybenzoic acid (3-PBA) | - | - | [55,56] |
549 (Study I); 195 (Study II) | Before wearing uniforms, after 14 days, after 28 days of wearing, and 28 days after cessation of wearing uniform | Germany | Two sub-cohorts in Germany and one in Afghanistan | Permethrin concentration in uniforms: 0.13 mg/cm2 | Exposure biomarker in urines | Permethrin metabolites: cis-DCCA, trans-DCCA 3-PBA | - | - | [57] | |
224 | - | United States | Iraq/Afghanistan | - | - | - | - | Chronic multisymptom illness. | [58] |
Pollutant | Sample Size | Time after Exposure | Solider Nationality | Exposure site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References |
---|---|---|---|---|---|---|---|---|---|---|
Cs Gas (Tear Gas) | 87 | 2–8–24–30 h | United States | United States | 0.086–4.9 mg/m3 | Exposure biomarker in urines | 2-chlorohippuric acid | - | - | [60] |
- | - | United States | United States | 2.33–3.29 mg/m3 | - | - | - | - | [61] | |
6730 | 5–15 min during exposure | United States | United States | 0.4–53.3 mg/m3 | Exposure biomarker | Personal air sampling | - | - | [62] | |
6723 | 7 days before CS exposure and 7 days after exposure | United States | United States | 0–2 mg/m3, 2–5 mg/m3, 5–10 mg/m3, >10 mg/m3 | - | - | - | Acute respiratory illnesses. | [63] |
Pollutant | Sample Size | Time after Exposure | Solider Nationality | Exposure Site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References |
---|---|---|---|---|---|---|---|---|---|---|
Oil Combustion | 1599 | 3 months | United States | Kuwait | - | - | - | Eye and upper respiratory tract irritation, shortness of breath, cough, rashes, and fatigue | - | [64] |
125 | During exposure: every fortnight for 5 months | United Kingdom | Kuwait | - | - | - | - | No lung function changes before and after deployment. | [65] | |
1560 | 5 years | United States | Kuwait | - | - | - | - | Asthma, bronchitis, injury and major depression. | [66] | |
61 | Sampling: before, during, and after deployment in Kuwait | Germany | Kuwait | - | DNA adducts and gene polymorphism | PAH-DNA adducts in blood; -OH-PG (1-hydroxypyrene-glucuronide) in urines; GSTM1 and GSTT1 gene polymorphisms | - | - | [68] | |
168 | - | United States | Kuwait city | - | Exposure biomarkers in blood | VOC: benzene, m-/p-xylene, o-xylene, styrene, and toluene | - | - | [68] | |
3440 | Sampling: before, during, and after deployment in Kuwait | Germany | Kuwait | - | - | 1-hydroxypyrene; VOCs; Sister chromatid exchange; DNA-PAH adducts. | - | - | [70] | |
Cooking Oil Fumes | 98 | At the beginning and at the end of the weekly shift | Taiwan | Taiwan | PAH measured in kitchens and in offices | Exposure biomarker in urines and oxidative DNA damage biomarker | 1-hydroxypyreneand 8-oxodeoxyguanosine | - | Oxidative DNA damage. | [71] |
Pollutant | Sample Size | Time after Exposure | Solider Nationality | Exposure site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References |
---|---|---|---|---|---|---|---|---|---|---|
Open Pit Burning | 20,000 | 1.3 years (mean years) | United States | Iraq and Afghanistan | - | - | - | - | Rheumatoid arthritis and lupus. | [72] |
21,000 | - | United States | Iraq | - | - | - | - | Chronic multisymptom illness. | [73] | |
22,844 | - | United States | Iraq | - | - | - | - | Respiratory outcomes. | [74] | |
- | - | - | Iraq | PAHs, polychlorinated dibenzo-p-dioxins (PCDD), and polychlorinated dibenzofurans (PCDF) | - | - | - | [75,76] | ||
400 | - | United States | Iraq | - | - | - | - | Respiratory and cardiovascular disease. | [77] | |
179,914 | - | United States | Iraq, United States, and South Korea | - | - | - | - | Respiratory symptoms and asthma. | [78] | |
400 | - | United States | Iraq and Afghanistan | - | microRNA expression | PCDD/PCDF: let-7a-5p, let-7d-5p, miR-144-3p, miR-16-5p, miR-32-5p | - | - | [79] | |
400 | - | United States | Iraq and Afghanistan | - | Exposure biomarkers in serum | PAH and PCDD/PCDF | - | - | [80] | |
800 | - | - | - | - | microRNA expression | hsa-miR-26a, hsa-miR-30b, hsa-miR-103, hsa-miR-126, hsa-miR-766. | - | - | [81] | |
178,766 infants | - | - | - | - | - | - | - | Birth defects. | [82] |
Pollutant | Sample Size | Time after Exposure | Solider Nationality | Exposure Site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References |
---|---|---|---|---|---|---|---|---|---|---|
Jet Fuel | 130 | Prior to and after exposure, 15 and 30 weeks during exposure. | United States | United States | Jet fuel (JP-4), 1,1,1- trichloroethane, methyl ethyl ketone, xylenes, toluene, and methylene chloride. | Biomarkers of genotoxicity | Chromatid exchanges and micronuclei frequency | - | - | [87] |
74 | Post-shift on friday (Day 1) and during the following workweek (Days 2–6) | United States | United States | Personal breathing zone and work areas via active sampling methods. | Exposure biomarkers in urines, exhaled breath, and blood. Gene polymorphism | - Dermal exposure (total hydrocarbons, benzene, toluene, ethylbenzene, and xylene and naphthalene); - Exhaled breath (BTEX and naphthalene); -Urine samples (1- and 2-naphthol, 2-, 3-, and 9-hydroxyfluorene; 1-, 2-, 3-, and 4-hydro-xyphenanthrene; 1-hydroxypyrene and VOC mercapurates, including N-acetyl-S-(benzyl)-L-cysteine, N-ace-tyl-S-(phenyl)-L-cysteine. - Blood samples (benzene, ethylbenzene, m-/p-/o-xylenes, and toluene). - GSMT1 polymorphism and DNA pattern methylation | - | - | [88] | |
24 | During three consecutive workdays | United States | United States | Personal air samples: naphthalene | Biomarker of exposure in urines | 1- and 2-naphthol | - | - | [89] | |
73 | During four consecutive workdays | United States | United States | Personal air samples: benzene, ethylbenzene, toluene, xylene, total hydrocarbons, and naphthalene. | - | - | - | - | [90] | |
73 | During four consecutive workdays | United States | United States | Personal air samples analyzed for benzene, toluene, ethylbenzene, m-/p-xylene, o-xylene, and total hydrocarbons | Biomarker of exposure in urines. Gene polymorphism | 1- and 2-naphthol, 2-, 3-, and 9-hydroxyfluorene, 1-, 2-, 3-, and 4-hydroxyphenanthrene, and 1-hydroxypyrene; GSTM1 polymorphism and glutathione S-transferase theta-1 (GSTT1) | - | - | [91] | |
69 | Post-shift sampling | United States | United States | Personal air samples: total hydrocarbons | Biomarker of exposure in blood | Ethylbenzene, toluene, o-xylene, and m/p-xylene, and for the smoking biomarker, 2,5-dimethylfuran. | - | - | [92] | |
74 | Post-shift on a Friday afternoon (Day1) and continued Monday morning through Friday morning of the following workweek (Days 2–6) | United States | United States | Personal air samples: naphthalene and total hydrocarbons. | Biomarkers of exposure in urines | 1-naphthol and 2-naphthol | - | - | [93] | |
Submarine fuel | 38 | - | United States | United States | - | - | - | Reactive airways dysfunction syndrome (RADS) | - | [95] |
1 | - | United Kingdom | - | Median weighted levels of benzene exposure over 13-year period: 189 ug/m3 | - | - | - | Chronic myeloid leukemia. | [96] |
Pollutant | Sample Size | Time after Exposure | Solider Nationality | Exposure Site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References |
---|---|---|---|---|---|---|---|---|---|---|
Firing Ranges | 175 | During training period | Israel | Israel | Overall range of airborne lead levels in personal samples: 0.08–168.4 μg/m3 | Biomarkers of exposure in blood | Blood lead level | - | - | [97] |
120 | During working period | Korea | Korea | - | Biomarkers of exposure in blood | Blood lead level | - | - | [98] | |
546 | During working period | Italy | Italy | Environmental lead using personal samplers in 6 indoor and 6 outdoor firing ranges (<25 pg/m3) | Biomarkers of exposure in blood | Blood lead level | - | - | [99] |
Pollutant | Sample Size | Time after Exposure | Solider Nationality | Exposure Site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References |
---|---|---|---|---|---|---|---|---|---|---|
Sunlight exposure (Skin Cancer) | 154 | - | United States | Tropical/non-tropical theaters | - | - | - | - | Melanoma | [110] |
370 | - | - | Pacific theater (World War II) | - | - | - | - | Skin cancer. | [101] | |
5524 | - | - | Pacific theater (World War II) | - | - | - | - | Melanoma and colon cancer. | [103] | |
176 | During working period | United States | United States | - | - | - | - | Melanoma | [104] | |
300 | ||||||||||
2696 | - | - | Iraq | - | - | - | - | Eczematous dermatitis, benign neoplasms, and skin cancers. | [105] | |
6670 | - | United States | United States | - | - | - | - | Non-melanoma skin cancer. | [106] | |
- | - | United States | United States | - | - | - | - | Melanoma. | [107] | |
2093,157 | - | United States | United States | - | - | - | - | Melanoma. | [108] | |
35,157 | - | Australia | Tropical locations | - | - | - | - | Melanoma. | [36] | |
21,582 | During exposure: from first day of service until date of death, emigration, or end of follow-up. | Norway | Lebanon | - | - | - | - | Cancer incidence and all-cause mortality | [111] |
Pollutant | Sample Size | Time after Exposure | Solider Nationality | Exposure Site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References |
---|---|---|---|---|---|---|---|---|---|---|
Electromagnetic fields | 166 | During exposure | India | India | Electromagnetic fields monitored at different locations. | Stress response | Catecholamine levels in blood | - | - | [111] |
- | - | Poland | Poland | 204 military devices monitored | - | - | - | - | [112] | |
39,850 | - | France | France | - | - | - | - | Overall mortality and cancer mortality | [113] | |
10,495 | - | Norway | Norway | - | - | - | - | Male infertility and offspring sex ratio | [118] |
Pollutant | Sample Size | Time after Exposure | Solider Nationality | Exposure Site (Operation Theater) | Environmental Monitoring (Exposure) | Biomarkers (Early Biological Effect) | Biomarker Description | Early Clinical Effect | Late Clinical Effect | References |
---|---|---|---|---|---|---|---|---|---|---|
Ionizing Radiations | 74 | 2 years | United States | Iraq | - | Biomarker of exposure in urines | Uranium concentration | - | - | [129] |
35 | 3 years | United States | Iraq | Biomarker of exposure in urines | Total and isotopic uranium concentrations. Analysis of metals. | - | - | [129] | ||
35 | 18 years | United States | Iraq | - | Biomarkers of exposure in urines. Gene mutations. | Total and isotopic uranium concentration; Peripheral blood cells: micronuclei (MN), chromosome aberrations, and mutations of hypoxanthine- guanine phosphoribosyl transferase (HPRT) and phosphatidylinositol glycan class-A (PIGA). | - | - | [126] | |
36 | 25 years | United States | Iraq | - | Biomarkers of exposure in urines | Total and isotopic uranium concentrations. Analysis of metals. | - | - | [130] | |
70 | - | United States | Iraq | - | Biomarkers of exposure in urines. Gene mutations | Total and isotopic uranium concentrations. Analysis of metals. Peripheral blood cells: hypoxanthine-guanine phosphoribosyl transferase (HPRT) mutations | - | - | [128] | |
35 | 18 years | United States | Iraq | - | Biomarker of exposure in urines and biomarkers of genotoxicity | Total uranium concentration Peripheral blood cells: Micronuclei | - | - | [127] | |
35 | 22 years | United States | Iraq | - | Biomarker of exposure in urines. | Total uranium concentration | - | chronic dermatological findings (dermatitis) | [131] | |
122 | - | Canada | Canada | - | Biomarker of exposure in urines. | Total uranium concentration Hair: isotopic uranium (238:235 U ratio) | - | - | [132] | |
9188 | - | Sweden | Balkans | - | - | - | - | Overall incidence of cancer | [133] | |
341 | - | United Kingdom | Iraq | - | Biomarker of exposure in urines. | Uranium concentration and 238 U/235 U isotopic ratio | - | - | [134] | |
14,012 | - | Denmark | Balkans | - | - | - | - | Overall incidence of cancer | [135] | |
153,530 | - | Holland | Balkans | - | - | - | - | incidence of all cancer | [136] | |
185,413 | 4–14 years | Italy | Balkans | - | - | - | - | General mortality and cancer mortality | [137] | |
981 | -Before the deployment (T0) -At the end of the deployment period (T1) - In the operative theater | Italy | Iraq | - | Biomarkers of exposure in urine and serum. Biomarkers of genotoxicity and DNA damage | - Urine and serum: As, Cd, Mo, Ni, Pb, U, V, W, and Zr, and Uranium isotopic ratio 238 U/235 U Peripheral blood cells: DNA adducts, micronuclei, GSTM1, XRCC1, and OGG1 polymorphisms; Oxidative DNA alterations (8-Hydroxy-2′-deoxyguanine) | - | - | [3] |
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Geretto, M.; Ferrari, M.; De Angelis, R.; Crociata, F.; Sebastiani, N.; Pulliero, A.; Au, W.; Izzotti, A. Occupational Exposures and Environmental Health Hazards of Military Personnel. Int. J. Environ. Res. Public Health 2021, 18, 5395. https://doi.org/10.3390/ijerph18105395
Geretto M, Ferrari M, De Angelis R, Crociata F, Sebastiani N, Pulliero A, Au W, Izzotti A. Occupational Exposures and Environmental Health Hazards of Military Personnel. International Journal of Environmental Research and Public Health. 2021; 18(10):5395. https://doi.org/10.3390/ijerph18105395
Chicago/Turabian StyleGeretto, Marta, Marco Ferrari, Roberta De Angelis, Filippo Crociata, Nicola Sebastiani, Alessandra Pulliero, William Au, and Alberto Izzotti. 2021. "Occupational Exposures and Environmental Health Hazards of Military Personnel" International Journal of Environmental Research and Public Health 18, no. 10: 5395. https://doi.org/10.3390/ijerph18105395