Jack M. Heller

Anthrax vaccination and self-reported symptoms, functional status, and medical conditions in the National Health Survey of Gulf War Era Veterans and Their Families

PURPOSE To evaluate the health status of Gulf War veterans who reported receipt of anthrax vaccination and a small group of Gulf War veterans for whom documentation of anthrax vaccination exists. METHODS Among the 11,441 Gulf War veterans who completed a health survey, 4601 reported receiving the anthrax vaccine during the war; 2979 veterans reported not receiving it; 3861 were uncertain. Also, 352 of these respondents were documented by the Department of Defense as having received anthrax vaccination. We compared the medical history of these groups of veterans using multivariate analyses. Finally, we analyzed perception of exposure and its relation to reporting bias. RESULTS There were statistically significant differences in prevalence for almost all outcomes studied between those who reported having received anthrax vaccination and those who did not so report. However, when we compared the veterans for whom vaccination records exist to the group who self-reported that they had not received the vaccine, the significant differences in prevalence for almost all of the outcomes disappeared. CONCLUSIONS The extent of a reporting bias should be carefully considered when one evaluates the health consequences of anthrax vaccination based on self-reported data.

Risk Factors for Mental Disorder Hospitalization after the Persian Gulf War: U.S. Armed Forces, June 1, 1991–September 30, 1993

Effects of Persian Gulf War (August 2, 1990-July 31, 1991) and Gulf War occupation on post-War hospitalization risk were evaluated through Cox proportional hazards modeling. Active-duty men (n = 1,775,236) and women (n = 209,760) in the Army, Air Force, Navy, and Marine Corps had 30,539 initial postwar hospitalizations for mental disorders between June 1, 1991 and September 30, 1993. Principal diagnoses in the Defense Manpower Data Center hospitalization database were grouped into 10 categories of ICD-9-CM codes. Gulf War service was associated with significantly greater risk for acute reactions to stress and lower risk for personality disorders and adjustment reactions among men. Personnel who served in ground war support occupations (men and women) were at greater risk for postwar drug-related disorders. Men who served in ground war combat occupations were at higher risk for alcohol-related disorders. Longitudinal studies of health, hospitalization, and exposure beginning at recruitment, are needed to better understand how exposure to combat affects the mental health of military personnel.

Ten years and 100,000 participants later: occupational and other factors influencing participation in US Gulf War health registries.

For more than a decade after the Gulf War, there has been concern that wartime exposures have resulted in significant morbidity among Gulf War veterans. After the end of the war, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) initiated health registries to provide systematic clinical evaluations of Gulf War veterans who chose to participate. By September 1999, there were 32,876 participants in the DoD Comprehensive Clinical Evaluation Program and 70,385 participants in the VA Gulf War Registry Health Examination Program. We identified demographic and military service factors, as well as potential war-related exposures associated with subsequent registry participation after 10 years of observation. Veterans potentially exposed to oil well fire smoke, those near Khamisiyah, Reserve and National Guard, Army veterans, and veterans in the theater of operations during intense combat periods were most likely to elect to participate in a registry. These findings support the hypothesis that certain occupational factors and wartime exposures may influence subsequent health care–seeking behavior.

The postwar hospitalization experience of Gulf War veterans participating in U.S. health registries.

In response to concerns that Gulf War veterans were experiencing increased morbidity resulting from wartime exposures in the Gulf War, the Department of Veterans Affairs and the Department of Defense (DoD) initiated clinical registries to provide systematic health evaluations for self-referred Gulf War veterans. The authors used Cox’s proportional hazard modeling with data from all DoD hospitals to estimate the probability of hospitalization resulting from any cause, resulting from diagnosis in a major diagnostic category, and resulting from a specific diagnosis of interest. After adjusting for other risk factors, registry participants were 1.43 times more likely to have a postwar hospitalization than registry nonparticipants (95% confidence interval, 1.40–1.46). These findings support the hypothesis that registry participants were more likely to experience postwar morbidity than veterans who chose not to enroll in the health registries.

Polycyclic Aromatic Hydrocarbon Biomarkers of Internal Exposure in U.S. Army Soldiers Serving in Kuwait in 1991

Abstract Biomarkers of exposure were applied to a cohort of U.S. Army soldiers who were deployed to Kuwait and Saudi Arabia in 1991 in the aftermath of the Persian Gulf War. The U.S. Army Environmental Hygiene Agency (currently the U.S Army Center for Health Promotion and Preventive Medicine) monitored air and soil for ambient PAHs. In addition, a group of 61 soldiers kept diaries of daily activities. These soldiers provided blood and urine samples in June in Germany before deployment to Kuwait, in August after 8 weeks in Kuwait, and in October, one month after the return to Germany. DNA, prepared from white blood cells, was assayed for PAH-DNA adducts by immunoassay and bulky aromatic adducts by 32P-postlabeling. Urinary 1-hydroxypyrene-glucuronide (1-OH-PG) was determined by synchronous fluorescence spectrometry. Contrary to expectations, environmental monitoring showed low ambient PAH levels in the areas where these soldiers were working in Kuwait. In addition, literature values for ambient PAH monitor...

Environmental Air Sampling Near Burn Pit and Incinerator Operations at Bagram Airfield, Afghanistan.

Objective: This study presents environmental air samples collected at a US military installation with a solid waste disposal facility (SWDF) containing a burn pit from 2005 through 2012 and compared these results with occupational (breathing zone) samples. Methods: Particulate matter (PM) environmental samples were collected as part of the installation monitoring program. Service Members in four security positions were monitored for PM and acrolein occupational exposures. Results: The highest recorded PM2.5 concentration occurred at the SWDF. A highly populated sampling site, the Bazaar site, had the highest mean PM10, with the SWDF following in second. Acrolein and respirable PM were considerably higher in the breathing zone samples than environmental samples. Conclusions: The diversity of results support the concept of a complex environment with multiple polluting sources and changing meteorological and operational conditions.

Oil Well Fires of Operation Desert Storm—Defining Troop Exposures and Determining Health Risks

During Operation Desert Storm, in February 1991, Iraqi troops began burning Kuwaiti oil wells. Almost immediately there was concern about possible adverse health effects in U.S. personnel exposed to crude oil combustion products. Combustions products were predicted from the known composition of Kuwaiti crude oil. Monitoring sites were established in Saudi Arabia and Kuwait; about 5,000 environmental samples were studied. Data collected were used to develop health risk assessments for the geographic areas sampled. This initial approach to assessing risk had to be greatly expanded when Congress passed Public Law 102-190, requiring development of means to calculate environmental exposures for individual U.S. service members. To estimate daily exposure levels for the entire area over 10 months for all U.S. troops, air dispersion modeling was used in conjunction with satellite imagery and geographic information system technology. This methodology made it possible to separate the risk caused by oil fire smoke from the total risk from all sources for each service member. The U.S. military responses to health concerns related to the oil well fires and to Public Law 102-190 were reviewed. Consideration was given to changes in technology, practices, and policies over the last two decades that might impact a similar contemporary response.