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1. ATSDR > Public Health Assessments & Consultations

INTRODUCTION

The emphasis in this section will be on the three known past exposure situations that posed public health hazards. Additionally, we describe the two situations that we think pose potential public health hazards and include a list of information that we need in order to make definite conclusions about them. We also briefly describe five additional situations that we have determined do not pose public health hazards.

ATSDR's public health assessments are exposure, or contact, driven. Chemical contaminants disposed or released into the environment at MCB Camp Lejeune have the potential to cause adverse health effects. However, a release does not always result in exposure. People can be exposed to a chemical only if they come in contact with the chemical. Exposure may occur by breathing, eating, or drinking a substance containing the contaminant or by skin (dermal) contact with a substance containing the contaminant.

The type and severity of health effects that occur in an individual from contact with a contaminant depend on the exposure concentration (how much), the frequency and duration of exposure (how long), the route or pathway of exposure (breathing, eating, drinking, or skin contact), and the multiplicity of exposure (combination of contaminants). Once exposure occurs, characteristics such as age, sex, nutritional status, genetics, lifestyle, and health status of the exposed individual influence how the individual absorbs, distributes, metabolizes, and excretes the contaminant. Together these factors and characteristics determine the health effects that may occur as a result of exposure to a contaminant.

ATSDR reviews existing health outcome data (e.g., birth and death certificates, birth defects registries, and cancer registries), when available, if people have been exposed to site contaminants or if the community has concerns related to specific health outcomes.

I. PAST PUBLIC HEALTH HAZARDS-PAST EXPOSURE SITUATIONS

In the past, people were exposed to contaminants on base in the following situations that, at the time, posed a public health hazard. In order of health priority, they are (1) acute exposure to lead in the tap water in on-base buildings containing plumbing with lead solder; (2) past exposure to VOCs in three drinking water systems on base; and (3) past exposure to pesticides in the soil at Site 2-Former Day-Care Center (Table 1). MCB Camp Lejeune has taken action to stop or reduce exposure in all of these situations; therefore, they are no longer a public health hazard. Table 1 outlines those cases. None of the exposed populations received combined exposures from any other identified situations.

A. Lead Exposure (Tap Water)

Base employees and residents could have been exposed to extremely high levels of lead in tap water in some of the buildings on base. The source of the lead is the plumbing containing lead solder or brass fixtures. In 1994, lead testing of 102 adults did not show blood lead levels of health concern, but it is not known if these individuals drank water containing high levels of lead. If people consume water contaminated with lead at levels detected in many of the taps on base, they could absorb enough lead to experience long-term health consequences. Therefore, we recommend that people highly sensitive to the effects of lead, such as children, pregnant women, and women considering pregnancy not drink water from taps where lead is ever detected at 15 parts per billion (ppb) or higher. We also recommend that other adults should not drink water containing lead above 50 ppb. Furthermore, everyone on base should try to reduce their exposure to lead by flushing water lines before using them. MCB Camp Lejeune has taken action on all three of these recommendations. (See Summary and Follow-up of this section.)

Table 1. Past Public Health Hazard Situations

Lead Sampling

During 1992, in accordance with EPA's Lead and Copper Rule, MCB Camp Lejeune began regularly testing the tap water on base for lead and copper (4). The findings we discuss here are based on three sampling rounds for the major drinking water systems (serving 10,001­50,000 people) on base, Holcomb Boulevard, Hadnot Point, and MCAS New River, beginning in July 1992. Sampling for the minor drinking water systems (serving 501 to 3,300 people), Courthouse Bay, Rifle Range, and Onslow Beach, began in December 1993. Our findings are based on two sampling rounds each year for those systems from 1992 to 1996. We have received sampling data from 260 different faucets.

The base is carrying out all the procedures required by the Lead and Copper Rule, i.e., regularly sampling tap water (every 6 months) and developing a water treatment plan to reduce lead and bring the base systems into compliance with EPA's established action levels of 15 ppb for lead and 1300 ppb for copper (5).

The sampling priority scheme established by EPA concentrates on buildings that had copper pipes and lead-containing solder installed between 1983 and 1987 because the solder used during that time was more apt to leach lead into the tap water (5). MCB Camp Lejeune conducted a materials evaluation of records kept for each building on base. They found no buildings with lead piping, but for all the drinking water systems, they did find buildings with copper piping and lead-containing solder. The base's sampling plan, in accordance with EPA regulations, concentrated on those buildings and focused on single-family homes, where the population at greatest health risk lives (4). Lead was detected in tap water samples from buildings on each of the water systems. No lead or copper were detected in any of the water plants, which indicated that the source of the contamination in each system was the plumbing (4). We reviewed the tap water sampling data for potential health hazards. Copper levels did not pose a health concern.

Lead levels were consistently low in nearly all the single-family homes tested. However, since 1994 when the sampling began, tap water in seven houses tested at levels above 15 ppb (levels ranged from 17 - 65 ppb. Four homes have had filter units already installed and three homes are awaiting the filter unit installation (6). Once a home sample contains elevated lead levels above 15 ppb, the base carries out an investigation to determine if the elevated lead is confined to one tap faucet or if others in the home are elevated as well. If more than one faucet has elevated lead level, the entire home is connected to a lead-removing water filtration system (7). Since the base began this procedure in 1994, four homes have had filters installed on at least one faucet. All schools and day-care centers were sampled for lead and copper. None were found to be above EPA action levels (8).

The lead levels from the other buildings sampled on base fluctuated tremendously with each sampling and ranged from less than 2 ppb (lower limit of detection) to 10,100 ppb. The highest level, 10,100 ppb, was much higher than the next highest concentration of 2720 ppb and possibly could be a piece of lead solder that broke away from the pipe and was collected in the sampling bottle. Even though the 10,100 ppb may be a rare case, many faucets (11.5%) contained lead at extremely high levels, above 200 ppb.

Although water from a high percentage of "deep sink" faucets tested showed elevated lead levels, extremely high lead levels detected in one sampling round were often not detected in a subsequent sample from the same tap. The reasons for the inconsistency are not clear. However, the levels detected in many samples throughout the base, which ranged from 16 ppb to 10,100 ppb, were of immediate health concern. The base has posted signs on all "deep sink" faucets commonly found in janitor's closets and in laundry rooms not to drink water from that faucet. Additionally, the base provides educational material in their housing guide to all newcomers and puts articles in the base paper several times per year updating and reminding individuals to flush their tap water faucets before use in the morning and after the faucet has not been used in the past 6 hours.

Human Exposure Routes and Public Health Implications

ATSDR has identified these specific areas where people were being exposed: (1) residents of single-family homes (approximately 28 individuals including adults and children), (2) residents of multifamily buildings and bachelor enlisted quarters (approximately 10,000 individuals), and (3) workers exposed to lead at various office buildings on base (approximately 15,000 individuals).

Since 1992, the base has maintained a blood lead screening program for all children receiving their 1-year well baby check-up and once a year for all children under 6 years of age. Approximately 1200 child blood lead levels are tested per year. This program will be discontinued in 1997 for all children seeking medical attention at the base hospital. The Primary Care Clinic will continue this practice at least until October 1997. However, parents of all children seeking medical attention are required to fill out a potential lead exposure questionnaire to help identify children at risk for lead exposure. All children whose parents answer yes to any question will automatically have their blood levels tested. To date, there have only been seven cases of elevated blood lead levels in children 6 years old or younger. The medical personnel in conjunction with facilities personnel have carried out investigations on all children with elevated blood lead levels. In several cases, the paint in the children's home has been implicated as the probable source of the lead exposure. In these cases, the residents were relocated and their homes abated for lead paint. One child was treated for lead poisoning as a result of his exposure to lead paint. In other cases no lead source was identified. In two cases, the families moved to other military installations, eliminating the likelihood of continued lead exposure.

In response to ATSDR's concern about extremely high lead levels found in two base buildings, the base tested the blood lead levels of 102 adults. One of the buildings is a barracks where the highest lead levels were detected in tap water of the laundry room deep sink used for filling the canteens of field training personnel. The other building is an office building, where people are known to make coffee from tap water. Ninety-nine out of 102 blood lead levels were within the expected national average range for adults (9,10). Three individuals had only slightly elevated blood lead levels at 10, 11, 12 micrograms lead per deciliter blood (µg/dL) respectively (11). No adverse health effects associated with these blood lead levels are expected to occur in these three adults. However, there is no information on whether or not individuals who had their blood lead tested drank water from those taps containing high lead levels. Therefore, the blood sampling results are inconclusive because they do not provide a correlation between people drinking lead contaminated water and blood lead levels. For this reason, we must interpret the blood lead data cautiously, and we have recommended that individuals not drink water from taps containing high lead levels. Our recommendations are based on the known health risks posed by lead, particularly at the very high levels detected intermittently in some of the taps at MCB Camp Lejeune.

Because lead levels at MCB Camp Lejeune fluctuated above and below the action level of 15 ppb (less than 2 ppb to 10,100 ppb) and some of these lead levels were extremely high, two aspects of lead exposure are of concern. One is exposure, even once, to extremely high levels of lead. The second is intermittent exposure to even moderate levels of lead over an extended period of time, e.g., more than a year. Under both of these exposure conditions, people can absorb enough lead to raise their body burden of lead to levels that could pose health problems. People swallowing lead-contaminated water at the highest concentrations detected (1000 to 10,100 ppb) can experience acute effects, such as nausea and vomiting, but they can also absorb enough lead to cause serious long-term adverse health effects (12).

In order to evaluate the likelihood of adverse health effects in people at MCB Camp Lejeune who drink lead contaminated water, we reviewed the available scientific information. Studies of lead's health effects on people are based on blood lead levels, a measure of the amount of lead absorbed by the body, not the amount of lead detected in water or some other medium. Blood lead is measured in micrograms per deciliter (µg/dL). Several studies have analyzed the correlation between lead levels in drinking water and resulting blood lead levels in infants, older children, and adults (13-21).

ATSDR used these mathematical factors for estimating the likelihood of adverse health effects in people at MCB Camp Lejeune who drink lead-contaminated water. Based on these calculations, people drinking water containing lead at levels above 50 ppb could absorb enough lead to experience long-term health consequences. Moreover, people highly sensitive to the effects of lead, particularly children, infants, and fetuses, could experience irreversible adverse health effects such as decreased IQ and compromised mental development (22).

The health effects of lead are not immediately apparent. Once in the blood, lead is distributed to soft tissue (kidneys, bone marrow, liver, and brain) and mineralizing tissue (bones and teeth). Bones and teeth contain about 95% of the total body burden of lead in adults (12).

It is the total body burden of lead that is related to the risk of adverse health effects. Because the body accumulates lead over a lifetime and releases it slowly, even small doses of lead over time can cause lead poisoning. Further, relatively low blood lead levels can cause adverse health effects, some of which, like decreased IQ or mild behavioral disorders, may not produce noticeable signs or symptoms.

Exposure to high levels of lead can damage the brain, red blood cells, and kidneys of adults at blood lead levels ranging from 40 to 100 µg/dL and children at blood lead levels of 35 to 50 µg/dL. Acute effects of exposure to high lead levels are nausea, vomiting, and headache. Lead exposure in adults may increase blood pressure. High levels of blood lead (40 µg/dL) may affect sperm or damage other parts of the male reproductive system, making it difficult for a couple to have children (12).

Fetuses and children are especially sensitive to the effects of lead. Additionally, when women are pregnant, lead stored in their bone can enter their bloodstream, increasing the amount of lead reaching the fetus and resulting in premature birth, low birthweight, and decreased mental ability. In infants and young children, lead exposure has been shown to decrease intelligence, slow growth, and cause hearing problems at blood lead levels at or below 10 µg/dL, a level previously thought to be safe. These effects can persist as children get older and interfere with successful performance in school (22).

Summary and Follow-up

Lead was detected throughout the drinking water systems of MCB Camp Lejeune, but the data were inconsistent upon repeat sampling, with lead levels fluctuating above and below the EPA action level. Given the very wide range of lead levels detected in the tap water and the inconclusiveness of the blood lead sampling, ATSDR made the following recommendations to protect the health of base personnel, residents, and visitors: (1) stop exposure of personnel, residents, and visitors at taps that showed elevated lead results; and (2) educate all MCB Camp Lejeune employees, residents, and visitors about how to reduce their lead exposure (i.e., by flushing taps). As a result of ATSDR's recommendations, MCB Camp Lejeune took the following actions:

• posted "DO NOT DRINK" signs at deep sink faucets basewide to stop people from drinking water from those faucets because they seem to release more lead than other faucets

• posted signs at faucets where water samples show lead levels above 50 ppb, and

• installed filters on water lines to stop residents of single-family homes from drinking water from faucets that show lead levels above 15 ppb.

In addition to the educational efforts carried out by MCB Camp Lejeune, ATSDR provided a pamphlet (included as Appendix D) for MCB to distribute to the base community (personnel, residents, and visitors). In general, we recommend that pregnant women and children not drink water containing lead at levels greater than 15 ppb, and adults not drink water containing lead at levels above 50 ppb (23). MCB Camp Lejeune has already implemented all of these recommendations and continues to educate new base employees, residents, and visitors. The base also continues to monitor lead levels in drinking water basewide (24, 25, 26).

Because lead levels at MCB Camp Lejeune fluctuated above and below the action level of 15 ppb (less than 2 ppb to 10,100 ppb) and some of these lead levels were extremely high, we could not evaluate the likelihood of adverse health effects in people who drank tap water. People who drank lead-contaminated water at the highest concentrations detected (1000 to 10,100 ppb) would have experienced acute effects, such as nausea and vomiting. Because these people could absorb enough lead to cause serious long-term adverse health effects, they can contact their physician for a blood lead screening or follow-up evaluation.

Health Outcome Data

The health outcome data collected to address this exposure were obtained from the Naval Hospital at MCB Camp Lejeune. Blood lead levels were collected from 102 individuals who may have been exposed to lead in drinking water from the two buildings that had the highest detected lead levels. Only three people had blood lead levels slightly above the national average for adults. However, there is no information on whether or not individuals drank water from taps with elevated lead levels. Therefore, ATSDR has recommended that exposure cease in all buildings showing lead levels above 50 ppb.

Additional health outcome data was collected regarding elevated blood lead levels in children of military personnel at MCB Camp Lejeune. All children of Camp Lejeune personnel are required to have their blood lead levels tested on their first birthday and again annually after that. Seven children who were tested in 1993 had blood lead levels above the Centers for Disease Control and Prevention's maximum recommended level of 10 µg/dL for children. MCB Camp Lejeune conducted investigations to determine the possible source of the lead to which the children may have been exposed. Tap water from all base schools, day-care centers, and single-family residences was tested. Lead paint in the homes of these children was determined to be the source of the lead. Lead paint abatement programs have been initiated by the base. One child was treated for lead poisoning as a result of his exposure to lead paint.

Conclusion: Even though MCB Camp Lejeune was following all current EPA regulations for the Lead and Copper Rule, the concentrations of lead detected at drinking water taps collected from 1992 to 1996 in several buildings on base were of immediate health concern. People drinking lead-contaminated tap water may have absorbed enough lead to experience acute or long-term adverse health effects.

Completed Actions: MCB Camp Lejeune placed notices in the base newspaper and posted educational material to notify people of possible lead in drinking water. In response to ATSDR's concerns, MCB Camp Lejeune sampled blood lead levels of workers and residents of the two buildings on base that had the highest lead levels detected in the tap water. Although no elevated blood lead levels were found, no information is available on whether the individuals tested drank from the water taps containing high lead levels. Based on ATSDR recommendations, MCB Camp Lejeune took further action to stop exposure by restricting the use of taps in certain buildings. Additionally, ATSDR developed a flyer addressing frequently asked questions and ways to reduce lead exposure. MCB Camp Lejeune distributed the flyer to all employees, residents, and visitors. As a result of ATSDR's recommendation, MCB Camp Lejeune continues to provide educational material to all base employees, residents, and visitors on ways people can reduce their lead exposure from drinking water. MCB Camp Lejeune continues to monitor lead levels in base drinking water. Additionally, corrosion control devices have been installed in the Hadnot Point, New River Air Station, Courthouse Bay, and Onslow Beach systems to reduce the ability of the water to leach lead from the plumbing. As a result of ATSDR's recommendation, MCB Camp Lejeune posted "DO NOT DRINK" signs at deep sink faucets basewide to stop people from drinking water from those faucets because they seem to release more lead than other faucets. To prevent people from drinking contaminated water, the base has also posted signs at faucets where water samples show lead levels above 50 ppb. As a result of ATSDR's recommendation, MCB Camp Lejeune installed filters on water lines to stop residents of single-family homes from drinking water from faucets that show lead levels above 15 ppb. The water lines in several homes were replaced.

Planned Action: MCB Camp Lejeune continues to sample tap water for lead and copper contamination in accordance with EPA regulations as overseen by NCDEHNR. MCB Camp Lejeune continues to finalize the corrosion control measures on their water systems to reduce lead from leaching into the water from the plumbing. Recommended Action: If future water samples show lead levels that exceed 15 ppb, MCB Camp Lejeune should promptly advise women and children not to drink water from those faucets. Adults should be advised not to drink water from any faucet where lead exceeds 50 ppb.

B. Volatile Organic Compound Exposure (Tap Water)

In the past, the Tarawa Terrace, Hadnot Point, and Holcomb Boulevard water distribution systems on base were contaminated with volatile organic compounds (VOCs) (see Table 2). The sources of contamination were leaks from off-base and on-base underground tanks, some of which were installed in the 1940s. People who used water from these systems between 1982 to 1985 were exposed to VOCs. Exposure was intermittent and stopped when the contaminated wells were closed in 1985. From the sampling data, we estimated probable exposure dose levels for adults and concluded that noncancerous and cancerous health effects are unlikely to occur in those adults exposed. For children, we could not determine the likelihood of either noncancerous or cancerous health effects because there is not enough scientific information on the adverse health effects these compounds might have on children. However, there is evidence that suggests that, because of their developing systems, fetuses are potentially more sensitive to the effects of VOCs than either adults or children. Several epidemiologic studies have suggested associations between exposure to VOCs and birth defects, low birthweight, and late fetal death. ATSDR conducted a study of birth outcomes of women who were exposed to VOCs in drinking water at MCB Camp Lejeune during their pregnancy. Interim results of that study, reported in 1997, indicate that for most live births, there was no association between housing supplied with water from the Tarawa Terrace system and decreased mean birthweight (MBW) and increased numbers of babies born small for gestational age (SGA). Associations between the Tarawa Terrace water system and MBW and SGA were observed in two potentially susceptible subgroups: infants of mothers age 35 and older and infants whose mothers had histories of fetal deaths. For mothers whose housing was supplied with water from the Hadnot Point system, decreased MBW and increased SGA were observed in male, but not in female, infants. Decreased MBW and increased SGA were not associated with housing supplied by the Holcomb Boulevard system. The findings for both Hadnot Point and Tarawa Terrace were unanticipated because associations were observed in certain subgroups but not others. ATSDR is conducting more research on VOCs in other populations that may confirm or refute the importance of these associations. Final analyses of fetal death and pre-term delivery data collected for the Camp Lejeune pregnancy study will be completed in 1997.

VOC Sampling

In 1982, MCB Camp Lejeune performed basewide routine sampling of treated drinking water for THMs, a procedure to test for chlorine disinfection by-products. In May 1982, the laboratory noted difficulty in measuring THMs in two of the eight water systems in operation at that time because of interference by unidentified compounds. The analysis was then expanded to include trichloroethylene (TCE) and tetrachloroethylene (PCE), which were thought to be the interfering compounds (27). The findings for each distribution system are summarized below.

Hadnot Point Water Distribution System

At Hadnot Point, tap water samples contained TCE at 1400 ppb and 1,2 dichloroethylene (DCE) at 407 ppb in May 1982, but in July 1982, levels dropped to 20 ppb TCE and 1,2 DCE was not detected (see Table 2) (27). The drop in these levels can be explained by the use of different supply wells (a few containing contamination and others not) on different days. In the Hadnot Point system, any given well would have been in use about two-thirds of the time because water demand did not require using all wells at the same time (28). There were 39 operational wells in the system, but only 20 of those wells were used at any one time. The wells pump water to the distribution system where the water is blended and treated. This process means that although the contamination is then spread from the one well to the entire distribution system, it is also diluted by being combined with water from uncontaminated wells. Chlorine, fluoride, and softeners are added to the water before it is pumped to water towers before distribution (28). The possible sources of contamination at the Hadnot Point distribution system are leaking underground storage tanks containing TCE and fuels, spills during vehicle maintenance operations, and disposal of drums at Sites 6, 9, and 82 and associated storage lots in OU 2 (29, 79).

In July 1984, as part of the Navy Assessment and Control of Installation Pollutants (NACIP) Program, MCB Camp Lejeune conducted water quality sampling in wells on base. They found that eight of the 39 wells in use at Hadnot Point and one of the seven wells in use at Tarawa Terrace were contaminated with various VOCs. All nine wells were abandoned and have not been used in the drinking water system since 1985 (28).

* - EPA's Drinking Water Standard, referred to as the Maximum Contaminant Level (MCL) allowable
ND - None Detected
J - Estimated Value
† - Detection limit was 10 ppb.

Tarawa Terrace Water Distribution System

Tap water sampling in the Tarawa Terrace water system in May 1982 detected PCE at 80 ppb, a level that remained consistent during the July sampling. 1,2-DCE was detected at 12 ppb. Trace amounts TCE were detected, but because of the laboratory instrument detection limit of 10 ppb, TCE was estimated to be 8 ppb. At the time of the 1982 sampling, no source for the contamination at either Hadnot Point or Tarawa Terrace system had been identified (31). Furthermore, there were no drinking water standards for these chemicals in 1982; TCE, PCE, and 1,2-DCE levels in drinking water were not regulated until the Safe Drinking Water Act was amended in 1991 (32). Sampling in February 1985 detected PCE at 215 ppb. Table 2 shows the maximum detected concentrations of VOCs at the tap and the current drinking water standard, referred to as the Maximum Contaminant Level (MCL) allowable.

Subsequently, it was determined that contamination at the Tarawa Terrace distribution system was caused by an off-base dry-cleaning operation (ABC Cleaners) whose septic system released the cleaning fluid PCE into the ground (33). The septic system was installed in 1954 and used until 1985. In 1958, a well supplying the Tarawa Terrace system was drilled approximately 900 feet from the dry-cleaners. Because the well was so close to the septic field, the well was probably contaminated soon after it was built. That well could have contaminated the water distribution system with PCE for as long as 30 years. Over time, contaminants migrated into a second base well, located approximately 1800 feet south of the septic system, but the PCE contamination was detected before this well was put into use. In 1985, both of these contaminated wells were shut down (31). Unable to meet the increasing water demand without those wells, the Tarawa Terrace distribution system was closed (28). This public health assessment evaluates exposures that occurred during the time for which sampling data are available. However, the ATSDR study of birth outcomes reviewed available birth records over the longer estimated exposure duration (1958­1985).

Holcomb Boulevard Water Distribution System

On January 27, 1985, a generator fuel line at the Holcomb Boulevard water distribution plant burst, leaking fuel into the system. This situation was identified after the base received complaints of a gasoline smell in on-base residential tap water (31). MCB performed sampling of the system and found that gasoline had entered the Holcomb Boulevard distribution system. The system was immediately shut down and flushed out. Emergency back-up water was then pumped from the Hadnot Point system, whose VOC contamination was not yet identified, into the Holcomb Boulevard distribution lines. Tap water samples taken from Berkeley Manor Elementary School in the Holcomb Boulevard system on January 31, 1985, contained TCE at 1148 ppb and DCE at 407 ppb (Table 2). Contaminants measured at several points in the Holcomb Boulevard system were consistent with samples taken from the Hadnot Point Water treatment plant on the same date. Therefore, the source of TCE and DCE in the Holcomb Boulevard system originated from the contaminated emergency water supplied by the Hadnot Point system. People were switched back to the clean Holcomb Boulevard system 12 days later when the generator fuel line was repaired (31).

Human Exposure Route and Public Health Implications

Our exposure estimates assume that people were exposed to VOCs in drinking water during the time tap water sampling data showed contamination of the water systems. People drinking or bathing with water supplied by Hadnot Point and Tarawa Terrace water distribution systems during 1982 to 1985 were exposed to VOCs. Most likely, contamination was present before 1982, but there is no sampling information to confirm this assumption. Because of the random use of contaminated wells (water demand did not require all wells to be in use at the same time), we estimated exposures to be intermittent, occurring off and on, for 3 years, 1982­1985. See Table 3. The base residents and employees exposed included adults, children, and fetuses.

Holcomb Boulevard distribution system received contaminated drinking water for 12 days in 1985 when a broken pipe emergency required that back-up water be piped in from the Hadnot Point system, which contained VOC contamination. Therefore, people drinking or bathing with water from Holcomb Boulevard water distribution system from January 27 to February 7, 1985, were exposed to VOCs on a short-term basis (less than 14 days).

In general, exposure to VOCs in water can occur from ingestion, inhalation, or skin contact with contaminated water. Because these chemicals readily change from liquid form to vapor, showering, bathing, and cooking can contribute to the estimated exposure dose. Reports in the scientific literature indicate that, while showering, people generally inhale an amount of VOCs equivalent to drinking 2 liters of water (34). Our VOC exposure estimates assume exposure to VOCs from ingesting 2 liters of water per day and inhaling an equivalent concentration of VOCs during showering. The estimated exposure doses for people drinking contaminated water in these three systems are presented in Table 3.

TCE is similar to PCE in chemical composition and in the way the body metabolizes it. However, we have evaluated the effects of each chemical separately, and those results are presented in Table 3. We also qualitatively consider the combined effects of the chemicals on the body when evaluating the likelihood of cancer.

Noncancerous adverse health effects are not expected for the adults who were exposed to VOCs by drinking or bathing in the contaminated water at MCB Camp Lejeune. During the 1940s and early 1950s, TCE and PCE were used to anesthetize patients during operations. A review of available information on those people and also information on occupational exposures indicates that short-term exposure to TCE, regardless of route (ingestion, inhalation, or skin absorption) at concentrations of 100 to 10,000 times greater (160,000­1,000,000 ppb) than those detected at MCB Camp Lejeune depress the central nervous system, causing headache, dizziness, nausea, vomiting, and intoxication (35). Long-term exposure to TCE at 200,000­400,000 ppb, which is 142 to 285 times higher than the levels detected at MCB Camp Lejeune, as reported in the scientific literature caused vertigo, short-term memory loss, and harmful liver and kidney effects (35). Because the concentrations of TCE detected in the drinking water at MCB Camp Lejeune are so much lower (100 to 10,000 times lower) than the levels causing the previously mentioned effects, it is unlikely that adults would have developed noncancerous adverse health effects. More recently, very subtle effects of TCE on nervous system reflexes have been observed after long-term exposure to no more than 35,000 ppb (36). However, these subtle effects were observed in a population exposed to TCE for 20 years, which is much longer than most residents at MCB Camp Lejeune would have received contaminated water.

Certain people are potentially more sensitive to the effects of VOCs. These more sensitive groups include chronic consumers of alcohol, people with heart disease, people taking disulfiram (a medication used to treat alcoholism), and people taking the anticoagulant warfarin (37). These medications increase the toxicity of VOCs on the liver.

† - Increased cancer risk is based on > 5.5 x 10^-5.
J - Estimated value
NOTE: Dose calculations and cancer risk estimates are included in Appendix F-2.
The Probable Health Effects does NOT include those for fetuses, which would be unknown.

Cancerous Effects

Typically, ATSDR uses human epidemiologic and occupational studies when evaluating the likelihood of cancerous effects or cancer risk. However, too few epidemiologic studies have been carried out on low-level exposure to VOCs to make sound cancer estimates. Therefore, we decided to base our assessment of cancer risk from exposure to VOCs at MCB Camp Lejeune on data from animal studies. The International Agency for Research in Cancer (IARC) classifies TCE and PCE as "probably carcinogenic to humans" based on "sufficient" evidence of carcinogenicity in animals and "limited" evidence in humans (38). The animal studies evaluated the cancer effects from known exposure to VOCs. On the basis of these animal studies, mathematical formulas were derived using factors to convert animal data into values relevant to humans.

Using cancer risk estimates, ATSDR determined that cancerous health effects are unlikely in adults who were exposed to VOCs in drinking water at MCB Camp Lejeune (Appendix E-1). Although cancer is not expected to occur, not enough scientific information on humans is available to rule out the possibility of cancerous health effects from low-dose exposure to VOCs. A few epidemiologic studies have suggested that exposure to VOCs may be associated with leukemia, non-Hodgkins lymphoma, and bladder and kidney cancer (39, 40, 41, 42). The exposure doses in these studies were similar to or slightly higher than what was estimated for people at MCB Camp Lejeune. However, there are too few studies to see any definite pattern of cancers related to VOC exposure. In addition, these studies are further limited methodologically because of the difficulty of verifying and quantifying people's exposure to VOCs. Because the results of the epidemiologic studies suggest a possibility of cancer from exposure to VOCs at low doses, more studies are needed to adequately address the issue of human cancer associated with low-dose VOC exposure.

Health Outcome Data

Cancer Data
At this time, ATSDR is not planning a follow-up cancer statistics evaluation of adults at MCB Camp Lejeune for the following reasons. A simple review of cancer statistics from the North Carolina cancer registry would not be useful because cancer registries contain cancer cases diagnosed each month for a specific county. When exposures occur, generally all residents of the county are not equally affected. Instead, the people exposed would be a smaller, localized group such as the small group of residents at Tarawa Terrace, MCB Camp Lejeune. Therefore, evidence of higher cancer rates in groups this small may be hidden within the rates of cancer for the entire county.

In addition, latency for most types of cancer is between 10 and 20 years. This creates two problems. First, those exposed to potential VOC carcinogens in the 1982­1985 time frame, would just now be beginning to be diagnosed with cancer. Secondly, the average stay of residents at MCB Camp Lejeune at that time was 3 years, and most of the exposed individuals who develop cancer are likely to have moved before they are diagnosed. Hence, most of the cancer cases that might have occurred among exposed individuals would not be recorded in the North Carolina cancer registry as occurring to MCB Camp Lejeune residents.

The potential effects of VOC exposure on children have been evaluated only in Woburn, Massachusetts, where a cluster of childhood leukemia cases has been investigated in several different studies. The Woburn studies suggested an association between childhood leukemia and access to VOC-contaminated drinking water (42, 43, 44). This association was quite strong in children who were exposed to the largest quantities of VOCs in utero (43). In addition, cancer rates declined to expected levels about 8 years after the contaminated wells were closed, which is a reasonable latency period for childhood cancer. The contaminant levels in the Woburn wells were TCE, 267 ppb; PCE, 21 ppb; chloroform, 12 ppb; and other VOCs. The wells were used 59% of the time, and water was blended with water from six other municipal wells, thus lowering the actual concentrations of VOCs people would be drinking at their taps. The risk of childhood leukemia associated with VOC-contaminated drinking water in Woburn was impossible to estimate precisely because the overall number of childhood leukemia cases in Woburn was small, the number of years during which Woburn water was contaminated was not known, and what VOC concentrations were present in tap water was not known. In addition, some associations between chemical exposure and disease arise by coincidence. This is why it is necessary to conduct epidemiologic studies in several different populations to establish a definitive link between exposure and disease. Nevertheless, the findings at Woburn raise concerns about potential childhood cancer risks associated with VOC exposure in utero. Therefore, we recommend that, if feasible, ATSDR conduct a study of cancer in children potentially exposed to VOCs in utero while their parents resided at Camp Lejeune.

Noncancerous Effects

Adverse Birth Outcomes
Women may experience adverse pregnancy outcomes from exposure to toxic substances even when their own health is not threatened, because fetuses are potentially more sensitive to the effects of VOCs (45, 46). Several epidemiologic studies suggested the possibility that pregnant women exposed to VOCs (at levels similar to those detected at MCB Camp Lejeune) may have an increased risk of adverse pregnancy outcomes. The outcomes include birth defects such as heart malformations, neural tube defects, oral clefts, low birthweight, and increased fetal death (45, 46-51). Some of these studies have significant limitations, including questions about whether all of the study population was exposed, how long exposure took place, and the exact concentrations of VOCs to which these mothers were exposed. Due to these limitations, more studies are needed to better evaluate the relationship between VOC exposure and adverse pregnancy outcomes.

To help address the issue about pregnancy outcomes, ATSDR began a study at Camp Lejeune in 1995. In an interim report released in 1997, ATSDR identified approximately 6000 infants whose mothers resided in VOC-exposed housing areas while pregnant (52, 53). A statistically significant decrease in mean birthweight and a statistically significant increase in the condition small for gestational age was observed in male infants born to mothers whose housing was supplied with water from Hadnot Point. Birthweight in this group was compared with birthweight of infants of women living in other officers' housing. No differences in mean birthweight or the condition small for gestational age were noted in most residents receiving water from Tarawa Terrace compared with residents of other housing areas. However, in Tarawa Terrace residents, the children of mothers who were 35 years of age or older and the children of mothers who had previously had a fetal loss were more likely to have been born small for gestational age. Infants whose mothers were very briefly exposed to VOCs from the Holcomb Boulevard system were not more likely to have lower mean birthweight or to be born small for gestational age.

Summary and Follow-up

Human exposure to TCE, PCE, and 1,2-DCE in drinking water systems at MCB Camp Lejeune has been documented over a period of 34 months, but likely occurred for a longer period of time perhaps as long as 30 years. Included in the population that used this water were approximately 6000 residents in base family housing (52, 53). This population consisted of a large proportion of young married women. Even though adverse health effects are not expected in adults, concern was raised about potential toxic effects on developing fetuses.

As discussed previously, it is difficult to draw conclusions from a single epidemiologic study, and most of the other epidemiologic studies completed to date have been so different in study design that their results cannot be adequately compared. Also, finding associations in some subgroups but not others is plausible, but was not expected. Research conducted in other groups of infants exposed to these chemicals in utero will be necessary before firm conclusions about the effects of low-level VOC exposure on birthweight can be drawn. ATSDR is currently conducting another study of TCE in drinking water and birthweight as part of its National Exposure Registry activities. The Exposure Registry study may confirm or refute some of these observations. A future report based on the Camp Lejeune birth data will examine the potential association between VOC exposure and preterm delivery and late fetal death. Birth defects will be studied only briefly because the data are too limited for an adequate evaluation.

Another potential effect of fetal exposure to VOCs is childhood cancer. Information about the potential for this effect is limited, but provocative. Therefore, ATSDR recommends a study of cancer in children who were exposed to VOCs at MCB Camp Lejeune while in utero.

Completed Action: In 1985, MCB Camp Lejeune ceased use of VOC-contaminated drinking water wells at Hadnot Point, Tarawa Terrace, and Holcomb Boulevard. Ongoing Action: In 1995, ATSDR completed collecting data for a study of VOCs in drinking water and birth outcomes at MCB Camp Lejeune. An interim report was released in 1997. A final report is also expected in 1997.

Recommended Action: ATSDR recommends that a study be conducted of cancer in children who were probably exposed in utero to VOCs at MCB Camp Lejeune. This study would further the understanding of the health effects of low-dose VOC exposure in susceptible populations, and provide parents with information about their children's health risks.

C. Pesticide Exposure (Site 2-Former Nursery/Day-Care Center)

The soil around Building 712 at Site 2 was contaminated with the pesticides chlordane and DDT and its breakdown products, DDD and DDE. At different times over the years, people working or playing on the surrounding grounds were exposed to different concentrations of these pesticides in surface soil from the parking lot, lawn, or playground. People exposed to contaminated soil include office workers, lawn-care workers, children, and adults who used the parking lot. Those exposures were estimated to be high enough to increase the lifetime risk for cancer in office workers, but noncancerous adverse health effects are not likely. Lawn-care workers and other adults are not expected to have noncancerous or cancerous effects as a result of their exposure to the pesticides at this site. However, because of the limited scientific information available on adverse effects in children exposed to pesticides, ATSDR was not able to adequately address the likelihood of either cancerous or noncancerous adverse health effects in them. All exposures were stopped in 1993 when access to the contaminated areas was physically restricted. Also, contaminated soil was removed in October 1994. Table 4 outlines the pesticide exposure situations.

Site 2-History and Use

Building 712 is located in the northeastern portion of MCB Camp Lejeune just off Holcomb Boulevard (Figure 1). From 1945 through 1958, the building was used as a pesticide storehouse and as an office for the pesticide workers. Two outside concrete pads, level with ground surface, were used as platforms for mixing pesticides and washing pesticide containers. These pads and the surrounding soils contain the highest level of contamination (Figure 2). In 1958, pesticide handling was relocated to a different area on base and Building 712 remained unused until 1966 (3). There is no record that Building 712 was ever decontaminated. The surrounding grounds were not decontaminated until 1994, when the contaminated soil was removed from the parking lot and lawn areas (24, 25).

Figure 2.

In 1966, Building 712 was opened as a day-care facility for the children of MCB Camp Lejeune employees. The day-care center had an enrollment of approximately 45 children ranging in age from 6 weeks to 12 years; most were about 5 years old (55). The children's playground area was fenced and approximately 100 feet from the old concrete wash pad. A gravel parking lot is located at the rear of the building. The old concrete mix pad was adjacent to the parking lot, and cars could actually park on the concrete pad.

In 1982, during environmental contamination investigations at MCB Camp Lejeune, pesticides in surface soil were detected at several locations around the building, i.e., near the mix and wash pads, in the lawn area, in the parking lot, in the day-care playground area, and in the drainage ditch (3). Figure 2 diagrams those locations at Site 2. The pesticides detected (DDT and chlordane) are not water soluble. They bind tightly to soil particles and are not easily washed away from the soil. Therefore, movement of pesticides from the immediate area where they were released is not expected. However, migration of the soil particles from erosion due to heavy rains or winds may explain the presence of pesticides in the adjacent drainage ditch.

In June 1982, after environmental contamination was detected, the Marine Corps relocated the day-care center to another area on base (56). In 1989, Building 712 was used as a personnel office. In 1994, the office workers consisted of one part-time and fifteen full-time employees (57). The area previously used as a playground is now covered with grass. Exposures were stopped in December 1993 when MCB Camp Lejeune installed a fence and posted signs in the lawn and parking lot warning people not to enter the contaminated areas (58). In 1994, the concrete pads and contaminated soil from the parking lot and lawn areas were removed (24, 25). The parking lot was backfilled with clean gravel. The lawn was backfilled with clean soil and seeded with grass.

Human Exposure Routes and Public Health Implications

Exposures to pesticide at Building 712 stopped in December 1993, so the discussion here is for estimates of past, not current, exposure. ATSDR identified four groups of people who were exposed to pesticide-laden soil. In the past, (1) office workers were exposed to parking lot dust, (2) lawn-care workers were exposed to soil stirred up by lawn mowers. During the time period from 1966 to 1982, (3) children were exposed to dust from the parking lot and soil in the playground, and (4) adults were exposed to dust from the day-care parking lot.

In 1982 and 1993, soil samples were collected from different locations surrounding Site 2. We discuss here the levels of exposure we estimate for each group beginning with the most highly exposed. The exposure levels are dependent on assumptions we make about the length of time people were exposed, their contaminant dose, and their own sensitivity based on age. We have evaluated the exposure dose for each group of people who would have been exposed to contaminated soil at each sampling location. See Table 4 and Appendix E-2 for details.

ATSDR determined the likelihood that either cancerous and noncancerous adverse health effects will result from the exposure dose of the chemical contaminant. Because cancerous and noncancerous health effects occur through different biological mechanisms, they are evaluated separately, using different health guidelines and scientific information. If either cancerous or noncancerous health outcomes are likely to result from exposure to contaminants, the exposure is considered a public health hazard.

ATSDR's approach is conservative. (In other words, we include a wide margin of safety in our estimates of risk.) We use the maximum concentrations detected for estimating exposure dose. This estimate gives us a "worst case" estimate of the likelihood of adverse health effects. Thus, our public health recommendations are protective of the most sensitive members of the public.

1. Office Workers-Past Exposure

Office workers were exposed to pesticide contaminated dust when they parked their cars in the parking lot. The contaminated dust would have been absorbed by breathing or swallowing it. We assume that exposure would have lasted longer than 1 year because the length of employment is commonly longer than 1 year. The personnel office employs 16 employees.

Surface soil samples collected in 1993 from the parking lot area adjacent to the old concrete mix pad (the area with the highest concentrations of pesticide) contained these maximum levels: DDD at 1200 parts per million (ppm), DDT at 930 ppm, DDE at 30 ppm, and chlordane at 0.31 ppm (59).

The estimated exposure doses for office workers are listed in Table 4. Noncancerous adverse health effects resulting from those exposures are unlikely. However, when evaluated using the cancer risk values, we estimate that, as a result of their exposure, office workers may have an increased risk of developing cancer over their lifetime (Appendix E-2). Simultaneous exposures to those pesticides may increase this risk. Therefore, we concluded that exposure to pesticides at the levels detected in the parking lot area posed a public health hazard.

2. Lawn-Care Workers-Past Exposure

Lawn-care workers were exposed to pesticides by breathing or swallowing dust stirred up by the lawn mowers. We estimate those exposures would have been seasonal, occurring for 4 months of the year, 1 day per week, and possibly could have lasted more than 1 year for an estimated five individual lawn-care workers (24).

Surface soil samples collected in 1993 (Table 4) at the grass-covered areas contained maximum levels of DDT at 3000 ppm, DDD at 1200 ppm, DDE at 30 ppm, and chlordane at 7.4 ppm (59).

The estimated exposure doses for lawn-care workers are listed in Table 4. Most likely, lawn-care workers were exposed to lower doses of pesticides than are people who apply pesticides. However, pesticide applicators are aware that safety equipment such as respirators, gloves, and coveralls greatly reduce their chance of exposure, whereas lawn-care workers would not usually wear such equipment when mowing the lawn.

Noncancerous adverse health effects resulting from those exposures are unlikely. Additionally, we evaluated the likelihood of increased cancer risk to lawn-care workers from exposure to the chemicals (chlordane, DDT, DDE, and DDD). On the basis of the estimated duration of exposure, it is unlikely that lawn-care workers have any increased risk of developing cancer as a result of their exposure. Therefore, the exposure to lawn-care workers at Site 2 does not present a public health hazard. Appendix E-2 lists the exposure doses and cancer risk values estimated at Site 2.

3. Children at Day Care-Past Exposure: 1966­1982

Due to their hand-to-mouth activity, children ingest more soil than adults. As a result, children who attended the day-care center were exposed to higher doses of pesticides than were adults. Children at the day-care center absorbed the pesticides by touching the soil in the playground and by breathing or swallowing the soil. We estimated that approximately 225 individual children would have been exposed during the time the day-care center was in operation. We assumed that children would have attended the day care for longer than 1 year because the average tour of duty for military personnel at MCB Camp Lejeune at that time was 3 years. Therefore, we estimated exposure to be chronic.

When soil sampling was carried out in 1982, surface soil samples collected from the playground area contained DDT at 6.7 ppm and chlordane at 0.39 ppm. Because the breakdown of those compounds is slow, we assumed that the concentrations were within the same range throughout the 16-year period that the day-care center operated.

† - Increased cancer risk is based on 5.5 x 10^-5.
Values for children's cancer risk are reported here as unknown because generalizing cancer risk calculation for children is strongly questioned among the scientific community.
Appendix E-2 contains the assumptions used in estimating dose and cancer risk.

We calculated exposure doses for pica and nonpica children, based on the amount of soil to which the children would have been exposed. Children are classified as "pica" if they intentionally eat nonfood items, in this case soil. Pica behavior occurs in about 16% of children age 6 months to 2 years old (60). The exposure dose for pica children usually is greater than for nonpica children and would represent a worst-case exposure dose. The estimated exposure doses for pica children exposed to pesticide contaminated soil in the playground are in Table 4.

Children received additional pesticide exposure from the dust in the parking lot. We assumed that exposure would have lasted longer than 1 year. The additional exposure doses for children are also listed in Table 4.

One difficulty in estimating the health risk posed by these exposures is that the effects of pesticides in children have not been well studied. The way pesticides are metabolized in the body has been studied for many years in adults, who have usually been exposed as a result of accidental or occupational exposure. However, no scientific studies were found that described how pesticides are metabolized in children. This is important when trying to estimate the effects on very young children because children less than 2 years old may not yet have developed the enzymes that metabolize these pesticides (60).

We assume that the sensitivity of children older than 2 is similar to that of adults. Therefore, as in the adult populations, we do not think noncancerous adverse health effects are likely in children as a result of this exposure.

Cancer mechanisms in children are not well understood, but could be similar to those in adults; therefore, children exposed at Site 2 may have some increased lifetime risk of cancer. However, generalizing cancer risk calculation for children is strongly questioned among the scientific community because of a child's changing metabolism. Metabolic changes can cause children to be either more sensitive or less sensitive to the effects of a carcinogen based on their ability to repair cell damage and other factors. Therefore, we do not think a numerical estimate of increased risk would be applicable for children because we cannot generalize from adult studies to children.

4. Adults at Parking Lot-Past Exposure: 1966­1982

Adults who used the parking lot of Building 712 when it was a day-care center were exposed to pesticide-contaminated dust. This group would have included day-care center employees and parents taking their children to the day-care center. The approximate number of exposed adults is difficult to estimate. However, we believe that more than 50 adults were exposed during the time the day-care center was in operation. The exposure would be through breathing or swallowing contaminated dust and may have lasted longer than 1 year.

Surface soil samples collected in 1982 from the parking lot area adjacent to the old concrete mix pad contained the highest concentrations of pesticides within the parking lot area: DDT at 7500 ppm, DDD at 644 ppm, DDE at 69 ppm, and chlordane at 45 ppm. The estimated exposure doses for adults exposed to pesticide contaminated soil are in Table 4.

At these exposure doses, we do not think noncancerous adverse health effects are likely. However, as with the other groups described here, we think that exposure was high enough to increase the lifetime risk of developing cancer. Simultaneous exposures to DDT, DDE, DDD, and chlordane may have further increased this risk. For these reasons, we concluded that the exposure in the past posed a public health hazard.

Chemical-Specific Considerations

DDT - p,p'-dichlorodiphenyltrichloroethane,
DDD - p,p'-dichlorodiphenyldichloroethane, and
DDE - p,p'-dichlorodiphenyldichloroethylene

Since it was first used in 1946, DDT has been studied extensively in humans and animals. We reviewed the available scientific literature and determined that DDT and its breakdown products, DDD and DDE, at concentrations higher than those detected at MCB Camp Lejeune are only mildly harmful to humans.

We do not predict noncancerous adverse health effects in people exposed to pesticides at Site 2. The scientific literature has reported cases in which workers were accidentally poisoned after drinking concentrated DDT. In these cases, which had DDT concentrations much higher than those estimated for people at MCB Camp Lejeune, health effects were limited to headaches, confusion, vomiting, nausea, increased sensitivity of the mouth and lower part of the face, and tremor of the extremities. In general, symptoms occurred as soon as 30 minutes after a large dose or as late as 6 hours after a small dose (60, 61). Complete recovery from the acute symptoms occurred within several weeks.

Even today, DDT's effect as a human carcinogen is unknown (62). EPA has classified it as a possible human carcinogen based on evidence that it causes cancer in animals. Epidemiologic studies of pesticide workers suggest an association between long-term exposures to high doses of DDT and pancreatic cancer (63). In the interest of public health, ATSDR's approach is cautious, and we have accepted the worst-case evaluation for these exposures. Although we have estimated the exposure doses to be representative of actual exposures, our cancer risk estimates are designed to be highly conservative. We have therefore estimated cancer risk as if DDT and its breakdown products DDD and DDE were human carcinogens (Appendix E-2). Combined chemical exposures may further increase this risk. Even though our cancer risk estimates are conservative, we consider these risks to be a public health hazard and have recommended that exposure be stopped. MCB Camp Lejeune has removed contaminated soil from this site.

Chlordane

The level of chlordane detected in the soil surrounding Site 2 during the 1982 and 1993 samplings are considered low. ATSDR estimated the exposure doses to chlordane in the area surrounding Building 712. These estimated exposure doses were much lower (10 to 100 times lower) than any dose reported to be associated with noncancerous adverse health effects (64). Further, the limited number of scientific studies of long-term human exposure to chlordane have shown no consistent detrimental effects in adults. There are only anecdotal reports suggesting a correlation between chlordane exposure and the subsequent development of aplastic anemia and leukemia (65).

When evaluated using the cancer risk values, the maximum concentration of chlordane detected is not expected to cause any increased risk of cancer in any of the exposed groups. Therefore, chlordane at the levels detected does not pose a public health hazard.

Summary and Follow-up

Workers in Building 712 were exposed to levels of DDT and its breakdown products in soil estimated to be high enough to increase the lifetime risk for cancer. In 1993, because surface soil sampling indicated that pesticides in the lawn and parking lot were of health concern, MCB Camp Lejeune installed a fence to prevent lawn-care and office workers from coming in contact with the contaminants and stopped mowing in that area. In 1994, MCB Camp Lejeune removed the concrete pad and contaminated soil. After the soil was removed, confirmation sampling was performed to ensure that the desired clean-up levels were achieved.

Health Outcome Data

ATSDR did not review the health outcome data of local cancer registries because such a review would provide inconclusive information for the following reason. Because pancreatic cancer (the cancer potentially associated with DDT exposure) only occurs in small numbers within the county's total population and because a very small number of workers were exposed, any evidence of excess cancer cases in this small group may be hidden within the rates of cancer for the entire county.

A local family had concerns that their child's current allergies might be caused from exposure to pesticides received while attending that day-care center. Because of these concerns, ATSDR contacted the director of Human Services at MCB Camp Lejeune to determine if records had been kept on individuals who attended the day-care center at Site 2. No records were kept on the children who attended the day-care center. Therefore, we could not review specific health outcome data for those individuals.

Because no health outcome data were reviewed, ATSDR conducted a literature search to determine if an increase in allergy cases had been reported from a similar exposure. No link between pesticide exposure and general allergies was identified. However, in this case, exposure to the pesticides found at Site 2 (DDT and chlordane) could possibly cause an allergic response if exposures to DDT or chlordane recurred, but would not cause general allergies to other substances such as cats, dusts, or grasses. Further, if the child was no longer being exposed to DDT and chlordane, then that child would not be expected to currently have allergic responses. DDT and chlordane have not been used in the United States since the 1970s. Moreover, one would not likely see a sustained reaction over the 12 years since the time the day-care center was closed.

Conclusions: The soil around Building 712-Site 2 was contaminated with the pesticides chlordane and DDT, and its breakdown products DDD and DDE. At different times, four groups of people have been exposed to different concentrations of these pesticides in soil from the unpaved parking lot or the lawn. The exposures of office and day-care workers and parents to contaminated soil in the parking lot were estimated to be high enough to increase their lifetime risk for cancer. Lawn-care workers are not expected to have an increased cancer risk based on their exposure to contaminated soil in the lawn area. Noncancerous health effects are not likely in any of the people exposed.

Completed Actions: At Site 2, sampling data from 1993 indicated that pesticide levels in surface soils in the lawn and parking lot were of health concern. MCB Camp Lejeune installed a fence to prevent lawn-care and office workers from coming in contact with the contaminants and stopped mowing in that area. MCB Camp Lejeune removed the concrete pads and contaminated soil. During this action, the removal action contractor conducted air monitoring and implemented dust control procedures, as needed, to prevent office workers and visitors from being exposed to site contaminants. After the soil was removed, confirmation sampling was performed to ensure that the desired clean-up levels were achieved.

Planned Action: No further actions planned or needed for the protection of public health. Recommended Action: No further actions recommended or needed for the protection of public health.

Agency for Toxic Substances and Disease Registry, 1825 Century Blvd, Atlanta, GA 30345
Contact CDC: 800-232-4636 / TTY: 888-232-6348 

Department of Health and Human Services