PUBLIC HEALTH ASSESSMENT
RIO ABAJO, HUMACAO COUNTY, PUERTO RICO
Public Health Status
The Frontera Creek National Priorities List (NPL) site is not a public health hazard based on alack of current exposure to site-related contaminants. Mercury in the soil and air may havecaused slight muscle tremors prior to 1990 for a few individuals at the Technicon facility. It ispossible that methylene chloride in the air, though not site-related, may have caused slightchanges in the liver and kidney or mild reversible decreases in vision and hearing in individualswho both worked and lived in the Frontera Creek area during the period between 1983 - 1985. However, this conclusion about methylene chloride is uncertain because of difficulties inidentifying methylene chloride exposure levels for the Frontera Creek area and in evaluating thetoxicity of methylene chloride.
Extent of Contamination
The environmental sampling of the Frontera Creek NPL site was well-designed for evaluating thehealth impact of the site. The initial air monitoring done in 1989 was not conducted for asufficient period of time to adequately identify probable exposure levels, especially off-site. However, monitoring done in 1993-4 was appropriately conducted.
The environmental data indicates that mercury contamination is restricted to air, surface soil, andsediment from the ditch at the Technicon facility. Mercury concentrations in surface andsubsurface soils, sediment, surface water, ground water, potable water, and biota for the rest ofthe Frontera Creek site area were either below method detection limits or within the backgroundrange for Puerto Rico. Air levels of mercury and methylene chloride both on- and off-site wereabove background. Methylene chloride and methyl isobutyl ketone concentrations in the water ofthat portion of Frontera Creek that passed through the industrial facilities met ATSDR'sguidelines for contaminants of concern. Except for arsenic levels in soils from one samplinglocation at each of two industrial facilities, other chemicals analyzed were either withinbackground ranges or below method detection limits.
Even though the mercury levels in fish were within background levels, the individuals who eatseveral fish meals a week may be exposed to mercury at a level of health concern. Fishermenneed to be informed of the possible health risk from consuming large amounts of fish.
The maximum (2.2 µg/m3) and average (0.4 µg/m3) concentrations of mercury in the on-site(industrial area) air could represent a health hazard if those levels are an accurate measurement oftypical concentrations and if exposure continued regularly for a year or more. It is not possible todetermine whether the maximum (0.09 µg/m3) and average (0.07 µg/m3) concentrations ofmercury measured in the off-site air represent a health hazard, because the only availableanalytical method is not very accurate. In addition, air samples taken in 1989 were not taken onenough days and over a sufficient portion of the day to accurately identify typical exposurelevels.
The individuals who worked at or near Squibb and also lived at Ciudad Cristiana during theperiod of 1983 - 1985 were at risk of having noncarcinogenic health effects related to methylenechloride exposure. Those individuals may have had continuous exposure to methylene chloridefor varying periods and air levels. There also may have been periods when there was noexposure. Slight subclinical (i.e., not harmful) changes in the liver and kidney or mild, reversibledecreases in vision and hearing might have occurred. However, this conclusion about methylenechloride is uncertain because of difficulties in identifying methylene chloride exposure levels forthe Frontera Creek area and in evaluating the toxicity of methylene chloride.
Health consequences due to barium, even at the background levels found at Ciudad Cristiana,may have been possible for children at Ciudad Cristiana who ate large amounts of soil (5 gramsor more a day). Neither carcinogenic nor noncarcinogenic effects appear to be possible for any ofthe other exposures.
Health Outcome Data Evaluation
Cancer and developmental effects were identified as biologically plausible health outcomes. Cancer is plausible because there was a carcinogen, methylene chloride, in a completed humanexposure pathway. Methylene chloride was not a site-related contaminant. Cancer incidencewere not evaluated in this public health assessment because the only available data, the city ofHumacao, was for a much greater population, 50,000, than the probable exposed population of1,000. Developmental effects were plausible health outcomes because some women wereexposed to mercury levels (4.0 µg/dl or greater) which could result in delayed motordevelopment and delayed language development in children exposed in the womb. This mercuryexposure was not related to the Frontera Creek NPL site. Appropriate data to evaluate thosekinds of effects were not available.
Self-reported outcomes ranged from rashes, bleeding gums, and headaches to numbness, lupus,and cancer. Most of the individuals reporting health outcomes associated them with exposure tomercury. Many of the reported outcomes/symptoms such as joint and back pain, asthma,cardiovascular disease, diabetes, lupus, and cancer have not been associated with mercuryexposure in the past. While the other reported outcomes have been associated with mercury, atleast some of them have also been linked with several other causes such as methylene chloride,infectious diseases, and stress. Mercury is an unlikely cause for the reported health outcomesbecause of the lack of significant exposure.
The average blood mercury level for the approximately 290 individuals tested while or just afterthey were residents of Ciudad Cristiana are within "normal" limits for a population thatconsumes 5 or more fish meals a week. It is not clear whether the average Ciudad Cristianaresident ate that amount of fish. None of the individual results was above the 20 µg/dl levelwhere health effects appear to begin to be observed.
However, 27 of the 64 (42%) women of child-bearing age in the 290 tested had blood mercurylevels above the 4.0 µg/dl where health effects appear to begin to be observed in their unbornbabies. Children exposed to these levels while in their mother's womb may have walked laterthan the normal maximum of 19 months, or talked later than the normal maximum of 26 months. A study done of Iraqi children indicates that about 25% of the children with maternal bloodmercury levels of 4 - 20 µg/dl would have walked or talked later; the rest with this range ofmaternal blood levels had no adverse health effects. It is not known whether thosedevelopmental delays would be permanent or temporary. At maternal levels of 4 - 20 µg/dl,more severe effects such as mental retardation, deafness, blindness, microcephaly (small brain),and cerebral palsy are not observed.
A major limitation with the blood mercury data reviewed is that the participants wereself-selected which could result in a weighing of the results either to the high or low side. Thedifference of the percentage of results above 5 µg/dl between the Puerto Rico Department ofHealth (PRDH) study (0.6% - 6/993) and this set of results (29.0% - 84/290) indicates that theremay be such a problem.
ATSDR recommends that Puerto Rico review all available data on mercury in Puerto Rican fish and, then, consider advising Puerto Rican fishermen about the possibility of health consequencesfrom eating large amounts of fish.
The Comprehensive Environmental Response, Compensation, and Liability Act of 1980(CERCLA), as amended, requires ATSDR to perform public health actions needed at hazardouswaste sites. To determine if public health actions are needed, ATSDR's Health ActivitiesRecommendation Panel (HARP) has evaluated the data and information developed in theFrontera Creek Public Health Assessment.
HARP determined that the former residents of Ciudad Cristiana and Humacao health careprofessionals should receive additional information on the toxicity of mercury and of other site-related contaminants. The specific type and targets of this education will be identified byATSDR's Divisions of Health Assessment and Consultation, and Health Education.
If additional information becomes available which indicates human exposure to site-relatedcontaminants may be at levels of public health concern, the HARP will reevaluate the need forfollow-up public health actions.
Public Health Action Plan
The purpose of the Public Health Action Plan (PHAP) is to ensure that this public healthassessment not only identifies public health hazards but also provides a plan of action designedto mitigate and prevent adverse human health effects resulting from exposure to hazardoussubstances in the environment.
Two public health action have already been completed. Squibb, with review by EPA, conducted additional air monitoring for methylene chloride in the Frontera Creek area in 1993-4which met ATSDR concerns about the 1989 air monitoring. In the second, ATSDR requestedthat Puerto Rico consider issuing a fish consumption advisory on mercury for those areas ofPuerto Rico where a combination of background mercury levels and high fish consumption ratescould result in a hazard to health. Puerto Rico Department of Health considered ATSDR'srequest, but declined to issue a fish advisory because the fish mercury levels were typical forPuerto Rico.
One public health action was planned, but circumstances have delayed its implementation. Inthis planned public health action, staff from ATSDR's Divisions of Health Education and HealthAssessment and Consultation were going to provide information on mercury and methylenechloride during public availability meetings that were to be held as part of the public commentrelease of the Frontera Creek Public Health Assessment The meetings were cancelled becausethe Ciudad Cristiana ex-residents group withdrew their invitation. ATSDR will mail informationon mercury and methylene chloride directly to the ex-residents.
Public Health Comment
The Frontera Creek Public Health Assessment was available for public review and commentfrom August 12, 1994 through October 12, 1994. The Public Comment Period was announced inthe El Nuevo Diá and San Juan Star, which are island-wide newspapers, the El Oriental, aHumacao-based weekly, and on WALO, a Humacao radio station. Copies of the public healthassessment were made available for review at the home of Jose Sepulveda, the leader of theCiudad Cristiana Ex-Residents Group, the Antonio Roig Public Library in Humacao, theHumacao College Library, and the EPA Caribbean Field Office in Santurce. In addition, thepublic health assessment was sent to eight persons or organizations. Comments were receivedfrom Applied Geotechnical and Environmental Service Corporation (AGES), the environmentalconsultant to Squibb Manufacturing, and the Puerto Rico Department of Health.
A public meeting and a public availability session to discuss the public health assessment withthe Ciudad Cristiana Ex-Residents and take public comments was scheduled for August 20, 1994at Vista Hermosa in Humacao. The Ex-Residents withdrew their invitation on August 19 andthus the public meeting and availability session were not held.
Comments and responses are described in Appendix G which starts on page 99.
John R. Crellin, Ph.D.
Environmental Health Scientist
Health Science Section
Remedial Program Branch (now called the Superfund Site Assessment Branch [SSAB])
Environmental Science Section
Remedial Program Branch
Mark Rodriguez, M.D., M.P.H.a
Health Science Section
Remedial Program Branch
ATSDR Regional Representative:
Arthur C. Block
Senior Public Health Advisor
Region II - New York
Regional Program Office
a No longer with ATSDR
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