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DISCUSSION

A. Pathways Analyses

ATSDR identifies human exposure pathways by examining environmental and human factors which may lead to contact with contaminants of concern. A pathways analysis considers five principal elements: (1) a source of contamination, (2) transport through an environmental medium, (3) a point of exposure, (4) a route of human exposure, and (5) a receptor population. Completed exposure pathways are those for which the five elements are evident, and indicate that exposure to a contaminant has occurred in the past, is currently occurring, or will occur in the future. ATSDR regards people who come into contact with contamination as exposed; for example, people who reside in an area with contaminants in air, or who drink water known to be contaminated, or who work or play in contaminated soil are considered to be exposed. Potential exposure pathways are those for which exposure seems possible, but one or more of the elements is not clearly defined. Potential pathways indicate that exposure to a contaminant could have occurred in the past, could be occurring currently, or could occur in the future. Identification of an exposure pathway does not imply that health effects will occur. Exposures may be, or may not be, substantive. Thus, exposures may or may not cause adverse health effects.

ATSDR staff developed a list of contaminants of concern (see Appendix A) and then reviewed data and information from the Environmental Protection Agency (EPA), New Jersey Department of Environmental Protection (NJDEP), Ocean County Health Department (OCHD) and the Brick Township Municipal Utilities Authority (BTMUA) to assess past and current possible exposures.

B. Public Health Implications

The contaminants of concern identified have the potential to cause adverse health effects. However, for adverse health effects to occur, the pathway for exposure must be completed. A release does not always result in exposure. A person can only be exposed to a contaminant if they come into contact with the contaminant. Health effects resulting from the interaction of an individual with a hazardous substance in the environment depend on several factors. One is route of exposure; that is whether the chemical is inhaled; consumed with food, soil, or water (ingestion); or whether it contacts the skin (dermal). Another factor is the dose level to which a person is exposed, and the amount of the exposure dose that is actually absorbed. Mechanisms by which chemicals are changed in the environment or inside the body, as well as the combination (types) of the chemicals also is important. Once exposure occurs, characteristics such as age, sex, nutritional status, genetics, lifestyle, and health status of the exposed individual influence how the contaminants are absorbed, distributed, metabolized, and excreted. Together those factors and characteristics determine the health effects that may occur as a result of the exposure to a contaminant. Substantial variation in those mechanisms exists among individuals.

1. Completed Exposure Pathways

Virtually all residents of Brick Township obtain their drinking water from the BTMUA, with the exception of residents of Brick Beach who are served by the New Jersey American Water Company. The BTMUAs water supply comes from both groundwater wells and surface water (the Metedeconk River). Prior to 1994 the BTMUA used primarily groundwater for distribution, but by 1994 the amount of surface water had increased gradually to about two-thirds of the supply. Today about 70% of the water supply is from surface water. The groundwater and surface water supplies are mixed at the treatment plant prior to being distributed to residences. At the treatment plant, the water goes through a disinfection process that includes the addition of chlorine. In 1995 the BTMUA began adding chlorine to the drinking water distribution system at two locations in addition to the water treatment facility (during the summer months only) to ensure continued disinfection of the drinking water throughout the system.

During the study period (1987-1995) two types of contaminants in the municipal drinking water supply were evaluated: solvents (i.e. TCE and PCE) and disinfection byproducts (i.e. trihalomethanes (THMs) such as chloroform and bromoform). Bromoform, chloroform and tetrachloroethylene (PCE) were found in the drinking water supply above ATSDR comparison values (see Appendix C) at various times during the study period. These chemicals are discussed in more detail below.

a. Trihalomethanes

The primary method of disinfection of drinking water used in the U.S. and New Jersey involves the addition of chlorine to drinking water. THMs and other disinfection byproducts are formed by the interaction of chlorine with organic matter in the water. Naturally occurring organic matter in the water is the result of the decomposition of plant matter (e.g., leaves) and the metabolism of aquatic biota (e.g., algae). The longer the chlorine has a chance to react with the organic matter in the water, the higher the amount of THMs produced. This means that areas furthest from the treatment plant are more likely to have higher THMs in the drinking water than areas closer to the treatment plant. In addition, in areas where there is a low use of water or where there is a "dead-end" in the system, or where the system consists of small diameter pipes, the water tends to move very slowly and the chlorine has more time to react with any organic matter in the water to produce more THMs. As a result, residences in different areas can have very different levels of THMs in their drinking water. In addition, a sample taken in one location may have THM levels that are very different from homes that are less than 1 mile away. For example, homes located at a dead-end or low volume area of the system may have THM levels that differ substantially from levels found at nearby homes that are not at a low volume point in the system.

THMs will also vary in levels by season. In the summer and fall, there tends to be more organic matter in surface water (e.g., leaves and other vegetation), so there also tends to be more residual organic matter in the drinking water that can react with chlorine. (Ground water has very little organic matter so the chlorination of ground water produces very low or undetectable amounts of THMs.)

THMs include chloroform, bromoform, dibromochloromethane and bromodichloromethane. Other disinfection byproducts include MX (3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone) and the haloacetic acids (e.g., trichloroacetic acid). Teratogenicity, mutagenicity, and carcinogenicity have been suspected as being associated with the ingestion of several of the disinfection byproducts including THMs (Mills 1998, Boorman 1999).

THMs in drinking water have been linked to adult cancers in a few studies (Cantor 1997, Mills 1998). The strongest association is with bladder cancer. Associations have also been found for rectal and colon cancers. Recently, a study found an association between duration of residence with a chlorinated surface water source and brain cancer, but the association was found only for males (Cantor 1999). It is not known whether these cancers are caused by one or more of the THMs, by some other disinfection byproduct in the drinking water, or some combination of THMs and other disinfection byproducts.

THMs in drinking water have also been linked to adverse birth outcomes such as spontaneous abortion, small for gestational age, neural tube defects (NTD), oral cleft defects, and heart defects (Bove 1995, Waller 1998, Klotz 1999).

Of particular interest is the association between THMs and NTD. In two NJ studies, levels of THMs within the range found in some samples taken in Brick Township were associated with at least a two-fold increased risk of NTD (Bove 1995, Klotz 1999). On the other hand, a study conducted in Nova Scotia found a smaller increased risk of NTD with levels of THMs within the range found at Brick (Dodds 1999). An NTD is a defect of the spinal cord that occurs when the neural tube fails to close properly during the period between day 21 and day 26 of pregnancy. Recently, the drug thalidomide, which caused severe limb defects during an epidemic in Europe in the late 1950s and early 1960s, has been linked to an increased risk of autism (Stromland 1994, Rodier 1997). Among those exposed in utero to thalidomide, a high percentage developed autism. However, all the cases of autism were exposed to thalidomide between day 20 and day 24 of the pregnancy. Those exposed to thalidomide at other periods during pregnancy did not develop autism. This evidence suggests hypothesis that the period when the neural tube closes may also be a period when exposures to certain chemicals might lead to the development of an ASD. It also suggests an hypothesis that chemicals that cause NTD, since they act during this period of gestation, might also cause ASD. However, research on these hypotheses is at a very early stage. Therefore, it is currently unknown whether in utero exposure to environmental chemicals such as the disinfection byproducts of chlorination are associated with ASD.

THMs were found in the municipal drinking water supply approximately 356 times in samples taken between 1987 and 1995. Total THMs were detected at levels between 1 to 251 parts per billion (ppb).2 The highest THM level (251 ppb) was found at the Crab Shack. The next highest levels were also at the Crab Shack in August 1994 and ranged from 123 ppb to142 ppb. During the study period, other sites which had at least one sample above 100 ppb but below 140 ppb were Crossroads Realty, Baywood Hardware, Greenbriar Clubhouse, and Lionshead Clubhouse, and Shore Acre Plaza. Total Trihalomethanes exceeded 80 ppb approximately sixteen times in sampling data during the study period. The current EPA Maximum Contaminant Level (MCL) is 80 ppb based on an annual rolling average. It should be noted however, that the MCL for THMs was lowered from 100 ppb to 80 ppb in February 1999. The primary THM detected in Brick Township water supplies was chloroform with a range of <1 ppb to 240 ppb. No data were available on the levels of disinfection byproducts other than THMs during this period.

ATSDR attempted to contact the families of the 43 children who participated in the clinical exams and who were diagnosed with ASD to obtain residence during pregnancy and date of birth information. Two families declined to be contacted by ATSDR and one family could not be contacted after repeated attempts to obtain residence during pregnancy. ATSDR was able to obtain date of birth information for 41 children and residence during pregnancy for 40 children. Therefore ATSDR used 41 children as the denominator for its calculations. Twenty eight (28) of the children who participated in the clinical exams and were diagnosed with ASD were born in Brick Township, 12 were born outside of Brick Township, and the place of birth for one child was unknown. The residence during pregnancy for children born in Brick Township was plotted through Geographic Information Systems (GIS) and indicated no apparent grouping or pattern (see Figure 4). Residence during pregnancy also was plotted and compared to the top 15 and top 50 THM levels found in the municipal drinking water system. This pattern also was random and did not indicate a relationship between residence and THM levels.

ATSDR calculated the month and year of the first trimester for children who participated in the clinical exams and were diagnosed with ASD. For approximately 40% of the children who participated in the clinical exams, the first trimester was in 1991 or 1992. ATSDR reviewed THM data for the years prior to 1991 and 1992. The peak THM level (251 ppb) was in March 1988 and there were several THM samples that exceeded 100 ppb in September 1990 and September 1992. These levels do not correspond with the birth or conception periods of children with autism or PDD. In 1988 when the peak THM level occurred in March one child in the study was in the first trimester. In 1990 several THM levels exceeded 100 ppb in September and there were four children in the study in their first trimester. In 1992 several THM levels exceeded 100 ppb in September and there were five children in the study in their first trimester at or about this time. In 1991 the year with the highest number of children in the study with ASD total THM levels did not exceed 100 ppb.

ATSDR plotted residence during pregnancy and distance to the nearest sampling locations with THM samples greater than 80 ppb and greater than 60 ppb. There were 14 participants within approximately one mile of a sampling point location where THM levels exceeded 80 ppb at least once between 1987 and 1995. Five of these 14 study participants lived within approximately one mile of a sampling point location where THM levels exceeded 80 ppb during the pregnancy period. Thus, about 18% (5/28) of the participants who lived in Brick Township resided within one mile of a sampling point that exceeded 80 ppb during their pregnancies. All of the 28 participants lived within approximately one mile of a sampling point location where THM levels exceeded 60 ppb at least once between 1987 and 1995. Eight of these 28 study participants (about 29%) lived within approximately one mile of a sampling point location where THM levels exceeded 60 ppb during the pregnancy period.

Based on these analysis, ATSDR is not able to show a clear pattern between elevated THM levels and the pregnancy period for children in the prevalence study.

THM data from other NJ water systems was compared to THM data in Brick Township. Out of 198 water companies with THM data available for review, between 1988 and 1993, the Brick Township water system ranked 30th for average THMs. This means that there were 29 systems in the state during this time period with higher average THM levels. About 45 out of these 198 systems have similar surface water systems to the one in Brick Township. However, out of the data reviewed for the 198 NJ water systems Brick Township had the 2nd highest reported THM level (251 ppb) which was obtained at the Crab Shack. Based on this THM data review, Brick Townships THM levels could be considered typical or average for similar surface water systems in NJ with the exception of the 251 ppb sample.

i. Bromoform

Bromoform is one of the THMs. It was found in samples from the Brick Township drinking water supply fourteen times between 1987 and 1995. The concentration of Bromoform was detected at levels from 0.6 to 5 ppb. Bromoform exceeded the ATSDR comparison value of 4 ppb (see Appendix C) only once during the study period. In general, the range of bromoform found in the Brick Township water supply are similar to levels found in other areas of NJ as well as areas in the U.S. where the bromine content in water is very low. In areas of the U.S. where bromine levels in water are high, bromoform levels are ten to thirty times higher than the highest level found in the Brick Township supply.

Studies in animals indicate that long-term intake of bromoform can cause cancer. However, the levels found in the Brick Township water supply are very low and are not expected to increase a persons risk of developing cancer. Evidence from animal studies is sparse but has not indicated that bromoform is a teratogen. Other than the studies of THMs in drinking water, there have been no studies of exposure to bromoform and cancers or adverse birth outcomes in humans. ATSDR did perform a cancer risk analysis for Bromoform found in the Brick Township drinking water supply (see Appendix D).

ii. Chloroform

Chloroform is another of the THMs. It was found in drinking water supply samples approximately 356 times between 1987 and 1995. The concentration of chloroform was detected at levels from 0.6 to 240 ppb3. Chloroform exceeded the ATSDR comparison value of 6 ppb in 320 of the samples in the study period.

Based on animal studies, chloroform may be anticipated to be a carcinogen and a teratogen. In one study, the offspring of mice exposed to chloroform by inhalation had increased incidences of cleft palate and growth retardation. The observed defects and growth retardation occurred among fetuses exposed during organogenesis (days 8-15 of gestation). ATSDR performed a cancer risk analysis for Chloroform found in the Brick Township drinking water supply (see Appendix D).

b. Tetrachloroethylene (PCE)

During 1987, two small municipal wells were found to be contaminated with the solvents PCE and TCE. These wells were shut down in early 1988. Water from these wells was sent (along with water from other ground water and surface water sources) to the treatment plant were it was mixed prior to disinfection. Because the water was mixed at the treatment plant, the PCE and TCE from the two contaminated wells were diluted by the rest of the water that was not contaminated with TCE and PCE prior to reaching Brick residences. In addition, because of the mixing of water prior to delivery, all residences served by the BTMUA received approximately the same amount of TCE and PCE. The amount of TCE and PCE in the drinking water reaching every home in Brick depended on the percentage of the total water that was supplied by the two contaminated wells. On average, these two wells supplied about 2% each to the total supply during 1987, but the percentage of total water supplied by these two wells varied depending on the demand on the system (e.g., more water is usually consumed in the summer months) and the pumping rates of each well in the system as well as the amount of water provided by surface water sources.

PCE was found in distribution system 12 times between 1987 and 1994 at levels between 0.13 to 6 ppb. PCE was not detected after 1994. PCE exceeded the ATSDR comparison values of 0.7 ppb in five of these samples. The EPA MCL for PCE is 5 ppb and was exceeded once during the study period.

Data reported by the NJDEP and reviewed by ATSDR indicated higher values for PCE in well #2 (170 ppb - 360 ppb) and well #8 (6 ppb - 29 ppb). These wells provided approximately 2% each to the total water supply and were mixed with water not contaminated with PCE at the treatment plant prior to distribution to homes, so high levels found at the well were substantially diluted by the time they reached homes. This is the reason why the well samples are high, but the distribution samples are no higher than 6 ppb.

PCE is a synthetic chemical that is widely used for dry cleaning fabrics and for metal-degreasing operations. It also is used as a starter material for making other chemicals and is used in some consumer products. Other names for tetrachloroethylene include perchloroethylene, PCE, perc, tetrachloroethene, perclene, and perchlor.

There have been a few studies linking PCE in drinking water to cancers in humans. In one study, exposure to high levels of PCE in drinking water (i.e., from about 500 ppb to over 1 ppm) was associated with increased risk of leukemia and bladder cancer. A second study of this same population found that similar levels of PCE in drinking water was associated with breast cancer. A study in NJ found an association between PCE levels greater than 5 ppb and increased risk of leukemia and non-Hodgkins lymphoma, but the increase was only among females. In Woburn, MA, a 1979 drinking water sample from two contaminated wells detected trichloroethylene (TCE) at 267 ppb and PCE at 21 ppb. A cluster of childhood leukemia was linked to these drinking water contaminants (Lagakos, 1986). It is not clear whether the causative agent was TCE, PCE or the mixture, but since TCE was the predominant contaminant, the focus has been on TCE.

Based on human and animal studies, the International Agency for Cancer Research has determined PCE to be a probable human carcinogen. The U.S. EPA considers PCE to be on a continuum between probably and possibly carcinogenic to humans. ATSDR performed a cancer risk analysis for PCE found in the Brick Township drinking water supply (see Appendix D).

It is unknown whether PCE is a human teratogen. There is animal data indicating PCE at high doses can cause reduced fetal weight. A few studies have linked occupational exposure to PCE among dry cleaning workers and spontaneous abortions, but these findings have been contradicted by other studies that found no increased risk among dry cleaning workers. In a study conducted in NJ, PCE levels in drinking water above 10 ppb were associated with an increased risk of oral clefts. At U.S. Marine Corp Base, Camp LeJeune, NC, PCE levels in drinking water ranging from 76 ppb to 215 ppb were associated with a slight increase in small for gestational age among base residents. However, among the subgroup of Camp LeJeune mothers aged 35 years and older, the association between PCE exposure in drinking water and the risk of small for gestational age infants was nearly fourfold. In Woburn, MA, a 1979 drinking water sample from two contaminated wells detected trichloroethylene (TCE) at 267 ppb and PCE at 21 ppb. A study of birth outcomes parallel to the childhood cancer study found increased risks for several birth defects including NTD and an increased risk of small for gestational age. However, it is unclear whether the increased risks are due to the TCE, PCE or the mixture. Given that TCE was the predominant contaminant, the focus has been on TCE.

ATSDR also reviewed PCE data and compared it with the month and year of the first trimester for children who participated in the clinical exams and who were diagnosed with ASD in the prevalence study. Based on the data reviewed seven of the samples indicating PCE in the municipal drinking water were in either 1987 or 1988 and there was one positive sample for PCE in 1994. In 1987 the year with the most hits of PCE there was one child in the first trimester from the study. In 1988 there were three children in the first trimester from the study. In 1994 all children were through the first trimester before the positive PCE sample. Again the data is limited and the number of children in our study is small, but based on this information PCE levels and children diagnosed with autism or PDD in the prevalence study do not appear to be correlated.

2. Incomplete Exposure Pathways

In addition to the THMs, two other chemicals were found in BTMUA wells (#2 and #8) in 1987 and 1988. These were trichloroethylene (TCE) and tetrachloroethane. TCE and tetrachloroethane are not evaluated further in this report, since they were not detected in finished water or the distribution system. Therefore there would be no completed exposure pathway. To prevent possible exposure to these substances the BTMUA discontinued the use of wells 2 and 8 in January 1988.

3. Potential Exposure Pathways

a. Brick Township Landfill

The groundwater beneath the Brick Township Landfill has been shown to be contaminated with a variety of Volatile Organic Compounds (VOCs) and metals (see Appendix C, Table 2). ATSDR completed a Public Health Assessment (PHA) in 1989 and a Site Review and Update (SRU) in 1995 for the Brick Township Landfill. Copies of the PHA and SRU are available by request from ATSDR.

The landfill operated from 1949 through 1979. Disposal operations ceased at the landfill in May 1979. The landfill also has been known as McCormicks Dump, Frenchs Landfill and as the Brick Township Landfill. The landfill was used for the disposal of municipal solid waste, bulk liquid waste, commercial and construction waste, and sewage and septic waste. Disposal records indicate that sewage and septic wastes, municipal solid wastes, and bulk liquid wastes were the most common materials disposed. An undetermined quantity of labeled and unlabeled 55 gallon drums were also disposed of at the landfill. The Brick Township Landfill was added to the EPAs National Priority List (NPL) in December 1982.

Sampling data has shown that the groundwater beneath the site is contaminated and the contaminant plume is migrating southeast from the site. In addition to groundwater contamination, the PHA noted on-site soil contamination and low level contamination of one private well in the landfill vicinity.

ATSDR previously concluded that the Brick Township Landfill presented no apparent public health hazard, because all residents in the area are supplied water by the municipal drinking water system, preventing exposure to contaminated groundwater. ATSDR recommended in its SRU that the landfill be secured on all boundaries to restrict entry and exposure to physical hazards, erect warning signs, and to fill in the borrow pit to prevent accidents. An ATSDR representative visited the site in January 2000 and noted that access to the site has been restricted and warning signs have been posted. The borrow pit has not been filled, but Brick Township plans to fill the pit by summer 2000.

ATSDR also concluded in the SRU that the site constituted no apparent public health hazard in the past as a result of the ingestion of contaminated groundwater, because maximum exposure doses of chloroform and trichloroethylene detected in residential wells were below levels where adverse health effects were likely.

ATSDR received and reviewed additional data for this report on the contaminated groundwater plume that is migrating southeast from the site. The groundwater plume has spread further than noted in the past, but still does not present a public health hazard, because all residents in the area are on the municipal drinking water supply.

Based on the results from recent testing of the groundwater plume, Brick Township imposed a restriction on the use of private irrigation wells in the vicinity of the Brick Township Landfill in September 1999. This restriction remains in effect. As an added precaution, persons with private irrigation wells in the vicinity of the landfill will have their wells disconnected and sealed by Brick Township. These persons will then be hooked up by the Township to the municipal water system for irrigation purposes. ATSDR has reviewed recent sampling data and determined that levels of contamination from use of irrigation wells were not high enough or frequent enough to have caused adverse health effects. The disconnection and sealing of irrigation wells in the vicinity of the Brick Township Landfill will prevent future exposures to groundwater contaminants.

ATSDR plotted residence during pregnancy and distance to the Brick Township Landfill for children who participated in the clinical exams and were diagnosed with ASD (see Figure 7). There were three residences of study participants in the vicinity of the landfill. Two of the three residences are southwest of the landfill and one residence is south-southwest of the landfill. The closest of these three residences is approximately 0.3 miles to the southwest. Groundwater sampling indicates that the groundwater plume is moving away from the landfill site to the southeast, away from the residences of the study participants. Therefore, it is unlikely that the contaminated groundwater plume from the Brick Township Landfill is associated with the ASD for children in the prevalence study.

b. Fluid Packaging Spill

ATSDR reviewed the BTMUA report and sampling data regarding Fluid Packagings discharge of a mineral oil product to the Cedar Branch Creek of the Metedeconk River. ATSDR agrees with the BTMUA conclusion that the BTMUAs intake on the Metedeconk River was not impacted from the discharges from Fluids storm sewer outfall. The storm sewer outfall from Fluid Packaging goes to the Cedar Bridge Branch which is more than a mile below Forge Pond, where the BTMUA collects water from the river. The BTMUA took surface water samples upstream from its intake as an added safety measure. The results of these samples showed no VOCs or semi-volatiles above ATSDR comparison values. The report also determined that groundwater flows established from the monitoring wells have not affected the BTMUAs well field, because groundwater contamination affiliated with Fluid is in shallow bearing zones and has an easterly flow. BTMUA wells are north east of these monitoring wells.

ATSDR reviewed sediment data from the storm sewer outfall at Fluid Packaging. Most likely the VOCs found near the storm sewer outfall would be volatilized in the Cedar Branch Creek before they reached the Metedeconk River. Of the metals detected at the storm sewer outfall mercury was the most significant and it would tend to bind tightly with sediment near the outfall. Any remaining mercury would be significantly diluted as it moved downstream through Cedar Branch Creek and further diluted once entering the Metedeconk River.

c. Swimming in the Metedeconk River

ATSDR requested available environmental data for the Metedeconk River and the Windward Beach swimming area from the NJDEP, the OCHD and the BTMUA. Data for evaluating this possible exposure pathway was limited. The data reviewed indicated no chemical contaminants above ATSDR Comparison Values for VOCs for the Metedeconk River upstream from the BTMUAs water intake. No VOC data was available for the Windward Beach swimming area. The Metedeconk River is more than a half mile wide where Cedar Branch Creek enters and it is highly unlikely that contaminants from Fluid Packaging would reach the swimming area. In addition, ATSDR believes that due to the continual current and tidal fluctuation of the Metedeconk River that any past chemical releases to the river would be diluted to trace amounts. Exposure to these trace amounts through occasional swimming in the river (even more frequent swimming in summer months) would not be great enough to cause adverse health effects to pregnant mothers or young children.

4. ATSDR Child Health Initiative

To ensure that the health of the nations children is protected, ATSDR has implemented an initiative for each investigation to protect children from exposure to hazardous waste. ATSDR recognizes the unique vulnerabilities of infants and children demand special emphasis in communities faced with contamination of their water, soil, air, or food. Infants and children are usually more susceptible to toxic substances than adults due to immature and developing organs. Children are more likely to be exposed to contaminants, because they play outdoors and they often bring food into contaminated areas. These activities may increase their exposure to toxicants in dust, soil, and airborne particulate matter. Some children exhibit excessive hand to mouth behavior (pica), which may increase their intake of toxicants. Children are smaller, which results in higher doses. Most importantly, children depend completely on adults for risk identification and management decisions, housing decisions, and access to medical care. ATSDRs evaluation contained within this document considered children as a susceptible sub-population. Estimates of exposure were calculated using conservative values for children (i.e. weight, ingestion rate, etc.).

COMMUNITY HEALTH CONCERNS

ATSDR staff met several times with the community, individually and during public forums. ATSDR held public meetings on September 24, 1998 and January 12, 1999. ATSDR also held availability and information sessions on January 13, 1999 and July 20, 1999. These meetings helped ATSDR understand and collect specific health concerns from the community. In addition to public meetings and availability sessions, ATSDR staff worked in conjunction with the OCHD to collect environmental information and concerns by mail. ATSDR and CDC also called and met with parents of children with autism during the investigation. The three main concerns from community members were incorporated into the PHAP: (1) Were there chemicals in the municipal drinking water supply at levels that may have adversely affected the health of pregnant mothers or children diagnosed with autism, (2) Could swimming in the Metedeconk River have adversely affected my child's health, and (3) Could environmental contamination at the Brick Township Landfill have adversely affected the health of pregnant mothers or children diagnosed with autism? These questions are addressed in the conclusions below.

CONCLUSIONS

  1. Were there chemicals in the municipal drinking water supply at levels that may have adversely affected pregnant mothers or children diagnosed with autism?

    After reviewing and analyzing the data provided from the NJDEP, BTMUA and the OCHD on TCE, PCE, and THMs ATSDR concludes the following: (1) Based on the information provided TCE was never found in the distribution of the municipal drinking water supply and therefore, would not cause adverse health effects to children or pregnant mothers. (2) PCE was detected at low levels in the municipal drinking water supply several times between 1987 and 1994, but was mixed after the point of detection with millions of gallons of uncontaminated water prior to being distributed to any residents of the township. Therefore, any PCE that may have reached a residence would have been diluted to a very low quantity and would not be expected to cause adverse health effects to children or pregnant mothers. (3) Total THM levels in the municipal drinking water supply exceeded 80 parts per billion (ppb) several times during the study period.

    Since there is no clear pattern linking the residences of the cases, during mothers pregnancies, with location and timing of the high THM levels, it appears unlikely that THMs in the municipal drinking water supply were associated with ASD in Brick Township.

  2. Could swimming in the Metedeconk River have adversely affected my child's health?

    ATSDR does not believe that levels of chemicals in the Metedeconk River would have been at sufficient levels to cause adverse health effects to children or pregnant mothers who swam in the river in the past, because the continual current and tidal fluctuation of the Metedeconk River would dilute any past chemical releases to the river to trace amounts. Exposure to trace amounts through occasional swimming in the river (even more frequent swimming in summer months) would not be likely to cause adverse health effects.

  3. Could environmental contamination at the Brick Township Landfill have adversely affected pregnant mothers or children diagnosed with autism?

    The groundwater beneath the Brick Township Landfill is contaminated with a variety VOCs and metals. ATSDR believes that the contaminated groundwater would not have adversely affected pregnant mothers or children near the site, because residents in the area are supplied water by the municipal drinking water system, preventing exposure to the contaminated groundwater. ATSDR believes that any exposure to contaminated groundwater through the use of irrigation wells near the site would not have been at high enough levels or frequent enough to adversely affect the health of pregnant mothers or children.

RECOMMENDATIONS

  1. ATSDR encourages the BTMUA to continue to monitor and control THM levels in accordance with current regulations.

PUBLIC HEALTH ACTION PLAN

The Public Health Action Plan (PHAP) for the Brick Township Autism Investigation contains a description of actions taken and actions planned by the Agency for Toxic Substances and Disease Registry (ATSDR) and/or other government agencies after completion of this public health assessment.

  1. Public Health Actions Taken

    1. ATSDR and CDC developed a draft PHAP in March 1988. On April 1, 1988 Senator Torricelli, Representative Smith, and the parents were briefed on the PHAP and their comments were solicited.

    2. ATSDR and CDC met with parents and Dr. Eric London to learn more about concerns and obtain additional feedback on the PHAP.

    3. ATSDR and CDC conducted public meetings in Brick Township on September 24, 1998 and January 12, 1999 to discuss the PHAP plan and provide additional opportunities for parents and community members to discuss the PHAP or specific community health concerns.

    4. ATSDR prepared a draft consultation of current literature on possible associations between chemical exposure and autism. The draft consultation was completed and distributed in January 1999.

    5. ATSDR also held availability and information sessions on January 13, 1999 and July 20, 1999.

    6. In addition to meetings, ATSDR has provided two fact sheets and several update letters to the community The last update letter was mailed in December 1999.

  2. Public Health Actions Planned

    1. ATSDR will continue to review any new environmental data associated with this investigation and if necessary, revise the conclusions and recommendations contained in this public health assessment.

       2   This 251 ppb THM value was used as the maximum value by ATSDR even thought the BTMUA has suggested that the value is "out of line". Even though the value appears to be high it could not be refuted. ATSDR did note that over the study period (1987-1995) the next closest value was 142 ppb for this same sampling location.

        3     This 240 ppb chloroform value was used as the maximum value by ATSDR even though the BTMUA has suggested that the value is "out of line". ATSDR did note that over the study period (1987 - 1995) the next closest value was 116 ppb for this same sampling location. Even though the value appears to be high it could not be refuted. The possibility exists that persons may have been exposed at this level.

 

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