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September 22, 2004

ATSDR's Child Health Considerations

ATSDR is committed to protecting children's health in Mongmong. We recognize that infants and children might be more vulnerable than adults to environmental exposure. This vulnerability results from several factors, including that (1) children are smaller than adults, so they get higher doses of chemical exposure per unit of body weight; (2) children are more likely to play outdoors and bring food into contaminated areas and, as a result, can contact and ingest soil particles at higher rates than adults; and (3) children's bodies can be more sensitive to the effects of chemical exposures. Children have developing body systems that can sustain permanent damage if toxic exposures occur during critical growth stages. Because of these sensitivities, ATSDR uses health guidelines that are protective for children.

Conclusions About Child Health in Areas Affected by PCBs From APP

ATSDR evaluated the exposures children would experience from eating food items from free-range animals (e.g., chicken and eggs), breathing in air contaminants near APP, drinking water from municipal or private sources, and coming into contact with buried wastes.

ATSDR has no reason to expect that levels of PCBs in animals (cattle, swine/swine (pigs), goats, sheep and rabbits) consuming soil vegetation or store-bought feed contaminated with PCBs at or below current tolerance levels will accumulate residues in their fat above those in found in dietary bread basket studies of New Zealand, Europe, and the United States.

PCB levels found in soils in residential areas, where local food sources are most likely to be obtained, are very low and should not result in the accumulation of harmful PCB levels in free ranging animals. PCB levels in a soil sample collected from the old transformer pad at the Agana Springs (Upland)location, where clean-up of PCB-contaminated soil has not occurred, exceeded ATSDR's screening level. As a precautionary measure, children should avoid eating free-range chicken eggs that are obtained exclusively or primarily from the location sampled near the old transformer pad at Agana Springs (Upland). ATSDR's child dose estimates are very health-protective, and it is likely that actual doses under actual exposure conditions would be significantly lower. ATSDR's suggestion is based on the fact that sampling data are not available for any free-range animals and certain animal products such as eggs and milk are known to bioaccumulate PCBs and other organic compounds.

Reducing Risk of Exposure to Biologic Hazards in Foods

People can reduce the possibility of exposure to biological hazards in foods harvested from the Agana Swamp and River by:
  • Thoroughly cooking foods to kill all bacteria and parasites.
  • Avoiding the handling of raw foods if they have open cuts or wounds.
  • Before exposing other foods, disinfecting surfaces and utensils that have come in contact with raw foods.adverse health effects in children from other exposures related to air contamination or contamination in other environmental media.
Although very low concentrations of chemicals (i.e., VOCs and pesticides) have been detected in drinking water supplies, the levels were below EPA's MCLs and ATSDR would not expect to see adverse health effects in children from these exposures. ATSDR would also not expect to see adverse health effects in children from other exposures related to air contamination or contamination in other environmental media.

ATSDR recommends that families and individuals consider adopting the National Academy of Sciences' recommendations for a life-long commitment to reducing exposures to dioxin-like compounds: select low-fat products; trim and discard visible fat from fish, poultry, pork, beef, and other meats; avoid practices that add or retain animal fat; wash all fruits and vegetables; and peel root and waxy-coated vegetables (IOM 2003).


See Appendix B for definitions of conclusion categories.

Exposure Issues
  • ATSDR evaluated groundwater contamination at APP and assessed the potential for contaminants to migrate to the principal aquifer used for drinking water. PCBs and other site-related contaminants were not detected above ATSDR's screening level in on-site groundwater samples. ATSDR continues to evaluate additional information pertaining to groundwater underneath APP with characterization still ongoing. The Navy has agreed to install 2 additional monitoring wells down gradient of APP, in the direction of groundwater flow, to better measure any past or current migration of site-related contaminants.

    Drinking water from municipal supply wells located in the Mongmong area poses no past or current public health hazard from chemical contamination. ATSDR's evaluation shows that the drinking water supply is monitored routinely, and that results of past monitoring have consistently met all Guam and federal safe drinking water standards. Some very low concentrations of volatile organic compounds and pesticides were detected during routine monitoring, but at levels well below their maximum contaminant levels for drinking water. Monitoring of supply wells in the Mongmong area has periodically detected bacterial contaminants at levels that exceed Guam and federal safe drinking water standards. Continuing frequent bacteriological sampling, continuing standard operating procedures that include "boil water advisories" during catastrophic events including typhoons, and detecting sewer system leaks and promoting septic tank upgrades will provide a safer water supply.

    Drinking water from Agana Spring during the time period it was used as a municipal water source (from 1937 to 1957) poses no apparent past public health hazard. Although past data is not available, persistent chlorinated compounds such as PCBs and many pesticides are not readily soluble in water and, if present, would have been more likely to be detected at higher levels in the sediments. ATSDR considers it unlikely that chemical contaminants in water from Agana Springs would have been detected in the past at levels known to be harmful.

  • Guam residents asked ATSDR to evaluate whether past stack discharges from the former APP caused local air pollution to reach levels of health concern. ATSDR considered two approaches when researching this issue: we evaluated measurements of air pollution made on Guam and we assessed the available data for use in a computer model to estimate potential air quality impacts from the former APP's emissions. The available ambient air monitoring data suggest that sulfur dioxide and particulate levels in neighborhoods downwind from the former APP did not reach levels of health concern. The current available information, however, is insufficient for an evaluation of past emissions from the power plant. Thus past exposures to power plant stack emissions pose an indeterminate public health hazard. Since the power plant no longer operates the stacks, exposure does not exist and poses no current or future public health hazard.
Community Concerns
  • Although land snails are generally not eaten on the island of Guam, eating land snails does not pose a past or current public health hazard from chemical exposures. ATSDR classifies this exposure as no public health hazard because our evaluation shows that PCBs are not likely to significantly bioconcentrate in the land snail at levels that would pose a health concern. Although the threat of exposure from chemical contamination (especially organic compounds) is very low, land snails and other snails including apple snails commonly contain parasites or other bacteriological organisms that may be harmful.

    Eating free-range animals from residential locations near APP that contained PCBs in surface soil at levels below ATSDR's level of health concern poses no past or current public health hazard. ATSDR has not identified any populations in the Mongmong area that subsist primarily on products from free-range animals. Occasional consumption of eggs, even from the most contaminated locations, is not likely to pose a hazard. ATSDR believes that levels of PCBs in free-range animals will be below those found in retail foods from around the world. Based on this fact, ATSDR does not believe that excessive exposure to PCBs from free-range animals has occurred. ATSDR classifies this possible exposure as no apparent public health hazard: although some low-level PCB exposure from eating free-range chickens, chicken eggs, and meat from free-range swine (pigs) from most of the residential locations near APP is possible, the levels detected in surface soil were very low and the actual exposure to animals or people is not expected to be significant. It is unlikely that hot spots (i.e., areas near the old transformer pad) near Agana Springs (Upland) are the sole source of food for free ranging animals.

    For all locations, however, the potential uptake of heavy metals in the internal organs (e.g., liver, kidney) of livestock-especially sheep and goats-cannot be evaluated with available information. As a prudent public health practice, Guam Department of Agriculture, GEPA, and GDPHSS may want to evaluate and provide guidance to residents (especially sensitive populations) who may be at risk for exposure to heavy metals from consuming internal organ meats.

  • ATSDR concludes that the trace amounts of PCBs that might evaporate from Agana Swamp, if any, are not of public health concern and therefore poses no public health hazard. This conclusion is based on our knowledge of PCBs' chemical and physical properties and our experience evaluating numerous other aquatic environments with far greater PCB contamination.

  • ATSDR reviewed available information on air emissions of dusts from roadways. This review suggests that local residents likely are not exposed to dusts from roads near the former APP, or to site-related contaminants that might be found in the dusts at levels of health concern. Therefore, ATSDR considers this no apparent public health hazard.

  • ATSDR believes that the very low levels of PCBs and other contaminants in the Agana Swamp sediments that may become airborne during swamp fires pose no public health hazard. It is conceivable that excessive exposure to the pollutants that naturally occur in smoke from fires could cause acute respiratory health effects, such as cough, difficulty breathing, and aggravated asthma symptoms. Children, the elderly, and people with existing heart and lung conditions are most at risk for experiencing these health effects. Whether or not health effects occur depends on the amount of smoke that people inhale. ATSDR has no knowledge if fires in Agana Swamp have ever actually caused adverse health effects among local residents, but Guam residents can help avoid potential smoke-related health problems by minimizing the amount of smoke they inhale during swamp fires.

  • Much of the village of Mongmong is located on the old 5th Field Marine Depot, a former military installation. The residents have expressed concerns about the chemical warfare materials discovered at this former site and the possibility that other buried wastes will be unearthed in the Mongmong area. To date, no leaks have been observed with any of the chemical warfare materials identified and such materials pose no apparent public health hazard. However, very little information is known about the amount of material buried and the locations of burial from military and non-military sources including battlefield contamination.

  • Community members have concerns about exposures to PCBs during work-related activities. Previous civilian employees should contact workers' compensation programs as indicated in the "Community Concerns" section of the document. Previous military personnel should contact the Veteran Administration points of contact also identified in the "Community Concerns" section. Current military personnel should contact their local military medical treatment facility.

  • ATSDR has not identified any water samples collected during the Navy's APP investigations that have been analyzed for chlordane. Chlordane has been detected in water samples collected by the Guam Waterworks Authority as part of routine monitoring of supply wells used for the community's drinking water. The highest concentration detected was 0.62 ppb in February 2001. This is below EPA's MCL of 2 ppb for chlordane (GWA 2003). ATSDR classifies exposure to chlordane in drinking water as no apparent public health hazard.

    People typically receive the highest exposures of chlordane from living in homes that were treated with chlordane for termites. The most common source of low-level exposure, though, is chlordane-contaminated food. If you know or suspect that chlordane was used in your home or on your property, you can have your property tested to determine whether chlordane is still present and at what level. Tests are also available to measure chlordane in your blood, but they are expensive and not generally included as part of routine blood tests for physical examinations. ATSDR does not anticipate health problems for individuals from past, routine use of chlordane for pest control.


Based on the conclusions about potential exposure pathways associated with Agana Power Plant and other identified sources of contamination, ATSDR makes the following recommendations.
  1. ATSDR recommends that GEPA (or the potentially responsible party) authorize a removal action for PCB-contaminated soil near the old transformer pad within the Agana Springs (Uplands) sampling location where an old transformer pad was located and where concentrations were detected at 7,800 ppm.

  2. As an added precaution, ATSDR suggests that children and other sensitive populations not consume free-range chicken eggs from the small portion of the Agana Springs [Upland] area where PCBs were detected at higher levels.

  3. ATSDR recommends that Government of Guam consider issuing smoke advisories on days when relatively large fires burn in Agana Swamp. These advisories should warn residents, particularly children, the elderly, and people with heart or lung conditions, to avoid exposure to smoke from the fires. Sensible exposure reduction measures include staying indoors, leaving smoke-affected areas, and avoiding strenuous activity in smoke-affected areas. ATSDR recommends that the local residents, especially those special populations mentioned above, heed these advisories. This recommendation is made to address a general public health concern at Guam, not one specific to operations at the former APP.

  4. ATSDR recommends families and individuals consider adopting the National Academy of Sciences' recommendations to "select low-fat products; trimming and discarding visible fat from, fish, poultry, and [other] meat products; avoid practices that add or retain animal fat; and wash vegetables and peeling root and waxy-coated vegetables as a life long commitment." Specifically, we believe there are substantial health benefits from eating a variety of foods including a diet low in saturated fat and cholesterol (i.e., < 10% of daily calories from saturated fat and cholesterol) and moderate in total fat intake (i.e., < 30% of daily calories from total fat). Exposure to PCBs will also be reduced by eating a variety of food, including a variety of fish and seafood and using food preparation and cooking techniques that remove fat and PCB from the food that is eaten.

  5. In addition, to reduce the risk of illness from biological contamination, ATSDR recommends that all meat from the swamp be fully cooked and utensils, work surfaces, and cutting boards be cleaned and sanitized and kept separate from other raw or cooked foods. As always, standard public health cooking times, temperatures, and refrigeration recommendations should be followed.

  6. ATSDR also recommends that doctors and health care providers follow their usual monitoring practices. People should continue their usual annual health care checkups. To improve overall health, families and individuals should consult with their health care providers on ways to lead healthy lifestyles, especially on diet and exercise programs.

Public Health Action Plan

The public health action plan (PHAP) for the APP recommends actions for ATSDR and other government agencies at and in the vicinity of the site. The PHAP is designed to ensure that this PHA not only identifies public health hazards but provides a plan of action designed to mitigate and prevent adverse human health effects resulting from exposure to hazardous substances in the environment. The public health actions completed and to be implemented are as follows:

Completed Actions
  1. The Navy has done extensive remediation and sampling, both on the APP property and in surrounding areas. They have issued several fact sheets and reports for the community and held many public meetings to keep the people of Mongmong informed of their findings and activities, and to solicit their input.

  2. ATSDR has visited the APP site and surrounding community, held public availability sessions for the people of Mongmong, and met with several representatives from government of Guam agencies and the congressman from Guam. Since 2000, ATSDR has also issued several fact sheets, preliminary findings, a site summary public health consultation for the Mongmong/APP area, and a focused PHA for three selected PCB exposure pathways outlined in the initial health consultation (ATSDR 2000a, 2000b, 2002a, 2002b, 2003).

Ongoing and Planned Actions
  1. ATSDR is developing fact sheets and presentation materials in preparation for a site visit in 2004 to present the findings of the focused PHA for Agana Power Plant.

Preparers of the Report

Charles Grosse, M.S.
Environmental Health Scientist
Federal Facilities Assessment Branch
Division of Health Assessment and Consultation

Aimee Treffiletti, M.P.H.
Environmental Health Scientist
Federal Facilities Assessment Branch
Division of Health Assessment and Consultation


Gary Campbell, Ph.D.
Team Lead, Defense
Federal Facilities Assessment Branch
Division of Health Assessment and Consultation

Sandra Issacs
Branch Chief
Federal Facilities Assessment Branch
Division of Health Assessment and Consultation

Obaid Faroon, DVM, Ph.D.
Division of Toxicology


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