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Meeting Summary the 2009 Vieques Scientific Consultation

Historical Reference
This website is provided by the Agency for Toxic Substances and Disease Registry (ATSDR) ONLY as an historical reference for the public health community. It is no longer being maintained and the data it contains may no longer be current and/or accurate.

Note: The purpose of the 2009 meeting was to review and discuss studies that have been conducted for Vieques and generate recommendations for further work. During the two-day meeting, participants posed questions and made individual recommendations.

I. Group Discussion of Data Needs

Presentations were given on each topic and a discussion period followed. At the end of each topic, participants discussed the strengths and limitations of available studies and what the next steps should be.

1. Environmental Data—Seafood

  • Some participants suggested that we consider the Agency’s past analysis to determine exposures from fish consumption preliminary studies that provide an opportunity to more fully characterize this pathway. This pathway deserves additional analysis possibly using U.S. Environmental Protection Agency (USEPA) and World Health Organization (WHO) screening values for mercury levels.
  • Future work needs to ensure that: 1) enough fish are sampled; 2) that assumptions are appropriate for intake and body weight, and; 3) that conclusions are protective and correspond with recommendations from Food and Drug Administration (FDA) and others. The Agency should also consider possible economic impacts to the fishermen and impacts on the dietary habits of people living on the island.
  • The Agency should consider the variability in consumption patterns for people on the island.
  • The previous work included sampling 142 fish and shellfish from 6 locations around Vieques. The goal was to collect 5 of each species from each location. Some participants questions if this number was representative.
    • Any follow up work should ensure that the appropriate types and numbers of seafood are collected and sampled. Specifically, the seafood analyzed should be the types that people who live on the island eat regularly.
    • Future work must comply with the established protocols for minimum sample sizes.
  • Future work should look at the contaminants in different parts of the seafood and determine what happens to the contaminants when the fish is cooked. Does cooking change the structure or availability?
  • Are there differences in contaminant distribution across and among species?
    • Should advisories be species-specific and include information about different parts of the seafood based on levels of contamination?
  • What about the mobility of the seafood species? Are some fish more mobile so they move in and out of the area quickly; while others may stay and, therefore, may have higher levels of contamination?
    • There was a 1979 Draft Environmental Impact Statement that was developed as a result of a lawsuit by the Government of Puerto Rico. This document could provide information about fish mobility.
    • Does the contamination affect mobility and the types of fish caught? For example, are fish that are exposed to contaminants easier to catch?
  • The previous analysis used seafood consumption of 7 times per week. Some participants stated that average seafood consumption may be as high as 9 times per week.
  • Is it appropriate to analyze fish from the local markets? How do you ensure that these fish were caught in the areas of most concern?
  • Use appropriate body weights for people living on Vieques. The average body weight is lower for people living on the island. (This comment was mentioned several times, but was discussed in detail related to the seafood analysis).
  • Determine if averaging across the samples collected skews the final results. (There was a concern that samples that contained high levels could be masked).
  • The analysis should consider how contaminants move through the food chain. For example, while people don’t eat the sea grasses, the grasses are eaten by fish and other seafood. If the sea grasses are contaminated, will the contamination pass to the seafood that people eat?
    • Also determine if there are normal levels of some substances in sea grasses. If so, is there information for this region?
  • Consider the current literature and FDA recommendations regarding mercury in seafood, specifically for women of child-bearing age and those who are pregnant or breastfeeding.
  • Some participants felt that the previous ATSDR conclusions imply that it is safe for all people to eat unlimited amounts of fish caught off the shores of Vieques.
  • The analysis should include possible fetal exposures. Which compounds cross the placenta in pregnant women? (These comments were mentioned several times, but were discussed in detail related to mercury in seafood).
    • It’s important to analyze possible exposures to children appropriately. The analysis should consider possible exposures prior to birth.

2. Environmental Data—Ecology

The ecology surrounding the island was impacted by the past naval operations. Many of the past studies focused on the land and not the marine environment.

  • The corals that are/were in contact with the bombs are diseased based on the observed lack of color and lesions in some species.
  • The water surrounding the bombs is dangerous based on the EPA drinking water standards.
  • Some work should be done to determine the compounds in organisms near the underwater ordnance. There is a concern about collecting and exporting seafood such as the sea urchin roe from organisms near the bombs.
  • Will relocating the submerged bombs simply move the contaminants to another fishing area?
  • Future work needs to consider the movement of contaminants such as TNT from the environment into fish. Keeping in mind that higher concentrations of contaminants bioaccumulate as you move up the food chain.
  • Future analysis needs to consider both the terrestrial landscape and the marine environment (coral reefs). Need to answer the question, are soils a good indicator of how pollutants move through the ecosystem?
  • Trace Elements: Are the military activities responsible for exposure of the local population to levels above the threshold levels of trace elements?

3. Environmental Data—Gardens/Crops/Farming

  • Have airborne contaminants reached the gardens and locally grown produce that are grown on the island? Work needs to be done to address crops such as yucca, pigeon peas, peppers, beans, pumpkins and squash that are grown and consumed in the area.
  • There are some cultural differences regarding the parts and types of the vegetables that are eaten. Future work needs to gather information to better understand how crops are used so that the Agency can provide options.
  • People who have goats drink the milk and eat the cheese. We need to determine if infants are also fed goats’ milk.

4. Environmental Data—Soil Sampling

  • What is the best depth for collecting soil samples? Do samples collected as far down as 6” dilute the possible contaminants that are on the surface?
  • Should samples include only soils that are swept from the surface?

5. Environmental Data—Air Sampling

  • Did past air sampling capture contaminants in the dust that were generated by the bombs and exploded ordnance? Were these contaminants deposited into the ecosystem and environment?
  • Need to further characterize wind-blown dust. This analysis should include samples from the current Navy activities. The Navy is collecting air monitoring data. Some participants were concerned that if the data are averaged over a 24 hour period, it may be of little use.
  • What is the best measure for particulate matter? Does using PM 10 over a 24-hour period skew results? PM 2.5 may be a more appropriate measure. Samples should be collected and reported by time periods as opposed to averaged over a 24-hour period.
  • Smaller particles can be inhaled more easily and can lodge deep in the lungs, causing damage. This is especially important for children who have smaller airways and more rapid respiration.

6. Environmental Data—Drinking Water

What do we know about water collection systems? What are the practices used for rainfall collection systems?

7. Biomonitoring

A targeted biomonitoring effort may help to fill some of the gaps and answer some exposure questions. Future efforts should focus on reducing current human exposures as opposed to re-creating past exposures. Because many of the naval operations have stopped, community concerns are focused more on current exposures from activities such as the open burning and open detonation.

  • The biomonitoring work should be high quality, comprehensive and technically sound. The analysis should consider exposures to children, use reference ranges that are appropriate for the population, and consider including tissues such as cord blood.
  • The Agency should investigate the synergistic effects of the exposures, taking a holistic approach when evaluating the exposures.
  • Additional environmental samples may be collected in conjunction with the biomonitoring efforts, if needed, to characterize sources of contamination.
  • Any biomonitoring effort should include a quality food intake survey (such as FDA’s Market Basket Survey) that includes foods that people on the island eat regularly. Additional questions need to address how the foods are prepared and when they are consumed. In summary, we need to ensure that we ask the right questions.
  • The biomonitoring effort should be population-specific to ensure that appropriate weights and other population-based information are used. The group discussed using National Health and Nutrition Examination Survey (NHANES) data and including a reference population from the main island of Puerto Rico.
  • Any future study design should consider factors that may exist on the island such as the susceptibility of the population, lower income levels, possible nutritional deficiencies, lack of healthcare, lack of insurance, multiple stressors and a population at special risk.
  • What about the effects of stress and noise? Consider the effects on the immune system, cardiovascular disease and preterm labor.
  • The Agency could design the study using the CDC Epidemic Intelligence Service (EIS) process. Using this model, the Agency could quickly determine whether elevated levels are present. This model could lead to looking at the environment to conduct additional pathway analysis.
  • Consider conducting human tissue sampling. Some recommendations included testing hair, urine, blood and cord blood. Hair analysis would analyze internal exposure, urine and blood would be indicators of acute exposure and cord blood could be used as a marker for 3rd trimester exposures and could provide information about environmental exposures to the mother.
  • There is a need to conduct work that will provide results and answers in a short period of time.

8. Health Outcome Data

  • Prior to 2001, cancer cases in Vieques were sought and reviewed in a more exhaustive way than cases in mainland Puerto Rico. Since 2001, the same practices have been used in Vieques as on mainland Puerto Rico.
  • Cancer incidence is higher (statistically significant) in Vieques vs. mainland Puerto Rico for:
    • total cancers (both sexes analyzed together) during the time period of 1995-1999
    • lung and bronchus (males) during the time period of 1990-1994
    • prostate cancer during the time period of 1995-1999
  • Cancer mortality is higher (statistically significant) in Vieques vs. mainland Puerto Rico for:
    • total cancers (both sexes analyzed together) during the time period of 2000-2004
    • prostate cancer during the time period of 2000-2004
  • Access to healthcare must be evaluated and improved.
  • An analytical epidemiological study is needed to investigate the causes of cancer in Vieques.
  • Future work should include a review of the available cancer data acknowledging some of the challenges that exist with analyzing data from such a small population. The work should also focus on continuous variables such as kidney function and birth weight to assess possible health outcomes.
  • Reported increased infant mortality in Vieques for 1990-1994 based on data from vital statistics.
    • Vieques 19.9 per 1000
    • Puerto Rico 12.8 per 1000
  • Prevalence of hypertension in young women was higher in a sample of 733 women from Vieques compared to a sample of 629 women from Reforma on the main island.
  • Age standardized mortality for the period 1991 – 1998 was higher for:
    • Cancer – 31%
    • Diabetes – 41%
    • Cirrhosis – 95%
    • Hypertension – 381%
  • Mortality from hypertension was reported almost 4 times higher for 1991-1998 but was not elevated for the period 2000-2004.
  • Reported low birth weight in children from Vieques compared to Puerto Rico for 1995-1997.
  • Areas for future exploration:
    • Prevalence of hypertension in young women
    • Mortality from hypertension
    • Trend of infant mortality
    • Low birth weight, pre term birth, other birth outcomes that can be investigated with birth certificate data
    • Summarizing cancer incidence and mortality for 1990 - 2004
  • Is it possible to conduct an epidemiological study that would investigate the causes of disease? This could include following a cohort group with people from the island.
    • Consider continuous variables, such as blood pressure, kidney function, birth weight, etc.

9. Pathway Analysis

  • Conduct additional evaluations to determine the location of contamination on the island. This should consider worst-case scenario, but ensure that the scenario is realistic.
  • Determine the extent of contamination on the island by looking at plants, fish, the marine environment and soil.
  • Future work should consider the effects of long-term exposure. Is there an accumulated dose as a result of prolonged exposure?
  • Need to identify the most at-risk pathways then intervene where appropriate.
  • Additional work needs to determine the synergistic effect of exposures. This should look at the combined exposure to contaminants that people experience. Then determine possible health effects, as opposed to looking at the effects from each contaminant and measuring the total of that exposure from all sources. For example, look at exposures to mercury (Hg), lead (Pb) and arsenic (As) and determine possible health effects from the combined exposure.

10. Site Characterization

Do we know what is in the environment surrounding the site? The Agency has requested a complete inventory from the Department of Defense that includes all compounds released at the site.

  • Information is needed about what was released; where contaminants were released; and, the amount of different components that were used during the Navy activities. For example, how much lead was contained in the typical bomb? Do we know the chemical composition of the different munitions? Do we know the types of metals that were used in the bomb casings?
  • Will the contamination levels at the site change over time?
  • Were chemical weapons used on Vieques?
  • Some scientists report finding strontium in the environment on Vieques. Was this radioactive strontium?
  • How does the Agency define incidental exposures? This needs to be clear in the documents moving forward.

* Individual recommendations from the 2009 meeting were taken into consideration, and many of the issues are being addressed in the Summary Report.

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