sign in sign up
<<
Home , Pneumoconiosis

Special Feature: Comprehensive CME Program on Disaster Medicine Part 2 Research and Reviews

Chronic Effects of Inhalation of Dust or Sludge

JMAJ 56(2): 91–95, 2013

Iwao UCHIYAMA*1

Abstract During the 2011 Great East Japan Earthquake, different kinds of rubble, waste, ocean floor sludge, and other materials containing chemical substances were piled up by the tsunami in addition to the collapse of buildings. It is anticipated that large quantities of dust will be generated from these collapsed buildings and rubble during post-disaster reconstruction. It has long been known that dust from work environments and air pollution can be carcinogenic and affect the . There is a high possibility of inhalation of organic dust, bacteria, dust containing chemi- cal substances, dust, and other materials during the post-disaster reconstruction. Inhalation of dust containing mold or Legionella bacteria causes hypersensitivity and Legionnaires disease. Inhalation of asbestos dust can cause lung cancer and ten-odd years later. To prevent inhalation of these kinds of dusts, it is important to control dust generation such as by sprinkling water, to rigidly enforce the wear- ing of dust masks, and for the elderly and children especially to avoid very dusty places.

Key words Dust, Asbestos, Mesothelioma, Sludge

Introduction health effects of inhalation of dust specific to disaster recovery and dust from sludge that could A year has already passed since the Great East contain pollutants such as chemical substances Japan Earthquake of March 11, 2011. However, and heavy metals. It also discusses preventive since this disaster involved a nuclear power plant measures. accident on top of the damage caused by the earthquake and tsunami, a clear course toward Respiratory Disorders Caused by recovery is still not visible. Inhalation of Dust in the Environment In the Great East Japan Earthquake, in addi- tion to the collapse of buildings and other struc- Dust in the work environment tures as a result of the earthquake, the tsunami It has long been known that inhalation of dust that struck after the quake caused rubble and causes respiratory disorders. The following are waste mixed with metals, wood, plastic, and other the main chronic respiratory disorders that result materials, all of which was mixed with a large from the inhalation dust in the work environ- amount of ocean floor sludge, to pile up on land. ment and their causes: The disposal of all this waste will continue over (1) Pneumoconiosis and pulmonary (sil- a long period toward recovery, and it is thought ica and asbestos, etc.) that the demolition and removal of buildings will (2) Hypersensitivity pneumonitis and farmer’s shift into full swing from here on. lung (hay, mold, spores, etc.) This paper examines the possibility of chronic (3) Occupational (toluen diisocyanate,

*1 Senior Visiting Researcher, National Institute for Environmental Studies, Ibaraki, Japan. Professor Emeritus, Kyoto University, Kyoto, Japan ([email protected]). This article is a revised English version of a paper originally published in the Journal of the Japan Medical Association (Vol. 141, No. 1, 2012, pages 61–65).

JMAJ, March / April 2013 — Vol. 56, No. 2 91 Uchiyama I

phthalic anhydride, sawdust, etc.) a correlation between fine particulates with a

(4) Occupational lung cancer (asbestos, hexava- diameter under 2.5 mm (PM2.5) and an increase lent chromium, etc.) in mortality from lung cancer or cardiopulmo- The Pneumoconiosis Act1 was established in nary disease.4 1960, strengthening control of the work environ- Thereafter, similar study results were pub- ment. However, in 2009 the rate of positive find- lished in many countries, and in 2009 a new air 2 ings in pneumoconiosis examinations was 2.1%, quality standard for PM2.5 was established (yearly indicating that this is a problem that has yet to average of no more than 15 mg/m3 and a daily be solved. average of no more than 35 mg/m3) in Japan.5,6

Dust in the ambient air Generation of Dust During Smoke and soot problems caused by burning Reconstruction After a Major Disaster occurred in areas throughout Japan from the Meiji period (1868–1912) forward. Not long after Dust is generated in the rubble and waste gath- World War II, there was a high incidence of ered in temporary collection sites and holding asthma among U.S. military personnel and their yards, and during the deconstruction of remain- families stationed in Yokohama City, Kanagawa ing buildings and removal and transport of those Prefecture close to the Keihin industrial area waste. That dust could contain asbestos fibers (what was called “Yokohama asthma”). These scattered in the air from sprayed asbestos and cases were recorded as asthma caused by air asbestos board used in the past. Additionally, the pollution.3 In the late 1950s and early 1960s, the decay of food and household garbage generates situation was severe in the center of Osaka, which organic dust including pathogens and mold. is located in the Hanshin industrial area; visibility Unlike soil particles, the sludge transported in wintertime was sometimes 0 meters, and there by the tsunami consists of fine clay particles that was a high incidence of chronic and tend to create dust when dried. Furthermore, the bronchial asthma. tsunami could swallow up various chemical sub- It is well known that later there was a high stances as it moved over the land. This sludge that incidence of health problems including asthma was piled up by the tsunami could turn into dust (Yokkaichi asthma) caused by sulfur dioxide that contains chemical substances and heavy

(SO2) at petrochemical complexes in Yokkaichi metals. City, Mie Prefecture. Dust in the ambient air was initially regulated Respiratory disorders caused by inhalation as the total amount of dust. However, since it of organic dust such as mold and bacteria is mainly particles with a diameter under 10 mm Mold and bacteria tend to multiply in buildings that are inhaled into and affect the respiratory that have flooded, collapsed, or been left vacant system and suspend in the air for a long time, for a long time. Repeatedly inhaling the organic ambient air quality standard was established dust created from these organisms during the for these particles as suspended particulate cleanup of rubble causes the development of matter (SPM) in 1972. SPM concentrations have hypersensitivity pneumonitis. declined gradually since then. Farmer’s lung, which is caused by the spores There are two large peaks in SPM size. Fine of thermophilic actinomycetes in hay, has long particles, which have a diameter in the vicinity of been known. In houses, certain types of mold, 1 mm, are mainly produced by combustion. Diesel such as Aspergillus fumigatus and Trichosporon particulate and tobacco smoke are included in asahii, that propagate inside air conditioners this category. Particles larger than that, called and in humid areas also cause hypersensitivity coarse particulate matter, include things like pneumonitis. soil particles and sea salt particles. Moreover, the The conditions that develop at the time inhalation of dust into the respiratory system or of year when people start using air conditioners the deposition rate in the respiratory system dif- are called summer hypersensitivity pneumonitis fers depending on particulate size, and evidence and ventilator (air conditioning lung, has suggested that fine particles have a stronger humidifier lung). Inhaling chemical substances effect. In 1993, a paper was published that found and/or organic dusts that become antigens to-

92 JMAJ, March / April 2013 — Vol. 56, No. 2 CHRONIC HEALTH EFFECTS OF INHALATION OF DUST OR SLUDGE

gether with dust while picking up in disaster- frame structures. In 1972, the World Health affected houses and removing rubble during the Organization (WHO) and International Labor daytime often results in the development of Organization (ILO) announced that, “asbestos is , phlegm, and febrile symptoms four to a carcinogenic substance.” Japan has prohibited six hours later in the evening and night. This the use of sprayed asbestos (exceeding 5%) since may result in pneumonia symptoms including 1975 with the aim of protecting workers. How- shortness of breath and dyspnea. Symptoms ever, asbestos continued to be used in large persist for 8–12 hours and will naturally improve amounts as a building material and it was not in a few to 10 days if the antigens are removed until 2004 that its manufacture and use were or the similar dusty place is avoided. Steroid completely banned. Consequently, it is highly administration is effective in the case of a strong likely that sprayed asbestos is remained in build- allergic reaction. ings constructed up to around 1980, when it is Although not a chronic effect, care is also possible that even alternative sprays contami- needed regarding Legionnaire’ disease caused by nated asbestos. bacteria belonging to the genus Legionella, typi- It was 1989 when the asbestos concentration fied by Legionella pneumophila, which usually in the general environment became regulated lives in moist soil. Once Legionella bacteria enter and a standard value at the boundary of factory amoebae or ciliates in water, they can live for a grounds (10 fibers/liter) was established. The long time, even in a poor environment. Inhaling WHO’s Criteria 53 of Legionella bacteria living in bathtub circulating 1986, which was the basis for the standard value, systems, showers, or cooling tower water, etc., can indicated that the asbestos concentration in cause mass infection. The incubation period for ambient air of cities around the world at that Legionella pneumonia is 2–10 days. While there time was 1–10 fibers/liter, upon which it stated are cases of the condition becoming serious and that, “In the general population [living in cities], fatal in the elderly, there is no human-to-human the risks of mesothelioma and lung cancer attri- transmission. Milder cases, called , butable to asbestos cannot be quantified reliably present with cold-like symptoms followed by and are probably undetectably low.” 6 recovery. While there have been no reports of Presuming that there is a green belt or roads mass infection during or after a disaster thus where people do not live, normally about 10–20 far, a clinical kit that easily detects antigens in meters wide between the boundary of factory urine is on the market, which has made diagnosis grounds and general residential areas, the stan- simple. Consequentially, reports of Legionnaire’ dard value at the boundary of factory grounds disease could increase from here on. Under assumes that if the concentration at the bound- Japan’s law concerning infectious diseases, this ary of factory grounds is 10 fibers/liter or less, disease is classified as a class 4 requiring report it will diffuse and dilute to about 1 fiber/liter by immediately after diagnosis. the time it reaches general residential areas. In any case, avoiding inhalation of these kinds Therefore, it is not true that an ambient air con- of organic dusts is important as a countermea- centration or indoor air concentration of asbes- sure. The elderly and children should be made to tos no more than 10 fibers/liter is safe. avoid dusty areas and the raising of dust should The asbestos concentration in the environ- be controlled by sprinkling water and the wear- ment of major Japanese cities gradually declined ing of effective dust masks should be enforced from 1 fiber/liter around 1985 and has remained when cleaning up houses and removing rubble. at about 0.1–0.4 fibers/liter recently. However, following the 1995 Great Hanshin Earthquake, Respiratory disorders caused by inhalation the asbestos concentration in the environment of asbestos dust was observed to have increased compared to The problems of mesothelioma and lung cancer before the earthquake for over six months due caused by inhalation of asbestos are what are to the deconstruction and removal of collapsed important as chronic effects on the respiratory buildings and structures. For this reason, the system. Ministry of the Environment (MOE) of Japan The use of asbestos increased rapidly when revised the Air Pollution Control Law in 1996, sprayed asbestos was used extensively in steel- making it mandatory working practice to remove

JMAJ, March / April 2013 — Vol. 56, No. 2 93 Uchiyama I

sprayed asbestos before disassemble or renova- concentrations. Nevertheless, it is important to tion. Additionally, a Handling Manual for the take measure to prevent secondary disasters Asbestos Splash Prevention in Times of Disaster7 among workers and ordinary residents, includ- was established in 2007 based on experiences in ing observing working standards during the de- two major disasters up to that point. molition of architectural structures, controlling Since the second half of the 1990s, quanti­ the generation of dust by sprinkling water, and tative has been conducted on preventing the inhalation of dust by wearing dust carcinogens with no threshold (hazardous air masks (national assay disposable masks DS2, pollutants) such as benzene, based on the use N95, etc.; small size for children). of mathematical models to extrapolate down to low concentrations, leading to the establishment Respiratory disorders caused by inhalation of environmental standards. According to risk of sludge assessments by the WHO Regional Office for Sludge may contain seafloor sediment, patho- Europe8 and the U.S. Environmental Protection genic microorganisms (anaerobic bacteria), and Agency,9 which think that asbestos is a carcino- heavy metals, chemical substances, oils (poly­ gen with no threshold, the lifetime excess cancer cyclic aromatic hydrocarbons, Polychlorinated risk combining lung cancer and mesothelioma Biphenyls (PCBs)), and dioxins that have run off from continuing to inhale asbestos at about 0.1 from factory effluent. It has also been pointed fibers/liter over a lifetime is about1 10 5 (1 in out that the tsunami could have swallowed up 100,000 people). various pollutants as it moved over the land. In In Japan, the ambient air quality standard is analyses conducted thus far, bacteria that cause set so that the lifetime excess cancer risk will be food poisoning have been identified from several no more than 1015. Accordingly, it can be said samples and arsenic has been detected in con­ that the current asbestos concentration in the centrations exceeding environmental standards general environment is the same as the level of for soil. The National Institute for Environmental this environmental standard or slightly higher. Studies is currently measuring pollutants in According to the vital statistics of the Minis- sludge, and we are now awaiting publication of try of Health, Labour and Welfare of Japan, the early analytical results. number of deaths due to mesothelioma (pleural, When sludge remains for a long time, decay peritoneal) was 1,209 in 2010 and is still on an advances and opportunities increase for inhaling upward trend. In an investigation conducted by dried dust, regarding which care is needed, since the MOE in Hyogo Prefecture in 2006, approxi- highly alkaline dust (pH 10–11) causes a strong mately 16% of persons who died from mesothe- inflammatory reaction in the upper and lower lioma were ordinary residents with no experience . Hands should be washed ade- of occupational exposure or occupation-related quately if sludge is touched. exposure. Additionally, one worker who was Soma City, Fukushima Prefecture has an- engaged in the disposal of rubble following the nounced and put into practice a system of coun- 1995 Great Hanshin Earthquake has unfortu- termeasures to health impairment from sludge nately been reported as already having developed in Soma.10 mesothelioma, which has been acknowledged in this case as a work-related illness. Health effects caused by inhalation of dust Thus, it is extremely important to observe in the 9/11 terrorist attacks in the U.S. the peacetime working standards as much as The 9-year cumulative disease incidence rate has possible during the demolition and renovation been reported for 27,449 out of a cohort of 50,000 of collapsed buildings containing asbestos and people who inhaled harmful dust while engaged during the disposal of waste so as to not push in rescue and recovery operations during and the asbestos concentration in the surrounding after the 9/11 terrorist attacks in the U.S.11 New environment up further. York City firefighters, who sustained the greatest The measurements of airborne asbestos con- exposure, were not included in this report, but centrations conducted by the MOE following it did include ordinary volunteers. The results the 2011 Great East Japan Earthquake seem to showed an overwhelmingly high incidence of have not identified areas with especially high respiratory symptoms—asthma (27.6%),

94 JMAJ, March / April 2013 — Vol. 56, No. 2 CHRONIC HEALTH EFFECTS OF INHALATION OF DUST OR SLUDGE

(42.3%)—as well as depression, PTSD, and panic struction and removal of collapsed buildings, it disorder. Moreover, a high rate of abnormal is important to carry out disposal as much as respiratory function was found, with 3/4 having possible in accordance with peacetime manuals, low forced vital capacity (FVC). These results to control the generation of dust by sprinkling suggest that inhalation of dust and other pollut- water, to strictly observe the wearing of dust ants may have respiratory and other long-term masks, and especially to stop the elderly and effects and also suggests once again the impor- children from going near such areas. tance of preventing dust inhalation. Since the development of mesothelioma caused by the inhalation of dust during recovery Conclusion from the 1995 Great Hanshin Earthquake and the report of a cohort study of people who were There is a high likelihood of inhaling organic engaged in firefighting, rescue, and recovery work dust, bacteria, and chemical substances when in the 9/11 terrorist attacks suggest an increase cleaning up rubble, decomposed matter, and in respiratory diseases, it is important to make moldy building materials and removing sludge. use of these lessons in order to prevent secondary Additionally, in order to prevent the carcinogenic accident. effects of inhaling asbestos during the decon-

References

1. Pneumoconiosis Act. http://law.e-gov.go.jp/htmldata/S35/S35HO for Preventing Asbestos From Becoming Airborne in Times of 030.html. (in Japanese) Disaster, Air Environment Division, Environmental Management 2. Japan Advanced Information Center of Safety and Health. Bureau, Ministry of the Environment. Handling Manual for Pre- Occupational Accidents Statistics: Fiscal 2009 Status of Imple- venting Asbestos From Becoming Airborne in Times of Disaster. mentation of Pneumoconiosis Health Management by Type of August 2007. http://www.env.go.jp/air/asbestos/indexa.html. (in Industry. (in Japanese) Japanese) 3. Himi Y. Forty-three years with the environmental administration. 8. World Health Organization Regional Office for Europe. Air Qual- Life and Environment. 1997;42(9):79–85. (in Japanese) ity Guidelines for Europe. 2nd ed. Copenhagen: WHO Regional 4. Dockery DW, Pope CA 3rd, Xu X, et al. An association between Publication; 2000:128–135. air pollution and mortality in six U.S. cities. N Engl J Med. 1993; 9. Integrated Risk Information System (IRIS). Asbestos (CASRN 329:1753–1759. 1332-21-4). 1996. http://www.epa.gov/iris/subst/0371.htm. 5. Ministry of the Environment. The establishment of environmental 10. Soma City, Fukushima Prefecture. System of Countermeasures standards relating to fine particulate matter (report). http://www. to Health Impairment From Sludge in Soma. June 2011. http:// env.go.jp/council/toshin/t07-h2102.html. (in Japanese) www.city.soma.fukushima.jp/0311_jishin/img/soma_sludge_ 6. International Programme on Chemical Safety (IPCS). Environ- manual.pdf. (in Japanese) mental health criteria 53. Asbestos and other natural mineral 11. Wisnivesky JP, Teitelbaum SL, Todd AC, et al. Persistence of fibres. Geneva: WHO; 1986. multiple illnesses in World Trade Center rescue and recovery 7. Investigative Commission on Production of a Handling Manual workers: a cohort study. Lancet. 2011;378:888–897.

JMAJ, March / April 2013 — Vol. 56, No. 2 95