Chemosphere 43 )2001) 951±966 Dioxin exposure and public health in Chapaevsk, Russia B. Revich a,*, E. Aksel b, T. Ushakova b, I. Ivanova c, N. Zhuchenko c, N. Klyuev d, B. Brodsky d, Y. Sotskov e a Center for Demography and Human Ecology of Institute for Forecasting, Russian Academy of Sciences, Nakhimov's prosp. 47, Moscow 117418, Russian Federation b Cancer Scienti®c Research Center, Russian Academy of Medicine Sciences, Kashirskoe Drive 24, Moscow 115478, Russian Federation c Moscow Medical Academy, Rossolima str., 11a, Moscow, Russian Federation d Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Leninsky prospekt, 33, Moscow 117071, Russian Federation e State Committee of Environmental Protection, Barrikadnaya 2/6, Moscow 123812, Russian Federation Abstract One of the largest environmental polluters in Chapaevsk )Samara Region, Russia) is the Middle Volga chemical plant. From 1967 to 1987, it produced hexachlorocyclohexane )lindane) and its derivatives. Currently, it produces crop protection chemicals )liquid chlorine acids, methyl chloroform, vinyl chloride, and some other chemicals). Dioxins were detected in air 0:116 pg=m3), in soil )8,9±298 ng/kg), in the town's drinking water )28,4±74,1 pg/liter), and in the cow's milk )the content of 2,3,7,8 ± TCDD was 17,32 pg TEQ/g fat). The mean content of dioxins in seven pooled samples of human milk )40 individual trials) was 42,26 pg TEQ/g fat, in four female workers' blood samples ± 412,4 pg TEQ/g fat, in six residents'blood samples )those who lived 1±3 km from the chemical plant) ± 75,2 pg TEQ/g fat, in four residents' blood samples )5±8 km from the plant) ± 24,5 pg TEQ/g fat. To assess cancer risk and reproductive health status, ocial medical statistical information was used. In general, the male cancer mortality observed rate in Chapaevsk is higher than expected. The SMR is higher for lung cancer 3.1)C.I. 2.6±3.8), urinary organs 2.6)C.I. 1.7±3.6). Chapaevsk women have a higher risk overall due to breast cancer 2.1)C.I. 1.6±2.7) and cervix cancer 1.8)C.I. 1.0±3.1). The incidence rates were higher for lung cancer in males and for female breast cancer in all age groups compared to Russia and Samara Region in 1998. Signi®cant disruptions in reproductive function were detected. The mean frequency of spontaneous abortions in the last seven years was statistically higher 24.4% in Chapaevsk )compared to other of the towns region). The average rate of premature labor was 45.7 per 1000 women in Chapaevsk that is signi®cantly higher than in most Samara Region towns. The frequency of newborns with low birth weight was 7.4%. In Russia and in most of the Samara Region towns, this rate is lower )6.2±5.1%) but not statistically dierent. For the determination of congenital morphogenetic conditions )CMGC), 369 children born between 1990 and 1995 were examined. The average number of CMGC per child was signi®cantly higher, 4.5 for boys and 4.4 for girls. The ®rst results indicated serious disruptions associated with high dioxin levels in human milk and blood in Chapaevsk. We suggest that Chapaevsk is an incredibly interesting site for further environmental-epidemiological research to assess the impact of dioxins on human health. Ó 2001 Published by Elsevier Science Ltd. Keywords: Dioxins; Blood; Human milk; Breast cancer; Lung cancer; Spontaneous abortions; Newborns with low birth weight; Congenital morphogenetic eects; Congenital morphogenetic conditions; Congenital malformations; Sex ratio; Environmental health; Russia * Corresponding author. Tel.: +7-095-332-4313; fax: +7-095-718-9771. E-mail address: [email protected] )B. Revich). 0045-6535/01/$ - see front matter Ó 2001 Published by Elsevier Science Ltd. PII: S 0 045-6535)00)00456-2 952 B. Revich et al. / Chemosphere 43 62001) 951±966 1. Introduction 3. to estimate incidence and mortality rates, and specif- ically describe reproductive health in the population Published studies of dioxin exposure and its impact according to ocial statistical data; on human health are few in number and limited to 4. to assess the impact on genetic characteristics; certain geographical regions. The majority of studies 5. to assess male sexual maturation and abnormalities in have been concentrated in Italy )after the incident in the male reproductive system based on case-control Seveso), the US, Vietnam )as a result of using Agent studies. Orange), Germany )occupational studies) and other An article by Revazova et al. )2000) about the cyto- countries. There are two towns in Russia where similar genic eects of dioxins in residents of Chapaevsk has studies are being conducted ± Ufa )Bashkiria) and been published in this issue of Chemosphere. Chapaevsk )Samara Region). Chapaevsk is located 43 km to the southwest of Sa- mara, on the Chapaevka River, which ¯ows into the Volga River. The population of the town is 83,000. One 2. Methods of study of the largest environmental polluters in Chapaevsk is the Middle Volga chemical plant. Prior to 1949, the 2.1. Sampling human milk Plant produced chemical blister agents: mustard gas and lewisite. From 1967 to 1987, it produced hexachlorocy- Sampling of human milk was carried out in Decem- clohexane )lindane) and its derivatives. Currently, it ber 1997±June 1998 according to the World Health produces crop protection chemicals )liquid chlorine, Organization )WHO) criteria. Forty samples of human acids, methyl chloroform, vinyl chloride, and some other milk were pooled into seven samples. The average age of chemicals). Previously it was considered that hexachlo- mothers was 22.0 years. All surveyed mothers classi®ed rane production was responsible for dioxin contamina- their diet as mixed. Ninety percent of women eat ®sh tion in the city's environment. Tests seemed to con®rm once a week or rarely, 80% of women eat meat more it. But after the production was stopped in 1987, a than two times a week, and dairy products every day. All continued output of dioxin was still observed. The study respondents never smoked, as they self-reported in the of the present -day chemical production technologies interview. revealed that dioxins and similar compounds can be formed in the production of methyl chloroform, vinyl chloride, dichlorpropionic acid, hexachlorethane, sodi- 2.2. Blood um pentachlorphenolate and polychloroform )Environ- ment and public health in Chapaevsk city, 2000). Blood samples were taken from 14 people. The A large network of industrial plants was created blood was centrifuged, frozen and transported on dry during industrialization in Russia, intended for the ice. Ninety percent of women lived in Chapaevsk for production of toxic agents with high chlorine content. more than three years and 75% of them for more than One such plant was founded in Chapaevsk, Samara ®ve years. Income for one member of a family in these Region. Industrial plants, mainly related to the military- three groups was nearly the same. A detailed inquiry industrial complex, occupied 51% of the total region into diet did not ®nd great dierences between the area. These plants produced 86% of the city's income. groups. They employed approximately half of the city's popu- lation. 2.3. Cow's milk Beginning in 1989, a stable trend towards reduced production has been observed in the city, as well as in Samples were taken from private households of the country as a whole. The greatest reduction of more Chapaevsk residents. Residents use vacant lots in the than 83% took place at the defense plants. The chemical city as cow pastures, including areas near the chemical industry reduced production by more than 50%. The plant. reduced volume of production in Chapaevsk is higher than in Samara Oblast and in Russia on the whole. The ®rst results of dioxin analysis in soil samples 2.4. Methods of dioxin analysis indicated high concentrations. High levels of dioxin were registered in soils at the city center, in the soils of gar- The technique for the isomer-speci®c analysis of dens and agricultural ®elds. This led the Chapaevsk City PCDDs and PCDFs in complex lipophilic matrices Administration to begin studies to assess the impact of consists of ecient extraction involving a salting out dioxin on human health with the following aims: procedure, which is followed by the clean-up on the 1. to estimate environmental exposure to dioxin; carbon microcolumn that permits to separate lipids. The 2. to estimate blood and milk levels of dioxin; ®nal puri®cation is done using an aluminum column. B. Revich et al. / Chemosphere 43 62001) 951±966 953 2.5. Sample extraction of milk eects, 369 children were examined who were born be- tween 1990 and 1995. All these children go to kinder- 13 One hundred milliliter of milk forti®ed with C12- gardens in Chapaevsk at locations in dierent districts of labeled surrogate standards were mixed with 100 ml the city. In order to obtain the most accurate and acetone and 100 ml hexane and swirled by a homoge- complete information on the birth of children with nizer for 3 min until a homogeneous medium was congenital malformations )CMF), an analysis of the formed. After the addition of 70 g ammonium sulfate, medical records was carried out in all the obstetric and the mixture was shaken until all the ammonium sulfate treatment centers, as well as at prevention centers )ma- was dissolved. When the layers separated )5 min), the ternity hospitals, ambulatory care, and pathology de- precipitation was ®ltered through a glass ®lter using a partments) in the city. After identifying children with gentle vacuum.