Therefore, an estimated total of 16,000 to 17,000 births occurred among women who were pregnant while living at Camp Lejeune during the study period (ATSDR, 2003). This report is a snapshot of your water quality in 2019. In addition to opportunities for public input prior to the meeting, several public comment periods were scheduled during the two day meeting as well as time for questions and answers between the panel members and the public participants. Work is now proceeding on the epidemiologic study. J. Wanzer Drane, P.E., Ph.D. received his Ph.D. in biometry from Emory University in Atlanta, Georgia; mechanical engineering studies at the Louisiana Polytechnic Institute; and nuclear engineering studies at the Oak Ridge School of Reactor Technology. Public Health Assessment: U.S. Marine Corps Camp Lejeune, Onslow County, North Carolina. A committee of the National Research Council will review the scientific evidence on associations between adverse health effects and historical data on prenatal, childhood, and adult exposures to contaminated drinking water at Camp Lejeune, North Carolina. This annotated map shows contaminated wells within the Hadnot Point Industrial area on the base, which once included a on-base refueling station. For example, for a successful study to be conducted on any of the cohorts noted above, it would be necessary to first identify a large proportion of the members of the cohort, and then to link them with medical or mortality records. Major heart defects were associated with exposure to TCE-contaminated drinking water in a study conducted in Tucson (Goldberg et al., 1990). It is unknown when the contamination of the Hadnot Point system wells began, but the contamination could have started back in the 1950s. Learn about research on past chemical contamination. Jerry Ensminger, Mike Partain and their allies have have built archives of thousands of pages of documents demonstrating the length, severity and extent of drinking water contamination at Camp Lejeune. However, staff of the Camp Lejeune Naval Hospital estimated that about one third of mothers receiving prenatal care at the hospital were transferred from Camp Lejeune before delivery. Consensus was not sought and votes were not conducted. Kenneth Cantor, Ph.D., M.P.H. The final selection of the panel members was made by the Office of Science. Relatively few potentially exposed persons lived on the base for more than two or three years. In July 2003, work began to develop a study protocol. Am J Epidemiol 1995;141:850-62. These comments were provided to the panel members in advance of the meeting. From the 1950s through the 1980s, people living or working at the U.S. Marine Corps Base Camp Lejeune, North Carolina, were potentially exposed to drinking water contaminated with industrial solvents, benzene, and other chemicals. The advisory group would have several roles involving oversight of Camp Lejeune study activities: providing advice on methods to identify various groups of individuals who had lived or worked on the Base; suggesting health end-points for studies and study approaches; reviewing study protocols; and serving as liaison between scientific investigators, the military, and the community. Progress Report: Survey of Specific Childhood Cancers and Birth Defects Among Children Whose Mothers Were Pregnant While Living at U.S. Marine Corps Base Camp Lejeune, North Carolina, 1968-1985. At Tarawa Terrace, PCE was detected at 80 ppb. An important feature of the contamination of these two drinking water systems at Camp Lejeune was its intermittent nature. The protocol received approval from the CDC Institutional Review Board and the US Office of Management and Budget in 2004. In addition to evaluating mortality and cancer risk within exposed and unexposed segments of the Camp Lejeune population, the panel discussed other health outcomes of interest that might be studied. A case-control study of childhood leukemia in Woburn, Massachusetts: the relationship between leukemia incidence and exposure to public drinking water. Since exposure ended in late 1984 or early 1985, it was suggested that the end of the time period for eligibility be extended for a few years beyond those dates. This report along with transcripts from the meeting will be provided to all meeting participants, other interested parties, and will be posted on the ATSDR website at http://www.atsdr.cdc.gov/sites/lejeune/eventsarchive.html. This report offers a summary of research on the historical Camp Lejeune water contamination up to 2009. Dr. Drane is currently professor of biostatistics at The Arnold School of Public Health at the University of South Carolina. ATSDR surveyed the parents of 12,598 eligible children, representing an overall participation rate of between 74% and 80% depending on the estimate used for births that occurred off base. In summary, members of the Camp Lejeune Scientific Advisory Panel recommended the following: Agency for Toxic Substances and Disease Registry. Government Accountability OfficeAtlanta, GA, Drue H. Barrett, PhDActing Associate Director for ScienceOffice of ScienceNational Center for Environmental Health/Agency for Toxic Substances and Disease RegistryAtlanta, GA, Frank Bove, PhDSenior EpidemiologistDivision of Health StudiesAgency for Toxic Substances and Disease RegistryAtlanta, GA, Jason Broehm, JD, MSPublic Health AdvisorCDC Washington OfficeWashington, DC, Jeffrey C. ByronThe Few, The Proud, The ForgottenHamilton, OH, Mary R. ByronThe Few, The Proud, The ForgottenHamilton, OH, Gary Campbell, PhDEnvironmental Health ScientistDivision of Health Assessment and ConsultationAgency for Toxic Substances and Disease RegistryAtlanta, GA, Kenneth Cantor, PhD, MPHSenior InvestigatorDivision of Cancer Epidemiology & GeneticsNational Cancer InstituteBethesda, MD, J. Wanzer Drane, PhD, PEProfessorArnold School of Public HealthDepartment of Epidemiology and BiostatisticsUniversity of South CarolinaColumbia, SC, Jerome M. EnsmingerThe Few, The Proud, The ForgottenRichlands, NC, Jim EvansAudiovisual SpecialistSound On-SiteSmyrna, GA, Henry Falk, MD, MPHDirectorCoordinating Center for Environmental Health and Injury PreventionCenters for Disease Control and PreventionAtlanta, GA, John FlorenceVisual Information SpecialistAgency for Toxic Substances and Disease RegistryAtlanta, GA, Athena Gemella, MSPeer Review CoordinatorOffice of ScienceNational Center for Environmental Health/Agency for Toxic Substances and Disease RegistryAtlanta, GA, Linnet Griffiths, MALead Public Health AnalystOffice of Financial and Administrative ServicesAgency for Toxic Substances and Disease RegistryAtlanta, GA, Ellen HarrisAdvocate for Women & ChildrenFort Gaines, GA, Carole D. Hossom, BSEnvironmental Health ScientistDivision of Health Assessment and ConsultationAgency for Toxic Substances and Disease RegistryAtlanta, GA, Sandy Isaacs, BS, MT (ASCP)Branch ChiefDivision of Health Assessment and ConsultationAgency for Toxic Substances and Disease RegistryAtlanta, GA, Courtney Denning-Johnson Lynch, PhD, MPHStaff ScientistDivision of Epidemiology, Statistics, and Prevention ResearchNational Institute of Child Health and Human DevelopmentNational Institutes of HealthRockville, MD, Richard Maas, PhD, MSPHDirector/ProfessorEnvironmental Studies DepartmentEnvironmental Quality InstituteUniversity of North Carolina at AshevilleAsheville, NC, Morris Maslia, PEEnvironmental EngineerDivision of Health Assessment and ConsultationAgency for Toxic Substances and Disease RegistryAtlanta, GA, Chris MazzoliniThe Daily NewsJacksonville, NC, Daphne B. Moffett, PhDSenior Environmental Health ScientistDivision of ToxicologyAgency for Toxic Substances and Disease RegistryAtlanta, GA, John Oh, MPHSenior Health Policy AnalystU.S. Copy of PowerPoint presentation used by ATSDR staff to provide background on Camp Lejeune related activities conducted by ATSDR staff. Verification of the NTD, oral cleft, and childhood leukemia cases is ongoing. A decision was made to focus on conotruncal heart defects because these defects are pathogenetically similar and they were associated with maternal residential proximity to toxic waste sites in a California study (Croen et al., 1997). Ornella Selmin, Ph.D. received her Ph.D. from the University of Podova, Italy in molecular and cellular biology. Invited scientists were asked to disclose any actual or perceived conflicts of interest. Panel members recommended that an advisory panel, with long-term stability, be established. Dr. Cantor served as the Chairperson on the Camp Lejeune Scientific Advisory Panel. *Items 1 and 2 were distributed by ATSDR staff; all other items distributed by members of the public in attendance at the meeting. All panel deliberations occurred in public. In early February 1985, a tap water sample detected 215 ppb PCE, 8 ppb TCE, and 12 ppb DCE. The goal of the Office of Science was to select a panel of 5-7 members who had well-established expertise in one or more areas of environmental or occupational epidemiology, cohort tracing, studies involving military populations, dose reconstruction, the health effects of trichloroethylene (TCE) and tetrachloroethylene (PCE), neurodevelopmental and other neurological disorders, and biostatistics. Information from the birth certificate was used to determine birth weight and gestational age. The beginning of the exposure period is not as clear, and may have been as early as 1950 in some instances. The Marine Corps continues to locate individuals who lived or worked at Camp Lejeune anytime in 1987 or prior. The base began sampling the Hadnot Point system in October 1980 for trihalomethanes (THMs), a chlorination disinfectant byproduct. The Camp Lejeune Scientific Advisory Panel met in Atlanta, Georgia on February 17 and 18, 2005. These individuals were instrumental in having ATSDR convene this meeting of a scientific panel, in which a substantial part of the agenda was devoted to personal testimony by many of these individuals. The effectiveness of this group, the experience of several panel members in working with other exposed communities with past exposure to environmental contaminants, and the personal testimony of community members led panel members to this recommendation. from the Cornell University Medical College and his M.P.H. An important objective of the survey was to determine whether an epidemiologic study of these adverse outcomes was feasible. Marine Corps Base Camp Lejeune "Home of Expeditionary Forces in Readiness" Water Quality Reports 1999-2010. Several panel members felt strongly that the military has an ethical responsibility to notify all potentially exposed and affected persons from Camp Lejeune, and the nature of the exposure. 2000 Water Quality Reports The transcripts of the meeting and the final panel report are being distributed to all meeting participants and posted on the ATSDR website http://www.atsdr.cdc.gov/sites/lejeune/eventsarchive.html). THM samples taken at Tarawa Terrace in November 1982 and in 1983 were found to be contaminated with PCE. In all of these areas, the panel felt that community members, with a personal involvement and concern about health effects associated with their past exposures, must be fully involved in any future research effort. Using water-distribution system modeling, it is possible to estimate quite accurately the proportional contribution of water from a water source to any location serviced by the water-distribution system. A list of the material provided to the panel during the meeting is provided in Appendix 5. In December 1984, some of the Hadnot Point wells were shut down or placed offline. The final panel consisted of seven members who had expertise in epidemiology and public health, biostatistics, drinking water contaminants, pesticides, toxicology, reproductive health, and environmental health. Maslia, M.M. Agency for Toxic Substances and Disease Registry. Sitemap ATSDR concluded that both cancer and non-cancer health effects were unlikely in adults exposed to VOC-contaminated drinking water at Camp Lejeune based on worst-case estimates. The Agency for Toxic Substances and Disease Registry (ATSDR) is required by law to conduct a public health assessment (PHA) at each NPL site. Onslow County, North Carolina. First, the survey used the birth certificate information from the previous Camp Lejeune study of SGA (ATSDR, 1998). One panel member suggested that a few years during the exposure period could be selected for feasibility purposes to test whether a subset of the larger exposed group of people could be identified. Health Survey Movies. On January 31, 1985, buildings in the Holcomb Boulevard service area that were temporarily receiving water from Hadnot Point were sampled and high contamination was found at the Berkeley Manor Elementary School (1,148 ppb TCE and 407 ppb 1,1-Dichloroethene [DCE]), an Officers club (890 ppb TCE and 332 ppb DCE), the Married Officers Quarters (1,041 TCE), and two Berkeley Manor Housing Units (905 ppb and 981 ppb TCE, 335 ppb and 369 ppb DCE). Case-control study of childhood cancers in Dover Township (Ocean Country), New Jersey. Volatile Organic Compounds in Drinking Water and Adverse Pregnancy Outcomes: U.S. Marine Corps Camp Lejeune. APPENDIX 1: List of Registered Meeting Participants, Bonnie Anderson, BAAssistant DirectorU.S. GA, Christopher StallardFacilitatorCoordinating Office for Global HealthCenters for Disease Control and PreventionAtlanta, GA, Alison Thompson,Military FellowOffice of Senator Elizabeth DoleWashington, DC, Mariana Toma-Drane, MPHDoctoral StudentHPEB DepartmentArnold School of Public HealthUniversity of South CarolinaColumbia, SC, Paul Visintainer, PhDProgram Director/ProfessorDepartment Health Quantitative SciencesSchool of Public HealthNew York Medical CollegeValhalla, NY, T. Michael WhiteU.S. This technique can also provide the relative concentrations of specific contaminants in the water delivered to study subject residences. The panel also faulted a regional naval unit responsible for providing Camp Lejeune with technical expertise and advice on water quality. Paul Visintainer, Ph.D. received his Ph.D. in epidemiology from the University of Pittsburgh. Atlanta: US Department of Health and Human Services, 1997. Even though Marine Corps commanders issued an order in 1974 to safely dispose of solvents, dangerous chemicals were still dumped near water wells for years. THM samples taken at Hadnot Point in November 1982 and in 1983 were found to be contaminated with TCE and PCE. Based on this information, ATSDR estimated that between 3,500 and 4,500 mothers were transferred from Camp Lejeune before delivery. The study was completed and published as an ATSDR report in August 1998. Bove FJ, Fulcomer MC, Klotz JB, Esmart J, Dufficy EM, Savrin JE. in environmental chemistry from the University of North Carolina at Chapel Hill. Richard Maas, Ph.D., M.S.P.H. APPENDIX 4: Camp Lejeune Scientific Advisory Panel Meeting Agenda, 9:00 am Call to Order, Introductions and Opening Remarks, 10:45 am ATSDR Staff Presentation and Discussion with Panel Members, 5:00 pm Open Discussion for Panel and Public, 2:45 pm Expert Panel Deliberation Wrap-up, APPENDIX 5: List of Material Provided to the Panel During the Meeting*. It was recognized that feasibility issues loom large with each of the outcomes, and preliminary work would be needed to see which of them would be possible to study, and which not. Obtaining Records and Filing Exposure Claims . A New Jersey study found an association between childhood leukemia in females and TCE-contaminated drinking water (Cohn et al., 1994). In case you have not heard, Camp Lejeune’s water supply was contaminated from leaking storage tanks that leached toxic chemicals into the ground water from 1953 to 1987. Dr. Visintainer has expertise in the areas of epidemiologic methods, perinatal epidemiology, biostatistics, and behavioral science. The expected completion date of the study is 2007. Exposure to PCE from Tarawa Terrace water was associated with elevated risk for SGA among infants born to mothers aged >35 years (adjusted OR=2.1, 90% CI: 0.9, 4.9) and among mothers with two or more prior fetal losses (adjusted OR=2.5, 90% CI: 1.5, 4.3) (Sonnenfeld et al., 2001). Camp Lejeune Rapid Benefits Assessment Were you stationed at Camp Lejeune? Samples taken in 1981 also indicated the presence of VOCs other than THMs in the Hadnot Point system. A new article on water-modeling used to support epidemiological studies at Camp Lejeune has been published in the international peer-reviewed journal WATER. David Ozonoff, M.D., M.P.H. A first step would be to determine the proportion of each population that could be identified, using school, employment, military, housing, and other relevant record systems, and the types of personal identifiers that are available to qualified researchers. It received four laboratory reports in 1980 and 1981 alerting it to the contaminant and recommending further study. The Camp Lejeune historic drinking water issue is an important concern for our Marine Corps family. In addition, many individuals lived off base and had potential exposures while working on base for various lengths of time. See Appendix 1 for a list of meeting participants. The analysis of the sample at Hadnot Point indicated the presence of VOCs other than THMs. Public drinking water contamination and birth outcomes. Appendix 3 contains a list of materials provided to the panel members prior to the meeting. Historical Documents Library made up of EPA, ATSDR USMC documents compiled by The Few, The Proud, The Forgotten (TFTPTF). Marine Corps Base Camp Lejeune. There is clearly overlap between some groups — for example, those who lived at Camp Lejeune during the exposure period and were also there earlier, in utero. All contaminated wells in the Hadnot Point system were closed in early February 1985. Neural tube defects and oral cleft defects were found to be associated with TCE in a NJ drinking water study (Bove et al., 1995). Dr. Maas has expertise in the areas of chemistry, environmental science, water, lead, air, arsenic, pesticides, and health effects & pediatrics. Parents were asked if the child had had a birth defect or had developed a childhood cancer. All verified cases and a random sample of non-cases will be selected for inclusion in the epidemiologic study. During the period 1980-1985, a sampling program of the supply wells and water distribution systems at the base found that some of the wells in the Hadnot Point and Tarawa Terrace systems were contaminated with volatile organic compounds (VOCs). Birth defects (neural tube defects, oral cleft defects), Childhood cancers (Childhood leukemia, non-Hodgkins lymphoma), Infertility, miscarriage, premature labor, and other reproductive health outcomes. About 43,000 are active military personnel and their dependents total about 53,500. In July 1982, PCE levels at Tarawa Terrace ranged from 76 ppb to 104 ppb. Many persons who lived at Camp Lejeune as children or adults and who had likely exposure to TCE have been very active in placing their health concerns before the public. The title of the article is: “Reconstructing Historical VOC Concentrations in Drinking Water for Epidemiological Studies at a U.S. Military Base,” by M.L. Atlanta, Georgia: US Department of Health and Human Services, 1997. The sources of the contamination were an off-base dry … The following potential confounders and effect modifiers were included: sex of infant, maternal and paternal ages, maternal race, maternal and paternal education, military pay grade, maternal parity, adequacy of prenatal care, marital status, and year of birth. Public Health Assessment: U.S. Marine Corps Camp Lejeune, Onslow County, North Carolina. In addition to evaluating feasibility of identifying and tracking individuals, other issues need to be addressed before large-scale studies could be performed. As a first step in following up the PHA recommendation to conduct an epidemiologic study, ATSDR utilized available databases to evaluate whether associations existed between potential maternal exposure to the drinking water contaminants at the base and preterm birth (<37 weeks gestational age), small for gestational age (SGA), and mean birth weight deficit (ATSDR, 1998; Sonnenfeld et al., 2001). Courtney Denning-Johnson Lynch, Ph.D., M.P.H. Camp Lejeune Report: Reconstructing Historical VOC Concentrations in Drinking Water. In 1997, ATDSR issued a Public Health Assessment of potential risks to health at Camp Lejeune. ATSDR attempted to locate and contact the parents of each eligible child to elicit information on the child’s health as well as to confirm that the mother was a resident at the base at some point during the pregnancy. One panel member expressed this notion by stating that “exposure assessment is the Achilles heel of environmental epidemiology”. Community involvement must take place with full recognition of the uniqueness of the community of exposed individuals who had lived at Camp Lejeune. This would allow one to look at the temporal relation with disease by including persons during and after the relevant exposure period. It includes details about from where your water comes, what it contains, and how it compares to standards set by regulatory agencies. Initiation of recommended research activities should not await completion of current ATSDR activities to better characterize past exposure, but can be conducted in parallel with the current work. More precise estimates of cost must await completion of pilot and feasibility studies that would guide the direction and scope of future research. They were also hundreds of times lower than levels linked to adverse health effects found in workplace studies. These included: Health outcomes reported among people exposed as adults included: Other points made during public testimony focused on the following concerns: A more detailed description of the public comments made during the meeting can be found at http://www.atsdr.cdc.gov/sites/lejeune/eventsarchive.html (see meeting transcripts). Agency for Toxic Substance and Disease Registration, APPENDIX 5: List of Material Provided to the Panel During the Meeting, http://www.atsdr.cdc.gov/sites/lejeune/eventsarchive.html, Camp Lejeune Expert Panel to Meet (News Release), ATSDR Response to the Report of the Camp Lejeune Scientific Advisory Panel Held February 17-18, 2005, Agency for Toxic Substances and Disease Registry, Community Assistance Panel (CAP) and Media, U.S. Department of Health & Human Services. Each system had many more wells than were necessary to supply water on any given day. About 42,000 are retired and about 4,900 are civilian employees. Environ Health Perspect 1994;102:556-61. Several panel members agreed that ATSDR should amend the public health assessment to include the possibility that adult cancers and other adverse health outcomes may be related to VOC exposures. Mothers of 141 births that resided in housing units supplied briefly in 1985 by the Hadnot Point system when the Holcomb Boulevard system was down (due to a fuel pump failure) for at least one week before birth occurred were considered having “short-term” exposure to TCE. 1997 ATSDR Public Health Assessment (PHA). Page from (www.denix.osd.mil/denix/Public/News/Mariens/ECP/mcecp.html) on Marine Corps Environmental Campaign Plan, 1997. The Tarawa Terrace and Hadnot Point water systems were affected by chemical contaminants; however, the levels varied. The panel recognized that a crucial part of any study of health effects of TCE or other chemicals in drinking water is an accurate assessment of past exposures. 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