For decades, the United States has formulated and used chemical products to control insects and other animal populations that may transmit diseases. Over the past 20 years, pesticides used according to label directions have posed only a minimal health threat to healthy adults. However, there are numerous civilian sector reports of health problems resulting from overexposures due to misuse or accidents. Of particular note for this investigation are reports documenting the potential for organophosphate and carbamate pesticides, which exhibit some similarities to certain chemical warfare agents, to cause adverse neurological effects in humans. During the Gulf War, military preventive medicine personnel, and those they supervised, applied pesticides throughout the theater of operations. The possibility that pesticides may cause long-term adverse health effects has caused concern for some veterans and some within the medical and scientific communities. Indeed, some Gulf War veterans have reported a wide array of unexplained illnesses that some believe may be related to their use of and exposure to pesticides, alone or in combination with other health stressors that were present during the war.

Pesticides available within the military supply system were all registered with the Environmental Protection Agency. To conform to Agency standards, the pesticide had to be applied by the military in accordance with the product label to control the pests listed on the label. Failure to comply with any part of the label constituted misapplication of the pesticide, increasing the risk of overexposures. Actual application procedures were largely undocumented. For instance, investigators have not been able to determine the amounts of each pesticide used during the Gulf War. They were only able to find material ordering data, not actual usage data (i.e., application rates). By considering the reported frequency of use and potential toxicity, investigators have identified 15 pesticides of potential concern comprising 12 different active ingredients.

During the Gulf War, the potential existed for service members to be exposed to levels of pesticides that could result in adverse health effects. US military personnel used preventive medicine capabilities and guidance to control pest-borne diseases, often through the direct action of applying pesticides. The personnel, known as applicators, who applied pesticides, were at the greatest risk of exposures above safe levels. In addition, individual soldiers used personal pesticides such as DEET and permethrin, and coalition forces and host nation personnel applied a variety of pesticides.

For the pesticides used in the Gulf, exposures may have occurred in a variety of ways, despite all precautions. A pesticide may have been inhaled, swallowed, and deposited on the skin. A pesticide may also have been deposited on soil and surface water, buildings, tents, and clothing. Once the pesticide contacted human tissue, it may have been absorbed completely, partially, or not at all, depending on circumstances. For example, perhaps one-fifth of the DEET applied would have been absorbed through the skin, while little or none would have been ingested and inhaled. A small fraction of the permethrin sprayed on clothing, tents, insect netting and helmet covers may have been absorbed through the skin and inhaled, while little or none would have been ingested. Pesticide fogging around living quarters also may have contributed to a significant level of pesticide inhalation. Service members in the immediate vicinity of pest strips would have been exposed to pesticides via inhalation. Pesticides may have been absorbed through the skin and inhaled due to the unauthorized use of pet flea and tick collars. Under conditions of inappropriate use and application, these exposures may have resulted in exposure of US troops to levels of pesticides that could result in adverse health effects.

Preventive medicine personnel who apply certain pesticide sprays and fogs are required to use the appropriate personal protective equipment, which may include boots, gloves, coveralls, goggles and respirators. The required protection depends on the pesticide applied. During the Gulf War, the use of personal protective equipment by applicators varied depending on several factors, including availability, serviceability, and whether the applicator followed the guidance. In some cases, applicators did not use appropriate personal protective equipment.

The Deployment Health Support Directorate could locate no sampling data and no information about pesticide application rates generated during the Gulf War. However, we conducted over 900 interviews with veterans we believed might have information about pesticide use during the Gulf War, including preventive medicine personnel. Of these interviews, 322 provided specific information related to pesticide exposure.

This report also relies on information from the RAND literature review and RAND Gulf War veteran survey, as described in Sections IV.E.3 and IV.E.4, respectively. The survey describes pesticide use by the average service member during the Gulf War, and provides the best available information on which pesticides the general military population may have used for personal use, or applied in or around their living or working environment.

As part of this investigation, we performed a health risk assessment of pesticide use by land-based service members deployed to the Gulf. The health risk assessment identifies groups who, because of their occupational specialty, may have been at greater risk for adverse health effects arising from exposures to pesticides. Most veterans were exposed to pesticides, but at levels insufficient to cause even minor health problems. Investigators uncovered no evidence that the majority of veterans were exposed to unhealthful levels of pesticides.

The results of this analysis benefit our understanding of the issues related to the military’s use of pesticides. A number of the findings and conclusions reached in this report will benefit pesticide handling and management activities in future deployments, as well as provide DoD with areas for additional research in order to better define health risks under conditions that previously may not have been suspect.

During the Gulf War:

• The military did a very good job protecting service members from infection by pest-borne diseases. There was a low incidence of pest-borne diseases (only 40 documented cases) among service members due in part to the effective pest management programs implemented by the military.
• It is likely that at least 41,000 service members may have been overexposed to pesticides. Information from a scientifically peer-reviewed retrospective health risk assessment (HRA) and from RAND indicate that these service members may have been overexposed to various combinations of pest strips, sprayed pesticides, and fly baits. Approximately 30,500 members of the general military population may have been at elevated risk for short-term health effects because of exposure to pest strips. Another group of about 7,000 of the general military population may have been overexposed to pesticides applied during spraying operations. Approximately 3,500 to 4,500 pesticide applicators were probably one of the more highly pesticide-exposed groups.
• Overexposures to pesticides, particularly organophosphates and carbamates, may have contributed to the unexplained illnesses reported by some Gulf War veterans. The HRA and the RAND survey indicate that some service members may have been overexposed to pesticides. In studies of non-veterans, overexposures to organophosphates and carbamate pesticides, which produced acute symptoms at the time of exposure, have been associated with late or chronic symptoms similar to some of those reported by some Gulf War veterans. Some epidemiologic studies of Gulf War veterans have found associations between self-reports of pesticide exposure and self-reported symptoms.

Further research is needed in the following areas:

• Effects of low-level pesticide exposures. Because most pesticide exposures were low level and did not produce signs and symptoms near the time of exposure, it is important to know whether these types of exposures might produce long-term health effects.
• Pesticide interactions with other chemicals. The HRA does not account completely for some potentially important combined exposures. While it considered combinations of organophosphate and carbamate pesticides, it does not account for additional concurrent exposures to DEET, permethrin, pyridostigmine bromide, or low levels of nerve agents. Some personnel may have been exposed to varying combinations of these chemicals.
• Epidemiologic studies focused on Gulf War or other military pesticide applicators. Investigators were unable to locate a single epidemiologic study of military pesticide applicators. Such a study could be highly useful in helping to better characterize the link, if any, between pesticide exposures during the Gulf War, and chronic health effects.

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Comments - Not part of article:

• OP pesticides are being looked closely in studies  *
• However, when you look at what they are supposed to do; and what 2-butoxyethanol is supposed to do (also labeled by EAP as a pesticide - so maybe used somewhere, too) ...
• 2-butoxyethanol lines up better with what happened to 'gulf war syndrome' troops *

• "Pesticide fogging around living quarters also may have contributed to a significant level of pesticide inhalation."

Fogging is the worst exposure to 2-butoxyethanol - note this MSDS says to avoid misting  pdf

• "Preventive medicine personnel who apply certain pesticide sprays and fogs are required to use the appropriate personal protective equipment, which may include boots, gloves, coveralls, goggles and respirators. The required protection depends on the pesticide applied. During the Gulf War, the use of personal protective equipment by applicators varied depending on several factors, including availability, serviceability, and whether the applicator followed the guidance. In some cases, applicators did not use appropriate personal protective equipment."