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#528 - Infectious Disease and Pollution, 08-Jan-1997

Between 1980 and 1992 in the U.S., the death rate due to infectious
diseases as the underlying cause of death increased 58%, from 41 to 65
deaths per 100,000 population, according to the JOURNAL OF THE AMERICAN
MEDICAL ASSOCIATION.[1] The increase was larger among males (69%) than
among females (44%). The greatest increase occurred among people
between the ages of 25 and 44; in this age group, the death rate from
infectious diseases rose from six to 38 deaths per 100,000 people, more
than a six-fold increase. Among people over the age of 65, the death
rate from infections increased from 271 per 100,000 to 338 per 100,000,
a 25% increase during the period. Among children younger than 5, the
death rate from infectious diseases declined during the 12-year period.
Overall, during the period, age-adjusted mortality from infectious
diseases increased 39% in the U.S.

The bulk of the increase can be accounted for by the AIDS virus. During
the period 1980-1992, deaths attributed to AIDS appeared and then
increased to 13 per 100,000. However, if the AIDS virus is omitted
entirely from the statistics, the death rate due to infectious diseases
as the underlying cause still increased 22% during the period.

Deaths from infectious diseases not related to AIDS increased
substantially during the period. For example, the death rate for
respiratory infections increased 20%, from 25 to 30 deaths per 100,000,
and the rate of death from septicemia (a blood infection) increased
83%, from 4.2 to 7.7 per 100,000.

Among the leading causes of death in 1980, infectious diseases ranked
fifth in the U.S., based on underlying-cause-of-death data. (The big
four causes of death in 1980 were heart disease, cancers, strokes, and
accidents.) By 1992, infectious diseases ranked third, after
cardiovascular disease and cancers.

This analysis has underestimated the contribution of infectious agents
to the U.S. death rate because it counted only deaths in which
infection was clearly the "underlying cause." Infections contributed to
--but were not the "underlying cause" of --many more deaths than those
counted in this analysis, the authors of the study say.

The authors of the study cannot explain all of the increases that they
observed. They think some of the increases may have been caused by
improper food handling, and by the appearance of microbes that are
resistant to antibiotics.

The development of microbes resistant to antibiotics is now recognized
as a large and growing public health problem. (See REHW #402.)

Medical researchers concerned about increasing rates of infectious
disease are recommending wider use of the vaccine that is now available
for pneumonia caused by the bacterium, STREPTOCOCCUS PNEUMONIA.[2]

They are also recommending that physicians prescribe antibiotics
prudently. (Unnecessary use of antibiotics is a major cause of the
development of antibiotic-resistant strains of bacteria.) Furthermore,
they urge people with a case of the sniffles to stop demanding
antibiotics from their doctor. The common cold is caused by viruses,
not bacteria, and antibiotics are not effective against viruses. Use of
antibiotics to treat the common cold merely increases the number of
antibiotic-resistant bacteria in the world. Many physicians report that
they prescribe antibiotics for colds, even though they know such a
remedy will not be effective, because patients demand it.

In addition to antibiotic-resistant microbes, another possible
contributor to the rising death rate from infectious diseases is damage
to the human immune system. Immune system damage is known to occur as a
result of our constant exposure to combinations of exotic chemicals.
For example, the National Academy of Sciences acknowledged in a 1992
study, "In the general population, increasing numbers of people suffer
from disorders of the immune system, such as allergies, asthma, and
AIDS. The incidence of asthma has increased 58% since 1970, and it is
well known that nitrogen dioxide and ozone, common air pollutants,
interact with allergens to increase the frequency and severity of
asthma attacks."[3]

The immune system is a complex set of specialized cells and organs that
defends the body against attack by invaders. When it functions
properly, the immune system fights off diseases caused by bacteria,
viruses, fungi, parasites, and cancer cells. "When it malfunctions,
however, it can unleash a torrent of diseases, from allergy to
arthritis to cancer to AIDS," according to the federal National
Institutes of Health (NIH).[4] When it malfunctions, the immune system
can fail to protect against infectious diseases.

In 1996, a study of pesticides and the immune system, published by the
World Resources Institute (WRI), examined a growing body of literature
from around the world, showing that many common pesticides degrade the
immune systems of laboratory animals, wildlife, and humans.[5]

WRI examined studies of all major classes of pesticides --
organochlorines such as DDT, organophosphates such as malathion, and
carbamates such as aldicarb.

Though most of the studies were of laboratory animals, WRI reviewed
studies of wildlife as well.

In a controlled experiment, Dutch virologist Albert D.M.E. Osterhaus of
Erasmus University in Rotterdam fed two groups of harbor seals fish
from different sources.[6] One group of seals received relatively clean
fish from the North Atlantic and the other group received fish from the
industrially-polluted Baltic sea. The Baltic fish contained 10 times as
much organochlorine pollution (for example, DDT and PCBs) as the
Atlantic fish. Osterhaus emphasized that both kinds of fish were taken
from catches destined for (and considered legally fit for) human
consumption.

For 2 years, Osterhaus sampled blood from the seals every six to nine
weeks and made various measurements of immune system function. Almost
immediately after the experiment began, vitamin A levels dropped 20 to
40 percent in the blood of seals fed fish from the Baltic and remained
low throughout the 2-year experiment. Vitamin A is associated with
disease resistance; lower vitamin A levels in the blood correspond to
greater vulnerability to disease.

Seals fed Baltic fish showed another important change: the level of NK
cells in the blood remained 20 to 50 percent below normal throughout
the study. NK cells are "natural killer" cells that attack foreign
bodies in the blood, thus providing important immune protection.

Other key components of the immune system were compromised in the
Baltic-fed seals. In a healthy immune system, B cells produce
antibodies and T cells orchestrate the immune response to foreign
invaders. In the Baltic-fed seals, the T-cell response to a standard
set of antigens dropped 25 to 60 percent, compared to the Atlantic-fed
seals.

"I was surprised to see significant immune changes in animals that were
fed on a normal diet using fish fit for human consumption," Osterhaus
says.[7]

WRI commissioned scientists in Eastern Europe to translate technical
studies of chemical effects on the human immune system. Lyudmila
Kovtyukh of the Academy of Sciences of Kishinev, Moldova (a republic
between Romania and the Ukraine) reported heavy use of pesticides
around Kishinev. She also reported that children living in the
pesticide-contaminated areas had unusually high incidence of acute
respiratory infections, including pneumonia, ear infections,
tuberculosis, and dental caries. Adults in the area also had unusually
high rates of infections. Scientists there measured diminished T cell
populations, and they were able to show a dose-response relationship
with pesticide exposure: the greater the pesticide exposure, the
greater the loss of T cells.[8]

An ongoing series of studies of Inuit natives in northern Quebec,
Canada, has shown that organochlorine contamination of the food chain
(including many pesticides) leads to a buildup of these toxic
substances in breast-fed Inuit babies.[9] Inuit infants and children
suffer from high incidence of infectious diseases, specifically ear
infections (chronic otitis),[10] and meningitis.[11] In some cases,
these children's immune systems are so damaged that they cannot be
vaccinated against disease because their immune systems cannot produce
the needed antibodies.

After the discovery of sulfa drugs in the 1930s, and other antibiotics
in the 1940s and '50s, many public health specialists assumed that
infectious diseases were readily controllable, and were perhaps even a
thing of the past. This gave rise to an emphasis on heart disease and
cancer. Now, however, we know that this perspective was mistaken.
Infectious diseases are making a comeback world-wide. Recent evidence
indicates that the dramatic failure of our regulatory system for
controlling toxic chemicals is contributing to the re-emergence of this
class of diseases, even in parts of the globe, such as the Arctic,
where use of toxic chemicals has been minimal.

In 1996 the American Medical Association acknowledged that worldwide
pollution, leading to global warming, is likely to increase the
incidence of infectious diseases in many human communities.[12] The
links between pollution and human disease have become impossible to
deny.

--Peter Montague (National Writers Union, UAW Local 1981/AFL-CIO)

=====

[1] Robert W. Pinner and others, "Trends in Infectious Diseases
Mortality in the United States," JOURNAL OF THE AMERICAN MEDICAL
ASSOCIATION January 17, 1996, pgs. 189-193.

[2] L. Seachrist, "Infections making a deadly comeback," SCIENCE NEWS
Vol. 149 (January 20, 1996), pg. 38. And see Daniel B. Jernigan and
others, "Minimizing the Impact of Drug-Resistant Streptococcus
Pneumonia (DRSP)," JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION January
17, 1996, pgs. 206-209.

[3] David W. Talmage and others, BIOLOGIC MARKERS IN IMMUNOTOXICOLOGY
(Washington, D.C.: National Academy Press, 1992), pg. 1.

[4] Lydia Woods Schindler, UNDERSTANDING THE IMMUNE SYSTEM [NIH
Publication No. 88-529] (Bethesda, Md.: National Institutes of Health,
July, 1988), pg. 1.

[5] Robert Repetto and Sanjay S. Baliga, PESTICIDES AND THE IMMUNE
SYSTEM: THE PUBLIC HEALTH RISKS (Washington, D.C.: World Resources
Institute, 1996). Available for $14.95 from WRI Publications, P.O. Box
4852, Hampden Station, Baltimore, MD 21211. Telephone: 1-800-822-0504,
or (410) 516-6963. fax: (410) 516-6998. E-mail: chrisd@wri.org.

[6] Peter S. Ross, Rik L. De Swart, and Albert D.M.E. Osterhaus,
"Contaminant-related Suppression of Delayed-type Hypersensitivity and
Antibody Responses in Harbor Seals Fed Herring from the Baltic Sea,"
ENVIRONMENTAL HEALTH PERSPECTIVES Vol. 103, No. 2 (February 1, 1995),
pgs. 162-167.

[7] Janet Raloff, "Something's Fishy," SCIENCE NEWS Vol. 146 (July 2,
1994), pg. 9.

[8] See J. Raloff, "Pesticides may challenge human immunity," SCIENCE
NEWS Vol. 149 (March 9, 1996), pg. 149.

[9] Eric Dewailly and others, "Inuit Exposure to Organochlorines
through the Aquatic Food Chain in Arctic Quebec," ENVIRONMENTAL HEALTH
PERSPECTIVES Vol. 101, No. 7 (December 1993), pgs. 618-620.

[10] G. Julien and others, "Chronic otitis and hearing deficit among
native children from Kuujjuaraapik (Northern Quebec): a pilot project,"
CANADIAN JOURNAL OF PUBLIC HEALTH Vol. 78 (1987), pgs. 57-60.

[11] J.F. Proulx, "Meningitis in Hudson's Bay, Northern Quebec,
Canada," ARCTIC MEDICAL RESEARCH Vol. 47 (1988), pgs. 686-687.

[12] Jonathan A. Patz and others, "Global Climate Change and Emerging
Infectious Diseases," JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Vol.
275, No. 3 (January 17, 1996), pgs. 217-223.

Descriptor terms: disease statistics; infectious diseases; american
medical association; aids; bacteria; viruses; immune system; mortality
statistics; cancer; heart disease; accidents; stroke; septicemia;
antibiotic resistance; resistance; pneumonia; world resources
institute; pesticides; wildlife; seals; atlantic ocean; baltic sea;
ddt; pcbs; estern europe; moldava; inuit; quebec; canada; otitis; ear
infections; meningitis; global warming; children;