1. Presenter Disclosures
Arnold Schecter, MD, MPH
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose.

2. Update: Vietnam and Agent Orange
Arnold Schecter, MD, MPH
APHA 2010
Division of Environmental and Occupational Health Sciences, University of Texas School of Public Health, Dallas, TX, U.S.

3. Agent Orange Agent Orange: Sprayed in Vietnam 1962-1971
Spraying stopped due to science but mostly public outcry
Agent Orange was half 2,4-D and half 2,4,5-T
2,4,5-T phenoxyherbicide contaminated with 2,3,7,8-TCDD (the most toxic dioxin)
Spraying was in parts of southern Vietnam only
1975: U.S. Vietnam War ends

4. Ranch Hand Herbicide Spraying Missions Red Area Indicates Sprayed Areas

5. Worldwide Research Dioxin can cause: Cancer Immune deficiency
Nervous system problems
Reproductive problems
Developmental problems

6. Worldwide Research (Continued)
Endocrine system damage
Skin pathology (including chloracne)
Liver damage
High blood pressure
Heart attacks

7. (U.S.) “Veterans and Agent Orange, Update 2009” Institute of Medicine (IOM) U.S. National Academy of Sciences (NAS)
New diseases added:
B cell leukemias, such as hairy cell leukemia
Parkinson's disease
Ischemic heart disease
Institute of Medicine. (2009). Veterans and Agent Orange Update 2009.

8. Agent Orange Sprayed by Aircraft
85 % was sprayed from fixed wing aircraft

9. 15 % - sprayed from back packs, naval vessels and helicopters
Agent Orange Spraying
15 % - sprayed from back packs, naval vessels and helicopters

10. Barrels of Agent Orange

11. Research History (1)
Research began in the 1970’s with Harvard University:
Most toxic dioxin (TCDD) very high levels in:
Vietnamese nursing mothers’ milk (1845, now 1.0 ppt)
Vietnamese fish from sprayed area
Baughman, R, Meselson, M. Environmental Health Perspectives. 1973; 5:27-35.

12. Research History (2)
1980s: International Agent Orange conference (Ho Chi Minh City, Vietnam) with Committee, J. Constable, M. Hatch (U.S.)
1980s – 2010: Vietnam Ministry of Defense and Soviet/Russian collaboration; Tropical Medicine Institute
1980s – 2000s: Vietnam – epidemiology, cancer, reproductive effects
1990s: France – epidemiology, cancer, reproductive effects

13. Research History (3)
1984 – 2010: U.S./Vietnam measured dioxins in people and the environment
1980s – 2009: U.S., Canadians, and Vietnamese report TCDD elevated in Vietnamese, wildlife, and environmental samples

14. Research History (4)
1980s – 2009: Elevated TCDD in people, wildlife, food (Bien Hoa, Da Nang, Central Highlands) with Constable, Schecter, Hatfield group, Russian lab, Hoang Dinh Cau, Le Cao Dai, Hoang Trong Quynh, others
Second international Agent Orange meeting in Hanoi, Vietnam sponsored by Committee

15. Research History (5) 2000s: Founding of Vietnam dioxin laboratories
Ho Chi Minh City (1)
Hanoi (1) – second under construction
2000s: Remediation planning and efforts in Vietnam
Funding: U.S. and Vietnam governments, Ford Foundation and others

16. 2,3,7,8 TCDD and Dioxin TEQs (lipid, ppt) in Vietnamese Blood Collected 1991 – 1992
Schecter A, Dai LC, Thuy LTB, Quynh HT, Minh DQ, Cau HD, Phiet PH, Phuong NTN, Constable JD,
Baughman R, Päpke O, Ryan JJ, Fürst P, Räisänen S. American Journal of Public Health ;85(4):

17. Financial Support Vietnam government
U.S. Congress: $6 million+ over 4 years for remediation study and health improvement
NGOs: Ford Foundation led the way but is ending Agent Orange work in 2010

18. TCDD and TEQ in Food from Bien Hoa, 2003 (ppt ww)
*Channa Striatta (snakehead)
Schecter AJ et al. J Occup Environ Med. 2003; 45:

19. TCDD TEQ from Bien Hoa City and Aluoi Valley ‘hot spots’ (ppt)
*EU Maximum Level 4 ppt (lipid) ** EU Max Level 8 ppt (ww) *** EU Max Level 1.5 ppt (lipid)
1. Dwernychuk L, et al. Chemosphere :
2 Schecter A et al. J Occup Environ Med. 2003; 45:

20. Bien Hoa City Residents (2008)
Knowledge about dioxins is limited
Unaware of routes of exposure
Little concern for health impacts of dioxins
Few are taking preventive measures
66% of people surveyed did not care or know the sources of food that they ate daily
Le Vu Anh et al. Organohalogen Compounds Volume 70, 2008,

21. Da Nang Airbase (2009) High TCDD levels in localized areas:
Soil up to 365,000 ppt TEQ
Sediment up to 6,270 ppt TEQ
Fish up to 3,000
Vegetables up to 2,174
However, newest data has not been released
Le Thi Haoi 2009 Organohalogen Compounds. Dioxin 2009

22. Compensation, Remediation
2000s: Compensation by Vietnamese government to Vietnam “Victims of Agent Orange”
2010: Remediation with medium temperature soil treatment to begin
High temperature incineration too expensive
Toxic waste landfills require lifelong monitoring but not expensive initially
Bacterial remediation inadequate for large scale treatment

23. Remediation Da Nang Airbase (2008)
$ Ford Foundation + U.S. Congress + U.S. EPA + Vietnam government
Progress:
Construction of integrated facilities:
Preventing infiltration and land erosion
Monitoring
Special filtration systems
New reservoir and overflow dam
Warnings and bans in contaminated areas
Canh, P.N. Organohalogen Compounds, Volume 70, 2008,

24. Dioxin Concentrations in Three “Dioxin Hotspots”
Location n
Range (I-TEQ, pg/g dry wt)
Estimation for dioxin cleanup area (m2)
1Da Nang 63
4.3 – 200,338
~ 104,000
1Bien Hoa 54
ND – 409,818
~ 30,000
1Phu Cat 12
0.1 – 49,462
> 2,000
2Bien Hoa 4
ND – 1,164,699 NA
1. Son LK, Sau TK, Lanh DN, Net NX, Truong NX, Minh NV, Tam TN. Organohalogen Compounds. 2007; 69:
2. Schecter, A, Dai, LC, Papke, O, Prange, J, Constable, JD, Matsuda, M, Thao, VD, Piskac, AL. Journal of Occupational and Environmental Medicine. 2001; 43:

25. Agent Orange: The Future
Remediation
Health monitoring
Vietnam
U.S.
Elsewhere
Prevention/treatment of individuals potentially exposed to Agent Orange

26. Acknowledgements The people of Vietnam
Vietnamese exposed to Agent Orange
U.S. veterans exposed to Agent Orange
Vietnamese scientists and agencies
Collaborating dioxin scientists from many countries
Agencies which funded our public health work