ATSDR in Partnership With Missouri
The Agency for Toxic Substances and Disease Registry (ATSDR) is the lead
public health agency responsible for implementing the health-related provisions
of the Comprehensive Environmental Response, Compensation, and Liability Act of
1980 (CERCLA). ATSDR is an Atlanta-based federal agency with more than 400
employees and an annual budget for 2003 of approximately $82 million. ATSDR is
responsible for assessing the presence and nature of health hazards at specific
Superfund sites, helping to prevent or reduce further exposure and illnesses
resulting from those hazards, and expanding the knowledge base about the health
effects of exposure to hazardous substances.
ATSDR works closely with state agencies to carry out its mission to serve the
public by using the best science, taking responsive public health actions, and
providing trusted health information to prevent harmful exposures and disease
related to toxic substances. ATSDR provides funding and technical assistance to
states and other partners through cooperative agreements and grants to identify
and evaluate environmental health threats to communities. These resources enable
state and local health departments and other grantees to further investigate
environmental health concerns and to educate communities. From
fiscal
years 1983 through 2003, ATSDR awarded more than
$10.8 million—more
than
$1.2 million in the last 2 years—in direct funds and
services to
Missouri for comprehensive support of its
environmental health unit. In addition to direct funds and services, ATSDR staff
provides technical and administrative guidance for state-conducted site
activities.
ATSDR Site-Specific Activities
Public Health Assessment-Related Activities
One of the agency's important mandates is to conduct
public health
assessments of all National Priorities List (NPL) sites and of other
sites where a significant threat to public health might exist.
Thirty-two sites have been designated to the NPL in
Missouri.
A public health assessment is a written, comprehensive
evaluation of available data and information on the release of hazardous
substances into the environment in a specific geographic area. Such releases are
assessed for current or future impact on public health. ATSDR, in collaboration
with public health and environmental officials from Missouri,
has conducted 38 health assessments in the state, including the
following recent examples.
Riverfront—The Riverfront site consists of
six operational units (OUs) located throughout the city of New Haven
and at the old city dump. The contaminants of concern at this site are
tetrachloroethylene (TCE) and its breakdown products. ATSDR and the
Missouri Department of Health and Senior Services (MDHSS)
have distributed pertinent toxicological information about TCE and its
breakdown products to residents and attended community meetings and public
availability sessions to discuss health effects of exposure to the
contaminants of concern. The U.S. Environmental Protection Agency (EPA)
sampled private wells to determine whether unsafe levels of contaminants
were present in the wells. At the recommendation of ATSDR and MDHSS,
whole-house filtration systems have been installed in residences at which
contaminant levels exceeded the EPA maximum contaminant level (MCL). MDHSS
has written a health assessment that has been released for public comment;
the document should be finalized in 2004.
Oak Grove Village Well—The Oak Grove Village
Well site is an uncontrolled and undefined plume of trichloroethylene
(TCE)-contaminated groundwater. TCE contamination was originally detected in
the well in 1986 by the Missouri Department of Natural Resources
(MDNR) at levels above the EPA MCL.
MDHSS, in cooperation with ATSDR, evaluated the public
health impact of the site. A health assessment released for public comment
in August 2003 assessed past, current, and future exposure to the
contaminated groundwater at the site. At EPA's request, the health
assessment also considered the health implications of Oak Grove Village
reactivating its well for public use until a new well can be drilled and put
into operation.
The health assessment concluded that this site is an indeterminate public
health hazard because it is not known whether the well will need to be
reactivated and because the future levels of TCE contamination in the old
Oak Grove Village well, the new well, or any other wells are not known.
A health consultation is also being written for La Jolla Springs,
which runs through Meramec Caverns and is being
contaminated by the same plume that is affecting Oak Grove Village.
A health consultation is a written or oral response from
ATSDR to a specific request for information about health risks related to a
specific site, chemical release, or hazardous material. It is a more limited
response than a public health assessment is. To date, 528
documented health consultations have been conducted at 155
sites in Missouri, including the following recent examples.
Herculaneum Lead Smelter—MDOH
and ATSDR have conducted several health-related activities at the 52-acre
Herculaneum Lead Smelter site in Herculaneum. The facility
has been in operation for more than 100 years. Test results have determined
that lead exposures to community residents pose an unacceptable public
health hazard. In February 2002, screening conducted by MDHHS
and ATSDR determined that 28% of children in the area had elevated
blood-lead levels. This represents an urgent public health hazard.
In March 2003, MDHSS, in cooperation with ATSDR, presented preliminary
results of all known blood-lead data collected from Herculaneum
residents in 2002 to the Herculaneum Community Advisory Group.
A health consultation released in August 2003 further evaluated those data
and compared them to the 2001 blood-lead data. This health consultation also
evaluated the blood-lead data collected for children under 72 months of age
who were serially tested in both 2001 and 2002.
The blood lead data reviewed indicate that exposures have occurred, are
occurring, and are likely to occur in the future and that these exposures
may have an adverse impact on human health. Consequently, this site has been
classified as a public health hazard.
Riverfront—ATSDR and MDHSS have completed
several health consultations to address specific health-related issues at
individual OUs at the Riverfront site in New Haven. One
health consultation was instrumental in the decision to provide whole-house
filtration systems to affected residents to prevent further exposure.
Another health consultation was instrumental in EPA's decision to test
indoor air at residences near contaminant plumes to determine whether vapor
intrusion of contaminants was occurring at unsafe levels. ATSDR determined
that vapor intrusion of contaminants at this site does not pose a health
threat at this time. ATSDR and EPA are developing an indoor air sampling
plan for OU4.
John Garland Park Landfill—The contaminants of concern at
this site in Kansas City are methane gas and TCE and its
breakdown products. Methane gas is being released from the landfill into the
air via a landfill gas collection system. In addition, a plume of TCE is
migrating off-site toward an industrial park adjacent to the landfill.
Several health consultations have been completed at this site. The most
recent draft health consultation recommends the following: conducting
ambient air monitoring in the neighborhood adjacent to the landfill to
determine whether unsafe levels of landfill gas are being released into the
community; collecting soil samples at landfill leachate sites to determine
whether landfill contaminants are present at unsafe levels; and defining the
extent of the groundwater contaminant plume and determining whether any
industrial wells are threatened by the plume.
This site has been proposed for Brownfield redevelopment as a park. ATSDR
will continue to coordinate health-related activities with EPA to determine
whether the site can be safely redeveloped as a park.
Minker/Stout/Romaine Creek (M/S/RC)
Site—The M/S/RC site is one of the many sites in Missouri that was
contaminated indirectly with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) from
spraying waste oil for dust suppression. The waste oil had been mixed with
TCDD-contaminated sludge from a hexachlorophene production facility in
Verona. The TCDD-contaminated waste oil was sprayed as a dust
suppressant at a horse arena near Imperial in June 1971,
after which some horses died and others got sick. In March 1973, the
contaminated soil was removed and used to fill a ravine that had developed
next to the former Minker residence. The contaminated fill material in the
ravine eroded across other properties and eventually made its way to Romaine
Creek. The Minker portion of the site discussed in this health consultation
is a residential site that includes the Minker residence and neighboring
properties. EPA asked MDHSS, in cooperation with ATSDR, to complete this
health consultation to assess whether the remedial actions taken at the
Minker portion of the site are protective of public health. A similar
determination was previously provided for other portions of the M/S/RC site.
A health consultation released in June 2003 categorized the Minker portion
of the M/S/RC site as no public health hazard for current exposures for TCDD
contamination.
Washington County (Waco) Landfill—MDHSS,
under a cooperative agreement with ATSDR, prepared a health consultation to
address health-related concerns with regards to the construction permit
application for the Waco Landfill in Richwoods. In August
2002, Safe Handling of Waste Managed Environmentally (SHOW-ME), a coalition
of concerned citizens, petitioned ATSDR requesting a health assessment.
Because this landfill has not yet begun operation and no release of
contamination has occurred, a health assessment was not conducted. However,
a health consultation released in May 2003 provided a limited review of the
potential public health concerns related to the site. This limited
consultation concluded that as long as the facility is constructed,
operated, and maintained as described in the permit, this facility will not
pose a threat to public health.
An exposure investigation collects information on specific
human exposures through biologic sampling, personal monitoring, related
environmental assessment, and exposure-dose reconstruction. ATSDR has conducted
four exposure investigations in Missouri, including
the following recent example.
Herculaneum—In September 2001, ATSDR
released a report for an exposure investigation (EI) conducted for the Doe
Run Smelter in Herculaneum. This investigation focused on
identifying sources of lead exposure in children who had elevated blood lead
concentrations. With the assistance of the Missouri Department of
Health (MDOH), ATSDR recruited two families for
the EI.
ATSDR collected biological samples (blood, urine) from the family members
and environmental samples (water, soil, dust, air, paint) from the houses.
These samples were analyzed for lead and stable lead isotopes. The results
of these analyses were used to identify possible sources of lead exposure in
the children. ATSDR concluded that lead contamination from the smelter has
made a substantial contribution to lead contamination in air, windowsill
dust, and house dust in one of the houses. Lead from smelter emissions is
the most likely source of lead recontamination of soil in the yard of that
house.
Health Education and Community Activities
Missouri has been a participant in ATSDR's cooperative
agreement program since 1989. Under this program,
MDH has
received funding and technical assistance for the development of community
education and activities associated with human exposure to hazardous substances
in the environment. Lead Day at West Elementary in
Park Hills
featured a special appearance by Leadosaurus, MDHSS's lead-education mascot.
Lead Day featured six teams of health educators rotating among classes and
presenting a comprehensive lead-education program developed for
elementary-school students.
Health Studies
Health studies are investigations conducted to determine the relationships
between exposures to hazardous substances and adverse health effects. They also
define health problems that require further investigation through, for example,
health surveillance or an epidemiologic study. Following are examples of health
studies or investigations that ATSDR conducted or supported in
Missouri.
Hazardous Substances Emergency Events Surveillance
System (HSEES)—HSEES was established by ATSDR in
1990 to collect and analyze information about releases of hazardous
substances that need to be cleaned up or neutralized according to federal,
state, or local law, as well as threatened releases that result in a public
health action, such as an evacuation. The goal of HSEES is to reduce the
morbidity and mortality of first responders, employees, and the general
public resulting from hazardous substances emergencies. Fifteen state health
departments, including Missouri, currently participate in
HSEES. HSEES captures data on over 5,000 events annually. Of these, 80%
occur at fixed facilities, and 20% are transportation-related events. Most
events occur between 8:00 AM and 5:00 PM on Monday through Friday. Persons
most often injured are employees.
Multiple Sclerosis and the Amoco Refinery in Sugar Creek—Residents
of Sugar Creek, a small community near Kansas City that is
adjacent to an Amoco oil refinery, have indicated their concern about the
rate of multiple sclerosis (MS) in their community. Anecdotal information
suggested a twofold to fourfold elevation in MS prevalence above the U.S.
figures. The Jackson County Health Department (JCHD)
entered into a cooperative agreement with ATSDR in September 2000 to more
fully explore MS prevalence in the area. This research activity includes the
development of methods for case ascertainment and case confirmation and the
estimation of MS prevalence for Sugar Creek and the surrounding community of
Independence. These two communities have a combined population of
almost 120,000 persons.
Study of Childhood Blood-Lead Levels Following Environmental Cleanup—MDH
was awarded a grant to conduct a follow-up study of childhood blood-lead
levels following environmental cleanup. The objective of the study was to
evaluate whether interventions (soil remediation and community and
professional health education) in the area since 1991 reduced the mean
blood-lead levels of all children, thereby reducing the proportion of
children with elevated blood-lead levels.
Census activities started in February 2000 in the Joplin area and in March
2000 in areas outside of Joplin. More than 9,000 households
were visited during the census; 847 households were found to have children
aged 6 to 72 months living near the Jasper County Superfund Site
at least 60 days before the beginning of the study. Blood samples were
obtained from 216 children in the original study area and 71 children in the
expanded area. Environmental sampling was conducted. A parent or guardian of
each of the children involved in the study responded to questions about
behavioral risk factors associated with blood-lead levels. Study results
indicated that interventions to reduce blood lead levels of children living
in the mining waste and smelter area of Jasper County have been effective.
Only 2% of the children tested in 2000 had blood lead levels greater than 10
micrograms per deciliter. A final study report was published September 2002.
Determining the Prevalence of MS and Amyotrophic Lateral Sclerosis
(ALS) in Communities Living Around Hazardous Waste
Sites—In fiscal year 2002, ATSDR awarded a cooperative agreement to
MDHSS for a cross-sectional prevalence study and a cluster
investigation in Herculaneum and Jefferson County
to address community concerns of excess ALS and MS and to define the
epidemiologic characteristics of cases. MDHSS will analyze medical records
to ascertain all MS and ALS cases treated since January 1, 1998. Medical
records of cases will be abstracted by professional abstractors and verified
by a neurologist consultant. Prevalence estimates for ALS and MS will be
calculated and the possibility of clustering will be evaluated using
geographical statistical techniques.
December 2003