Chapter 17

It is only in the last 50 years that diseases linked to environmental contamination have been recognized in pediatrics. Most environmental exposures now understood to be harmful to children were initially identified as a result of acute epidemics of illness affecting groups of people. For example, polluted outdoor air was not well understood to be unhealthy until the London Smog of 1952.1 An estimated 4000 people died from exposures to the very heavy air pollution; deaths were unusually high among the very young and the elderly. This led to the development of the first laws to regulate air pollution. Mercury was not understood to be harmful until an epidemic of cerebral palsy occurred among infants living near Minamata Bay, Japan, in the 1950s (Minamata disease).2 Between 1959 and 1972 in Iraq, seed grain treated with a mercury fungicide was accidentally eaten by humans instead of being planted in the fields, and thousands of Iraqi people developed mercury poisoning.3,4

The harmful effects of polychlorinated biphenyls came to light in 1968 when an epidemic of acne occurred among people in Japan; the disease was traced to the use of cooking oil inadvertently mixed with polychlorinated biphenyls (PCBs). About 2000 Japanese people exposed to the oil were diagnosed with Yusho (oil disease).5-7 Dioxin’s health effects were not well known until 1975 when a chemical plant explosion in Seveso, Italy, released large amounts of dioxin, and children in the area near the explosion developed chloracne, especially on areas of the body unprotected by clothing.8-10 Drinking water contamination became well recognized in 1986 when a cluster of childhood leukemia was uncovered in Woburn, Massachusetts, and was epidemiologically linked to drinking water supplied from 2 municipal wells contaminated with seepage of the animal carcinogens trichloroethylene, tetrachloroethylene, and chloroform from area chemical disposal pits that had been in use for several decades.11 Natural toxins began being recognized as potentially important indoor contaminants when, in 1994, a cluster of cases of acute pulmonary hemorrhage among infants was linked to inhalation exposures to natural toxins produced by molds that grow in chronically water-damaged environments.12

One of the most important themes that emerged from these acute epidemics of environmental diseases was that, unlike some other specialty areas of pediatrics, in environmental pediatrics, treatment of the individual patient is not sufficient; it is critical to identify and eliminate the sources of exposure so that disease does not recur in the known patients and so that additional cases do not occur.

Most signs and symptoms of illnesses linked to environmental contaminants are nonspecific and may occur only in association with fairly high-level exposures. The signs and symptoms of high-level, acute poisoning are relatively well-characterized for most chemicals. In contrast, the effects of low-level, chronic, and mixed exposures are poorly studied, particularly in infants and children. Establishing the environmental cause of a given illness is further complicated by the similarity of pollutant ...

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