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Exposure
Environmenul Indicators
625
BERTAZZI ET AL.
zones.
W__ E
Zone A
efefee
zone
Human Indicators
Early signs such as skin lesions and in
particular chloracne were markers to iden-
tify people
Figure 1. Map of the Seveso accident area showing the trichlorophenol plant, Icmesa, where the Tl ODD exposure
occurred, the three contamination zones, A, B, and R, and the surrounding noncontaminated area adc
pted
as
ref-
erence zone.
detectable TCDD was found in the thick samplers were used. TCDD wa 5S found in
upper 15-cm layer in 1977, and no further
15 of 19 sediment specimens sam pled in the
significant changes were observed after part of zone A nearest to the plan where the
that time (7). This information guided all accident took place. Values rajnged from
the reclamation processes. In zone A the 0.06 to 2.1 ng of TCDD/g of dust for dustentire top soil layer (at least 25 cm) was fall jar specimens and 0.17 to 0.50 ng of
removed and the area covered with fresh TCDD/g of dust for samples frorm high-voluncontaminated soil. Rehabilitation of ume samplers. Maximum TCI )D fallout
zone B entailed soil removal in public and
deposits occurred at the beginniing of the
private gardens only, whereas in the remain- summer and decreased with iincreasing
ing territory the top soil underwent treat- distance from the plant (10).
ments such as plowing, harrowing, and
TCDD levels in vegetatic in rapidly
sowing to dilute surface TCDD and help decreased as distance from tIhe factory
in its dispersal (9). TCDD levels in ground increased (6). Immediately afte r the acciand surface water and in sediment showed dent, TCDD levels reached va.lues up to
consistently negative results that confirmed several milligrams/kilogram, whiile in new
the low solubility of TCDD (6).
vegetation that grew in the yearss following
Airborne dust was monitored to evaluate the accident TCDD levels drropped by
the possibility that TCDD-containing par- several orders of magnitude (11'
ticles were airborne from the contaminated
Shortly after the accident arn outbreak
soils, particularly during the reclamation of animal deaths, mainly rabbits and poulworks; both dustfall jars and high volume try, was noted (12). Table 1 repworts rabbit
626
most
probably exposed
to
thousands of blood
Table 1. Estimated rabbit mortality in the Seveso accident area, July to August 1976.
Rabbits,
estimated no.
Contamination zone
1089
A, High exposure
4814
B, Medium exposure
18,982
R, Low exposure
Data adapted from Fanelli et al. (13).
Observed
deaths, no.
348
426
1288
Mortality, %
31.9
8.8
6.8
Table 2. Distribution of chloracne cases diagnosed in children 3 to 14 years of age in an 8-month period following
the Seveso accident.a
Prevalence, %
Chloracne cases, no.
Total population
19.6
42
214
A
48.1
26
54
Maxb
0.5
8
1468
B
0.7
63
8680
R
2.5
19
750
Poloc
0.1
51
48,263
Reference
factory.
R
to
the
closest
cPart
of
zone
of
zone
A
closest
to
the
factory.
bPart
et
al.
(
15).
from
Caramaschi
&Data adapted
Contamination zone
627
BERTAZZI ET AL.
628
Table 4. Mortality, 1976 to 1991, among the population involved in the Seveso accident, zone A (high-exposure area).
Males
Females
Cause of death, lCD-9classificationa
Obs
Exp
RR
95% Cl
Obs
Exp
RR
95% Cl
All causes (000-999)
39
38.3
1.0
0.7-1.4
31
29.5
1.1
0.7-1.5
0
Diabetes (250)
0.6
2
1.1
1.8
0.4-7.0
All circulatory disease (390-459)
21
12.8
1.6
1.1-2.5
12
12.3
1.0
0.6-1.7
Chronic rheumatic heart disease (393-398)
0
0.1
3
0.2
15.8
5.0-50.8
Hypertension (400-405)
1
0.4
2.3
0.3-16.2
3
0.8
3.6
1.1-11.0
Ischemic heart disease (410-414)
9
6.0
1.5
0.8-2.8
1
3.7
0.3
0.0-2.0
Acute myocardial infarction (410)
4
4.3
0.9
0.3-2.5
1
1.8
0.6
0.1-4.0
Chronic ischemic heart disease (412, 414)
0
5
1.6
3.0
1.2-7.3
2.4
Other heart diseases (420-429)
3
1.7
1.8
0.6-5.5
3
2.2
1.4
0.4-4.3
Cerebrovascular disease (430-438)
5
3.3
1.5
2
0.6-3.7
4.1
0.5
0.1-2.0
Respiratory disease (460-519)
5
2.1
2.4
1.0-5.7
2
1.5
1.3
0.3-5.3
Chronic obstructive pulmonary disease (490-493)
4
1.1
3.7
1.4-9.8
1
0.5
2.1
0.3-14.9
2
Digestive disease (520-579)
3.1
0.7
0.2-2.6
2
1.6
1.2
0.3-5.0
All cancers (140-208)
6
0.4
13.5
0.2-1.0
10
8.5
1.2
0.6-2.2
0
Stomach (151)
1.8
1
1.1
0.9
0.1-6.7
Colon (153)
0
0.8
2
0.8
2.6
0.6-10.5
Pancreas (157)
1
0.5
1.9
0.3-13.5
0
0.3
Other digestive (159)
0
0.2
2
0.2
8.1
2.0-32.8
Lung (162)
4
4.2
1.0
0.4-2.6
0
0.5
Melanoma (172)
0
0.1
1
0.1
9.4
1.3-68.8
Breast (174)
0
0.0
1
1.8
0.6
0.1-3.9
Ovary (183)
1
0.4
2.3
0.3-16.5
Prostate (185)
0
0.7
Bladder (188)
1
0.4
2.4
0
0.1
0.3-16.8
'ICD-9 classifications are in parentheses. Abbreviations: Exp, expected deaths; ICD-9, Intemational Classification of Diseases, Ninth Revision (World Health Organization,
Geneva); Obs, observed deaths.
Table 5. Mortality, 1976 to 1991, among the population involved in the Seveso accident, zone B (medium-exposure area).
Males
Cause of death, /CD-9classificationa
Obs
Exp
RR
95% Cl
All causes (000-999)
275
288.4
1.0
0.8-1.1
Diabetes (250)
6
4.9
1.2
0.5-2.7
All circulatory disease (390-459)
94
100.7
0.9
0.8-1.1
Chronic ischemic heart disease (412, 414)
18
13.9
1.3
0.8-2.1
Respiratory disease (460-519)
13
18.2
0.7
0.4-1.2
Chronic obstructive pulmonary disease (490-493)
9
9.3
1.0
0.5-1.9
Digestive disease (520-579)
15
20.8
0.7
0.4-1.2
All cancers (140-208)
104
1.1
0.6-1.3
93.8
Digestive (150-159)
33
35.6
0.9
0.6-1.3
Esophagus (150)
1
2.7
0.4
0.1-2.6
Stomach (151)
10
12.1
0.8
0.4-1.5
Colon (153)
5
6.0
0.8
0.3-2.0
Rectum (154)
7
2.4
2.9
1.3-6.2
Hepatobiliary (155-156)
4
7.2
0.6
0.2-1.5
liver (155)
4
6.5
0.2-1.7
0.6
Pancreas (157)
2
3.6
0.6
0.1-2.2
Respiratory(160-165)
40
1.2
32.0
0.9-1.7
Lung (162)
34
1.2
0.9-1.7
27.6
Bone (170)
0
0.6
Soft-tissue sarcoma (171)
0
0.3
Melanoma (172)
0
0.4
Breast (174)
0
0.1
Genitourinary tract (179-189)
10
10.5
1.0
0.5-1.8
Uterus (179-182)
Ovary (183)
Prostate (185)
6
1.2
0.6-2.8
4.8
Bladder (188)
3
3.2
0.9
0.3-3.0
1
0.1-5.5
Brain (191)
1.3
0.8
Thyroid gland (193)
1
0.2
4.9
0.6-39.0
Lymphohemopoietic (200-208)
12
2.4
1.3-4.2
5.1
Hodgkin's (201)
2
0.6
3.3
0.8-14.0
Non-Hodgkin's (200, 202)
2
1.4
1.5
0.4-6.0
1.1
Myeloma (203)
1
0.9
0.2-8.2
1.4-6.7
7
2.2
3.1
Leukemia (204-208)
0.7
2.9
Lymphatic (204)
0.7-12.3
2
0.9
3.3
1.0-10.6
Myeloid (205)
3
/CD-9classifications are in parentheses.
Females
Obs
193
13
79
16
10
8
13
48
18
0
7
3
2
4
3
1
2
2
1
0
0
9
5
1
0
Exp
193.8
7.4
80.6
12.5
10.0
3.2
10.3
54.2
21.3
0.6
6.8
4.9
1.6
3.5
2.3
1.8
4.0
3.5
0.4
0.2
0.7
11.4
7.7
3.0
2.7
0
3
1
0.9
0.9
0.3
3.9
7
2
0
4
1
0
0.3
1.2
0.6
1.8
0.5
0.1
RR
1.0
1.8
1.0
1.3
1.0
2.5
1.3
0.9
0.8
-
1.0
0.6
1.3
1.1
1.3
0.5
0.5
0.6
2.6
-
0.8
0.6
0.3
95% Cl
0.9-1.1
1.0-3.0
0.8-1.2
0.8-2.1
0.5-1.9
1.2-5.0
0.7-2.2
0.7-1.2
0.5-1.3
-
0.5-2.2
0.2-1.9
0.3-5.1
0.4-3.1
0.4-4.1
0.1-3.9
0.1-2.0
0.1-2.3
0.3-19.4
-
0.4-1.5
0.3-1.6
0.0-2.4
3.2
3.2
1.8
6.5
-
6.6
0.6
1.0-10.3
0.4-24.5
0.8-3.8
1.5-29.0
-
2.3-18.5
0.1-4.0
629
BERTAZZI ET AL.
Table 6. Mortality, 1976 to 1991, among the population involved in the Seveso accident, zone R (low-exposure area).
Males
RR
Obs
95% Cl
Cause of death, /CD-9classificationa
Exp
All causes (000-999)
2032
1.0-1.1
1.0
1964.0
1.1
38
1.8-1.5
Diabetes (250)
34.7
All circulatory disease (390-459)
755
1.0-1.2
1.1
684.7
133
Chronic ischemic heart disease (412, 414)
1.2-1.7
1.4
93.7
Hypertension (400-405)
1.3
34
25.3
0.9-1.9
133
Respiratory disease (460-519)
1.1
122.0
0.9-1.3
74
Chronic obstructive pulmonary disease (490-493)
1.2
63.0
0.9-1.5
Digestive disease (520-571)
1.1
165
144.3
1.0-1.3
All cancers (140-208)
654.5
0.9
607
0.9-1.0
Digestive (150-159)
249.2
226
0.9
0.8-1.0
18.9
1.6
Esophagus (150)
30
1.1-2.4
Stomach (151)
76
85.0
0.9
0.7-1.1
41.4
Colon (153)
34
0.8
0.6-1.2
19
16.8
Rectum (1 54)
1.1
0.7-1.8
Hepatobiliary (155-1 56)
50.4
35
0.7
0.5-1.0
Liver (1 55)
31
0.7
45.8
0.5-1.0
Pancreas (157)
20
25.3
0.8
0.5-1.3
Other digestive (159)
6
8.6
0.7
0.3-1.6
208
Respiratory (160-1 65)
225.2
0.9
0.8-1.1
176
Lung (162)
194.4
0.9
0.8-1.1
Bone (170)
2
4.2
0.5
0.1-2.0
Soft-tissue sarcoma (171)
4
1.9
2.1
0.7-6.5
Melanoma (172)
3
2.8
1.1
0.3-3.7
Breast (1 74)
0
0.6
73
72.3
1.0
Genitourinary tract (179-189)
0.8-1.3
Uterus (179-182)
Ovary (183)
Prostate (185)
1.2
39
33.0
0.8-1.7
Bladder (1 88)
21
22.1
0.9
0.5-1.5
Brain (191)
12
1.3
9.0
0.7-2.5
0
Thyroid gland (193)
1.5
Lymphohemopoietic (200-208)
27
0.8
34.8
0.5-1.2
Hodgkin's (201)
0
4.0
Non-Hodgkin's (200, 202)
10
9.4
1.1
0.5-2.1
Myeloma (203)
5
6.3
0.8
0.3-2.0
Leukemia (204-208)
12
15.1
0.8
0.4-1.5
Lymphatic (204)
6
4.5
1.3
0.5-3.2
4
Myeloid (205)
6.3
0.6
0.2-1.8
in
8/CD-9 classifications are parentheses.
630
have been caused by the social and emotional impact of the disaster (44). In addition, the immunotoxic action of dioxin
may have impaired defense mechanisms
that usually protect against respiratory
infection episodes, which play major roles
in the natural history of COPD (54). The
possible role of smoking as a confounding
factor, if even present, cannot explain the
high RR values for these causes. In fact,
the index and reference populations were
closely comparable with regard to this
factor (42), and smoking-related cancers
were not increased among the exposed
population. Few other epidemiologic
studies addressed the association of TCDD
Females
Obs
1695
75
797
141
74
84
37
89
401
158
5
58
33
12
25
12
11
Exp
35
29
7
0
3
67
65
27
21
1617.0
63.4
701.2
111.0
48.3
87.7
28.1
83.6
435.2
177.5
5.4
57.4
40.9
12.9
29.4
19.6
15.1
13.4
32.2
27.7
2.9
1.5
5.0
88.6
61.0
23.7
20.7
4
8
2
29
4
8
5
12
3
4
6.2
7.2
2.4
30.5
2.1
9.3
5.1
13.9
3.9
6.9
11
RR
1.0
1.2
1.1
1.3
1.5
1.0
1.3
1.1
0.9
0.9
0.9
1.0
0.8
0.9
0.8
0.6
0.7
0.8
1.1
1.0
2.4
95% Cl
1.0-1.1
0.9-1.5
0.6
0.8
0.2-2.0
0.6-1.0
0.8-1.4
1.1
1.1
1.0
0.6
1.1
0.8
1.0
1.9
0.9
1.0
0.9
0.8
0.6
1.0-1.2
1.1-1.5
1.2-2.0
0.8-1.2
0.9-1.9
0.8-1.3
0.8-1.0
0.8-1.0
0.4-2.4
0.8-1.3
0.6-1.2
0.5-1.7
0.6-1.3
0.3-1.1
0.4-1.4
0.4-1.5
0.8-1.5
0.7-1.6
1.0-5.7
0.8-1.7
0.5-1.6
0.2-1.8
0.5-2.4
0.2-3.6
0.6-1.4
0.3-5.8
0.4-1.8
0.4-2.5
0.5-1.6
0.2-2.6
0.2-1.6
14.
15.
16.
17.
18.
19.
20.
1985;155-174.
21.
1994;587-632.
22.
23.
24.
Press, 1983;215-225.
25. Bertazzi PA, Pesatori AC, Zocchetti C. The Seveso accident.
In: Geographical and Environmental Epidemiology: Methods
631
BERTAZZI ET AL
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
632
1:124-142 (1979).
633