DTIC ADA499675: A Probabilistic Risk Assessment for Deployed Military Personnel After the Implementation of the Leishmaniasis Control Program at Tallil Air Base, Iraq

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MODELING/GIS,RISKASSESSMENT,ECONOMICIMPACT
A Probabilistic Risk Assessment for Deployed Military Personnel After
the Implementation of the “Leishmaniasis Control Program”
at Tallil Air Base, Iraq
JEROMEJ.SCHLEIER,III,1,2RYANS.DAVIS,3LORENM.BARBER,1PAULAA.MACEDO,4
ANDROBERTK.D.PETERSON1
J.Med.Entomol.46(3):693Ð702(2009)
ABSTRACT LeishmaniasishasbeenofconcerntotheU.S.militaryandhasre-emergedinimpor-
tancebecauseofrecentdeploymentstotheMiddleEast.Weconductedaretrospectiveprobabilistic
riskassessmentformilitarypersonnelpotentiallyexposedtoinsecticidesduringthe“Leishmaniasis
ControlPlan”(LCP)undertakenin2003atTallilAirBase,Iraq.Weestimatedacuteandsubchronic
risksfromresmethrin,malathion,piperonylbutoxide(PBO),andpyrethrinsappliedusingatruck-
mountedultra-low-volume(ULV)sprayerandlambda-cyhalothrin,cyßuthrin,bifenthrin,chlorpyr-
ifos,andcypermethrinusedforresidualsprays.Weusedtheriskquotient(RQ)methodforourrisk
assessment (estimated environmental exposure/toxic endpoint) and set the RQ level of concern
(LOC)at1.0.AcuteRQsfortruck-mountedULVandresidualspraysrangedfrom0.00007to33.3at
the95thpercentile.Acuteexposuretolambda-cyhalothrin,bifenthrin,andchlorpyrifosexceededthe
RQLOC.SubchronicRQsfortruck-mountedULVandresidualspraysrangedfrom0.00008to32.8
atthe95thpercentile.Subchronicexposurestolambda-cyhalothrinandchlorpyrifosexceededthe
LOC. However, estimated exposures to lambda-cyhalothrin, bifenthrin, and chlorpyrifos did not
exceedtheirrespectivenoobservedadverseeffectlevels.
KEYWORDS organophosphate,pyrethroid,sandßy,Phlebotomus,Leishmania
Leishmaniasis has been of concern to U.S. military pendingontheregionandthestrain(Seamanetal.
personnelinthe20thcenturyandhasre-emergedin 1996).MucosalleishmaniasisisgenerallyaNewWorld
importance because of recent deployments to the diseaseandisrelativelyrare(Kenneretal.1999).In
MiddleEast(Magilletal.1993,AFPMB1999,Weina 1990and1991,therewere20casesofcutaneousleish-
etal.2004).Althoughleishmaniasisisnotconsidered maniasisand12casesofvisceralleishmaniasisinsol-
adiseaseofstrategicmilitarysigniÞcance,itmaypose diersdeployedtotheArabianPeninsuladuringOp-
a signiÞcant threat to mission objectives (AFPMB erationsDesertShieldandStorm(AFPMB1999).The
1999).Leishmaniasisisadiseasecomplexcausedby majorityofcasesinIraqsincethebeginningofOp-
17Ð20 species of protozoan parasites of the genus eration Iraqi Freedom in 2003 are associated with
Leishmania,whicharevectoredbyphlebotominesand increasedexposuretoinfectedsandßies(Colemanet
ßies(Croftetal.2006).Therearethreeclinicalsub- al. 2006). The increased exposure is caused by in-
types of leishmaniasis: cutaneous, mucocutaneous, creasednumbersofbreedingsitesbecauseofthede-
andvisceral.Themostcommonsubtypeiscutaneous structionofwaterandsanitationsystems,shortageof
leishmaniasis,with1.5Ð2millioncasesperyearworld- insecticides,equipment,accumulationofgarbage,and
wide, and the more serious subtype, visceral leish- the increase in the numbers of dogs in the streets
maniasis, infects 500,000 people per year worldwide (Jassimetal.2006).
(Herwaldt1999,Croftetal.2006,Ameen2007).Cu- In 2003 and 2004, the annual incidence rates of
taneousleishmaniasisalonenormallydoesnotcause leishmaniasisintheU.S.militarywere40.9and24.4per
death,althoughsecondaryinfectionsbybacteriacan 100,000 person-years (Lay 2004), respectively, al-
befatal(PiscopoandMallia2006).Untreatedvisceral though the rate could be as high as 10% of soldiers
leishmaniasishasacase-mortalityrateof30Ð60%,de- stationedinthePersianGulf(Pehousheketal.2004).
From January 2003 to November 2004, there were
1,178casesofleishmaniasisinservicemembersofthe
1Department of Land Resources and Environmental Sciences,
Montana State University, 334 Leon Johnson Hall, Bozeman, MT U.S.military,witharateof51.4casespermonth.Most
59717. oftheaffectedsoldiersservedinIraqand/orKuwait
2Correspondingauthor,e-mail:[email protected]. (Lay2004).In2003,theestimatedcaserateforsol-
3ElectricalConsultantsInc.,3521GabelRoad,Billings,MT59102. diersstationedneartheIraqÐIranboarderwas(cid:1)200
4Sacramento-Yolo Mosquito and Vector Control District, 8631
BondRd.,ElkGrove,CA95624. per 1,000 deployed persons (Aronson 2007a). From
0022-2585/09/0693Ð0702$04.00/0(cid:1)2009EntomologicalSocietyofAmerica
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1. REPORT DATE 3. DATES COVERED
2009 2. REPORT TYPE 00-00-2009 to 00-00-2009
4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER
A Probabilistic Risk Assessment for Deployed Military Personnel After
5b. GRANT NUMBER
the Implementation of the ’Leishmaniasis Control Program’ at Tallil Air
Base, Iraq 5c. PROGRAM ELEMENT NUMBER
6. AUTHOR(S) 5d. PROJECT NUMBER
5e. TASK NUMBER
5f. WORK UNIT NUMBER
7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION
Montana State University,Department of Land Resources and REPORT NUMBER
Environmental Sciences,334 Leon Johnson Hall,Bozeman,MT,59717
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14. ABSTRACT
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15. SUBJECT TERMS
16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF 18. NUMBER 19a. NAME OF
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694 JOURNALOFMEDICALENTOMOLOGY Vol.46,no.3
2001to2006,theincidencerateinIraqandAfghan- ULVandindoorresidualsprays)usedforsandßiesat
istanwas2.31casesper1,000person-yearsofservice, TallilAirBaseduringtheLCP.
with the largest numbers of leishmaniasis cases oc-
curring in late summer and fall of 2003 (Aronson
MaterialsandMethods
2007b).
Therehasbeenasharpreductioninleishmaniasis ProblemFormulation.Weperformedareasonable
casesinIraq/Afghanistan,mostlikelybecauseofim- worst-caseprobabilisticriskassessmentofacuteand
provementsintentsandbuildings,aswellasemphasis subchronic human exposures after the LCP was
on personal protective measures (PPMs) (Aronson adoptedduringOperationIraqiFreedomtoprotectall
2007b).Ofthe1,287casesofleishmaniasisdiagnosed coalitionforcesinthevicinityofTallilAirBase.Risk
from2001to2006,only4havebeenvisceral(Aronson assessment is the formalized basis for the objective
2007b).DuringOperationsDesertShieldandStorm, evaluationofriskinwhichallassumptionsanduncer-
theestimatedcostofleishmaniasistotheU.S.military tainties are clearly considered and presented (NRC
wasapproximately$18,000and92lostdutydaysper 1983).Reasonableworst-caseriskassessmentserron
patient(Grogletal.1993,GambelandAronson1997, thesideofsafetythroughdeliberateoverestimationof
Martinetal.1998,AFPMB1999).Assumingthe2003 theriskstohumansandtheenvironment.Probabilistic
and 2004 incidence rates of leishmaniasis, the esti- analysisincorporatessamplingfromthestatisticaldis-
mated overall cost of treatment and lost duty days tributionofeachinputvariableandpropagateseach
variable into output of estimated exposures. Acute
wouldbe$867,000to$918,000permonth.
exposures were deÞned in this study as single-day
Topreventsandßybites,theU.S.militaryprovides
exposuresafterasingleinsecticideapplication.Sub-
PPMs to military personnel, including insect repel-
chronicexposurestoinsecticidesweredeÞnedasthe
lents (DEET), insecticide treated bednets, and per-
exposuretoinsecticidesperdayover165dthatthe
methrin-impregnated battle dress uniforms (BDUs)
LCPwasinstituted,duringandaftertruck-mounted
(Martinetal.1998,AFPMB1999,Colemanetal.2006).
ULVandresidualsprayevents(Colemanetal.2006).
However,whenPPMswereavailabletoU.S.military
Exposures to two population groups, adult men and
personnelatTallilAirBase,Iraq,only31%ofmenand
adultwomen(18Ð65yrofage),wereestimatedfor
12%ofwomenusedthesemeasures.Userateswere
eachscenario,chemical,route,andpathway.
lowbecauseoftheintenseheat,blowingsand,anda
HazardIdentification.Weassessedthethreeactive
lackofknowledgeabouthowtousethem(Coleman
ingredientsresmethrin,malathion,andpyrethrinsand
etal.2006).
thesynergistpiperonylbutoxide(PBO)usedforthe
AtTallilAirBasein2003,theU.S.militaryadopted
truck-mounted ULV applications. We also assessed
the “Leishmaniasis Control Plan” (LCP) to reduce
the Þve active ingredients lambda-cyhalothrin, cy-
sand ßy populations. During the LCP, the military
ßuthrin, bifenthrin, chlorpyrifos, and cypermethrin
used truck-mounted ultra-low-volume (ULV) insec-
usedforresidualapplications.
ticides and residual sprays in and around tents, as
ToxicityandDose–ResponseRelationships.DoseÐ
well rodent and canine control (Coleman et al.
response information for each compound was re-
2006). The U.S. Armed Forces Pest Management
viewed, and endpoints were chosen based on acute
Board (AFPMB) recommends each of the control
and subchronic exposures. The toxicity thresholds
measuresundertakenatTallilAirBaseaswellasthe
usedinthisassessmentwereingestionreferencedoses
useofPPMsforthecontrolandpreventionofsandßy
(RfDs), which are established by the U.S. Environ-
bites(AFPMB1999,2008).However,littleornoim-
mentalProtectionAgency(U.S.EPA).IngestionRfDs
pactonsandßypopulationswasseenaftertheexten-
were based on the no observed adverse effect level
sivecontrolactivitiesatTallilAirBase(Colemanetal. (NOAEL)witha100-foldsafetyfactorforintra-and
2006). interspecies extrapolation uncertainties. The acute
Macedoetal.(2007)performedareasonableworst- oralRfDsforresmethrin,malathion,PBO,pyrethrins,
case, deterministic human-health risk assessment of lambda-cyhalothrin,cyßuthrin,bifenthrin,chlorpyri-
acute, subchronic, and chronic risks after truck- fos, and cypermethrin are 0.1, 0.14, 6.3, 0.07, 0.0025,
mounted ULV, indoor space sprays, surface-residual 0.02,0.01,0.005,and0.1mg/kgbodyweight(BW)/d,
sprays, insecticide-impregnated BDUs, and insecti- respectively (U.S. EPA 1998a, 2000b, 2002, 2004a,
cide-impregnatedbednets,usedforthemanagement 2005a,2006a,b,c,2008).ThesubchronicoralRfDsfor
ofmosquitoes.Theyshowedthattheriskstomilitary resmethrin, malathion, PBO, pyrethrins, lambda-cy-
personnel exposed to PPMs and mosquito manage- halothrin, cyßuthrin, bifenthrin, chlorpyrifos, and
ment tactics are most likely negligible. The vector cypermethrin are 0.1, 0.07, 0.16, 0.044, 0.001, 0.024,
controlmeasuresevaluatedbyMacedoetal.(2007) 0.015,0.0003,and0.06mg/kgBW/d,respectively(U.S.
are similar to those used at Tallil Air Base for the EPA 1998a, 2000b, 2002, 2004a, 2005a, 2006a, b, c,
controlofsandßies.However,themosquitomanage- 2008).
menttacticsdifferfromthetacticsusedatTallilAir EstimationofEnvironmentalConcentrations.We
Baseforthecontrolofsandßiesinnumberofappli- usedAERMODtier-1airdispersionmodel(U.S.EPA
cations, environment, and target vector. Therefore, 1999)inconjunctionwithBEESTsoftware(Version
weperformedaretrospectiveprobabilisticriskassess- 9.65; Oris Solutions, Austin, TX) to predict the air
ment on the management tactics (truck-mounted concentrations and surface deposition for the three
May2009 SCHLEIERETAL.:TALLILAIRBASELCP 695
Table1. Inputdistributionsforspraydepositionandaerialconcentrationsforeachchemicalusedfortruck-mountedultra-low-volume
applications
Input Distributiontype Parameter Resmethrin Malathion PBO Pyrethrins Units
Aerialconcentrations Gamma(truncated) Location 1.31 10.45 2.24 1.47 (cid:1)g/m3
Scale 1.76 14.02 0.22 1.98
Shape 1.81 1.81 2 1.81
Spraydeposition Weibull(truncated) Location 0.0003 0.002 2.24 0.0003 g/m2
Scale 0.001 0.008 0.22 0.001
Shape 0.91 0.91 2 0.91
PBO,piperonylbutoxide.
active ingredients and PBO within 6 h after truck- Schleieretal.(2008)andPetersonetal.(2006),which
mounted ULV application. In BEEST, we created a arebrießyreviewedhere.
camplayoutwith19tentssetback-to-backinsixrows Acuteinhalationexposurewasestimatedby
tosimulatethetentsetupatTallilAirBase.Theas-
PE (cid:2)(EEC(cid:3)RR(cid:3)D)/BW, [1]
sumptions included: (1) each chemical had a 24-h inhalation
half-lifeintheair;(2)theinsecticideswereappliedat where PE is potential exposure from inhala-
themaximumapplicationrateasstatedoneachlabel; tion(mg/kinghaBlaWtio)n,EECistheestimatedenvironmen-
(3)alloftheinsecticidesweresusceptibletothesame talairconcentrationsasestimatedbyAERMOD((cid:1)g/
weatherconditionsusingstandardizedweatherdata m3;Table1),RRisrespiratoryrateforeachgroupthat
fromAlbuquerque,NM,fromJuly1993toJune1994; isindicativeoflightactivitydominatedbymoderate
(4)allsprayeventsoccurredat2100hours;(5)each movement or periods of rest (m3/h; Table 2), D is
spray release was at 1.5 m; and (6) receptors were durationofexposure(h),andBWisbodyweightsfor
positioned radially from the center of the camp, to eachgrouprepresentingthegeneralU.S.population
(cid:1)230minalldirectionsandplacedat(cid:1)14-mintervals (kg;Table2).
throughoutthecampbothalongthetruckrouteand Acutedermalexposurefromspraydepositiononto
inbetweentents.WechoseweatherdatafromAlbu- thegroupwasestimatedby
querque because the area is a desert environment
that has standardized weather data for use with the PE (cid:2)(ADE(cid:3)CF(cid:3)AR(cid:3)AB)/BW,
dermal
AERMOD downloader. The maximum application
[2]
ratesfortruck-mountedULVresmethrin,malathion,
PBO,andpyrethrinsare7.85,71.62,43.94,and10.09g wherePE ispotentialexposurefromdermalcon-
dermal
(AI)/ha,respectively(Table1). tact(mg/kgBW),ADEisadjusteddermalexposure
(mg/lb[AI]),andCFisthedermalconversionfactor
thatistheincreaseinexposurefromtheßaggersce-
AcuteExposure
nario.Thereislimitedpubliclyavailableinformation
Truck-Mounted ULV Applications. We assumed on dermal deposition immediately after truck-
thatmultirouteexposuresimmediatelyafterasingle- mountedULVsprays,soweusedtheU.S.EPAPes-
sprayeventwerelimitedto24h.Routesofinsecticide ticideHandlerExposureDatabase(PHED)asacon-
exposuretoeachgroupwereinhalationanddermal. servative surrogate (U.S. EPA 1998b). The PHED
Assumptionsofbodyweight,respirationrate,andper- contains pesticide-handler scenarios derived from
centareaoftwohandsarepresentedinTable2.We Þeldstudiesandexposureestimatesbasedonphysical
assumedthateachgroupwouldbeoutsidewhenthe factorssuchasapplicationrate,hectarestreatedper
spraytruckpassed,andthedurationoftheexposure day, type of clothing worn, methods of application,
was6h.Theexposuremodelingassumptionsfollowed andformulationtype.WeusedthePHEDscenarioin
Table2. Assumptionsforbodyweight,respirationrate,andpercentsurfaceareaoftwohandsforadultmalesandfemales
Inputvariables Group Parameter Values Units Distribution Source
Bodyweight Adultmales Mean 78.65 kg Log-normal(truncated) Portieretal.(2007)
SD 13.23
Adultfemales Mean 65.47 kg
SD 13.77
Respirationrate Adultmales Mean 15.14 liters/min Log-normal(truncated) Allanetal.(2008)
SD 5.3
Adultfemales Mean 13.26 liters/min
SD 4.64
Percentsurfacearea Adultmales Mean 5.2 % Normal(truncated) U.S.EPA(1997)
oftwohands SD 0.5
Adultfemales Mean 5.1 %
SD 0.3
696 JOURNALOFMEDICALENTOMOLOGY Vol.46,no.3
whichaßagger(personmarkingthelocationforpes- PE (cid:2)(AR(cid:3)SA(cid:3)DAR(cid:3)TC)/BW,
surfaceresidual
ticideapplicationwhiletheapplicationisoccurring)
[7]
wasexposedtoaliquidapplication.Weusedauniform
distributionandassumedapersonwouldbeexposed
wherePE isthepotentialexposurefrom
10Ð100timesmorethanintheßaggerscenario(Schleier surfaceresidual
contactwithsurfaceresidualsprays(mg/kgBW),AR
etal.2008).ARisapplicationrate(kg[AI]/ha),ABis isthemaximumapplicationrate(mg/m2),SAisthe
dermalabsorptionrateforeachchemical,Disdu-
body surface area (equation 3) in contact with the
rationofexposure(h),andBWisbodyweight(kg; sprayedsurface(m2),whereweassumedthat50%of
Table2).Surfaceareaforallgroupswasestimated
thebodywouldcontactthesprayedarea,DARisthe
using
dermalabsorptionrate,TCisthetransferablesurface
SA(cid:2)(4(cid:3)BW(cid:4)7)/(BW(cid:4)90), [3] residueofinsecticides,whichweassumedtobe20%
(Williamsetal.2003),andBWisbodyweight(kg).
whereSAissurfaceareaandBWisbodyweight(kg; The maximum application rates for lambda-cyhalo-
Table2)ofthegroupbeingassessed(U.S.EPA1997). thrin,cyßuthrin,bifenthrin,chlorpyrifos,andcyper-
Toadjusttheßaggerexposureforadultwomen,we methrin are 120.56, 21.53, 26.12, 112.08, and 125.88
used mg/m2,respectively.Thedermalabsorptionratesfor
lambda-cyhalothrin,cyßuthrin,bifenthrin,chlorpyri-
ADE(cid:2)FE(cid:3)(SA /SA ), [4]
female male fos, and cypermethrin are 25, 5, 25, 3, and 2.5%, re-
whereADEistheadjusteddermalexposure(mg/lb spectively(U.S.EPA1998a,2002,2004a,b,2005a).
[AI]),FEistheßaggerexposure,SA isthesur-
female
faceareaofanadultwomanasestimatedbyequation
SubchronicExposure
3, and SA is the surface area of an adult man as
male
estimated by equation 3. We assumed a triangular We assumed multiroute exposures per day after
distribution,withthemaximumexposurebeingaßag- multisprayeventsoverthe165dinwhichtheLCPwas
gerwithnoclothing(0.053mg/lb[AI]),aminimum implemented. Routes of insecticide exposure were
exposure being a single layer of clothing with no from inhalation and dermal. The same assumptions
gloves(0.011mg/lb[AI]),andthemostlikelyexpo- aboutbodyweight,inhalationrate,andsurfacearea
sure being a person with his or her face, arms, legs, wereusedasstatedaboveforacuteexposure.
hands, and feet exposed (0.0327 mg/lb [AI]) (U.S. Subchronicexposuresfortruck-mountedULVwere
EPA 1997, 1998b). The dermal absorption rates for estimatedby
resmethrin,malathion,PBO,andpyrethrinsare2,10,
2,and0.22%,respectively(U.S.EPA2000a,2005b,c, PE (cid:2)(PE (cid:3)SE)/D, [8]
subchronicULV acuteULV
2006d).
where PE is the potential subchronic
Acute dermal hand contact with sprayed surfaces subchronic ULV
exposurefromtruck-mountedULV(mg/kgBW/d),
wasestimatedby
PE istheacutepotentialexposureforinha-
acuteULV
PE (cid:2) lation,dermal,andhandcontactwithsprayedsurfaces
handcontact
asestimatedbyequation6(mg/kgBW/d),SEisthe
(SA(cid:3)PSA(cid:3)EEC(cid:3)AB(cid:3)TC(cid:3)HC)/BW, [5] numberofsprayevents,andDisthe165-ddurationof
the exposure. The number of spray events for res-
wherePE ispotentialexposurefromhand
handcontact methrin,malathion,PBO,andpyrethrinsare59,26,68,
contact with sprayed surfaces (mg/kg BW), SA is
surface area of the group (m2), PSA is the percent and 9, respectively (Coleman et al. 2006). Because
PBO is present in both resmethrin and pyrethrins
surfaceareaofthehands(Table2),EECistheesti-
formulations,weaddedthenumberofsprayeventsfor
mated environmental concentration for spray depo-
sitionasestimatedbyAERMOD(mg/m2;Table1),AB bothchemicalstoobtainthenumberofsprayevents
forPBO.
isdermalabsorptionrateforeachchemical,TCisthe
Subchronicexposuresfromsurfaceresidualspray-
transferablesurfaceresidueofinsecticides,whichwe
ingwereestimatedby
assumedtobe20%(Williamsetal.2003),HCisthe
number of times one half of one hand contacted a PE (cid:2)(PE (cid:3)SE)/D,
surfacewithinsecticidepresent,whichweassumeda subchronicsurfaceresidual totalacute
uniform distribution of 1Ð10 times, and BW is body [9]
weight(kg;Table2).
wherePE isthepotentialsub-
Total acute exposure to active ingredients after subchronicsurfaceresidual
chronicexposurefromsurfaceresidualsprays(mg/kg
truck-mountedULVapplicationsforeachgroupwas
BW/d), PE is the acute potential expo-
estimatedby surface residual
surefromsurfaceresidualspraysasestimatedbyequa-
PE (cid:2)PE (cid:4)PE (cid:4)PE tion 7 (mg/kg BW/d), SE is the number of spray
acuteULV inhalation dermal hand-contact
events,andDisthe165-ddurationoftheexposure.
[6]
Thenumberofsprayeventsforlambda-cyhalothrin,
SurfaceResidualSpraying.Dermalexposurefrom cyßuthrin,bifenthrin,chlorpyrifos,andcypermethrin
contactwithsurfacesafterresidualsprayeventswere are 65, 24, 9, 7, and 3, respectively (Coleman et al.
estimatedby 2006).
May2009 SCHLEIERETAL.:TALLILAIRBASELCP 697
Table3. Adultmaleacuteandsubchronicprobabilistictotalpotentialexposure(PE )a(mg/kgBW/d)andriskquotients(RQs)b
total
atthe50th,90th,and95thpercentiles
Acuteexposure Subchronicexposure
Percentile
50th 90th 95th 50th 90th 95th
Resmethrin PE 0.0003 0.0007 0.0009 0.0001 0.0002 0.0003
total
RQ 0.003 0.007 0.009 0.001 0.002 0.003
Malathion PE 0.003 0.006 0.007 0.0004 0.0008 0.001
total
RQ 0.02 0.042 0.051 0.005 0.011 0.014
PBO PE 0.0002 0.0004 0.0004 0.00009 0.0001 0.0002
total
RQ 0.00004 0.00006 0.00007 0.0006 0.0009 0.001
Pyrethrins PE 0.0004 0.0008 0.002 0.00003 0.00006 0.00008
total
RQ 0.005 0.011 0.014 0.0006 0.001 0.002
Lambda-cyhalothrin PE 0.074 0.081 0.083 0.028 0.032 0.033
total
RQ 29.42 32.45 33.32 28.97 31.97 32.83
Cyßuthrin PE 0.0026 0.0028 0.003 0.0003 0.0004 0.0004
total
RQ 0.13 0.14 0.015 0.016 0.018 0.018
Bifenthrin PE 0.016 0.017 0.018 0.0008 0.0009 0.001
total
RQ 1.59 1.76 1.81 0.058 0.064 0.066
Chlorpyrifos PE 0.008 0.009 0.0092 0.0003 0.0004 0.0004
total
RQ 1.64 1.81 1.86 1.16 1.28 1.32
Cypermethrin PE 0.0076 0.0085 0.0087 0.0027 0.003 0.0031
total
RQ 0.077 0.085 0.l 0.0001 0.0002 0.0002
aPE isestimatedbyequations6Ð9.
total
bRQ(cid:2)PE /referencedose.
total
BW,bodyweight;PBO,piperonylbutoxide.
Risk Characterization. We used the risk quotient spraydeposition,dermalconversionfactor,andder-
(RQ)methodforourriskassessment,whichiscalcu- malexposure)todeterminepercentcontributionof
latedbydividingthetotalpotentialexposureasesti- theinputvariabletotheoutputvarianceofthemodel
matedbyequations6Ð9foreachgroup,chemical,and for each group and chemical for the truck-mounted
durationofexposurebyitsrespectiveingestiontoxic ULV.Sensitivityanalysisisdesignedtoidentifyinputs
endpointvalue(RfD).Themultirouteexposureinour thatarehavingasigniÞcantimpactonthevarianceof
assessmentwascomparedwiththeingestionRfDbe- themodeloutput(CullenandFrey1999).Wechose
cause it provided a conservative endpoint, which is only uncertain and not variable parameters to help
basedonthemostsensitiveNOAEL.EstimatedRQs direct future research examining the fate of the in-
are compared with a RQ level of concern (LOC), secticidesindesertenvironments.Sensitivityanalysis
which is set by the U.S. EPA or another regulatory wasnotperformedonsurfaceresidualspraysbecause
agency to determine whether regulatory action is ofthelackofuncertainparameters.
needed.TheRQLOCusedinourassessmentwas1.0.
AnRQ(cid:5)1.0meanstheestimatedexposureisgreater
thantherelevantRfD. Results
ProbabilisticAnalysis.Probabilisticriskassessments
differfromdeterministicriskassessmentsbysampling
AcuteRisk
valuesfromthedistributionsofexposuresandbiolog-
icalparameters.Toperformtheprobabilisticriskas- Truck-MountedULV.Riskquotientsdidnotexceed
sessment, we used Monte Carlo simulation (Crystal theRQLOCatthe50th,90th,and95thpercentilesof
Ball7.3;Decisioneering,Denver,CO)togeneratethe exposureforanygroupandchemical(Tables3and4).
exposuresandRQs.ProbabilitiesofoccurrenceofRQ Adultmaleandfemaleexposuresatthe95thpercen-
values were determined by incorporating sampling tilerangedfrom0.0004to0.007mg/kgBW/d(Tables
fromthestatisticaldistributionofeachinputvariable 3and4).MalathionhadthehighestandPBOhadthe
usedtocalculatetheRQs.Eachoftheinputvariables lowestRQsofthechemicalsassessed(Tables3and4).
wassampledsothatitsdistributionshapewasrepro- SurfaceResidualSpray.Adultmaleandfemaleex-
duced.Thevariabilityforeachinputwaspropagated posuretolambda-cyhalothrin,bifenthrin,andchlor-
intotheoutputofthemodelsothatthemodeloutput pyrifosexceededtheRQLOCatthe50th,90th,and
reßected the probability of values that could occur. 95th percentiles (Tables 3 and 4). Cyßuthrin and
Weperformedthisbyusing20,000iterationswiththe cypermethrin were below the RQ LOC for both
assumptionsoutlinedinTables1and2.Wetruncated groups(Tables3and4).Adultmaleexposureatthe
respiratoryrate,bodyweight,percentsurfaceareaof 95th percentile ranged from 0.003 to 0.083 mg/kg
twohands,airconcentrations,andspraydepositionat BW/d(Table3).Adultfemaleexposureatthe95th
zerobecauseitisnotpossibleforthesequantitiesto percentile ranged from 0.003 to 0.09 mg/kg BW/d
havenegativevalues. (Table 4). Lambda-cyhalothrin had the highest and
Sensitivityanalysiswasperformedusing20,000it- cypermethrin had the lowest RQs of the chemicals
erationsonuncertainparameters(airconcentrations, assessed(Tables3and4).
698 JOURNALOFMEDICALENTOMOLOGY Vol.46,no.3
Table4. Adultfemaleacuteandsubchronicprobabilistictotalpotentialexposure(PE )a(mg/kgBW/d)andriskquotients(RQ)b
total
atthe50th,90th,and95thpercentiles
Acuteexposure Subchronicexposure
Percentile
50th 90th 95th 50th 90th 95th
Resmethrin PE 0.0003 0.0006 0.0008 0.0001 0.0002 0.0003
total
RQ 0.003 0.006 0.008 0.001 0.002 0.003
Malathion PE 0.002 0.005 0.007 0.0004 0.0008 0.001
total
RQ 0.017 0.038 0.048 0.005 0.012 0.015
PBO PE 0.0002 0.0004 0.0004 0.00009 0.0001 0.0002
total
RQ 0.00004 0.00006 0.00007 0.0006 0.001 0.0011
Pyrethrins PE 0.0003 0.0007 0.0009 0.00002 0.00004 0.00005
total
RQ 0.0045 0.01 0.013 0.0004 0.0009 0.0011
Lambda-cyhalothrin PE 0.08 0.009 0.09 0.031 0.035 0.036
total
RQ 32.17 35.91 36.93 31.62 35.36 36.39
Cyßuthrin PE 0.0029 0.0032 0.0033 0.00042 0.00047 0.00048
total
RQ 0.14 0.16 0.017 0.017 0.019 0.02
Bifenthrin PE 0.017 0.019 0.02 0.0009 0.001 0.0011
total
RQ 1.74 1.94 1.99 0.063 0.071 0.073
Chlorpyrifos PE 0.009 0.01 0.011 0.0003 0.00041 0.00043
total
RQ 1.79 2 2.06 1.27 1.42 1.46
Cypermethrin PE 0.008 0.009 0.01 0.0001 0.00017 0.00018
total
RQ 0.084 0.094 0.l 0.003 0.0034 0.0035
aPE isestimatedbyequations6Ð9.
total
bRQ(cid:2)PE /referencedose.
total
BW,bodyweight;PBO,piperonylbutoxide.
SubchronicRisk theydidnotexceedtheNOAELs.Forexample,acute
adultfemaleexposureatthe95thpercentileforlambda-
Truck-MountedULV.Riskquotientsdidnotexceed
cyhalothrin,bifenthrin,andchlorpyrifoswas37,2,and
theRQLOCatthe50th,90th,and95thpercentilesfor
2% of the NOAEL, respectively. Subchronic adult
anygroupandchemical(Tables3and4).Totaladult
female exposure at the 95th percentile for
male exposure at the 95th percentile ranged from
lambda-cyhalothrin,bifenthrin,andchlorpyrifoswas
0.00008to0.001mg/kgBW/d(Table3).Totaladult
36,1.9,and1.5%oftheNOAEL.Withourconservative
female exposure at the 95th percentile ranged from
0.00005 to 0.001 mg/kg BW/d (Table 4). Malathion
had the highest, whereas pyrethrins had the lowest,
Table5. Sensitivityanalysis(percentcontributionoftheinput
RQsofthechemicalsassessed(Tables3and4).
variabletotheoutputvariance)ofuncertainfactors(airconcen-
Surface Residual Sprays. Adult male and female trations,spraydeposition,dermalconversionfactor,anddermal
exposuretolambda-cyhalothrinandchlorpyrifosex- exposure)usedinthetruck-mountedultra-low-volumeacuteand
ceededtheRQLOCatthe50th,90th,and95thper- subchronicexposuresforresmethrin,malathion,PBO,andpyre-
thrins
centiles(Tables3and4).Cyßuthrin,bifenthrin,and
cypermethrin were below the RQ LOC for both
Subchronic
groups(Tables3and4).Adultmaleexposureatthe Acuteexposure exposure
95th percentile ranged from 0.0004 to 0.03 mg/kg
Adult Adult Adult Adult
BW/d(Tables3and4).Adultfemaleexposureatthe males females males females
95th percentile ranged from 0.0001 to 0.036 mg/kg
Resmethrin
BW/d(Tables3and4).Lambda-cyhalothrinhadthe Airconcentrations 90.7a 99.9 96.8 100.0
highestandcypermethrinhadthelowestRQsofany Spraydeposition 9.2 0.1 3.2 0
chemicalassessed(Tables3and4). Dermalconversionfactor 0 0 0 0
Dermalexposure 0 0 0 0
Malathion
SensitivityAnalysis Airconcentrations 88.6 98.9 99.3 99.2
Spraydeposition 10.9 0.8 0.5 0.6
Sensitivity analysis of acute and subchronic expo- Dermalconversionfactor 0.4 0.2 0.2 0.2
Dermalexposure 0.1 0 0 0
sures from truck-mounted ULV chemicals showed
PBO
thatairconcentrationscontributedthelargestamount Airconcentrations 56.8 49.8 47.6 47.7
ofvariancetotheoutput,followedbyspraydeposi- Spraydeposition 33.0 36.2 43.2 35.5
tion,dermalconversionfactor,anddermalexposure Dermalconversionfactor 7.8 11.1 6.5 12.6
Dermalexposure 2.4 2.9 2.7 4.2
foradultmenandwomen(Table5).
Pyrethrins
Airconcentrations 89.8 100.0 71.3 99.7
Spraydeposition 10.2 0 28.6 0.3
Discussion
Dermalconversionfactor 0 0 0 0
Dermalexposure 0 0 0 0
AlthoughtheLCPÕsuseofresidualspraysresulted
in exposures to lambda-cyhalothrin, bifenthrin, and aPercentcontributionoftheinputvariabletotheoutputvariance.
chlorpyrifos that may have exceeded the RQ LOC, PBO,piperonylbutoxide.
May2009 SCHLEIERETAL.:TALLILAIRBASELCP 699
assumptions, exposures at the 95th percentile most Inthisanalysisofrisks,wedidnotprobabilistically
likelywouldnotresultinadverseeffectstoadultmen assessPPMssuchaspermethrin-impregnatedBDUs,
andwomen.Despitethefrequentapplicationsinthe bednets,andrepellentsbecauseofthelackofdocu-
LCP,ourresultssupportpreviousriskassessmentre- mentedvariabilitydatafortheseexposurescenarios.
sultsthatexposuretotruck-mountedULVinsecticides Macedo et al. (2007) showed that the use of per-
are most likely negligible (Peterson et al. 2006, methrin-impregnated BDUs and bednets presented
Macedoetal.2007,Schleieretal.2008). negligible risk to military personnel for acute, sub-
To predict deposition and air concentrations, we chronic((cid:6)180d),andchronicexposures((cid:5)180d).
usedAERMOD,whichisanindustrialplumemodel An exposure assessment of permethrin-impregnated
thatisnotdesignedforULVapplications.However, BDUs in the German military showed that the con-
AERMOD was the most appropriate model for air servativeriskestimatesofMacedoetal.(2007)sufÞ-
concentrationsanddepositionontosurfacesbecause ciently protected human health (i.e., they overesti-
thereisasubstantialdatagapinairconcentrationsand mated exposures by (cid:1)16-fold) (Appel et al. 2008).
fateofinsecticidesindesertenvironments.Previous Antwietal.(2008)showedthatadultmenandwomen
studies of truck-mounted ULV applications in tem- exposed to DEET concentrations (cid:3)40% exceed the
perate and subtropical climates have observed LOC for subchronic ((cid:6)180 d) exposures, but expo-
1Ð22.3%oftheinsecticidesprayedduringapplication sures did not exceed the LOC for the acute and
settledontotheground,withconcentrationsdecreas- chronic((cid:5)180d)scenarios.
Inadditiontoriskfromtheinsecticides,thereare
ingsubstantiallyover36h(Tuckeretal.1987,Moore
alsorisksofcontractingleishmaniasis.Theminimum
et al. 1993, Tietze et al. 1994, Knepper et al. 1996).
Þeldinfectionrateoffemalesandßieswas1.5%in2003
Concentrations found in previous Þeld studies are
(cid:1)0.6Ð12.5%ofwhatwasmodeledusingAERMOD. and2%in2004,with(cid:1)15%ofthosefemalesandßy
pools ((cid:1)12 sand ßies per pool) testing positive for
Inadditiontodepositionontosurfaces,weuseda
leishmaniasis parasites that cause human disease
ßagger exposure scenario to model deposition onto
(Colemanetal.2006).Thisindicatestheprobability
skin,whichwasdesignedforagriculturalapplications.
thatabitecouldresultinleishmaniasisinfectionwas
The default ßagger scenario in the U.S. EPA PHED
overestimatesexposureby(cid:1)40%,supportingthecon- (cid:1)0.3%.Witheachadditionalbite,theirriskincreased,
andsomesoldiersatthebasereceived(cid:5)1,000bitesper
servatismofthemodel(Driveretal.2007).
night(Colemanetal.2006).
Fortheresidualsprays,weassumedthattherewas
The risks are not limited to the insecticides and
nodegradationduringthe165-dperiod.Previousstud-
infectionbyleishmaniasis;therearealsorisksfromthe
iesexaminingd-phenothrin,d-tetramethrin,andres-
curativemedicaltreatments.Currentlytherearethree
methrinshowedthatthehalf-lifeoftheinsecticides
approvedmedicationsthathaveshowneffectiveness
was(cid:1)31Ð75donßoorsandwalls(Matobaetal.1998a,
intreatingleishmaniasis:antimonials,miltefosine,and
b).However,thesestudieswerecarriedoutinhouses
amphotericinBdeoxycholate.Antimonialsareusedas
andnottents;therefore,moredataareneededonthe
the Þrst line of treatment in leishmaniasis, whereas
persistenceofresidualspraysontentsurfaces.
miltefosineisusedwhenpatientsdonotrespondto
Inadditiontouncertaintiesindeposition,aircon-
antimonialsorrelapse(Aronsonetal.1998).Thecost
centrations,andbreakdownofinsecticides,thereare
effectiveness (U.S. $/death averted) of treatment is
alsotoxicologicaluncertaintieswithrespecttoPBO.
highestformiltefosineandantimonialsbecauseofthe
PBO has been shown to increase the toxicity of py-
relativelylowcost;however,themosteffectivetreat-
rethroids and pyrethrins to aquatic organisms, but
mentforleishmaniasishasbeenshowntobeampho-
thereisnoindicationthatPBOactsasasynergistin
tericinBdeoxycholate,whichcosts$30to$40more
mammals(Knowles1991,Pauletal.2005,Amweget per patient than antimonials (Vanlerberghe et al.
al. 2006, U.S. EPA 2006a). If a 10-fold uncertainty 2007).
factor was applied to the RfDs based on the toxico- AntimonialsmustbeadministeredbytheU.S.mil-
logical uncertainties of PBO synergizing with res- itary under an experimental protocol at approved
methrinorpyrethrins,neitherwouldexceedtheRQ medicaltreatmentfacilitiesbecausetheyarenotreg-
LOC, which is comparable to past risk assessments isteredforuseintheU.S.(AFPMB1999,Weinaetal.
(Petersonetal.2006,Macedoetal.2007,Schleieret 2004).Duringtreatment,3.2Ð60%ofpatientsexperi-
al.2008). enced arthralgias, myalgias, anorexia, herpes zoster,
Ourtruck-mountedULVsensitivityanalysisissim- nausea, vomiting, diarrhea, abdominal pain, chest
ilartothestudyperformedbySchleieretal.(2008), pain, local pain, headache, rash, itching, and fever
showingthatairconcentrationsanddepositionofin- (Aronson et al. 1998, Mohebali et al. 2007). Sodium
secticides onto surfaces contributed the largest stibogluconate and meglumine antimoniate have
amount of variance to the model output. Acute and shown cure rates of 88.3Ð97% (Aronson et al. 1998,
subchronic inhalation exposure, hand contact with Mohebalietal.2007).Thesideeffectsofmiltefosine
sprayedsurfaces,anddermalexposurecontributed95, are nausea, vomiting, diarrhea, motion sickness, ab-
4, and 1.5% on average to the overall exposure, re- dominalpain,coughing,headache,itching,andfever
spectively, which is comparable to past risk assess- andhavebeenobservedin1Ð41.4%ofpatientsduring
ments (Peterson et al. 2006, Macedo et al. 2007, treatment(Sotoetal.2004a,Mohebalietal.2007).The
Schleieretal.2008). curerateformiltefosinewas(cid:1)50%(Sotoetal.2001,
700 JOURNALOFMEDICALENTOMOLOGY Vol.46,no.3
2004a, b; Mohebali et al. 2007). Amphotericin B de- Aronson, N. E. 2007a. Leishmaniasis in American soldiers:
oxycholatehasbeenapprovedbytheU.S.Foodand parasitesfromthefront.InW.M.ScheldandJ.Hughes
DrugAdminstrationforthetreatmentofleishmaniasis (eds.),Emerginginfections7.ASMPress,Washington,DC.
(Herwaldt1999).ThesideeffectsofamphotericinB Aronson,N.E. 2007b. Leishmaniasisinrelationtoservicein
deoxycholate are back pain, sweating, headache, di- Iraq/Afghanistan, U.S. Armed Forces, 2001Ð2006. Med.
SurveillanceMon.Rep.14:2Ð5.
arrhea,itching,shivering,respiratorydistress,and/or
Aronson,N.E.,G.W.Wortmann,S.C.Johnson,J.E.Jackson,
cardiac arrhythmia, which have been observed in
R.A.Gasser,A.J.Magill,T.P.Endy,P.E.Coyne,M.
(cid:6)40%ofpatients(Bermanetal.1998,Muelleretal.
Grogl,P.M.Benson,etal. 1998. SafetyandefÞcacyof
2008).TreatmentwithamphotericinBdeoxycholate intravenous sodium stibogluconate in the treatment of
hasacurerateof(cid:1)92%after6mo(Sundaretal.1997, leishmaniasis:recentUSmilitaryexperience.Clin.Infect.
Muelleretal.2008). Dis.27:1457Ð1464.
Despitefrequentapplicationsandmultipathwayex- Berman,J.D.,R.Badaro,C.P.Thakur,K.M.Wasunna,K.
posures, our probabilistic estimates of exposure to Behbehani,R.Davidson,F.Kuzoe,L.Pang,K.Weera-
lambda-cyhalothrin, bifenthrin, and chlorpyrifos ex- suriya,andA.D.M.Bryceson. 1998. EfÞcacyandsafety
of liposomal amphotericin B (AmBisome) for visceral
ceededtheRQLOCbutdidnotexceedtheirrespec-
leishmaniasis in endemic developing countries. Bull.
tiveNOAELs.Becausetheresidualsprayapplications
W.H.O.76:25Ð32.
didnotseemtoaffectsandßypopulationsorprotect
Coleman,R.E.,D.A.Burkett,J.L.Putnam,V.Sherwood,
soldiers, future uses could be discontinued to lower J.B.Caci,B.T.Jennings,L.P.Hochberg,S.L.Spradling,
the risks from insecticides. Furthermore, the health E. D. Rowton, K. Blount, et al. 2006. Impact of phle-
risks from contracting leishmaniasis and adverse re- botominesandßiesonUSmilitaryoperationsatTallilAir
actionsduringtreatmentforthediseasearemostlikely Base,Iraq:1.Background,militarysituation,anddevel-
greaterthantherisksfromexposuretotheinsecticides opment of a “Leishmaniasis control program”. J. Med.
used. Entomol.43:647Ð662.
Croft, S. L., S. Sundar, and A. H. Fairlamb. 2006. Drug
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126.
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