Savannah River Site Health Effects Subcommittee (SRSHES) Meeting

Meeting Summary

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List of Acronyms
	ATSDR Agency for Toxic Substances and Disease Registry CDC Centers for Disease Control and Prevention DFO Designated Federal Official DOE  Department of Energy FACA Federal Advisory Committee Act HES  Health Effects Subcommittee HHS Department of Health and Human Services NCEH National Center for Environmental Health NIOSH National Institute for Occupational Safety and Health SRSHES Savannah River Site Health Effects Subcommittee

HHS and CDC convened an SRSHES meeting on January 10-11, 2002 at the Charleston Riverview Hotel in Charleston, South Carolina. The March 15-16, 2001 meeting minutes were unanimously approved with the changes as noted in the record. Current action items were reported as completed through agenda items or workgroup assignments. Personnel changes were announced for SRSHES and NCEH staff members. New administrative issues were outlined.

NIOSH summarized research involving SRS; listed studies expected to be completed or communicated in FY’02; described administrative activities; and outlined mechanisms to disseminate information to the public. The studies focus on occupational exposures that may be associated with health effects among DOE workers, such as leukemia, lung cancer and lung fibrosis. The research findings can be reviewed in the NIOSH 2001 program book on the web site.

NIOSH has enhanced its communication strategy by distributing one-page summaries of final reports that outline the background, findings, recommendations, limitations and advantages of each study. NIOSH also collaborates with a point of contact at each DOE site to obtain assistance in reaching organized labor representatives, retirees, public relations personnel or site contractors.

ATSDR reported on potential health effects from toxicity of heavy metals and radionuclides. The kidney is particularly targeted by toxins due to its extremely high blood flow of 25% of cardiac output. The five most common heavy metals in the environment are lead, arsenic, cadmium, mercury and uranium. In addition to kidney problems, these heavy metals can cause gastrointestinal effects, central nervous system dysfunction, increased calcium and protein in the urine, pain in extremities, or death at high chronic doses.

Site-specific research on heavy metals has been conducted at SRS and other DOE sites, but causal associations between toxicity and adverse health effects were not reported. Linking mercury exposure to kidney disease is extremely difficult with existing evidence. ATSDR hopes epidemiologic studies of mercury in blood, hair and urine will be conducted in the future to detect elevated levels and increases in kidney disease.

The Scenario Workgroup reported on its activities since the previous meeting. The six scenarios proposed by CDC were reviewed, lead reviewers were appointed, locations for each scenario were selected, required actions were identified, and recommendations were made. Chemical source terms and scenarios should be evaluated with the same level of rigor in terms of health effects in offsite populations. Synergistic effects of radiological and chemical scenarios should be considered.

Onsite workers should be better represented in the scenarios. Limitations of computer models that may impact the scenarios should be clearly stated. The workgroup expects to submit an initial draft of the scenarios to CDC within two weeks. CDC will not generate doses during the screening process, but SRSHES pointed out that screening level calculations require dose to be estimated before risk.

The Epidemiologic Data Workgroup reported on its activities since the previous meeting. Frequently used terms in epidemiologic research were defined; agreement was reached on sources to use; limitations of these data were noted; challenges in implementing epidemiologic studies were acknowledged; and searches were conducted to locate three types of relevant data: SRS workers, populations contiguous to SRS and non-human subjects at and around SRS.

The focus areas of the studies include cancer morbidity and mortality, congenital hypothyroidism, and SRS radionuclide releases. The workgroup hoped the data would assist the Scenario Workgroup and help CDC to determine whether an epidemiologic study or risk assessment will need to be conducted. SRSHES noted the lack of racespecific data collected for black SRS workers prior to 1979 and suggested other epidemiologic data sources the workgroup should consider.

The Community Summary Workgroup reported on its activities since the previous meeting. The existing full two-page summary with 935 words was decreased to less than 1.5 pages with 629 words. The meaning of the document was not changed, but deletions, clarifying words, simpler terms and sentence combinations were included to make the summary more user-friendly and understandable to communities. SRSHES was asked to provide comments because consensus must be reached on the final version that will be distributed to communities.

The Outreach Workgroup reported on its activities since the previous meeting. The workgroup’s roles were reinforced; mechanisms to circulate information were defined; specific tasks were outlined; information needs were identified; and recommendations were made. The workgroup will disseminate SRSHES materials to the public, update the SRSHES brochure, and actively recruit communities to participate in SRSHES activities.

NCEH has not set aside dollars specifically for the brochure, but will most likely be able to fund revision and distribution of the document. SRSHES suggested other target audiences for materials, such as high school students and local civic organizations. SRSHES was asked not to circulate the current brochure because the membership, telephone number and other information are outdated.

HES DFOs, chairs and senior agency staff members held a meeting in May 2001 to review the evaluation findings and recommendations. Areas where SRSHES disagreed with the evaluation report were noted, such as insufficient data, an inaccurate sample population, and inconsistency between the findings and SRSHES responses. SRSHES extensively discussed the evaluation recommendation to establish ground rules governing its operation. Agreement was reached to continue to use a modified version of Roberts Rules of Order as the SRSHES ground rules with no additional written guidelines; apply the rules with more vigor during meetings; and modify the rules to incorporate suggestions by SRSHES.

These recommendations focused on mutual respect, adherence to agenda schedules, clarification of the SRSHES mission, the process to reach consensus, and the need to make presentations more understandable to persons with any level of education or knowledge about SRSHES. NCEH confirmed that it will make stronger efforts in the future to define the role of SRSHES and clearly identify areas for which consensus advice is needed.

ATSDR’s training program for health professionals was developed because only a minimal amount of environmental health training is provided to physicians who do not specialize in occupational or environmental medicine. ATSDR conducts health care provider education through grand rounds in hospitals, cooperative agreements with partners and states, and publication of environmental health materials. ATSDR grantees are currently conducting the SRS environmental health education needs assessment.

For this project, demographics were researched for the target counties. Community leaders and other key contacts at federal, state and county levels were identified. Focus group meetings were held to obtain input from communities about SRS, such as perceptions of the site, perceived health concerns, desired information, credible sources and preferred channels. The focus group process will help to strengthen capacity building and networking at the local level. A draft document of these findings has been distributed to ATSDR and community leaders for review and comment.

The Proactive Workgroup reported on its activities since the previous meeting. The SRSHES long-range plan was drafted. Roles and responsibilities for specific workgroups were identified for the Phase III dose reconstruction; past, current and future health-related research; continuing education to SRSHES; and public education. The full SRSHES would be involved with implementing appropriate evaluation recommendations as well as developing and prioritizing milestones.

Based on SRSHES comments on the draft, the document will be revised, presented at the next meeting and submitted to CDC for approval. The final version will serve as the SRSHES plan for the next four to five years. Agreement was reached for the workgroup, SRSHES Chair and DFO to jointly prioritize the items and develop a time-line. NCEH confirmed that the draft is consistent with the FACA charter and CDC’s perspective of SRSHES roles and responsibilities.

The SRS former production worker health project has identified 25,580 former workers to date, but the list is still incomplete. A decision was made to focus on retirees because this group is more accessible, can be more easily located, has the longest latency period post-exposure and will probably present more health effects than other former workers. The most significant hazards to former workers were predicted to be noise, chlorinated solvents, asbestos, hydrogen sulfide, hydrazine, external ionizing radiation and beryllium. Test results among the examined population are as follows.

None of the clinical evaluations showed chronic beryllium disease; 156 workers had either restricted or obstructed breathing; 39 workers had both pleural and parenchymal abnormalities; 402 workers had material hearing impairment; and 44% had cardiovascular disease. Overall, SRS former production workers enrolled in the health project clearly exhibit hearing loss and respiratory problems related to employment at the site. The most common non-occupational health effects were found to be cardiovascular disease, overweight conditions and musculoskeletal problems. SRSHES emphasized the need for testing to be conducted by an outside group, since DOE is responsible for worker exposure and is also funding the project.

SRSHES revisited agenda items that were unfinished or unclear. Agreement was reached for the Scenario Workgroup to design a risk-based exposure ranking, identify future activities needed and provide input to the Proactive Workgroup on the SRSHES long-range plan. The Membership Workgroup urged CDC to make every effort to officially appoint the nominees as soon as possible. The Outreach Workgroup will move forward in updating the SRSHES brochure. The Epidemiologic Data Workgroup was asked to assist CDC in collecting additional health data and information on demographics, characteristics, lifestyles and other confounding factors of SRS populations.

SRSHES reviewed the action and agenda items raised during the meeting. Consensus recommendations to the agencies were unanimously approved as well: (1) NIOSH to undertake studies examining effects from exposure to radionuclide and chemical releases from SRS among female and black workers from the beginning of plant operations to the present; and (2) NCEH to examine female and black offsite populations as distinct groups rather than with the general population during the dose reconstruction project.

The Chair opened the floor for public comment at all times as designated on the agenda. The next SRSHES meeting is tentatively scheduled for the first week in June 2002 in Augusta, Georgia; the second or third week in June 2002 was selected as the alternate date. A one-day tour of SRS will be held the day before the meeting. The following meeting is tentatively scheduled for the second week in September 2002 in Savannah, Georgia.