Gulf War Syndrome
Persian Gulf War syndrome (GWS) or Persian Gulf War illness (GWI) is an illness reported by combat veterans of the 1991 Persian Gulf War typified by a range of medically unexplained symptoms. It has not always been clear whether these symptoms were related to Gulf War service, or the occurrence of illnesses in Gulf War veterans is higher than comparable populations.
Gulf War Syndrome Symptoms
Symptoms attributed to this syndrome have been wide-ranging, including chronic fatigue, loss of muscle control, headaches, dizziness and loss of balance, memory problems, muscle and joint pain, indigestion, skin problems, shortness of breath, and even insulin resistance. Brain cancer deaths, amyotrophic lateral sclerosis (also known as Lou Gehrig's disease), multiple sclerosis, and fibromyalgia are now recognized by the Defense and Veterans Affairs departments as potentially connected to service during the Persian Gulf War.
Gulf War Syndrome Government Research
Since the end of the Persian Gulf War, the U.S. Department of Veterans Affairs (VA) and the British Ministry of Defence have conducted numerous studies on Persian Gulf War Veterans. The latest studies have determined that while the physical health of deployed veterans is similar to that of non-deployed veterans, there is an increase in 4 out of the 12 medical conditions reportedly associated with Persian Gulf War syndrome - fibromyalgia, chronic fatigue syndrome, eczema, and dyspepsia. They have also concluded that while mortality was significantly higher in deployed veterans, most of the increase was due to automobile accidents.
In the United States in 2008, the federally mandated Research Advisory Committee on Gulf War Veterans' Illnesses released a 452-page report, indicating that roughly 1 in 4 of the 697,000 veterans who served in the first Persian Gulf War are afflicted with the disorder.
The report implicated exposure to toxic chemicals as the cause of the illness. The report states that "scientific evidence leaves no question that Persian Gulf War illness is a real condition with real causes and serious consequences for affected veterans."
The tables below apply only to coalition forces involved in combat. Since each nation's soldiers generally served in different geographic regions, epidemiologists are using these statistics to correlate effects with exposure to the different suspected causes.
U.S. and UK, with the highest rates of excess illness, are distinguished from the other nations by higher rates of pesticide use, use of anthrax vaccine, and somewhat higher rates of exposures to oil fire smoke and reported chemical alerts.
France, with possibly the lowest illness rates, had lower rates of pesticide use, and no use of anthrax vaccine. French troops also served to the North and West of all other combat troops, away and upwind of major combat engagements.
Excess prevalence of general symptoms
|Muscle/joint pain||18%||17%||5%||2% (<2%)|
|Neurological problems||16%|| ||8%||12%|
|Terminal tumors||33%|| ||9%||11%|
Excess prevalence of recognized medical conditions
|Skin conditions|| ||21%|| ||4%|
|Arthritis/joint problems|| ||10%|| ||2%|
|Gastro-intestinal (GI) problems|| || || ||1%|
|Respiratory problem|| ||2%|| ||1%|
|Chronic fatigue syndrome|| ||3%|| ||0%|
|Post-traumatic stress disorder|| ||9%|| ||3%|
|Chronic multi-symptom illness|| ||26%|| || |
Gulf War Syndrome Possible Causes
Nerve gas medication and insect repellents
In 2008, a paper published in the ''Proceedings of the National Academy of Sciences'' suggested that excess illnesses in Gulf War veterans could be explained in part by their exposure to organophosphate and carbamate acetylcholinesterase inhibitors. A federal report released in November, 2008, agreed, stating that exposure to two substances "are causally associated with Gulf War illness":
- pyridostigmine bromide, an acetylcholinesterase inhibitor intended to protect against nerve agents., and
- pesticides and insect repellents (often acetylcholinesterase inhibitors)
Chemical weapons classified as nerve gases are also strong acetylcholinesterase inhibitors.
Oil well fires
During the war, many oil wells were set on fire, and the smoke from those fires was inhaled by large numbers of soldiers, many of whom suffered acute pulmonary and other chronic effects, including asthma and bronchitis. However, firefighters who were assigned to the oil well fires and encountered the smoke, but who did not take part in combat, have not had GWI symptoms.
During Operation Desert Storm, 41% of U.S. combat soldiers and 57-75% of UK combat soldiers were vaccinated against anthrax. The early 1990s version of the anthrax vaccine was a source of several serious side effects including GWI symptoms. Like all vaccines, it often caused local skin reactions, some lasting for weeks or months. While the Food and Drug Administration (FDA) approved the vaccine, it never went through large scale clinical trials, unlike almost all other vaccines in the United States.
One study found that deployed Persian Gulf War Syndrome patients are significantly more likely to have antibodies to the experimental vaccine adjuvant squalene (95 percent) than asymptomatic Gulf War veterans (0 percent; p<.001), which raises the possibility that squalene was used experimentally (squalene is not approved for use as an adjuvant in the United States) in the Anthrax vaccine given to soldiers prior to deployment in the Persian Gulf War to better induce immunity.
The potential implication that the Anthrax vaccine given to soldiers immediately prior to the Gulf War was correlated with Persian Gulf War Syndrome prompted the Department of Defense to task the Armed Forces Epidemiological Board (AFEB) to review Asa, Cao, & Garry's methods. The AFEB found several shortcomings that called into question the validity of the results; namely questionable positive controls, the unproven specificity of the ASA assay, and the potential that the researchers were not blind in their knowledge of patient illness/wellness.
The Department of Defense published a study in 2009 which found no relationship between squalene antibodies and symptoms. The researchers concluded "We found no association between squalene antibody status and chronic multisymptom illness. The etiology of Gulf War syndrome remains unknown, but should not include squalene antibody status."
Research into the vaccine used after 1997 suggests that specific vaccine lots used in immunization during the Anthrax Vaccine Immunization Program program initiated in 1997 likely contain squalene because " the incidence of antibodies in personnel in the blinded study receiving these lots was 47% (8/17) compared to an incidence of 0% (0/8; P < 0.025) of the AVIP participants receiving other lots of vaccine."
Even after the war, troops that had never been deployed overseas, after receiving the anthrax vaccine, developed symptoms similar to those of Persian Gulf War Syndrome. The Pentagon failed to report to Congress 20,000 cases where soldiers were hospitalized after receiving the vaccine between 1998 and 2000.
Despite repeated assurances that the vaccine was safe and necessary, a U.S. Federal Judge ruled that there was good cause to believe it was harmful, and he ordered the Pentagon to stop administering it in October 2004. The ban was lifted in February 2008 after the FDA re-examined and approved the drug again. Anthrax vaccine is the only substance suspected in Persian Gulf War syndrome to which forced exposure has since been banned to protect troops from it.
Subsequent anthrax vaccines, however, have met with approval. On December 15, 2005, the Food and Drug Administration, released a Final Order finding that the current anthrax vaccines are safe and effective. The anthrax vaccine currently used is not the same vaccine that was issued during the First Gulf War.
Many of the symptoms, other than low cancer incidence rates, of Gulf War syndrome are similar to the symptoms of organophosphate, mustard gas, and nerve gas poisoning. Persian Gulf War veterans were exposed to a number of sources of these compounds, including nerve gas and pesticides.
Over 125,000 U.S. troops and 9,000 UK troops were exposed to nerve gas and mustard gas when an Iraqi depot in Khamisiyah, Iraq was bombed in 1991.
One of the most unusual events during the build-up and deployment of British forces into the desert of Saudi Arabia was the constant alarms from the NIAD detection systems deployed by all British forces in theatre. The NIAD is a chemical and biological detection system that is set up some distance away from a deployed unit, and will set off an alarm automatically if an agent is detected.
During the troop build-up, these detectors were set off on a large number of occasions, making the soldiers don their respirators. Many reasons were given for the alarms, ranging from fumes from helicopters, fumes from passing jeeps, cigarette smoke and even deodorant worn by troops manning the NIAD posts.
Although the NIAD had been deployed countless times in peacetime exercises in the years before the Gulf War, the large number of alarms was, to say the least, very unusual, and the reasons given were something of a joke among the troops.
The Riegle Report said that chemical alarms went off 18,000 times during the Gulf War. The United States did not have any biological agent detection capability during the Gulf War. After the air war started on January 16, 1991, coalition forces were chronically exposed to low (nonlethal) levels of chemical and biological agents released primarily by direct Iraqi attack via missiles, rockets, artillery, or aircraft munitions and by fallout from allied bombings of Iraqi chemical warfare munitions facilities.
Chemical detection units from the Czech Republic, France, and Britain confirmed chemical agents. French detection units detected chemical agents. Both Czech and French forces reported detections immediately to U.S. forces. U.S. forces detected, confirmed, and reported chemical agents; and U.S. soldiers were awarded medals for detecting chemical agents.
Some, including Richard Guthrie, an expert in chemical warfare at Sussex University, have argued that a likely cause for the increase in birth defects was the Iraqi Army’s use of teratogenic mustard agents. Plaintiffs in a long-running class-action lawsuit continue to assert that sulphur mustards might be responsible. Both chemical agents, at the exposure levels required to cause such birth defects, would be likely to produce elevated levels of cancer not seen in Gulf War veterans. Khanisiya was the location of an Iraqi chemical weapons storage facility bombed during the first Gulf War.
There is also speculation that residual chemical agents from the Iran–Iraq war caused environmental contamination and chronic exposure amongst the troops, consistent with the increased observation of birth defects amongst the Iraqis bracketing the period of the Gulf War.
Depleted uranium (DU) was used in tank kinetic energy penetrator and autocannon rounds on a large scale for the first time in the Gulf War. DU munitions often burn when they impact a hard target, producing toxic combustion products.
The toxicity, effects, distribution, and exposure involved have all been the subject of a lengthy and complex debate.
Because uranium is a heavy metal and chemical toxicant with nephrotoxic (kidney-damaging), teratogenic(birth defect-causing), and potentially carcinogenic properties, uranium exposure is associated with a variety of illnesses. The chemical toxicological hazard posed by uranium dwarfs its radiological hazard because it is only weakly radioactive, and depleted uranium even less so.
Early studies of depleted uranium aerosol exposure assumed that uranium combustion product particles would quickly settle out of the air and thus could not affect populations more than a few kilometers from target areas, and that such particles, if inhaled, would remain undissolved in the lung for a great length of time and thus could be detected in urine. Uranyl ion contamination has been found on and around depleted uranium targets.
DU has recently been recognized as a neurotoxin. In 2005, depleted uranium was shown to be a neurotoxin in rats.
In 2001, a study was published in Military Medicine that found DU in the urine of Gulf War veterans. Another study, published by Health Physics in 2004, also showed DU in the urine of Gulf War veterans. A study of UK veterans who thought they might have been exposed to DU showed aberrations in their white blood cell chromosomes. Mice immune cells exposed to uranium exhibit abnormalities.
A 2001 study of 15,000 February 1991 U.S. Gulf War combat veterans and 15,000 control veterans found that the Gulf War veterans were 1.8 (fathers) to 2.8 (mothers) times more likely to have children with birth defects. After examination of children's medical records two years later, the birth defect rate increased by more than 20%:
"Dr. Kang found that male Gulf War veterans reported having infants with likely birth defects at twice the rate of non-veterans. Furthermore, female Gulf War veterans were almost three times more likely to report children with birth defects than their non-Gulf counterparts. The numbers changed somewhat with medical records verification. However, Dr. Kang and his colleagues concluded that the risk of birth defects in children of deployed male veterans still was about 2.2 times that of non-deployed veterans."
In a study of U.K. troops, "Overall, the risk of any malformation among pregnancies reported by men was 50% higher in Gulf War Veterans (GWV) compared with Non-GWVs."
In the Balkans war zone where depleted uranium was also used, an absence of problems is seen by some as evidence of DU munitions' safety. "Independent investigations by the World Health Organization, European Commission, European Parliament, United Nations Environment Programme, United Kingdom Royal Society, and the Health Council of the Netherlands all discounted any association between depleted uranium and leukemia or other medical problems." Since then, there has been a resurgence of interest in the health effects of depleted uranium, especially since it has recently been linked with neurotoxicity.
Increases in the rate of birth defects for children born to Gulf War veterans have been reported. A 2001 survey of 15,000 U.S. Gulf War combat veterans and 15,000 control veterans found that the Gulf War veterans were 1.8 (fathers) to 2.8 (mothers) times as likely to report having children with birth defects.
Although not identifying Gulf War syndrome by name, in June 2003 the High Court of England and Wales upheld a claim by Shaun Rusling that the depression, eczema, fatigue, nausea and breathing problems that he experienced after returning from the Gulf War were attributed to his military service.
A 2004 British study comparing 24,000 Gulf War veterans to a control group of 18,000 men found that those who had taken part in the Gulf War have lower fertility and are 40 to 50% more likely to be unable to start a pregnancy. Among Gulf War soldiers, failure to conceive was 2.5% vs. 1.7% in the control group, and the rate of miscarriage was 3.4% vs. 2.3%. These differences are small but statistically significant.
In January 2006, a study led by Melvin Blanchard and published by the ''Journal of Epidemiology'', part of the "National Health Survey of Gulf War-Era Veterans and Their Families", stated that veterans deployed in the Persian Gulf War had nearly twice the prevalence of chronic multisymptom illness (CMI), a cluster of symptoms similar to a set of conditions often called Gulf War Syndrome.
On November 17, 2008 a congressionally appointed committee called the Research Advisory Committee on Gulf War Veterans' Illnesses, staffed with independent scientists and veterans appointed by the Department of Veterans Affairs, announced that the syndrome is a distinct physical condition. The committee stated that the condition was likely caused by a drug given to troops to protect against nerve gas, known as pyridostigmine bromide, and pesticides that were used heavily during the war.
It said other possible causes could not be ruled out. The committee recommended that Congress increase funding for research on Gulf War veterans' health to at least $60 million per year.
Tests of 5 Gulf War Veterans in 2007 and analyzed by Wayne State University Medical staff revealed the 5 Veterans studied have severe chromosome damage. The damage uncovered is 10 times the level found in the normal population. The chromosome damage is similar to that seen when exposed to Alpha radiation and could be related to Depleted Uranium munitions exposure. Further, more widespread tests need to be conducted before conclusions can be drawn from this research.
Similar syndromes have been seen as an after effect of other conflicts — for example, 'shell shock' after World War I, and ''post-traumatic stress disorder (PTSD)'' after the Vietnam War. A review of the medical records of 15,000 American Civil War soldiers showed that "those who lost at least 5% of their company had a 51% increased risk of later development of cardiac, gastrointestinal, or nervous disease."
A November 1996 article in the New England Journal of Medicine found no difference in death rates, hospitalization rates or self-reported symptoms between Persian Gulf veterans and non-Persian Gulf veterans. This article was a compilation of dozens of individual studies involving tens of thousands of veterans. The studies did find a statistically significant elevation in the number of traffic accidents suffered by Persian Gulf vets vs. non-Persian Gulf vets.
An April, 1998 article in Emerging Infectious Diseases found no increased rate of hospitalization and better health overall for veterans of the Persian Gulf War vs. Veterans who stayed home. James D. Knoke and Gregory C. Gray, Naval Health Research Center, San Diego, California, USA, Emerging Infectious Diseases 1998 Oct-Dec;4(4):707-9, Hospitalizations for unexplained illnesses among U.S. veterans of the Persian Gulf War.
The US Institute of Medicine, released their conclusions in a September 2006 report further casting doubts on the validity of Gulf War Syndrome, writing that although roughly 30% of service men and women who served either have suffered or still suffer from symptoms, no single cluster of symptoms that constitute a syndrome unique to Gulf War veterans has been identified.
While an increase in birth defects has also been attributed to Gulf War Syndrome, a study on members of the Mississippi National Guard deployed to the Persian Gulf, conducted in 1996 found that of a total of 55 births, five children were born with birth defects.
The study concluded that “The rate of birth defects of all types in children born to this group of veterans is similar to that expected for the general population.” In another study of 75,000 births conducted by the New England Journal of Medicine, 7.45% of the Gulf War veteran children were born with birth defects, compared to 7.59% for children of veterans not deployed in the Persian Gulf
Many U.S. veterans of the 2003 Iraq War have reported a range of serious health issues, including tumors, daily blood in urine and stool, sexual dysfunction, migraines, frequent muscle spasms, and other symptoms similar to the debilitating symptoms of "Gulf War Syndrome" reported by many veterans of the 1991 Gulf War, which some believe is related to the continued United States' use of depleted uranium.
New research from the United Kingdom, published in the medical journal the Lancet compared the health of thousands of service personnel who served in Iraq with the health of thousands who did not, stated:
"If we had found an increase in morbidity after the Iraq war equivalent to that before the Gulf War we could say that these changes were not related to the occurrence of symptoms; all we can now say at this stage is that our new data add to the evidence that there was some relation between the specific pattern of medical countermeasures used in 1991 and ill health."
After 10 years of research worldwide, overseen by the veterans' lawyers and funded by the UK's Legal Services Commission, no evidence was found which established any specific cause for the range of the health problems of over 2,000 British troops who were seeking disability pensions for Gulf War Syndrome.
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