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Dioxins and their effects on human health


Dioxins are environmental pollutants. They have the dubious distinction of belonging to the “dirty dozen” - a group of dangerous chemicals known as persistent organic pollutants. Dioxins are of concern because of their highly toxic potential. Experiments have shown they affect a number of organs and systems. Once dioxins have entered the body, they endure a long time because of their chemical stability and their ability to be absorbed by fat tissue, where they are then stored in the body. Their half-life in the body is estimated to be seven to eleven years. In the environment, dioxins tend to accumulate in the food chain. The higher in the animal food chain one goes, the higher is the concentration of dioxins.

The chemical name for dioxin is: 2,3,7,8- tetrachlorodibenzo para dioxin (TCDD). The name ‘dioxins’ is often used for the family of structurally and chemically related polychlorinated dibenzo para dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). Certain dioxin-like polychlorinated biphenyls (PCBs) with similar toxic properties are also included under the term “dioxins”. Some 419 types of dioxin-related compounds have been identified but only about 30 of these are considered to have significant toxicity, with TCDD being the most toxic.

Sources of dioxin contamination

Dioxins are mainly by products of industrial processes but can also result from natural processes, such as volcanic eruptions and forest fires. Dioxins are unwanted by products of a wide range of manufacturing processes including smelting, chlorine bleaching of paper pulp and the manufacturing of some herbicides and pesticides. In terms of dioxin release into the environment, waste incinerators (solid waste and hospital waste) are often the worst culprits, due to incomplete burning.

Although formation of dioxins is local, environmental distribution is global. Dioxins are found throughout the world in practically all media. The highest levels of these compounds are found in some soils, sediments and food, especially dairy products, meat, fish and shellfish. Very low levels are found in plants, water and air.

Extensive stores of PCB-based waste industrial oils, many with high levels of PCDFs, exist throughout the world. Long-term storage and improper disposal of this material may result in dioxin release into the environment and the contamination of human and animal food supplies. PCB-based waste is not easily disposed of without contamination of the environment and human populations. Such material needs to be treated as hazardous waste and is best destroyed by high temperature incineration.

Dioxin contamination incidents

Many countries monitor their food supply for dioxins. This has led to early detection of contamination and has often prevented impact on a larger scale. One example is the detection of increased dioxin levels in milk in 2004 in the Netherlands, traced to a clay used in the production of the animal feed. In another incident, elevated dioxin levels were detected in animal feed in the Netherlands in 2006 and the source was identified as contaminated fat used in the production of the feed.

Some dioxin contamination events have been more significant, with broader implications in many countries.

In July 2007, the European Commission issued a health warning to its Member States after high levels of dioxins were detected in a food additive - guar gum - used as thickener in small quantities in meat, dairy, dessert or delicatessen products. The source was traced to guar gum from India that was contaminated with pentachlorophenol (PCP), a pesticide no longer in use. PCP contains dioxins as contamination.

In 1999, high levels of dioxins were found in poultry and eggs from Belgium. Subsequently, dioxin-contaminated animal-based food (poultry, eggs, pork), were detected in several other countries. The cause was traced to animal feed contaminated with illegally disposed PCB-based waste industrial oil.

In March 1998, high levels of dioxins in milk sold in Germany were traced to citrus pulp pellets used as animal feed exported from Brazil. The investigation resulted in a ban on all citrus pulp imports to the EU from Brazil.

Another case of dioxin contamination of food occurred in the United States of America in 1997. Chickens, eggs, and catfish were contaminated with dioxins when a tainted ingredient (bentonite clay, sometimes called “ball clay”) was used in the manufacture of animal feed. The contaminated clay was traced to a bentonite mine. As there was no evidence that hazardous waste was buried at the mine, investigators speculate that the source of dioxins may be natural, perhaps due to a prehistoric forest fire.

Large amounts of dioxins were released in a serious accident at a chemical factory in Seveso, Italy, in 1976. A cloud of toxic chemicals, including 2,3,7,8-Tetrachlorodibenzo-p-dioxin, or TCDD, was released into the air and eventually contaminated an area of 15 square kilometres where 37 000 people lived. Extensive studies in the affected population are continuing to determine the long-term human health effects from this incident. These investigations, however, are hampered by the lack of appropriate exposure assessments. A minor increase in certain cancers and effects on reproduction have been detected and are being further investigated. Possible effects on the children of exposed people are currently being studied.

TCDD has also been extensively studied for health effects linked to its presence as a contaminant in some batches of the herbicide Agent Orange, which was used as a defoliant during the Vietnam War. A link to certain types of cancers and also to diabetes is still being investigated.

Earlier incidents of food contamination have been reported in other parts of the world. Although all countries can be affected, most contamination cases have been reported in industrialized countries where adequate food contamination monitoring, greater awareness of the hazard and better regulatory controls are available for the detection of dioxin problems.

A few cases of intentional human poisoning have also been reported. The most notable incident is the 2004 case of Viktor Yushchenko, President of the Ukraine, whose face was disfigured by chloracne.

Effects of dioxins on human health

Short-term exposure of humans to high levels of dioxins may result in skin lesions, such as chloracne and patchy darkening of the skin, and altered liver function. Long-term exposure is linked to impairment of the immune system, the developing nervous system, the endocrine system and reproductive functions. Chronic exposure of animals to dioxins has resulted in several types of cancer. TCDD was evaluated by the WHO’s International Agency for Research on Cancer (IARC) in 1997. Based on animal data and on human epidemiology data, TCDD was classified by IARC as a "known human carcinogen”. However, TCDD does not affect genetic material and there is a level of exposure below which cancer risk would be negligible.

Due to the omnipresence of dioxins, all people have background exposure and a certain level of dioxins in the body, leading to the so-called body burden. Current normal background exposure is not expected to affect human health on average. However, due to the high toxic potential of this class of compounds, efforts need to be undertaken to reduce current background exposure.

Sensitive subgroups

The developing fetus is most sensitive to dioxin exposure. The newborn, with rapidly developing organ systems, may also be more vulnerable to certain effects. Some individuals or groups of individuals may be exposed to higher levels of dioxins because of their diets (e.g., high consumers of fish in certain parts of the world) or their occupations (e.g., workers in the pulp and paper industry, in incineration plants and at hazardous waste sites, to name just a few).

Prevention and control of dioxin exposure

Proper incineration of contaminated material is the best available method of preventing and controlling exposure to dioxins. It can also destroy PCB-based waste oils. The incineration process requires high temperatures, over 850°C. For the destruction of large amounts of contaminated material, even higher temperatures - 1000°C or more - are required.

Prevention or reduction of human exposure is best done via source-directed measures, i.e. strict control of industrial processes to reduce formation of dioxins as much as possible. This is the responsibility of national governments, but in recognition of the importance of this approach, the Codex Alimentarius Commission adopted in 2001 a Code of Practice for Source Directed Measures to Reduce Contamination of Foods with Chemicals (CAC/RCP 49-2001), and in 2006 a Code of Practice for the Prevention and Reduction of Dioxin and Dioxin-like PCB Contamination in Food and Feeds (CAC/RCP 62-2006).

More than 90% of human exposure to dioxins is through the food supply, mainly meat and dairy products, fish and shellfish. Consequently, protecting the food supply is critical. One approach includes, as mentioned above, source-directed measures to reduce dioxin emissions. Secondary contamination of the food supply needs to be avoided throughout the food-chain. Good controls and practices during primary production, processing, distribution and sale are all essential to the production of safe food.

Food contamination monitoring systems must be in place to ensure that tolerance levels are not exceeded. It is the role of national governments to monitor the safety of food supply and to take action to protect public health. When incidents of contamination are suspected, countries should have contingency plans to identify, detain and dispose of contaminated feed and food. The exposed population should be examined in terms of exposure (e.g. measuring the contaminants in blood or human milk) and effects (e.g. clinical surveillance to detect signs of ill health).

What should consumers do to reduce their risk of exposure?

Trimming fat from meat and consuming low fat dairy products may decrease the exposure to dioxin compounds. Also, a balanced diet (including adequate amounts of fruits, vegetables and cereals) will help to avoid excessive exposure from a single source. This is a long-term strategy to reduce body burdens and is probably most relevant for girls and young women to reduce exposure of the developing fetus and when breastfeeding infants later on in life. However, the possibility for consumers to reduce their own exposure is somewhat limited.

What does it take to identify and measure dioxins in the environment and food?

The quantitative chemical analysis of dioxins requires sophisticated methods that are available only in a limited number of laboratories around the world. These are mostly in industrialized countries. The analysis costs are very high and vary according to the type of sample, but range from over US$ 1700 for the analysis of a single biological sample to several thousand US dollars for the comprehensive assessment of release from a waste incinerator.

Increasingly, biological (cell- or antibody) -based screening methods are being developed. The use of such methods for food samples is not yet sufficiently validated. Nevertheless, such screening methods will allow more analyses at lower cost. In case of a positive screening test, confirmation of results must be carried out via more complex chemical analysis.

WHO activities related to dioxins

Reducing dioxin exposure is an important public health goal for disease reduction, also with respect to sustainable development. In order to give guidance on acceptable levels of exposure, WHO has held a series of expert meetings to determine a tolerable intake of dioxins to which a human can be exposed throughout life without harm.

In the latest of such expert meetings held in 2001, the Joint FAO/WHO Expert Committee on Food Additives (JECFA) performed an updated comprehensive risk assessment of PCDDs, PCDFs, and “dioxin-like” PCBs. The experts concluded that a tolerable intake could be established for dioxins on the basis of the assumption that there is a threshold for all effects, including cancer. The long half-lives of PCDDs, PCDFs and “dioxin-like” PCBs mean that each daily ingestion has a small or even a negligible effect on overall intake. In order to assess long- or short-term risks to health due to these substances, total or average intake should be assessed over months, and the tolerable intake should be assessed over a period of at least one month. The experts established a provisional tolerable monthly intake (PTMI) of 70 picogram/kg per month. This level is the amount of dioxins that can be ingested over lifetime without detectable health effects.

WHO, in collaboration with the Food and Agriculture Organization (FAO), through the joint FAO/WHO Codex Alimentarius Commission, has established a ‘Code of Practice for the Prevention and Reduction of Dioxin and Dioxin-like PCB Contamination in Foods and Feed’. This document gives guidance to national and regional authorities on preventive measures. The establishment of Codex guideline levels for dioxins in foods is under consideration.

Since 1976 WHO has been responsible for the Global Environment Monitoring System’s Food Contamination Monitoring and Assessment Programme. Commonly known as GEMS/Food, the programme provides information on levels and trends of contaminants in food through its network of participating laboratories in over 70 countries around the world. Dioxins are included in this monitoring programme.

Since 1987, WHO has conducted periodic studies on levels of dioxins in human milk, mainly in European countries. These studies provide an assessment of human exposure to dioxins from all sources. Recent exposure data indicate that measures introduced to control dioxin release in a number of countries have resulted in a substantial reduction in exposure to these compounds over the past two decades.

WHO is now working with the United Nations Environmental Programme (UNEP) on the implementation of the ‘Stockholm Convention’, an international agreement to reduce emissions of certain persistent organic pollutants (POPs), including dioxins. A number of actions are being considered internationally to reduce the production of dioxins during incineration and manufacturing processes. In responding to the needs of the Stockholm Convention on POPs, the WHO GEMS/Food has developed a new protocol for a Global Survey of Human Milk for POPs in order to meet the health, food safety and environmental objectives of WHO, UNEP and their member countries. This protocol will assist national and regional authorities to collect and analyse representative samples in order to assess the current state of background exposure and in the future to assess the effectiveness of measures taken to reduce exposure.

Dioxins occur as a complex mixture in the environment and in food. In order to assess the potential risk of the whole mixture, the concept of toxic equivalence has been applied to this group of contaminants. TCDD, the most toxic member of the family, is used as reference compound, and all other dioxins are assigned a toxic potency relative to TCDD, based on experimental studies. During the last 15 years, WHO, through the International Programme on Chemical Safety (IPCS), has established and regularly re-evaluated toxic equivalency factors (TEFs) for dioxins and related compounds through expert consultations. WHO-TEF values have been established which apply to humans, mammals, birds and fish. The last such consultation was held in 2005 to update human and mammalian TEFs. These international TEFs have been developed for application in risk assessment and management, and have been adopted formally by a number of countries and regional bodies, including Canada, Japan, the United States and the European Union.

Sources: US Department of Health; The World Health Organization

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