Our results suggest that persistent small airways obstruction among survivors of the 1984 disaster may be attributed to gas exposure.

Nine years after the Bhopal methyl isocyanate disaster, we examined the effects of exposures among a cross-section of current residents and a subset of those with persistent symptoms. We estimated individual exposures by developing exposure indices based on activity, exposure duration, and distance of residence from the plant. Most people left home after the gas leak by walking and running. About 60% used some form of protection (wet cloth on face, splashing water). Mean and median values of the exposure indices showed a declining trend with increasing distance from the plant. For those subjects reporting any versus no exposure, prevalence ratios were elevated for most respiratory and nonrespiratory symptoms. We examined exposure-response relationships using exposure indices to determine which were associated with health outcomes. The index total exposure weighted for distance was associated with most respiratory symptoms, one measure of pulmonary function in the cross-sectional sample [mid-expiratory flow (FEF)(25-75), p = 0.02], and two measures of pulmonary function in the hospitalized subset [forced expiratory volume (FEV)(1), p = 0.02; FEF(25-75), p = 0.08). Indices that correlated with FEV(1) and forced vital capacity in the hospitalized subset did not correlate with the cross-sectional sample, and most indices (except total exposure) that correlated with the hospitalized subset did not correlate with the cross-sectional sample. Incorporation of distance into every index increased the number of symptoms associated; an improvement was also noted in the strength of the association for respiratory symptoms, but not for pulmonary function. The sum of duration (p = 0.02) and total exposure (p = 0.03) indices independently demonstrated stronger associations with percent predicted FEF(25-75) than the distance variable (p = 0.04). The results show that total exposure weighted for distance has met the criteria for a successful index by being associated with most respiratory symptoms as well as FEF(25-75), features of obstructive airways disease.

BackgroundThe disasters at Seveso, Three Mile Island, Bhopal, Chernobyl, the World Trade Center (WTC) and Fukushima had historic health and economic sequelae for large populations of workers, responders and community members.MethodsComparative data from these events were collected to derive indications for future preparedness. Information from the primary sources and a literature review addressed: i) exposure assessment; ii) exposed populations; iii) health surveillance; iv) follow-up and research outputs; v) observed physical and mental health effects; vi) treatment and benefits; and vii) outreach activities.ResultsExposure assessment was conducted in Seveso, Chernobyl and Fukushima, although none benefited from a timely or systematic strategy, yielding immediate and sequential measurements after the disaster. Identification of exposed subjects was overall underestimated. Health surveillance, treatment and follow-up research were implemented in Seveso, Chernobyl, Fukushima, and at the WTC, mostly focusing on the workers and responders, and to a lesser extent on residents. Exposure-related physical and mental health consequences were identified, indicating the need for a long-term health care of the affected populations. Fukushima has generated the largest scientific output so far, followed by the WTCHP and Chernobyl. Benefits programs and active outreach figured prominently in only the WTC Health Program. The analysis of these programs yielded the following lessons: 1) Know who was there; 2) Have public health input to the disaster response; 3) Collect health and needs data rapidly; 4) Take care of the affected; 5) Emergency preparedness; 6) Data driven, needs assessment, advocacy.ConclusionsGiven the long-lasting health consequences of natural and man-made disasters, health surveillance and treatment programs are critical for management of health conditions, and emergency preparedness plans are needed to prevent or minimize the impact of future threats.

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and 1 km to the north east ofthe factory. Conclusions -The value of combining the skills of geographers and epidemiologists in addressing public health issues is shown, particularly through the use ofgeographical information systems which proved powerful and effective. (J Epidemiol Community Health 1995;49:395-400) Interest in the effects on health of airborne pollution, particularly from point sources, has increased recently. The Small Area Health Statistics Unit (SAHSU) has a specific role in investigating these problems.' There remains, however, a challenge to develop both the methodology and information systems for solving this type of problem. We illustrate the benefits ofcombining geographical information systems (GIS) technology with epidemiological concepts. We examined the respiratory health status of a population living near a single industrial point source, a factory which has been in operation since 1974 and which produces plastic coated wallpaper. Residents living near the factory had expressed concern about airborne emissions, especially in terms of unpleasant smells and the potential risk of cancer. Vapours which are emitted from the factory's chimneys and which drift across nearby housing estates initiated the local concern. Fume scrubbing apparatus was installed in 1989 to reduce emissions. A substance used in the factory processes, azodicarbonamide, is a recognised causal agent in the development of occupational asthma.23Our null hypothesis was that after suitable standardisation no excess prevalence of asthma would be found in either children or adults in the area of the housing estate closest to the factory when compared with surrounding areas.

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