The Pine River statement: human health consequences of DDT use.
OBJECTIVE
Dichlorodiphenyltrichloroethane (DDT) was used worldwide until the 1970s, when concerns about its toxic effects, its environmental persistence, and its concentration in the food supply led to use restrictions and prohibitions. In 2001, more than 100 countries signed the Stockholm Convention on Persistent Organic Pollutants (POPs), committing to eliminate the use of 12 POPs of greatest concern. However, DDT use was allowed for disease vector control. In 2006, the World Health Organization and the U.S. Agency for International Development endorsed indoor DDT spraying to control malaria. To better inform current policy, we reviewed epidemiologic studies published from 2003 to 2008 that investigated the human health consequences of DDT and/or DDE (dichlorodiphenyldichloroethylene) exposure.


METHODS
We conducted a PubMed search in October 2008 and retrieved 494 studies.


RESULTS
Use restrictions have been successful in lowering human exposure to DDT, but blood concentrations of DDT and DDE are high in countries where DDT is currently being used or was more recently restricted. The recent literature shows a growing body of evidence that exposure to DDT and its breakdown product DDE may be associated with adverse health outcomes such as breast cancer, diabetes, decreased semen quality, spontaneous abortion, and impaired neurodevelopment in children.


CONCLUSIONS
Although we provide evidence to suggest that DDT and DDE may pose a risk to human health, we also highlight the lack of knowledge about human exposure and health effects in communities where DDT is currently being sprayed for malaria control. We recommend research to address this gap and to develop safe and effective alternatives to DDT.
Eskenazi
Brenda
B
School of Public Health, University of California-Berkeley, 2150 Shattuck Avenue, Berkeley, CA 94720, USA. eskenazi@berkeley.edu
Chevrier
Jonathan
J
Rosas
Lisa Goldman
LG
Anderson
Henry A
HA
Bornman
Maria S
MS
Bouwman
Henk
H
Chen
Aimin
A
Cohn
Barbara A
BA
de Jager
Christiaan
C
Henshel
Diane S
DS
Leipzig
Felicia
F
Leipzig
John S
JS
Lorenz
Edward C
EC
Snedeker
Suzanne M
SM
Stapleton
Darwin
D
D002273:Carcinogens / Q000633:toxicity; D003634:DDT / Q000633:toxicity*; D003920:Diabetes Mellitus / Q000139:chemically induced; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D007306:Insecticides / Q000633:toxicity*; D009420:Nervous System / Q000187:drug effects; D012098:Reproduction / Q000187:drug effects; D013723:Teratogens / Q000633:toxicity; D014874:Water Pollutants, Chemical / Q000633:toxicity*
D002273:Carcinogens; D007306:Insecticides; D013723:Teratogens; D014874:Water Pollutants, Chemical; D003634:DDT