Endemic Arsenic Poisoning

Abstract

Arsenicosis, also described as blackfoot disease, was first reported in the 1950s in Taiwan, China. In the mainland of China, endemic arsenic poisoning induced by consumption of arsenic-contaminated drinking water was first reported in 1983 in Kuitun City, Xinjiang Uygur Autonomous Region. The distribution of endemic arsenicosis has also been confirmed in Inner Mongolia Autonomous Region, Shanxi, Jilin, Ningxia, Qinghai, Anhui, Gansu, Hubei, Yunnan, and Shaanxi provinces. According to the recent research by Eawag, Swiss Federal Institute of Aquatic Science and Technology, there are estimated 19.6 million people who are at risk of being affected by arsenic-contaminated groundwater. In addition, another type of endemic arsenic poisoning is found due to burning coal containing high levels of arsenic. Consumption of arsenic-contaminated food (mainly corns and chili peppers) dried by burning coal with high concentration of arsenic and inhalation of arsenic-contaminated air are the main exposure routes of this kind of arsenicosis.

The early symptoms of endemic arsenic poisoning usually occur in the skin, characterized with pigmentation changes and hard patches (hyperkeratosis) on the palms and soles. In addition to skin alterations, endemic arsenic poisoning is reported to be associated with high risk of cancers in the lung, skin, liver, prostate, bladder, and kidney. The International Agency for Research on Cancer (IARC) has classified arsenic and arsenic compounds as human carcinogens. Other adverse health effects resulting from chronic ingestion of inorganic arsenic include neurotoxicity, diabetes, cardiovascular disease, and respiratory complications.

This chapter mainly introduces the latest studies of etiology and epidemiology, clinical manifestations, as well as the diagnostic standard and criteria of the endemic arsenicosis in China. The government of China has made great intervention progresses including provision of arsenic-safe water and improved stoves to mitigate the damage of this public health problem. What’s more, establishing an effective surveillance system including accurate water quality database and dynamic GIS mapping system using a geostatistical-based risk model is now necessary and important not only for the forthcoming large-scale screening but also for the ultimate goal of arsenic elimination.