First ACE Investigation

Overview

At the request of the Hawaii Department of Health (HDOH), the first ACE investigation surveyed civilians, military personnel, and families. It focused on those who worked or lived in areas served by the Joint Base Pearl Harbor-Hickam Water Distribution System affected by the November 20, 2021, water contamination. Survey questions included:

• How they were exposed to the contaminated water.
• The health symptoms they experienced.
• The medical care they sought.
• The impacts to their children and pets.

The ACE investigation survey outreach was electronic and in-person for rapid information collection. Affected people were across a wide geographic area.

The ACE team assisted HDOH from January-February 2022 by:

• Designing a data collection questionnaire.
• Modifying the survey so participants could take it online.
• Developing a data management plan.
• Analyzing survey results.
• Providing public health recommendations based on the ACE's results.

Key findings

2,289 eligible participants submitted surveys. At least one household member participated from 1,389 (14%) of 9,694 estimated affected households.

Nearly 90% of survey participants reported at least one new or worsening symptom since the incident. 17 participants reported overnight hospitalization. Many reported symptoms consistent with previous studies of exposure to petroleum hydrocarbons, including those related to:

• The respiratory system.
• The gastrointestinal tract.
• The nervous system.
• Mental health.

Some reported experiencing some symptom relief after switching to an alternative water source. This supports the association between symptoms and the contaminated water.

Exposure Routes

An exposure route is how a chemical enters a person or animal's body. ACE findings include:

• 1,115 participants (52%) reported at least one indication that their water was contaminated (petroleum smell or taste, or visible oily sheen).
• 1,821 participants (80%) reported that they ingested the potentially contaminated water through oral hygiene.
• 1,650 participants (72%) reported that they ingested the potentially contaminated water through drinking.
• 1,629 participants (71%) reported that they ingested the potentially contaminated water through cooking.

Health Symptoms

Based on the data, we found:

• 1,980 participants (87%) reported one or more new or worsening health symptom after the incident.
• 1,493 participants (75%) reported symptoms lasting 30 or more days.
• The largest percentage of reported symptoms related to the nervous system (62%); followed by the:
  • Gastrointestinal system (58%).
  • Skin (58%).
  • Ears, nose, or throat (47%).
  • Mental health (46%).
  • Eyes (42%).
  • Respiratory system (31%).
• 853 participants (37%) sought medical care; 17 participants reported overnight hospitalization.
• 2,123 participants (93%) switched to another water source after learning of the incident.
• 1,591 of the 1,980 symptomatic participants (80%) reported symptoms improving after switching to another water source.

Recommendations

Based on the ACE investigation's findings, the ACE team made recommendations to HDOH:

• Rebuild communities' confidence in the drinking water system by strengthening communication across agencies and with the public.
• Provide support to clinical providers to help them better identify, assess, treat, and document affected individuals, including identifying and mitigating psychosocial stressors.
• Ensure equity in the response across the affected populations.
• Consider additional health investigations, including a 6-month follow-up ACE investigation and activities to better understand longer-term health risks.