Objective: This study aimed to understand the immune health effects of jet fuels used by the US military. Methods: A systematic review of epidemiologic, animal toxicological, and mechanistic studies was conducted to assess evidence on immune effects following jet fuel exposure. Data were synthesized to evaluate evidence for specific immune health outcomes. Results: Animal toxicological studies provided moderate evidence that jet fuel exposure causes immune suppression and adversely impacts the immune system by altering immune organ weight, cellularity, and cellular function. Adverse changes were observed predominantly within the adaptive immune system, particularly T cells. There was indeterminate epidemiologic evidence that jet fuel exposure caused immune effects in humans. Conclusions: Evidence indicates that jet fuel exposure is likely to produce adverse immune effects, particularly in the adaptive immune system. Critical data gaps remain regarding impacts on host resistance, neoplastic disease, and autoimmune disorders.

Objective: The aim of this study was to assess the possible hepatic and renal health effects of jet fuels used by the US military. Methods: A systematic literature review utilizing epidemiologic, animal toxicological, and mechanistic studies was conducted to evaluate hepatic and renal health effects following jet fuel exposure. Results: Epidemiologic evidence for renal and hepatic outcomes was indeterminate, primarily due to the limited number and quality of human studies. Animal toxicological studies provided moderate evidence that jet fuel exposure impacts the renal system, while there was slight evidence for hepatic effects. Conclusions: Evidence suggests that exposure to jet fuels may cause nephrotoxicity and hepatotoxicity in humans. However, uncertainty remains due to the inconsistent direction of effects, the limited number of studies examining specific health outcomes, and the few published human studies available for review.

Objective: This study aimed to assess the neurologic, cognitive, and behavioral effects of jet fuels used by the US military. Methods: A fit-for-purpose systematic literature review approach based on the US EPA's IRIS handbook was used to conduct a comprehensive assessment of the scientific evidence. Data were synthesized to evaluate evidence for specific neurologic health outcomes. Results: Short- and long-term adverse effects on sensory functions (ie, auditory, visual), memory and cognition, motor coordination, and peripheral nervous system were observed in human and animal studies following exposure to jet fuels. Conclusions: The evidence indicates that exposure to jet fuels is likely to cause neurotoxicity in humans. Overall, the results indicate that the nervous system is sensitive to jet fuel exposure; however, uncertainty remains due to the limited number of quality epidemiologic studies and the large variety of jet fuels studied.

Objective: Jet fuel inhalation represents one of the most significant exposures among service members; however, health outcomes are unclear, and the processes linking exposures and respiratory effects are undefined. Methods: A systematic literature review of human, animal, and mechanistic studies was conducted to assess and synthesize the scientific evidence on the adverse respiratory effects of jet fuel exposure. Results: Animal studies provided moderate evidence that jet fuel inhalation resulted in adverse effects through cytotoxicity, tissue damage, inflammation, airway remodeling, and lung function changes, which was corroborated by mechanistic data. This was further supported by slight epidemiologic evidence that jet fuel exposure is associated with increased respiratory symptoms and disease. Conclusions: Evidence indicates that jet fuel exposure is likely to produce adverse respiratory effects, which may have important implications for exposed service members and veterans.

Objective: The aim of the study was to present the methods for a fit-for-purpose systematic review designed to assess the health effects of jet fuel exposure in military settings by synthesizing data from epidemiologic, animal toxicological, and mechanistic studies. Methods: Methods followed the US Environmental Protection Agency’s Integrated Risk Information System and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines with adaptations to meet the needs for this review. Results: A literature search was conducted across scientific databases, gray literature, and expert-identified sources, resulting in the inclusion of 279 relevant references. Results are presented in a systematic evidence map and companion articles. Conclusions: The methods employed ensure transparency in the screening, evaluation, and synthesis of data, establishing a foundation for further research on the health impacts of jet fuel exposure in veterans.