Archive for the 'Environmental Health' category

Measuring Household Dust for Potentially Dangerous Chemicals

Apr 08 2014 :: Published in Environmental Health

This blog post is part of a biomonitoring series.

Can analyzing our household or workplace dust help scientists predict the levels of potentially dangerous chemicals inside our bodies?

In a world where furniture, carpets, curtains and electronics are treated with potent flame-retardant chemicals, we are exposed continuously to novel chemical substances upon which little research has been conducted. The use of flame retardants has become necessary due to changing types of materials used in our household goods.

Measuring Household Dust for Potentially Dangerous Chemicals | www.aphlblog.org

“Think of your living room and all the synthetic materials used in the furnishings and curtains,” said Myrto Petreas, PhD, MPH, from the California Department of Toxic Substances Control. “Now compare that to what was in your grandmother’s living room. Her furniture was probably made with horsehair and wool, and was inherently not prone to fire. With synthetic fabric, there is more fire danger.”

The concern about flame retardants, she said, is that very little is known about these chemicals or what levels, if any, are safe for humans.

Around the time polychlorinated biphenyls, more commonly known as PCBs, were banned in 1979 due to human carcinogenic effects, chemists began creating new flame-retardant chemicals. Fifteen years ago, Petreas and her staff encountered one of the newer ones for the first time. “We were measuring chemicals in a study of breast cancer and looking at the body fat, levels of PCBs, etc. I went to a meeting in Sweden in 1998, where a researcher presented on these new chemicals, PBDEs (polybrominated diphenyl ethers), found in high levels in human breast milk. Back at the lab, I wondered, ‘Can we see it here?’ The levels were so high, I thought it was a mistake.”

Pausing, Petreas added, “The levels are 30 times higher in California now than they were in Sweden then.”

While researchers do not know for sure that the brominated flame retardants, especially the PBDEs, are carcinogens, they are structurally similar to the banned PCBs. They also assimilate into our fat. PCBs, although banned 35 years ago, are still found commonly in people, said Petreas, “because they are in the food web now.” Banning a chemical cannot eradicate it from the population, she explained, but “PBDEs are placed on purpose in our products. We are exposed through dust more than diet. After they are banned, 20 years from now, those PBDEs will be in the food web too, in birds and cows. They stay a long time in the body.”

PBDEs are endocrine disruptors that compete with the thyroid’s hormones, potentially affecting development and cognitive abilities. “In animals,” said Petreas, “they are carcinogens; in humans, we can now look and see but do not have the answers yet.”

The question about whether chemical levels found in dust can help predict the levels in our bodies is an interesting one to biomonitoring scientists who study chemical levels in the human body. “What you see in the dust takes many steps to reach your body,” said Petreas. Just because the chemical is in the air or dust does not mean that your body will absorb it. Also, it is possible that chemicals may be dangerous in combinations rather than alone. Genetics also likely influence susceptibility. Biomonitoring is a sufficiently new science that many questions remain unanswered.

However, it is feasible that scientists could get a good idea of exposure merely by studying the contents of a household’s vacuum cleaner.

Petreas’ lab has worked on two dust studies. One, the California Childhood Leukemia Study, with UC Berkeley, is looking for correlations between childhood leukemia and chemical exposures found in the home. The study is not complete but after looking at the dust samples, Petreas said, “we have seen differences among homes and geography. There is a socio-economic factor: there are higher levels of PBDEs in house dust among lower income households and people of color.”

They also found a high correlation in results from dust tests repeated 3-8 years apart on the same home, showing that the chemical levels were not declining much over time.

The second study, the Firehouse Dust Study that compared levels of pollutants in the blood of firefighters and in the dust of the firehouses, was a side-study of the Firefighters’ Occupational Exposures (FOX) study, conducted by Biomonitoring California with UC Irvine.

“In this pilot study, we tested the blood and urine of 99 men and 2 women,” said Petreas. “We had questionnaires about their work: do they work with forest fires or structural fires? What kind of protective gear do they have and is it used? Later, we wanted to combine the environmental measure with this earlier biological measure. We took samples of dust from the station’s vacuum cleaners. This gives an overall integrated measurement to what the firefighters have been exposed to over time in the firehouse.”

They discovered, perhaps unsurprisingly, that firefighters did have much higher levels of flame retardants in their blood than an average person. Researchers are still trying to identify the main sources of exposure.

Actually, PBDE levels in Californians are higher than in most Americans, largely because of the state’s unique flammability requirements. Petreas pointed out that because the California market is so large, many corporations are designing products to meet the state’s stringent flammability standards and then selling them across North America. As a result, PBDE levels in North Americans are much higher than in Europeans or Asians.

“[Researchers] are always a few levels behind the marketplace,” said Petreas. “We measure the PBDEs now, but already there are different chemicals being used and we don’t know what they are. We can see these chemicals in our samples, but we haven’t studied them yet.”

An important factor in launching these studies has been the creation of Biomonitoring California, a legislatively mandated program that aims to determine baseline levels of environmental contaminants in Californians, study chemical trends over time, and advise regulatory programs. Biomonitoring California is a collaborative effort between the California Department of Public Health, the Office of Environmental Health Hazard Assessment, and the Department of Toxic Substances Control.

“What else is out there that we don’t know about and haven’t looked for?” Petreas asked, echoing a concern that led to the creation of Biomonitoring California.

To reduce exposure to potentially dangerous chemicals, whether from dust or other sources, Petreas said, “Wash your hands before you eat. Just like your mother told you. Never eat at your computer. Leave your shoes outside. These things help with most public health concerns, whether avian flu or chemicals.”

_____________________

Without biomonitoring, public health practitioners face challenges in understanding whether environmental contaminants are actually being absorbed into people’s bodies. Given improvements in technology, the capabilities and expertise that exist in public health laboratories, and the increasing demand from the public for more information about chemical exposures, biomonitoring is poised to become an integral component of public health practice.

To learn more about biomonitoring, check out some of APHL’s Biomonitoring Resources:

Stay tuned for our soon-to-be-unveiled Meeting Community Needs page and of course, let us know if you have any feedback or suggestions.  

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Returning Biomonitoring Test Results in an Easy-to-Understand Format

Mar 11 2014 :: Published in Environmental Health

This blog post is part of a biomonitoring series.

Returning Biomonitoring Test Results in an Easy-to-Understand Format | www.aphblog.org

California passed novel legislation in 2006 that united three state departments in a new program called Biomonitoring California. These three departments—the California Department of Public Health, the Department of Toxic Substances Control and the Office of Environmental Health Hazard Assessment—are tasked with learning more about the chemicals found commonly in Californians, studying chemical trends over time and helping assess the effectiveness of current environmental chemical regulations.

“To address this legislation, we work very closely with our partners,” said Sandy McNeel, DVM, from California’s Department of Public Health. “We have different areas of expertise, so it is a very useful collaboration.”

The legislation defines “community” broadly with respect to biomonitoring studies. “Communities are not only geographically based, but also could be a group of pregnant women or a group who, because of their occupation, may have unusual exposure to certain chemicals,” said McNeel. Since inception, the program has initiated community-based studies of various types and collaborated with other researchers within state government and academia.

As these pioneering biomonitoring studies proceed, the state’s researchers are wrangling with an interesting facet of the law: they are required to return individual test results to all study participants who request them—in an easy-to-understand format.

While it may sound simple, it is very challenging to translate medical and laboratory research into straightforward English; or Spanish, as the case may be.

Still, the greater challenge is that no one, not even the scientists, really knows what some of the biomonitoring results mean in relation to human health. Whether a chemical causes health problems depends on how toxic the chemical is, how much a person takes in, and how long a person is in contact with the chemical.

Biomonitoring is a relatively new branch of laboratory science and new chemicals enter the marketplace every day. There are tens of thousands of chemicals in use today, many of which have not been studied throughly. Discovering possible health effects of chemicals can take years of research. Even with evidence that a chemical causes a particular health effect, it is difficult to know what level in people’s bodies would be harmful. Someone may have a high level of a chemical in her body and never have any effect from it. Another may have a similar level of the chemical and become ill, perhaps due to her genetic predisposition, an underlying health problem, other exposures, or additional unknown factors.

To help make all of this information clear to study participants, Biomonitoring California assembled a team that includes data analysts, chemists, epidemiologists, toxicologists, and health educators to identify what information would be useful to participants and how it should be worded or displayed for best effect.

After working through many versions of the results return format, the team field-tested it for feedback. The team simulated a set of biomonitoring test results and asked groups of volunteers from two ongoing studies to help refine it.

In one of those studies, the Firefighter Occupational Exposures (FOX) project, firefighters had been tested for a large number of chemicals, including some potentially dangerous flame retardants. The simulated results used in the testing process came with clarifying text, tables, graphs and a one-page fact sheet on each chemical or class of chemicals.

“We developed the materials to report results keeping in mind that the vast majority of study participants do not have a chemistry background or an understanding of what chemical exposure might mean,” said McNeel. “We spent quite a bit of time developing the text, thinking about the most understandable yet scientifically accurate way to describe the results.”

An individual can compare his or her results to others from the same study, as well as to data from the National Health and Nutrition Examination Survey (NHANES) when available.  This way a study participant can see where he or she stands in relation to a representative sample of the United States’ general population.

After the simulated results were shared with the firefighters, a couple of the biomonitoring staff met with them to identify any points of confusion. The feedback led the team to add an explanation of why this community, in particular, was being studied and why the human health implications of most chemical exposures are still largely unknown.

Going forward, as results are returned to study participants, Biomonitoring California staff will follow up to see if people have a good understanding of the test results.  “We tested, revised, tested, revised and still we consider these works-in-progress. We will continue to fine-tune the results return documents as we get more feedback from participants,” said McNeel.

McNeel added that, despite the results return team’s best efforts, some firefighters did express a degree of frustration about why they were being tested for chemicals if no one knows what the results mean. “Firefighters are an altruistic group of individuals,” she said. “We explained there just hasn’t been the research done to determine whether there are health effects associated with some of these chemicals and at what level health effects might start to occur. Some of our work is to help establish chemical levels in various groups so that we can compare and contrast them, and that this work will benefit future firefighters.”

Researchers with Biomonitoring California have found this design process rewarding. “All of us in the program really feel that it’s important for people to have a better understanding of chemicals in our environment,” said McNeel, “This is an area that deserves greater attention.”

To see an example of a results document, visit www.biomonitoring.ca.gov/sites/default/files/downloads/03162012FOXMockResultsPacket.pdf.

Without biomonitoring, public health practitioners face challenges in understanding whether environmental contaminants are actually being absorbed into people’s bodies. Given improvements in technology, the capabilities and expertise that exist in public health laboratories, and the increasing demand from the public for more information about chemical exposures, biomonitoring is poised to become an integral component of public health practice.

To learn more about biomonitoring, check out some of APHL’s Biomonitoring Resources:

Stay tuned for our soon-to-be-unveiled Meeting Community Needs page and of course, let us know if you have any feedback or suggestions.  

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Biomonitoring Project in Native American Community Helps Protect and Inform

Mar 05 2014 :: Published in Environmental Health

This blog post is part of a biomonitoring series.

Dr. Carin Huset began her career measuring chemicals in water, not people. “My doctoral thesis was on PFCs in wastewater, rivers and landfills,” she said. “It was all environmental, not public health, and much more abstract.”

Huset now spends her time testing people for chemical exposure. This work, known as biomonitoring, is on the leading edge of public health laboratory science. Huset and other laboratorians at the Minnesota Department of Health (MDH) public health laboratory are able to measure the amount of natural and manufactured chemicals inside of a person by analyzing blood or urine.

Currently, Huset and partners in the local health community are working with a group of Native American volunteers from the Fond du Lac Band of Lake Superior Chippewa to measure the chemical levels in their bodies. People living in this community may have greater contact with environmental chemicals as consumers of traditional foods such as fish and waterfowl.

Biomonitoring Project in Native American Community Helps Protect and Inform | www.aphlblog.org

This biomonitoring project is part of the wider federal Great Lakes Restoration Initiative (GLRI), which is focused on cleaning up toxins, resisting invasive species, protecting watersheds from polluted run-off and restoring wetlands. The GLRI is funding the MDH’s work with members of the Chippewa tribe to determine the impact of pollution on the local population.

Since biomonitoring is a relatively new area of laboratory science, Huset and her partners began designing a study that had no real counterpart, and therefore had to overcome a series of mundane, but critical, difficulties. Minnesota staff needed to work out tricky legal agreements with partner labs, add a new testing capability, identify and interview the study’s participants, and train clinic and other external staff.

“We needed to design a study that met the concerns of the community, as well as the requirements of the GLRI,” said Huset. The GLRI wants data on exposure to eight PCBs, Mirex, HCB, DDT and DDE, lead and mercury; the Minnesota laboratory added more than a dozen additional analytes to the test panel. Although mainly testing for chemicals resulting from potential environmental exposure, the lab chose to include a few extra, such as cholesterol and Hemoglobin A1C, which will allow study participants to follow up with their doctors to make personal health decisions. The lab is also studying the level of Omega-3 fatty acids in the participants, high levels of which are considered a positive effect of eating fish.

To conduct all of these tests, the clinic staff is “drawing 44 milliliters of blood, or about 7 tubes,” said Huset. Because each person’s blood must be divided for the varied laboratory tests and then delivered to more than one location, it was essential to design an easy-to-use sample kit; particularly since the blood is not drawn in-house, but at a clinic on the reservation. To reduce sample contamination and confusion, the kit has twenty different sample cups and vials with different colored caps.

A lab employee travels up to the clinic each Friday to collect the week’s frozen blood and urine samples, in part due to the clinic’s limited storage space, but more importantly, said Huset, because “the samples are precious and we worry about the potential for a power outage over the weekend, which would ruin them.”

Once the samples reach the MDH public health laboratory, some of them are then batched and sent to the Michigan Department of Community Health Laboratory or to private labs. Huset explained, “When the GLRI funding came through, one of the required tests was for PCBs, which affect other parts of the Great Lakes region, but are not a significant concern in Lake Superior or Minnesota.” Minnesota lab staff do not see a strong need for their facility to have this particular testing expertise, especially since PCB testing is relatively complex; also important, the GLRI funding did not come with an allowance to add new capacity. Fortunately, the Michigan laboratory has a robust PCB testing program.

“The contract work between the two states was more challenging than we expected. Both labs were willing participants, but we didn’t allow for the problems among the lawyers and the wording of the contracts,” said Huset. Once the technicalities were resolved, the partnership has worked smoothly.

Due to similar legal complications with a different laboratory partner, the Minnesota lab elected to allocate some of its own funds to develop testing capacity for 1-hydroxypyrene. “This was a test we wanted to develop anyway,” said Huset, “and it’s far less complicated than the PCB testing.” 1-Hydroxypyrene has been included in the study due to potential contamination in a Lake Superior watershed adjacent to a SuperFund site.

A great advantage to the researchers is that the Fond du Lac Band of Lake Superior Chippewa are “a very engaged and interested group,” said Huset. Participants have answered extensive questions about their personal history and habits.

A community’s engagement in a biomonitoring project is vital to its success. Prior to this GLRI project, the MDH ran four successful biomonitoring pilot studies, measuring arsenic levels in the urine of children who had played in contaminated soil, mercury in newborn screening collection cards, chemicals in pregnant women, and PFC levels in the blood of people affected by a contaminated community drinking water supply.

In the drinking water study, the participants’ commitment spurred the project on. “The community knew about their water contamination and were concerned. They pushed their legislators to push the funding through for the study,” said Huset.

In this case, PFC contamination had been discovered in 2004 in both private and municipal wells in a community. By the end of that year, the community’s exposure had been reduced through a combination of methods, including treating the municipal well, installing in-home filters, encouraging the consumption of bottled water, or transferring homes from private wells to the public water supply. In 2008, MDH conducted its initial biomonitoring study on people who had been exposed to the contaminated water and discovered that the levels of PFCs in their blood were higher than national levels. But then, in a follow up study in 2010, MDH discovered that the community’s average blood PFC levels had declined since 2008. The biomonitoring project demonstrated that the public health efforts undertaken in 2004 to reduce exposure had worked.

“This was a targeted public health action,” said Huset, “and it was effective.”

Part of the complexity of this process, in the pilot projects and again with the GLRI, is determining which chemicals to look for, what levels in people are safe, and when authorities should take action.

Noting the difference between measuring the chemicals levels in people and her earlier environmental work, Huset said, “People everywhere are very interested in what we do here, and they have a lot of questions.” Researchers do too, still trying to determine which pathways of exposure—such as diet, occupation or hobbies—predict contaminant concentrations in people. As studies like the GLRI project progress, it will be easier to identify public health actions that will protect people at increased risk of chemical exposure.

At the end of this study (sometime in 2014) researchers will have valuable new information about chemical exposure and human health. For more information about the Fond du Lac Band of Lake Superior Chippewa biomonitoring study, see www.health.state.mn.us/divs/eh/risk/studies/tribalstudy.html.

Without biomonitoring, public health practitioners face challenges in understanding whether environmental contaminants are actually being absorbed into people’s bodies. Given improvements in technology, the capabilities and expertise that exist in public health laboratories, and the increasing demand from the public for more information about chemical exposures, biomonitoring is poised to become an integral component of public health practice.

To learn more about biomonitoring, check out some of APHL’s Biomonitoring Resources:

Stay tuned for our soon-to-be-unveiled Meeting Community Needs page and of course, let us know if you have any feedback or suggestions.  

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West Virginia’s Spill and the Importance of Laboratories

Mar 04 2014 :: Published in Environmental Health

By Megan Weil Latshaw, Director, Environmental Health Programs

Living in the United States usually means we can expect clean water every time we turn on our tap.[1] But for over a week, hundreds of thousands of West Virginians were unable to use their water for drinking, bathing, showering or even brushing their teeth.[2]

The recent Elk River story led to many questions about chemicals policy in the US. For example, the New York Times called into question WV’s regulatory framework and National Public Radio discussed the lack of oversight of chemical storage facilities. It also drew attention to our lack of knowledge about these chemicals:

  • Deborah Blum, a Pulitzer-Prize winning writer, highlighted how little we know about chemicals in commerce.
  • The Director of the US Centers for Disease Control & Prevention (CDC) pointed out how little they knew about the original chemical of concern, 4-methylcyclohexanemethanol or MCHM.

West Virginia’s Spill and  the Importance of Laboratories | www.aphlblog.orgBut despite all the news around the spill, few articles mentioned the role of laboratories. The West Virginia Public Health Laboratory was one of the labs that stepped up to handle the surge in water samples. Environmental chemists worked around the clock and chemists from other parts of the laboratory were pulled in to help. They adapted a CDC method that allowed them to report results three times faster than the other responding laboratories. The end is not quite yet in sight: the lab continues testing tap water samples due to concerns about the lingering odor associated with the chemical.

Here at APHL we’re proud of the public health laboratories who have built capability & capacity to detect chemical contaminants, not only in water, but also in people. These public laboratories, whose sole mission is to protect the public’s health, are prepared to operate 24/7 in order to do so.

We’re also proud of the progress being made by federal agencies to build laboratory networks across the country, able to handle just such emergencies (such as EPA’s Water Laboratory Alliance and the Laboratory Response Network for Chemical Threats funded by CDC). There still remains a lot of work to be done though:

  • Barriers to activating these networks remain. We need additional funding to increase their visibility, broad usefulness & efficiency.
  • Neither of these networks provides funding to detect radiological agents.
  • Electronic exchange of data between laboratories, crucial during emergencies for prompt decision making, remains highly inefficient.
  • Due to funding cuts, laboratories struggle to maintain well-trained personnel and aging equipment.

 


[1] As NPR recently pointed out though, we only monitor public water supplies for ‘known’ contaminants. What about all those ‘unknowns’ like pharmaceuticals or personal care products that get washed down the drain or flushed? APHL called on EPA to work with states on additional drinking water contaminant monitoring systems.

[2] The Wall Street Journal published a timeline of the spill and response.

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Integrating Biomonitoring with CDC’s National Environmental Public Health Tracking Program

Feb 26 2014 :: Published in Environmental Health

This blog post is part of a biomonitoring series.

In 2011, CDC’s National Environmental Public Health Tracking Program formed a Biomonitoring Task Force, composed of grantees from the agency’s Tracking Network. Members of the new task force were asked to find out what biomonitoring data exists in states and, where possible, to add it to the national tracking network’s data portal.

“There is an important and growing partnership between CDC-funded state tracking programs and laboratories interested in biomonitoring,” said Jean Johnson, PhD, supervisor, environmental epidemiology unit, and director, environmental public health tracking and biomonitoring program, at the Minnesota Department of Health. “CDC tracking programs bring the environmental epidemiology piece that is a critical resource for state laboratories interested in population-based biomonitoring.”

Integrating Biomonitoring with CDC’s National Environmental Public Health Tracking Program | www.aphlblog.org

Identifying Environmental Health Surveillance as a Priority

The Tracking Network was established in response to a 2000 Pew Environmental Health Commission Report, which revealed a fragmented surveillance system. Information gaps and data silos prevented scientists from connecting data on environmental exposures with chronic disease data.

“The consensus was that, if we created surveillance for environmental health, we would do a much better job connecting environmental hazards and exposures to Americans’ health,” said Johnson.

In 2002, CDC funded the new surveillance program that is typically referred to as the Tracking Network. Sixteen states were brought on board to systemically collect, analyze and disseminate environmental public health data. Since that time the network has grown to 23 states plus New York City and several academic partners. The participating states pull the data together by identifying and exploring existing data sources. Epidemiologists analyze the data for trends and spatial patterns. The academic partners then take a research angle, examining the data for connections.

There are approximately 15 content areas tracked in each state, including air quality, drinking water, chronic disease from cancer registries, heart disease, and carbon monoxide poisoning. In most states, children’s blood lead levels are the only biomonitoring data that have been tracked systematically, although federal support for blood lead surveillance in the states was recently cut.

All of this data is available to the public on web portals. “That’s an important part of tracking too because it’s not just states that use the data,” said Johnson. “Universities, advocate organizations, community and local public health folks: if it’s public data, it’s accessible to everyone who wants to use it.”

The participating states all agree to track certain things so that the network is supplied with nationally consistent data and measures. Teams from the states first identify what a consistent measure is, and then provide the data to CDC and post it to the public portals. Yet states are also free to add supplemental information that may be particularly relevant to their region.

“This program has really helped build significant environmental epidemiology capacity in state health departments,” said Johnson.

Taking Environmental Health Surveillance a Step Further by Adding Biomonitoring Data

In 2011, network participants decided to investigate whether any of the biomonitoring work conducted in the states was consistent enough to allow for national tracking of the data. The Biomonitoring Task Force was established, and it developed and sent a survey to the 23 states in the tracking program. The survey asked the states to review the past 10 years of available biomonitoring data to identify what analytes were tested, how, on what populations and with what kind of funding. Essentially the network was searching for consistencies that would make a particular chemical (in populations) trackable on a national platform.

In the survey, biomonitoring testing was split into five categories:

1) Mandatory report data: some states require hospitals or clinics to report poisonings or chemical exposures

2) Population-based survey: surveillance to measure spatial or temporal differences in population exposure or to evaluate the efficacy of public health actions to reduce exposure (for example, any state programs similar to NHANES)

3) Targeted public health investigation: in response to community health concerns about contamination or a disease cluster (drinking water contamination)

4) Rapid response: in response to an emergency situation, such as a chemical emergency in a school or community

5) Support of academic research project: providing laboratory support to academic institutions

Overall the results (see slide image below) reveal that there is very limited consistency among state biomonitoring programs, which would make it difficult to enter the data into a national tracking program. Very few of the studies use probability-based population sampling methods, meaning that researchers cannot generalize the results outside of the tested group.

Johnson pointed out that each state likely has more biomonitoring data than was identified in the survey since a lot of work never gets reported or published in peer-reviewed journals.

The survey results made it clear that the state tracking grantees want to build their biomonitoring programs. However, there is a significant lack of sustained resources to support state biomonitoring work.

The next activity on the task force’s agenda is to write a white paper to describe the current limitations posed by the existing data, and recommend strategies to help create consistent data across the country.

In the years to come, as states develop their biomonitoring programs, it will be important to work with the tracking network so that this valuable data is accessible and useful to anyone who needs it.

Without biomonitoring, public health practitioners face challenges in understanding whether environmental contaminants are actually being absorbed into people’s bodies. Given improvements in technology, the capabilities and expertise that exist in public health laboratories, and the increasing demand from the public for more information about chemical exposures, biomonitoring is poised to become an integral component of public health practice.

To learn more about biomonitoring, check out some of APHL’s Biomonitoring Resources:

Stay tuned for our soon-to-be-unveiled Meeting Community Needs page and of course, let us know if you have any feedback or suggestions.  

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Chemical Exposure Study in NY is Innovative and Promising

Each year, about 250,000 babies are born in New York. Shortly after each birth, hospital staff pricks the baby’s heel, capturing and drying several drops of blood on a special filter paper known as a Guthrie card. The blood sample is then sent to the state’s newborn screening program at the Wadsworth Center, where it is screened for 45 different genetic, endocrine or metabolic disorders. The speed of the screening process and confirmatory diagnostic testing allows at-risk infants access to prompt and often life-saving medical care.

Chemical Exposure Study in NY is Innovative and Promising | www.aphlblog.org

Some of the remaining collection cards, which are held under highly secure conditions without any identifying links, are now being utilized in a fully consented biomonitoring study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The study will examine the link between environmental chemical exposures, childhood development and long-term health outcomes.

Biomonitoring is the direct measurement of natural and synthetic chemicals in a person’s body via blood, urine or breast milk samples. In this study, called Upstate Kids, 3,800 children are enrolled from birth and followed through the age of three. The study is approved by the Department of Health’s Institutional Review Board and is being performed with the full consent of the parents of enrolled children. It is a collaboration of the Wadsworth Center and the Center for Environmental Health within the New York State Department of Health and the State University at Albany, School of Public Health.

How is it possible to use stored collection cards for this purpose? According to Kenneth Aldous, PhD, director of the Environmental Health Sciences Division at Wadsworth, biomonitoring is experiencing a rapid expansion in capability due to “the advancement in computers and analytical instrumentation, which has allowed us to measure samples more quickly, using smaller and smaller volumes of human body fluids.”

It is natural that scientists who study the levels of chemicals in people, tracking the rise and fall of certain toxins through the years, would recognize the value of stored newborn blood samples. Dr. Kurunthachalam Kannan, a scientist at Wadsworth working on this study, noted that, “With the help of the parents, we can link the baby’s weight, head circumference, height, and other demographic information to health outcomes of babies. By gaining permission to extend the study once the children reach adulthood, we may also be able to monitor them over their lifetimes.”

The stumbling block for researchers has been that the dried spots on the cards are very tiny, far beyond what they consider a “smaller volume” sample. Is it even possible to create a sensitive enough assay to allow researchers to use the small volumes contained in these residual collection cards? Wadsworth experts now believe that it is.

Using a technique that involves liquid-liquid extraction and high performance liquid chromatography/tandem mass spectrometry method, Kannan and his colleagues have looked for certain endocrine disrupting environmental chemicals (polybrominated diphenyl ethers [PBDEs], perfluorooctane sulfonate [PFOS], perfluorooctanoic acid [PFOA] and bisphenol A [BPA]) in both whole blood samples and dried blood spots. Although they are still trying to determine how to get an accurate measurement of the sample’s exact volume, the results from the collection cards have been remarkably accurate in comparison to the whole blood samples.

In an interesting quirk of the study, the researchers realized they also needed to understand the specific amount of background chemical contamination present on the card. According to Kannan, it matters how the nurses handle the card at the hospital, how it is packaged and mailed, and even how long it is held during the newborn screening process. To evaluate this ambient contamination, laboratorians used a blank punch, reasoning that this spot (taken from an area of the card without any blood) would experience the same contamination as the dried blood, thus allowing scientists to correct for potential contaminations that happened in the hospital after birth compared to chemical exposure that occurred through the placenta.

The success of this study may open the door for biomonitoring programs to study all kinds of childhood exposure to chemicals. In the past, scientists were only able to make educated guesses on chemical exposure via a complex modeling process. Measuring the chemicals directly in people provides valuable information about the sources of chemical exposure and potential long-term health effects. As further research is done, it may also be possible to test for biomarkers for developmental concerns.

In addition to blood samples drawn at birth, and regular motor and social development updates, this study is also gathering extensive demographic information about maternal age, health and assisted reproductive interventions. Many people have concerns about the effect of IVF on the long-term health of the child and studies like this one may provide some answers. The parents of these children will receive ongoing updates of developmental progress and if any child develops health issues, there will be significant data that may help inform the child’s treatment.

With access to the incredible storehouse of information available from these collection cards from nearly every child in the state, in future approved studies, scientists may be able to look at a broader population for trends in chemical exposure over time. Just as public health programs succeeded in getting lead out of gas and paint, and ultimately out of people’s bodies, these studies will help identify which chemicals are causing problems for human health.

At the heart of it, said Aldous, “What is getting into us through the environment? What other chemicals are already present in newborns and how have they been exposed?” Also, said Kannan, “Why are some people sensitive to a chemical exposure of a small amount, when it takes much more to cause a health problem in the next person?”

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Sochi? So What? Public and Environmental Health at the Winter Olympics

By Michael Heintz, MS, JD, senior specialist, environmental laboratories, APHL

Sochi? So What? Public and Environmental Health at the Winter Olympics | www.aphlblog.org

Hi. I’m Michael and I admit it: I’m a Winter Olympics fanatic. From learning new geography at the Opening Ceremonies, to hoping for that US-Canada hockey game, and seeing the short-track speed skaters hurl themselves in roller-derby-on-ice, I can’t get enough. I’ll even watch a couple hours of curling. I’m all-in for two weeks (well, except ice dancing, but that’s another post).

However, in the midst of the competition and spectacle, the public and environmental health aspects can get lost. With the international locations, huge crowds and new buildings, the footprint of the Olympics can be significant. So where do the Olympics intersect with public and environmental health?

The Centers for Disease Control and Prevention provides basic information if you’re heading to the Games (and more generally for international travel). In addition to routine vaccinations, like chicken pox and your flu shot (which you should already have!), the CDC recommends specific ones for Russia, such as hepatitis-A and others if you are particularly at-risk or heading to remote areas. Visitors should also prepare a travel health kit, including the medications they might need during travel. The CDC even provides a list of Russian phrases to use if you are sick or injured.

Next, one particular aspect of public health at the Games is interaction with the other spectators or athletes. Always remember to wash your hands, wear your seatbelt and generally stay aware of your surroundings. And yes, sexually transmitted infections are a concern at the Olympics. Organizers help the athletes by distributing condoms (150,000 were distributed to athletes at the London Games), but you might be on your own, so be prepared.

Finally, we cannot ignore the environmental impact of the Games. Sochi has an average population of 350,000 people. The 2010 Winter Games in Vancouver attracted an estimated 500,000 visitors plus another 10,000 journalists and 2,700 athletes (not counting security or volunteers). In all, Sochi’s size may double (or more) for the Games. The huge number of people coming to this Black Sea resort town, plus the construction of the new venues and other capacity improvements, will stress Sochi’s environment.

In 1996, the International Olympic Committee added environmental protection as the third pillar of the Olympics. As part of this commitment, Sochi organizers are making efforts to build and conduct the Games in an environmentally responsible manner, including a Green Building recognition program. But with a $50 billion price tag to build and run the events, the environmental impacts include increased construction waste, water shortages, habitat disruption and increased logging. All of these activities increase the amount of pollution in air, soil and water resources. Add the increased demand for drinking and wastewater services, transportation, and curiously, saving last year’s snow, and the overall environmental impact of the Games may be significant. However, we won’t know the full effects until after the Games are over. Looking ahead, the Rio Summer Games have already launched their sustainability program for 2016. Expect future Olympics host-cities to continue concentrating on environmental concerns when preparing for the Games.

While the public and environmental health concerns don’t decrease my appreciation for the spectacle that is the Olympics, including the athlete’s amazing abilities and the two weeks of global good will, it does add context to what goes into making such an event happen. Just another reminder that public and environmental health is part of everything.

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Sarin Gas Attacks in Syria: What if it happened in the US?

Nov 19 2013 :: Published in Environmental Health

By Surili Sutaria Patel, Senior Specialist, Environmental Health, APHL 

“It is the worst use of chemical weapons on civilians in the 21st century,” said United Nation’s Secretary-General Ban Ki-Moon.

On the cool night of August 21st, residents of Ghouta, a suburb of the Syrian city of Damascus, were abruptly awakened by an explosion. In a region ravaged by civil war, explosions were unfortunately common; this particular explosion, however, was different.

An artillery rocket containing sarin gas had been released in the night, as the temperature dropped right before dawn. The cold, now-toxic air in Ghouta did not rise. Instead, the heavy gas circulated close to the ground and pervaded the lower levels of buildings where families rested for the night.

Almost immediately, many felt an onslaught of troubling symptoms: shortness of breath, disorientation, irritated eyes, blurred vision, nausea and vomiting. Many dropped into unconsciousness and over 1,400 people died, including 400 children, who would have been getting ready to go to school a few hours later.

Sarin is a volatile, man-made nerve agent used as a chemical weapon. First developed in Germany as a pesticide in 1938, sarin is a very toxic and fast acting gas. It is difficult to detect as it is a clear, colorless, tasteless and odorless vapor. Sarin enters the body through the eyes, skin, lungs or eating contaminated food. Instantly after exposure to the gaseous form and a few minutes after exposure to the liquid form the toxic effects of this chemical will present in humans. Sarin is a deadly chemical yet it is short-lived in the environment, presenting a very serious public health threat.

Given the symptoms (and the assumption that chemical weapons had been used), the UN stepped in to officially determine the cause of illness & death. They assembled an investigative team of scientists from Finland, Germany, Sweden and Switzerland to examine both environmental and clinical samples (blood, hair and urine).

A total of 30 environmental samples were collected from two impact sites and analyzed by two laboratories. Concurrently, a clinical investigation advanced: in addition to conducting medical examinations, 34 victims were selected to provide blood and urine samples for further investigation. Nearly 85% of the blood samples tested positive for sarin. The investigative team reported back with great confidence that the chemical weapon used was in fact, sarin.

The world mourned for these innocent people, so devastated by such an atrocious crime. The large-scale use of such weapons against civilians led to increased international attention on chemical weapons of mass destruction: their possession, storage, destruction, and use. Not only did the global community call for Syria to disclose and destroy their chemical weapons, but many countries examined their own system for responding to such an attack.

Sarin Gas Attacks in Syria: What if it happened in the US? | www.aphlblog.org

While it is painful to think of, what if this reprehensible act of terrorism had taken place on US soil? Americans are protected by the CDC-funded Laboratory Response Network (LRN) which maintains an integrated network of laboratories that can respond quickly to acts of biological or chemical terrorism, as well as all the other wonderful first responders that skillfully approach such a scene.   The Laboratory Response Network for Chemical Threats (LRN-C), comprises 54 public health laboratories at the local, state, and territorial levels, and has protocols similar to the UN investigative team: from the systematic method used to select individuals for clinical testing to the chain of custody protocols practiced when collecting and shipping the samples to the appropriate laboratories. LRN-C operates as a network of laboratories designated Level 1, 2 or 3 laboratory capabilities.

  • Level 3 laboratories work with hospitals and first responders for clinical specimen collection, storage and shipment.
  • Level 2 laboratories employ chemists trained to detect various toxic chemical agents, including nerve agents such as sarin.
  • Level 1 laboratories use high-throughput analysis to serve as surge-capacity laboratories for CDC, in case CDC is overwhelmed by the number of samples. These labs also have the capability to test even more chemicals than the Level 2 laboratories.

The LRN, with funding and assistance from CDC, serves as a global, national, state and local asset. Its staff remains crucial to any chemical response in the United States and even abroad.

While we hope for that day where the potential for such atrocities no longer exists, we recognize the need to remain vigilant and prepared. Most importantly, our hearts and thoughts remain with the people of Ghouta, and Syria at large.

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Biomonitoring, Tracking and Keeping You Healthy

Oct 24 2013 :: Published in Environmental Health

By Surili Sutaria Patel, MS, Senior Specialist, Environmental Health, APHL

There are multiple ways the environment – the air we breathe, the water we drink, the food we eat and the places we learn, work and play – influences our health. By measuring hazardous substances in our environment we can gain a better understanding of how we can reduce our exposures and prevent health problems in the future.

Biomonitoring, Tracking and Keeping You Healthy | www.aphlblog.org

The National Environmental Public Health Tracking Network (or Tracking Network) is a system that tracks all these factors to better understand how the environment is impacting our health. The Tracking Network, headed by the Centers for Disease Control and Prevention (CDC), provides 24 grants to state and local health departments to participate. Each jurisdiction has its own Network, but also feeds data into the National Tracking Network Portal. This lends insight into a variety of health indicators (e.g., air quality, birth defects, cancer, heart attacks, climate change, etc.), across geographic location and time, and more.

Biomonitoring – a tool used to measure hazardous substances once they have entered the body – furthers our knowledge of harmful environmental exposures. By examining blood and urine samples, biomonitoring programs have produced local exposure data identifying potentially-harmful chemicals and toxic substances in the human body. Biomonitoring studies can also compare results to CDC’s national biomonitoring data to learn whether a specific locality is more exposed than the US population.

By connecting tracking and biomonitoring data, states like Washington, Utah and Wisconsin are identifying harmful chemicals in both the environment and the human body. For example, in a webinar titled Environmental Public Health Tracking Meetings Public Health Labs, state environmental health director, Dr. Sam LeFevre outlined how the Utah Department of Health used tracking resources for conducting a state-wide biomonitoring study on lead and mercury exposure in newborn bloodspots. As one of the states that made up the Rocky Mountain Biomonitoring Consortium, and funded by CDC’s Phase 2 Implementation Grant from the Tracking Network, LeFevre and his team use neonatal bloodspots for conducting population surveillance for heavy metal exposure.

They chose metals because Utah is the third largest mining state in the US, with 24 active mines. Utah also has many fishing waters, 19 of which have fish advisories due to high mercury and other harmful metals. A lesson learned during the years Utah had an active child blood lead poisoning program was that the children most affected by lead poisoning were from upper-income families, who lived in homes with backyards made up of soil rich in metal oxides, traced back to their mining history. Now, by conducting biomonitoring on the bloodspots, the Utah Department of Health is painting a more accurate picture of the cause of elevated blood lead and mercury levels in children across the state. To learn more about Utah’s study, please view the free webinar. Here you will also find a presentation on Wisconsin’s tracking and biomonitoring work.

If you would like to share a success story about tracking and biomonitoring, please contact EH@aphl.org.

 

 

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Massive Molasses Mess and the Laboratory Response

This month is National Preparedness Month.  Follow APHL on our blogTwitter and Facebook for preparedness information and discussions all month!

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By Megan Latshaw, Director, Environmental Health Program, APHL

“It was shocking because the entire bottom is covered with dead fish. Small fish, crabs, mole crabs, eels. Every type of fish that you don’t usually see, but now they’re dead. Now they’re just laying there. Every single thing is dead. We’re talking in the hundreds, thousands. I didn’t see one single living thing underwater.” ~ Roger White, a diver (Massive Molasses Spill Devastates Honolulu Marine Life, NPR)

Massive Molasses Mess and the Laboratory Response) | www.aphlblog.org

We’ve all heard of killing someone with kindness, but who knew that sweetness could deal such destruction? The sweetness comprises almost 250,000 gallons of molasses, spilled into Honolulu harbor on September 9th as it was being loaded into a ship via pipeline.

Because the greatest priority relates to public health, the Hawaii Department of Health is leading the response rather than the US Environmental Protection Agency or the US Coast Guard.

Their State Laboratories Division will be doing bacteria testing (enterococci, clostridium and total).  Since this spill is relatively unprecedented the first two bacterial tests were chosen because 1) Hawaii has a lot of data on them and 2) they are currently used to monitor water quality. Scientists are not sure how the spill will affect these indicators but they theorize that the dead fish and the nutrient-rich liquid could lead to unusual growth in marine algae and harmful bacteria. These data plus some chemistry and physical parameters will help them figure out when things are starting to get back to normal.

Meanwhile, the laboratory expects to run out of supplies for this valuable testing.  They have called upon their peer network to borrow and replace consumables from their labs, on the outside possibility that their suppliers cannot provide them with the necessary materials quickly enough. Such outreach emphasizes the importance of building relationships through networks such as the Laboratory Response Network and the Environmental Response Laboratory Network.

Click the image above for an interview with Hawaii’s public health laboratory director and many of their staff.

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