Human biomonitoring for the protection of health E3040: Public Health Protection November 2, 2023 Kasia Kordas, PhD A poster of a hazard Description automatically generated with medium confidence +Exposure assessment plays a crucial role in understanding the potential harm to human health from environmental chemicals. +Individual studies by academic researchers, advocacy groups Small-scale Not systematic Focused on specific/vulnerable population groups +Human biomonitoring. Naidu R et al. Chemical pollution: A growing peril and potential catastrophic risk to humanity. Environment International 2021; 156:106616. What is human biomonitoring (HBM)? +“systematic and continuous or repetitive activity for collection of biological samples for analysis of concentrations of pollutants and its metabolites, with the objective to assess exposure, changes after specific interventions and standardized protocols that allow to compare the data observed over time and with reference levels and—if necessary— leading to corrective actions”. Angerer J, Ewers U, Wilhelm M. Human biomonitoring: state of the art. Int J Hyg Environ Health. May 2007; 210(3–4): 201–28 HBM reflects the internal dose of chemicals taken up from any or all sources in the environment Red Blood Cells A black background with a black square Description automatically generated with medium confidence Ambient monitoring is complementary but different +Measurement of chemicals in environmental samples, including air, water, soil and food. + Human health risk assessment process https://www.epa.gov/risk/conducting-human-health-risk-assessment#tab-1 How HBM fits with risk assessment process A diagram of a method Description automatically generated Luoro H et al. Human biomonitoring in health risk assessment in Europe: Current practices and recommendations for the future. International Journal of Hygiene and Environmental Health 2019: 222: 727-37. Why is HBM for risk assessment conducted? A graph of a number of people with different levels Description automatically generated with medium confidence Luoro H et al. Human biomonitoring in health risk assessment in Europe: Current practices and recommendations for the future. International Journal of Hygiene and Environmental Health 2019: 222: 727-37. HBM is not universally implemented +HBM is very costly – mostly rich countries or regions do it USA, Canada EU (China) +Not in Latin America & Caribbean Tamayo-Ortiz M et al. Annals of Global Health. 2022; 88(1): 80, 1–11. Secular trends in blood Pb, 2009-19, n=759 Queirolo, Kordas, Martínez, Barg, Mañay. Secular trends in blood lead concentrations of school-age children in Montevideo, Uruguay from 2009 to 2019 (under review). Leaded gasoline phased out 2004 Enormous effort to develop & implement HBM A diagram of a diagram of a business Description automatically generated with medium confidence 1.Government needs to recognize that HBM is important for population health. 2.Funding is essential – start-up costs & sustained investment. 3.Human resources with appropriate expertise and adequate level of training. 4.Laboratory set-up capable of handling samples 1.Standard operating procedures 2.Method validation 3.Implementation of QC/QA Tamayo-Ortiz M et al. Annals of Global Health. 2022; 88(1): 80, 1–11. Enormous effort to develop & implement HBM A diagram of a diagram of a business Description automatically generated with medium confidence 5. Logistics related to sample collection, transport, storage and processing. 6. Development and updating of data collection forms & data entry systems. Regular data checks. 7. Design and maintenance of (centralized) database system for long-term data storage and sharing. 8. Staff with appropriate data management skills needed. Tamayo-Ortiz M et al. Annals of Global Health. 2022; 88(1): 80, 1–11. Additional considerations A diagram of a diagram of a business Description automatically generated with medium confidence 9. Regular data sharing with scientific community. 10. Institutional accountability is required to ensure appropriate/efficient use of resources and data release to inform policy. 11. Regular measurement of pollutants should result in policies and regulations. 12. Regional cooperation may reduce costs, and harmonize protocols, data sharing, and cross-country comparisons. Tamayo-Ortiz M et al. Annals of Global Health. 2022; 88(1): 80, 1–11. European programs, 1 +Human biomonitoring for Europe (HBM4EU) Joint initiative of 28 countries – the 24 EU member states plus Norway, Switzerland, Iceland and Israel – and the European Environment Agency. €74 million in funding under Horizon 2020 (European Commission). Jointly implemented by 120 partners. Aimed to measure Europeans’ exposure to chemicals and their health effects and develop human biomonitoring (HBM) as an exposure assessment method. Program ended in June 2022. https://www.hbm4eu.eu/ A map of europe with different colored countries/regions Description automatically generated European programs, 2 +PARC - Partnership for the Assessment of Risks from Chemicals Launched in May 2022, with €400 million in funding (50% from EC & 50% from member states). 200 partner institutions, 3 EU authorities European Chemical Agency (ECHA), European Food Safety Authority (EFSA), European Environment Agency (EEA) Program aims to develop next-generation chemical risk assessment to protect human health and the environment. Results are intended to help launch European and member state strategies to reduce health risks from hazardous chemicals. https://www.eu-parc.eu/ A screenshot of a screenshot of a cell phone Description automatically generated A logo of a company Description automatically generated https://www.eu-parc.eu/ Overview of HBM4EU & PARC HBM4EU - Bridging Science and Policy Outputs A screenshot of a graph Description automatically generated https://www.hbm4eu.eu/ What’s being monitored? Vorekamp K et al. Biomarkers, matrices and analytical methods targeting human exposure to chemicals selected for a European human biomonitoring initiative. Environment International 2021: 146: 106082. Lengthy process for compound & biomarker selection A white rectangular sign with blue text Description automatically generated A close-up of a document Description automatically generated Summary of substances prioritized for HBM Vorekamp K et al. Biomarkers, matrices and analytical methods targeting human exposure to chemicals selected for a European human biomonitoring initiative. Environment International 2021: 146: 106082. Biomonitoring in the US in conjunction with the National Health and Nutrition Examination Survey (NHANES) +Conducted by the Centers for Disease Control and Prevention through National Center for Environmental Health +Monitors >400 chemicals and >80 nutritional biomarkers in human blood and urine +Periodically publishes the National Report on Human Exposure to Environmental Chemicals & Updated Tables +Data publicly available on NHANES website A table of blood sampling Description automatically generated with medium confidence How are chemicals selected for analysis & inclusion in National Exposure Report? •Scientific data that suggested exposure in the U.S. population •Seriousness of health effects known, or thought to result from some levels of exposure •Need to assess the efficacy of public health actions to reduce exposure to a chemical •Availability of an analytical method that is accurate, precise, sensitive, specific, and rapid •Availability of adequate blood or urine samples from the National Health and Nutrition Examination Survey (NHANES) survey •Analytical cost to perform the analysis A large white trailer with stairs and ladders Description automatically generated A little about NHANES Nationally representative survey A screenshot of a white box Description automatically generated A diagram of a stage Description automatically generated +Operating since 1959 Periodic at first Continuous since 1999 – 2-year cycles +Complex – survey design https://www.cdc.gov/nchs/nhanes/participant/participant-selected.htm Survey components +Telephone interview @ home Head of household & some targeted participants (>16 y) Survey questions Sleep Diet Mood, behavior, etc. +Mobile Examination Center Height, weight, waist circumference Blood pressure Body composition scan Balance test Liver function scan Blood draw Participants get some results back +Glucose test +Cholesterol +Nutritional status +Kidney function tests +Infectious diseases +Exposure to environmental chemicals Data are publicly available A screenshot of a computer Description automatically generated A screenshot of a search engine Description automatically generated A close-up of a document Description automatically generated Feeds into scientific publications A close-up of a text Description automatically generated A close-up of a text Description automatically generated Targeted HBM—biomonitoring for specific purpose +The Stockholm Convention on Persistent Organic Pollutants was adopted on 22 May 2001 and entered into force on 17 May 2004 +Persistent Organic Pollutants (POPs) •remain intact for long periods of time (many years); •become widely distributed throughout the environment through natural processes involving soil, water and, most notably, air; •accumulate in living organisms including humans, and are found at higher concentrations at higher levels in the food chain; •are toxic to both humans and wildlife. + https://chm.pops.int/TheConvention/ThePOPs/tabid/673/Default.aspx Targeted HBM—biomonitoring for specific purpose +Initial 12 Pesticides: aldrin, chlordane, DDT, dieldrin, endrin, heptachlor, hexachlorobenzene, mirex, toxaphene; Industrial chemicals: hexachlorobenzene, polychlorinated biphenyls (PCBs); By-products: hexachlorobenzene; polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/PCDF), and PCBs. A map of the world Description automatically generated Data warehouse A graph with numbers and a number Description automatically generated https://www.pops-gmp.org/index.html Designing HBM programs A white and blue document with blue text Description automatically generated Tamayo-Ortiz M et al. Annals of Global Health. 2022; 88(1): 80, 1–11. Designing HBM programs A close-up of a text Description automatically generated Tamayo-Ortiz M et al. Annals of Global Health. 2022; 88(1): 80, 1–11. How would you design a biomonitoring program? +Design type Census Survey Biobank +Target population? +Geographic coverage? +Frequency +Biological amples collected +Chemicals +