Editorial

Human biomonitoring: Towards more integrated approaches in Europe

Chemical exposure may cause serious adverse health effects. Under the Environmental Health Act in Korea, the first national survey, Korean National Environmental Health Survey (KoNHES), was conducted, and dozens of major environmental chemicals were measured among Korean adults between 2009 and 2011.

To understand the levels of exposure to environmental chemicals among general Korean adults population, and to identify factors that may influence the levels of exposure.

The blood and urine samples were collected from Korean adults with 19 years of age and older (n = 6311), and were analyzed for a number of environmental chemicals including metals, bisphenol A (BPA), and metabolites of polycyclic aromatic hydrocarbons (PAHs), phthalates, a pyrethroid insecticide (3-PBA) and several volatile organic carbons (VOCs). Demographic and other behavioral factors were asked through questionnaire.

Among general Korean adults, mercury, arsenic, cadmium, and metabolite of DBP (MnBP) were higher than those reported in other nationwide surveys of Canada, Germany, and USA. Most target chemicals except for MEOHP and 3-PBA showed significant differences on the exposure levels by sex

This is the first nationwide reconnaissance on exposure to environmental chemicals among general Korean population. Chemicals with high occurrence level will be further investigated to identify exposure sources and possible health outcomes, and eventually to develop measures to mitigate exposure.

In 2004 the European Commission and Member States initiated activities towards a harmonized approach for Human Biomonitoring surveys throughout Europe. The main objective was to sustain environmental health policy by building a coherent and sustainable framework and by increasing the comparability of data across countries. A pilot study to test common guidelines for setting up surveys was considered a key step in this process. Through a bottom-up approach that included all stakeholders, a joint study protocol was elaborated.

From September 2011 till February 2012, 17 European countries collected data from 1844 mother–child pairs in the frame of DEMOnstration of a study to COordinate and Perform Human Biomonitoring on a European Scale (DEMOCOPHES).¹ Mercury in hair and urinary cadmium and cotinine were selected as biomarkers of exposure covered by sufficient analytical experience. Phthalate metabolites and Bisphenol A in urine were added to take into account increasing public and political awareness for emerging types of contaminants and to test less advanced markers/markers covered by less analytical experience. Extensive efforts towards chemo-analytical comparability were included.

The pilot study showed that common approaches can be found in a context of considerable differences with respect to experience and expertize, socio-cultural background, economic situation and national priorities. It also evidenced that comparable Human Biomonitoring results can be obtained in such context. A European network was built, exchanging information, expertize and experiences, and providing training on all aspects of a survey. A key challenge was finding the right balance between a rigid structure allowing maximal comparability and a flexible approach increasing feasibility and capacity building. Next steps in European harmonization in Human Biomonitoring surveys include the establishment of a joint process for prioritization of substances to cover and biomarkers to develop, linking biomonitoring surveys with health examination surveys and with research, and coping with the diverse implementations of EU regulations and international guidelines with respect to ethics and privacy.

The objective of COPHES (Consortium to Perform Human biomonitoring on a European Scale) was to develop a harmonised approach to conduct human biomonitoring on a European scale. COPHES developed a systematic approach for designing and conducting a pilot study for an EU-wide cross-sectional human biomonitoring (HBM) study and for the implementation of the fieldwork procedures. The approach gave the basis for discussion of the main aspects of study design and conduct, and provided a decision making tool which can be applied to many other studies. Each decision that had to be taken was listed in a table of options with their advantages and disadvantages. Based on this the rationale of the decisions could be explained and be transparent. This was important because an EU-wide HBM study demands openness of all decisions taken to encourage as many countries as possible to participate and accept the initiative undertaken.

Based on this approach the following study design was suggested: a cross-sectional study including 120 children aged 6–11 years and their mothers aged up to 45 years from each participating country. For the pilot study the children should be sampled in equal shares in an urban and a rural location. Only healthy children and mothers (no metabolic disturbances) should be included, who have a sufficient knowledge of the local language and have been living at least for 5 years at the sampling location. Occupational exposure should not be an exclusion criterion. Recruitment should be performed via inhabitant registries or schools as an alternative option. Measures suitable to increase the response rate should be applied. Preferably, the families should be visited at home and interviewed face-to-face. Various quality control measures to guarantee a good fieldwork performance were recommended.

This comprehensive overview aims to provide scientists, EU officials, partners and stakeholders involved in the EU implementation process full transparency of the work carried out in COPHES. Thus this report presents the discussion and consensus in COPHES on the main aspects of designing and conducting fieldwork of a human biomonitoring study. Furthermore, it provides an example for a systematic approach that may be useful to other research groups or pan-European research initiatives. In the study protocol that will be published elsewhere these aspects are elaborated and additional aspects are covered (Casteleyn et al., 2012). Meanwhile the respective pilot study DEMOCOPHES had been conducted and assessed. The results and lessons learned will be published elsewhere.

A harmonized human biomonitoring pilot study was set up within the frame of the European projects DEMOCOPHES and COPHES. In 17 European countries, biomarkers of some environmental pollutants, including urinary cadmium and hair mercury, were measured in children and their mothers in order to obtain European-wide comparison values on these chemicals. The Belgian participant population consisted in 129 school children (6–11 years) and their mothers (≤ 45 years) living in urban or rural areas of Belgium.

The geometric mean levels for mercury in hair were 0.383 μg/g and 0.204 μg/g for respectively mothers and children. Cadmium in mother's and children's urine was detected at a geometric mean concentration of respectively 0.21 and 0.04 μg/l. For both biomarkers, levels measured in the mothers and their child were correlated. While the urinary cadmium levels increased with age, no trend was found for hair mercury content, except the fact that mothers hold higher levels than children. The hair mercury content increased significantly with the number of dental amalgam fillings, explaining partially the higher levels in the mothers by their higher presence rate of these amalgams compared to children. Fish or seafood consumption was the other main parameter determining the mercury levels in hair. No relationship was found between smoking status and cadmium or mercury levels, but the studied population included very few smokers. Urinary cadmium levels were higher in both mothers and children living in urban areas, while for mercury this difference was only significant for children. Our small population showed urinary cadmium and hair mercury levels lower than the health based guidelines suggested by the WHO or the JECFA (Joint FAO/WHO Expert Committee on Food Additives). Only 1% had cadmium level slightly higher than the German HBM-I value (1 μg/l for adults), and 9% exceeded the 1 μg mercury/g hair suggested by the US EPA.

Human biomonitoring is an important indicator and measure of exposure to environmental chemicals and provides information to support health protection policies and programs. Cycle 1 (2007–2009) of the Canadian Health Measures Survey (CHMS) collected and analyzed biological samples from over 5600 males and females aged 6–79 years, which established national representative blood and urine concentrations for a number of environmental chemicals including metals, organophosphate insecticide metabolites, polychlorinated biphenyls (PCBs), organochlorines (OCs), perfluorinated compounds (PFCs), bisphenol A (BPA), and cotinine. The results of CHMS Cycle 1 indicate that while some organophosphate insecticide metabolites were below limits of detection for most participants, metals, PCBs, OCs, PFCs and BPA were detected in almost all blood or urine samples. Significant differences (p < 0.05) in blood concentrations between males and females were also determined for several metals (e.g., lead for males and females was 15.1 and 11.8 μg/L, respectively), PFCs (e.g., PFOS for males and females was 11.13 and 7.07 μg/L, respectively), and OCs (e.g., p,p′-DDE for males and females was 134.43 and 172.07 μg/kg lipid, respectively) and in urine concentrations for BPA (1.29 and 1.04 μg/L for males and females, respectively). Future cycles of the CHMS will permit temporal trend analysis for a number of these chemicals.

Solid waste incinerators are industrial facilities, based on sustained high-temperature combustion processes and intended to treat hazardous, clinical, or municipal waste, so as to reduce its volume and hazardousness, capture, concentrate, and destroy potentially harmful substances, and, as of more recently, recover energy from the combustion of the waste for disposal.

Incineration is increasingly used in waste management, in an effort to counter the problem of growing waste production, consequentially increasing human exposure to the most critical pollutants potentially emitted by these facilities. However, emissions of pollutants under standard operating conditions have been substantially reduced by technological advances and increasingly stringent regulations, meaning that health effects such as cancer, respiratory, and reproductive effects previously linked to incinerator emissions may no longer be as relevant as expected. Nevertheless, as awareness of possible adverse effects of chronic low-level exposures to pollutants increases, the issue of the health impact of emissions on the surrounding population calls for increasingly accurate tools such as human biomonitoring for determination of exposure and conclusive establishment of related effects. Less easily quantifiable hazards associated with incinerator proximity and risk perception and its indirect health effects must also be considered in this context.