Children in Their Environments: Vulnerable, Valuable & at Risk

1. Children in Their Environments: Vulnerable, Valuable & at Risk EEA, WHO Europe & the Collegium Ramazzini workshop June 22nd, 2004 Biomonitoring, towards more integrated approaches Dr. Ludwine Casteleyn Chair TWG Biomonitoring of Children Ministry of the Flemish Community AMINAL

2. TWG Biomonitoring for Children Bloemen Louis, Brits Ethel, Boogaard Peter, Canna Michaelidou Stella, Fréry Nadine, Fucic Aleksandra, Harrison Paul, Jakubowski Marek, Lehners Maryse, Lorente Christine, Ramet José, Seifert Bernd, Schoeters Greet, Steenhout Anne, Ten Tusscher Gavin W., Wattiez Catherine, van Wijnen Joop Co Chairs: Sala Carlo, Knudsen Lisbeth E., Chair: Casteleyn Ludwine Assisted by: Joas Reinhard, Bauer Sonja Commission: Van Tongelen Birgit.

3. Human Biomonitoring = measuring in humans (effect) of exposure food air consumables water soil “Monitoring activities in children, using biomarkers, that focus on environmental exposures, diseases and/or disorders and genetic susceptibility, and their potential relationships”.

4. Biomarkers 2001-2006 http://www.milieu-en-gezondheid.be

5. Flemish Health and Environment StudyPilot study (1999) • Test feasibility, assess relevance (small scale study) • “whether residence in areas with different pollution pressure has a significant impact on internal exposure to pollutants and resulted in adverse biological effects” • 2 industrial suburbs of Antwerp: • Wilrijk: 2 waste incinerators • Hoboken: large non-ferrous smelter- known lead pollution • 1 rural municipality: Peer (“control area” - measured environmental pollution low) http://www.wvc.vlaanderen.be/gezondmilieu/ Koppen et al, 2001 Toxicology Letters, 123, 59-67 Koppen et al, 2002, Chemosphere, 48, 811-852 Nawrot et al, 2002, Env Health Perspectives, 110, 583-589 Staessen et al, 2001, Lancet, 357,1660-1669

6. Pilot studyCadmium blood 1 adolescents women 0.75 µg/L 0.5 * * 0.25 0 Wilrijk Hoboken Peer

7. Pilot study1-OH pyreen urine 0.15 adolescents women * 0.1 * µg/g creatinine 0.05 0 Peer Wilrijk Hoboken

8. Pilot study Marker PCBs serum 500 adolescents * women 400 * 300 ng/g vet 200 100 0 Peer Wilrijk Hoboken Nederland Zweden (gem. 29j) (gem. 42j) ('90-'92) ('86-'91)

9. Pilot studyDioxine-like substances 50 * adolescents 45 * women 40 35 30 pg TEQ/ g vet 25 20 15 10 5 0 Peer Wilrijk Hoboken Belgian women gem.32 j ('96-’98)

10. normal range Pilot study: Women: HPRT mutant-frequency 10 9 8 * 7 6 5 number/million cells 4 3 2 1 0 Peer Wilrijk Hoboken Van Larebeke et al, Biomarkers, vol. 9, no 1, 2004, 71-84

11. OK N O * R M A A L Pilot study Men: Sperm + testosterone testosterone blood 480 20 morphology sperm 18 460 16 14 440 12 ng/dL testosterone 420 10 % normal 8 * 400 6 4 380 2 360 0 Peer Wilrijk Hoboken

12. Pilot studyAdolescents: sexual maturation

13. Pilot study: conclusions • geographical differences & individual differences • adolescents and adults: geographical differences not following same trends • despite low measured environmental pollution ‘Peer’ not always reference area • findings suggest that current environmental standards are insufficientto avoid measurable biological effects • ...

14. Flemish biomonitoring program for surveillance of environmental health Flemish Institute for Technological Research (VITO), Belgium Greet Schoeters et al

15. Goals • Analyse time trends : efficacity of environmental measures for public health • Analyse spatial trends : healthy and unhealthy areas • Detect yet unknown environmental threaths: early warning system for unknown pollution sources / pollutants

16. Legal framework (B.S. 03-02-2004) Preventiedecreet Art 51 § 1 The Flemish government: 1. can set up a network for surveillance of exposure (measured in humans) and/or effects of exposure to physical and chemical factors in the population, with the intention to take measures to protect public health. 2.takes at least measures for the development and execution of a program for biomonitoring. 3. can - in execution of &1 - set up a fund (…). For this purpose a mandatory financial contribution can be imposed on industries or citizens that are responsible for the presence of physical or chemical factors harmful to health.

17. Human biomonitoring studies related to children in European countries • total number of questionnaires received: 97 • reported budget with 47 questionnaires: about57 million euro • about 480 000 children are covered (basis 90 questionnaires) • 42 covered heavy metals, • 25 projects examined asthma or allergies • 19 projects covered dioxin/PCB exposure, • 4 covered endocrine disrupters difficult to compare the data generated … generally not carried out using the same methodological approach.

18. Biomonitoring = Integration A substantial amount of biomarker data is collected • addressing simultaneously markers of exposure, effect and susceptibility and also additional data on environmental factors and health • addressing both children and their parents (particularly their mothers, therefore integrating prenatal and postnatal exposure) • Integrating: various routes of exposure various sources of past and recent exposure

19. 2 types of biomarker activities • SURVEY projects: activities that aim at periodical measurements in order to produce information on the prevalence of exposure to environmental agents and the related public health impact with a view to developing and evaluating policies that protect health • RESEARCH projects: activities that aim at improvement of knowledge on causal links between environmental factors and health by hypothesis generation and testing

20. Objectives of the German Environmental Surveys (GerES) B. Seifert, K. Becker, C. Schulz, C. KrauseFederal Environmental Agency, Germany • to generate representative data on the concentration distribution of environmental pollutants in media like air, water, soil, dust, food, and in human specimens, such as blood or urine; • to establish reference values based on these distributions;  • to document and interpret spatial and temporal differences in population exposure;  • to get insight into the contribution of different compartments (air, water, food) to the body burden; • to provide policy makers with information if and what measures should be taken.    

21. Problems and deficits • Recruitment of study population Biological samples such as blood and urine are difficult to obtain especially in children less invasive sampling techniques /financial incentives • Biomarkers validation of biomarkers is incomplete • Logistics biomonitoring is a time consuming effort • sufficient staff is not always available • high investment of medical staff is needed • continued funding of long term studies is problematic

22. Problems and deficits Communication • to the participants/public: what and how to communicate when the links with health risks, especially at the individual level, are not well defined • to the authorities: reporting to the relevant authorities is often lacking • good communication is crucial and an active involvement of professionals in the field is needed

23. Ethics • Ethical issues need special attention since sensitive information may be derived from biomonitoring and the child is not able to consent. Issues of confidentiality and data protection should have special attention as well as opportunities of opting out later when mature (18 years of age) see report of meeting in Copenhagen 5-7th Dec www.pubhealth.ku.dk/cgn

24. A more harmonised biomonitoring approach • Comparability would contribute to the EU Strategy for E & H by: • Providing data on distribution of exposure and related health impact across Europe • definition of reference values • detection of spatial differences in exposure (populations/regions at risk) • detection of temporal differences in exposure • Providing policy makers with better information on control measures to be taken • identification of priorities in exposure reduction strategies • allowing follow up of the efficiency of reduction strategies, • allowing a geographically differentiated E&H policy

25. A more harmonised EU biomonitoring approach • Enable a more effective use of resources by shared development of tools and strategies • Enable more meaningful results of national surveys as the number of study subjects involved becomes larger • Allow for a more equal distribution of efforts amongst European countries and a better respecting of the equal right of each European citizen on healthy environments.

26. Action Plan Approach: Step-by-Step Strategy I Develop guidelines for a harmonised EU approach for biomonitoring II Start an European wide pilot project III Develop tools to translate results into a response system http://www.brussels-conference.org/Download/baseline_report/BR_Biomonitoring_final.pdf http://europa.eu.int/comm/environment/health/pdf/040330biomonitoring.pdf

27. I. DEVELOP GUIDELINES • Develop technical guidelines for common use with the aim of harmonising • The guidelines should address issues related to initiation, performance and follow up of biomonitoring activities: • Design and protocol for surveys • Sampling strategy and analysis • Data treatment • Dissemination and information of results • Ethical rules and practices, social and legal aspects

28. II. START EU WIDE PILOT PROJECT • “Learning by doing” tool • Test and validate common harmonised approaches for all steps • Facilitate the establishment of collaboration networks and the sharing of methodologies • Promote the idea of harmonisation in biomonitoring. • Identify possible problems linked with such harmonisation

29. II. START EU WIDE PILOT PROJECT • In view of not complicating the study by major analytical problems it is proposed to select a pollutant: • for which there is already sufficient analytical experience. • for which the exposure and health relevance is well known • Possible candidates: lead and mercury • in line with a WHO proposal to ensure regular biomonitoring of lead (amongst other hazardous chemicals) in at risk children. lead and mercury

30. III Translate results into a response system • Develop scenarios for translation of biomonitoring data into a response system. Such scenarios require • integration of biological monitoring data with environmental monitoring and health data • the development of • reference values to which biomarker results from different areas or time periods can be compared • health based action levels that can help indicate when measures need to be taken in order to reduce body burden for most exposure- and effect biomarkers NO health based values exist Child-specific

31. III: Translate results into a response system • In order to translate the results of biomonitoring into policy measures, effective communication is needed. • Effective communication needs participation and exchange between the different stakeholders (general public, study participants, general practitioners, regulators, scientists, public interest NGO’s, industry, others) and will promote public awareness. • A communication plan is an essential part of a biomonitoring programme and should be a part of the study design.

32. HOW ? Establish specific working group(s) • Bringing together existing expertise and experiences • From MS already carrying out surveillance programmes • From occupational health field • From research field • Aim: to develop • harmonised technical procedures • a protocol for carrying out a pilot project • tools allowing for translation of biomarker results into intervention strategies • In coordination with Commission and MS

33. Integration of environment and health • Human biomonitoring is an excellent tool to better integrate the two fields, environment and health • One of its big advantages is that within the chain it is much closer to health effects than environmental monitoring Biomarkers of exposure Internal dose Biological effective dose Biomarker of effect Early response Altered structure and funcion Disorder Disease Emission Exposure Ambient level Biomarker of susceptibility

34. to measure is to know … the pitfalls lay in who’s to read and how? for proper policy making: interpretation - by experts - in combination with other data - respons - prevention and precaution - communication