SCHSAC Meeting
December 11, 2009
Environmental Public Health Tracking
and Biomonitoring in Minnesota
Minnesota Department of Health
Chronic Disease and Environmental Epidemiology
Shifts in the disease burden, public
concern, and scientific uncertainty

There has been a dramatic shift in the health burden from
infectious diseases to chronic diseases in last half century

During the same period of time, tens of thousands of new
chemical compounds have been produced and are in use by
manufacturers and consumers

Many of these chemicals have made their way into our air, water,
soil, food, homes and bodies

85% of Americans believe that the environment plays a
significant role in health (MMWR 1990)

Links between chronic diseases and environmental factors are
not well understood.
What is Environmental
Public Health Tracking?

Idea originated with a September, 2000 report of the Pew
Environmental Health Commission to Congress: State of
Environmental Public Health of the United States.

Current environmental public health system is
“fragmented ”

Information gaps and data “silos” preclude health
scientists from understanding relationships between
environmental exposures and disease

Recommended systematic, coordinated public health
surveillance of environmental hazards, exposures and
disease
EPHT at the CDC

Congress first appropriated funding to the CDC to plan and
establish a national EPHT network in 2002.

The national EPHT program will…
Link health and environmental data systems
 Bring together existing and new sources of data
 Draw data and information from state networks and from
national data systems
 Provide data that are nationally
consistent
 Make information available
through a web-based, secure
electronic network

CDC funds the National EPHT
Program:
(2009)
CDC currently funds 22 states, 1 city, and
4 academic partners to implement EPHT network.
Minnesota joined the network as a funded state in 2009.
Kinds of EPHT data:
Hazards
Hazard
Exposure
Health outcome
Pollutants measured in the water, air, or other
environmental media
E.g., fine particulate matter and ozone in the air
Kinds of EPHT data:
Exposures
Hazard
Exposure
Health outcome
Measurements of chemicals and their metabolites
in the body; a direct measure of exposure to
environmental hazards
E.g., blood lead levels
Kinds of EPHT data: Health
outcomes
Hazard
Exposure
Health
outcome
Chronic or acute health conditions potentially
related to environmental exposures; public health
surveillance data
E.g., asthma hospitalizations and mortality
Tracking Portal for Data Access
What is biomonitoring?
Biomonitoring is a direct measure of exposure. It
means directly measuring the amount of a
chemical (or its metabolites) in people’s bodies.
To measure the amount of a chemical in
someone’s body, a sample of urine, hair,
blood, or other body tissue is collected.
Biomonitoring in Minnesota

In 2007, Minnesota passed a law creating an Environmental Health
Tracking and Biomonitoring Program


MN Statutes 144.995-144.998
Directs MDH to develop four biomonitoring pilot projects in
communities “likely to be exposed” to:
•
•
•
•

Purpose of each pilot is to



Arsenic
Perfluorochemicals (PFCs)
Mercury
A fourth chemical (selected)
measure the amount and range of exposure in the community
build state capacity to do biomonitoring
Lessons learned will be used to develop an ongoing program for the
state
Is biomonitoring new?
The CDC Public Health Laboratory has been developing
laboratory methods for biomonitoring for over 30 years as
part of the National Health and Nutrition Examination
Survey (NHANES)

about 5,000 Americans are chosen each year to represent the
United States in a population health survey.

Participants provide samples of blood, urine, hair and
toenails for analysis by the CDC laboratory.

Results are published in a national report and in the
scientific literature. (4th report just released)

NHANES data provides a way to compare our results to a
national average.
MN specimens are analyzed at the
MDH Public Health Laboratory
•Lab has been building
capacity for biomonitoring over
the past 8 years
•analytic methods are highly
sensitive
•comparable to CDC methods
East Metro PFC
Biomonitoring Pilot Project
Perflurochemicals (PFCs) are a family of chemicals used for decades
to make products that resist heat, oil, stains, grease and water.
The biomonitoring project measured these PFCs in the blood of
people:
PFOA
Perfluorooctanoic acid*
C8
PFOS
Perfluorooctane sulfonate*
C8
PFBA
Perfluorobutyric acid*
C4
PFHxS
Perfluorohexane sulfonate
C6
PFHxA Perfluorohexanoic acid
C6
PFPeA
Perfluoropentanoic acid
C5
PFBS
Perfluorobutane sulfonate
C4
*Legislation required 3 specific PFCs be measured.
Background
Perfluorochemicals
Analysis in Water
Private and public
wells in the Twin
Cities east metro
area have
measurable levels of
PFCs.
PFBA, PFOS, and
PFOA are the most
prevalent.
“Non-stick Sticks to Us”
Some PFCs have long “half-lives” in the body of
3-9 years.
PFOA, PFOS, and PFHxS are found in the
blood in greater than 98% of US population
older than 12 years of age.
Others have very short “half-lives” of a few days
PFBA, PFBS
PFC Project Communities


Communities were defined by their drinking water
source.
 100 people from households served by Oakdale
municipal water supply.
 100 people from households with private wells that
contain PFCs > 0.1 ppb in Lake Elmo/Cottage
Grove.
To be eligible, participants must :
 have lived at their current residence since before
Jan. 1, 2005
 be adults, age 20 or older
How was the project done?


Individuals who agreed to participate were asked to
go to a local clinic to have 20 cc’s of blood drawn.
They were also asked to answer a short phone
questionnaire.



any work history at 3M and/or PFC production
current drinking water source and length of residence in the home
age, gender, ethnicity and general health status
About the participants
Oakdale (N = 98)
Mean
Range
Age
53
25 – 85
Residence Time in House
18
4 – 62
Length of Time lived in Oakdale
21
3.5 - 62
Age
53
20 -86
Residence Time in House
20
4 – 60
Average
Age
Average Length
of Residence
Male (n=88)
54
19
Female (n=108)
53
19
Worker (n=30)
59
21
Non Worker (n=166)
53
18
Lake Elmo/Cottage Grove (N = 98)
Gender
3M Employment
Results

3 chemicals were found in all 196
participants






PFOA
PFOS
PFHxS
PFBA was found in 55 people (28%)
PFBS was found in 5 people (3%)
PFHxA and PFPeA were not found in any
participants (all below the LOD)
P F O A S eru m L ev els (n g /m l)
18
17
16
15
14
0
0
0
0
0
0
0
0
0
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<
<
<
<
<
<
<
<
<
<
19
18
17
16
15
14
13
12
11
0
0
0
0
0
0
0
0
0
0
90
80
70
60
50
40
30
20
10
10
<
<
<
<
<
<
<
<
<
60
13
12
11
10
90
80
70
60
50
40
30
20
10
0
Number of Participants
Distribution of PFOA in the East
Metro Project Sample
70
GeoMean = 15.4 ng/mL
Range = 1.6 – 177 ng/mL
50
40
30
20
10
0
Number of Participants
35
30
GeoMean
13.6 ng/mL
25
25
20
20
15
15
PFOASerumLevels (ng/ml)
Number of Participants
40
0<
=
<
10 10
<=
<
20 20
<=
<
30 30
<=
<
40 40
<=
<
50 50
<=
<
60 60
<=
<
70 70
<=
<
80 80
<=
90 < 90
<=
10 < 10
0<
0
=
11 < 11
0<
0
=
12 < 12
0<
0
=
13 < 13
0<
0
=
14 < 14
0<
0
=
15 < 15
0<
0
=
16 < 16
0<
0
=
17 < 17
0<
0
=
18 < 18
0<
0
=
<1
90
0<
=
<
10 10
<=
<
20 20
<=
<
30 30
<=
<
40 40
<=
<
50 50
<=
<
60 60
<=
<
70 70
<=
<
80 80
<=
90 < 90
<=
10 < 10
0<
0
=
11 < 11
0< 0
=
12 < 12
0< 0
=
13 < 13
0< 0
=
14 < 14
0< 0
=
15 < 15
0< 0
=
16 < 16
0< 0
=
17 < 17
0< 0
=
18 < 18
0< 0
=
<1
90
Distribution of PFOA in Private Well
and Oakdale Municipal participants
Private Well Participants
Oakdale Municipal Participants
40
35
10
10
5
5
0
0
GeoMean
30
17.3 ng/mL
PFOA Serum Levels (ng/ml)
PFOA:
How do we compare to others?
Study and
Population
(Sample size)
Time
period
Geometric
Mean
ng/mL (ppb)
Range
ng/mL (ppb)
E. Metro PFC Biomonitoring Pilot Project
(N=196)
Oct 2008 –
Jan 2009
15.4
1.6 – 177
US NHANES
2,094 individuals (age 12 to > 60) from a
random sample of the US Population
2003
2004
3.9 (3.6 – 4.3)
0.1 – 77.2
Little Hocking, WV (N = 4,465)
Community (age 0 to >70) exposed to
PFOA contaminated drinking water
2005
2006
197
NA
Arnsberg, Germany
101 Males and 164 females from a
community with known PFC water
contamination
2006
Female 23.4
Male 25.3
Female 5.4 -99.7
Male 6.1 – 77.5
Occupational Group (N=215)
3M production workers
2000
1130
40 - 12700
P F O S S eru m L ev els (n g/m l)
46
44
42
40
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<=
<
<
<
<
<
<
<
<
<
<
<
<
<
<
<
<
<
<
<
<
48
46
44
42
40
38
36
34
32
30
28
26
24
22
20
18
16
14
12
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
80
60
40
20
10
<
<
<
<
50
38
36
34
32
30
28
26
24
22
20
18
16
14
12
10
80
60
40
20
0
Number of Participants
Distribution of PFOS in the East
Metro Project Sample
60
GeoMean = 35.9 ng/mL
Range = 3.2 - 448
40
30
20
10
0
PFOS :
How do we compare to others?
Study and Population
(Sample size)
Time
period
Geometric
Mean
ng/mL (ppb)
Range
ng/mL (ppb)
MDH E. Metro PFC Biomonitoring Pilot
Project (N=196)
Oct 2008Jan 2009
35.9
3.2 – 448
US NHANES
2,094 individuals (age 12 to > 60) from a
random sample of the US Population
2003 2004
20.7
0.3 – 435
2006
Female 5.8
Male 10.5
Females 1.7 – 16.7
Males 2.7 – 36.2
2000
440
10 - 7040
Germany (N; Males = 101, females = 164)
A random sample of individuals from an
area with PFC water contamination
Occupational Group (N=215)
3M production workers
Limitations of the pilot
project

Relatively small sample size limits the ability to
compare subgroups of participants

The pilot project does not include a local (Minnesota)
comparison group collected in the same time period

The pilot project is not able to identify the specific ways
participants were exposed to PFCs

The pilot project is not able to determine what illnesses
were or may be caused by participants’ exposure to
PFCs
PFCs and Health

PFCs are an “emerging” chemical

A very active area of environmental health
research
• Occupational studies
• General population studies
• Biomonitoring

Based on current science, we do not see
any increased risk of disease in people
caused by exposure at these low levels.
What will happen next?
Advisory panel recommended a followup study to see if levels decline in the
future as expected.
PFCs are removed from the drinking
water.
 Levels are declining in the general
population.

Biomonitoring has shown levels of PFCs declining
in the general population since 2000.
Temporal trends for five polyfluoroalkyl concentrations (ng/mL) from the CDC
NHANES and American Red Cross study populations for the population
geometric means (95% confidence intervals.)
Source: Olsen et al, 2008, Env. Sci. Technol, 42, 4989-4995.
Our staff in HPCD:
Michonne Bertrand
Adrienne Kari
Jean Johnson
Mary Jeanne Leavitt
Jeannette Sample
Leslie Schreier
Chuck Stroebel
Al Williams
Students:
Blair Manthey
CDC Epi Fellow:
Naomi Shinoda
Our Partners:
Environmental Health
Public Health Lab
MPCA and MDA
Advisory Panel
Steering Committee