Potential Sources Of Exposure Research Articles

Prevalence of elevated blood lead level in children with global developmental delay and its relation with parental and child attributes

Background: Lead, a potential neurotoxin, is found in soil, water and air as a result of its non-biodegradable nature. Common sources of lead toxicity in children are household paints, leaded pipes for water supply, canned food, coloured toys, herbal/folk remedies and electronic wastes. Along with this, other child and parental attributes have been found to contribute to elevated blood lead level (EBLL). Objectives were to estimate the prevalence and risk factors of EBLL in children with global developmental delay (GDD). Methods: This hospital based cross sectional study was conducted between October 2019 and October 2021 at department of paediatrics of JNMCH, AMU, Aligarh. Data regarding clinical and sociodemographic characteristics as well as parental attributes was collected and entered on pre-designed proforma. Results: Among 94 children with GDD mean BLL was found to be 6.72±6.46 mcg/dl and in their mothers it was 6.74±6.46 mcg/dl (p=0.984). A high prevalence of EBLL (>5 mcg/dl) in children with GDD (53.20%) and their mothers (49.3%) was noted. Various child and parental attributes were identified as potential sources of exposure to lead. Conclusions: A high prevalence of EBLL in children with GDD in our study area might also suggest higher exposure from environmental sources such as soil, water, electronic waste, lead acid batteries, etc. For countries like ours which is rapidly undergoing industrialisation, these potential sources need to be identified promptly and swift action in this regard is needed in addition to preventive measures at personal and family levels.

Concentrations of lead in ceramic tableware in South Africa

Ceramic ware is used around the world, usually daily. In the past, lead was used in the glazes and decorative paints applied to ceramic ware, mainly to increase durability, impart a smooth, glasslike finish to glazes and intensify decorative pigments. However, this use of lead at times contributed to lead exposure and poisoning. While measures have been put in place to limit the use of lead in ceramic ware in well-resourced countries, there is relatively little information on the situation in poorly resourced settings. In the current preliminary South African study, we assessed the lead content and leaching rates from newly purchased ceramic ware. The majority of the 44 ceramic ware items had lead levels ≥ 90 ppm. Elevated lead concentrations were found in the leachate from only one item. The findings indicate a need for further research on the potential for lead exposure from ceramic wares, and support calls for increased attention to the many potential sources of lead exposure in poorly resourced settings. Significance: The study reveals the potential for lead contamination of certain types of ceramic ware available in South Africa. Daily use of lead-contaminated ceramic ware may increase the risk of lead exposure, especially among the poorest. The study findings are indicative of a need for further research to fully characterise the extent of lead in ceramic ware.

Occurrence and potential release of heavy metals in female underwear manufactured in China: Implication for women's health

Underwear is a potential source of women's exposure to heavy metals owing to its direct contact with the skin, especially the skin of the vagina and vulva, which has a strong absorptive capacity. However, information regarding the prevalence of metals in female underwear, and its potential hazards, remains scarce. In the present study, we examined the concentrations and potential release of Cr, Co, Ni, Cu, As, Cd, Sb, and Pb in brassieres and briefs manufactured in China. We detected higher levels of Pb and moderate levels of other metals, relative to the metal levels reported for other textiles in the literature. Cu, As, Ni and Cd, had higher migration rates (MRs) from the underwear, with medians of 100%, 100%, 30.1%, and 20.7%, respectively. The median MRs of the other metals were in the range 1.07%–15.7%. On the whole, the total and extractable concentrations of these metals differed by item and fabric type. The pollution of raw materials and the use of chemical additives containing metals commonly contributed to the metals in the underwear. On the basis of the exposure estimation, the non-carcinogenic risks posed by the underwear metals were acceptable, but the carcinogenic risks from the metals in 5.18% of brassiere samples exceeded the acceptable level.

Assessment of urinary aromatic amines in Brazilian pregnant women and association with DNA damage: Influence of genetic diversity, lifestyle, and environmental and socioeconomic factors

Aromatic amines (AAs) are polar organic chemicals with a wide environmental distribution originating from various sources, such as tobacco smoke, diesel exhaust, and dermal absorption from textile products with azo dyes. The toxicity profile of AAs is directly related to the amino group's metabolic activation and the generation of the reactive intermediate, forming DNA adducts and potential carcinogenicity. Urinary levels of 8-hydroxy-2′-deoxyguanosine (8OHdG) are an important biomarker of DNA damage. Since AAs have been shown to cross the placental barrier, being a risk factor for adverse birth outcomes, prenatal exposure is a great public health concern. The present study aimed to measure the urinary levels of 58 AAs in Brazilian pregnant women (n = 300) and investigated the impact of this exposure on DNA damage by quantifying 8OHdG levels. The influence of tobacco smoke exposure and dermal absorption of AAs by clothes on urinary levels was also assessed. The results showed a 100% detection rate for eight AAs, two of them regulated by the European Union (2,6-dimethylaniline and 2,4-diaminotolune). Hundreds of AAs may be derived from aniline, which here showed a median of 1.38 ng/mL. Aniline also correlated positively with 2,6-dimethylaniline, p-aminophenol, and other AAs, suggesting exposure to multiple sources. The present findings suggest that both tobacco smoke and dermal contact with clothes containing azo dyes are potential sources that might strongly influence urinary levels of AAs in Brazilian pregnant women. A multiple regression linear model (R2 = 0.772) suggested that some regulated AAs (i.e., 2-naphthylamine and 4-aminobiphenyl), nicotine, smoke habit, age, and Brazilian region could induce DNA damage occurrence, increasing the levels of 8OHdG. Given the limited available data on human exposure to carcinogenic AAs, as well as the lack of toxicological information on those non-regulated, further studies focused on measuring their levels in human fluids and the potential exposure sources are clearly essential.

RETRACTED: Clinical characteristics of patients with mpox infection in the United Arab Emirates: a prospective cohort study

ObjectivesThe study aims to explore the risk factors, clinical characteristics, and outcomes of mpox infection in Abu Dhabi, United Arab Emirates (UAE). MethodsA prospective cohort study was conducted at two communicable disease centers in Abu Dhabi, UAE and patients admitted with confirmed mpox infections between May 01, 2022 and December 31, 2022 were included in our study. ResultsA total of 176 mpox patients were admitted, of which 93% (n = 164) were men and mean age was 30.4 ± 7 years. Individuals presented with mucocutaneous lesions, most commonly on the genital and anal regions (n = 157; 89%). Only 70 (39.8%) gave a history of sexual exposure. The most common systemic symptoms reported were fever (n = 91; 52%), exanthema (n = 92; 52%), and inguinal lymphadenopathy (n = 60; 34%). Median timeframe from systemic symptoms to appearance of lesions was 4 days (interquartile range 4-6 days). Complications were observed in seven (4%) participants; two (1.1%) individuals developed conjunctivitis, four (2.3%) patients developed penile edema, and one (0.6%) case of myocarditis was reported. In 60% (n = 106) of patients, a potential source of sexual exposure was not identified. ConclusionThe clinical characteristics of mpox cases in the UAE are similar to those in other countries. However, cultural and religious factors likely prevent patient disclosure of sexual exposure and symptoms, contributing to the limited information about the disease in the Middle East.

Rapid, efficient, and green analytical technique for determination of fluorotelomer alcohol in water by stir bar sorptive extraction

Fluorotelomer alcohols (FTOHs) are one of the major classes of per- and polyfluoroalkyl substances (PFAS). Due to their potential toxicity, persistence, and ubiquitous presence in the environment, some common PFAS are voluntarily phased out; while FTOHs are used as alternatives to conventional PFAS. FTOHs are precursors of perfluorocarboxylic acids (PFCAs) and therefore they are commonly detected in water matrices, which eventually indicate PFAS contamination in drinking water supplies and thus a potential source of human exposure. Even though studies have been conducted nationwide to evaluate the degree of FTOHs in the water environment, robust monitoring is lacking because of the unavailability of simple and sustainable analytical extraction and detection methods. To fill the gap, we developed and validated a simple, rapid, minimal solvent use, no clean-up, and sensitive method for the determination of FTOHs in water by stir bar sorptive extraction (SBSE) coupled with thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS). Three commonly detected FTOHs (6:2 FTOH, 8:2 FTOH, and 10:2 FTOH) were selected as the model compounds. Factors such as extraction time, stirring speed, solvent composition, salt addition, and pH were investigated to achieve optimal extraction efficiency. This “green chemistry” based extraction provided good sensitivity and precision with low method limits of detection ranging from 2.16 ng/L to 16.7 ng/L and with an extraction recovery ranging 55%–111%. The developed method were tested on tap water, brackish water, and wastewater influent and effluent. 6:2 FTOH and 8:2 FTOH were detected in two wastewater samples at 78.0 and 34.8 ng/L, respectively. This optimized SBSE-TD-GC-MS method will be a valuable alternative to investigate FTOHs in water matrices.

Harmful algal bloom aerosols and human health.

Harmful algal blooms (HABs) are increasing across many locations globally. Toxins from HABs can be incorporated into aerosols and transported inland, where subsequent exposure and inhalation can induce adverse health effects. However, the relationship between HAB aerosols and health outcomes remains unclear despite the potential for population-level exposures. In this review, we synthesized the current state of knowledge and identified evidence gaps in the relationship between HAB aerosols and human health. Aerosols from Karenia brevis, Ostreopsis sp., and cyanobacteria were linked with respiratory outcomes. However, most works did not directly measure aerosol or toxin concentrations and instead relied on proxy metrics of exposure, such as cell concentrations in nearby waterbodies. Furthermore, the number of studies with epidemiological designs was limited. Significant uncertainties remain regarding the health effects of other HAB species; threshold dose and the dose-response relationship; effects of concurrent exposures to mixtures of toxins and other aerosol sources, such as microplastics and metals; the impact of long-term exposures; and disparities in exposures and associated health effects across potentially vulnerable subpopulations. Additional studies employing multifaceted exposure assessment methods and leveraging large health databases could address such gaps and improve our understanding of the public health burden of HABs.

Associations of urinary phthalate metabolites with household environments among mothers and their preschool-age children

Phthalates have become a matter of public health concern due to their extensive use worldwide and negative health effects. The evaluation of potential sources of phthalate exposure is crucial to design prevention strategies, especially for vulnerable populations. This study included 528 mother-child pairs in the Taiwan Mother Infant Cohort Study who were followed up at ages 3–6 years between 2016 and 2020. Each mother was interviewed by using a structured questionnaire containing questions on demographic characteristics and household environment factors, such as the use of plastic food packaging, residential visible mold, insecticide sprays, and electric mosquito repellents. Eleven phthalate metabolites were analyzed in urine samples simultaneously collected from the mother-child pairs. The phthalate metabolite urinary concentrations were higher among the children than among their mothers, except those of mono-ethyl phthalate (MEP) and mono-2-ethylhexyl phthalate (MEHP). Multiple linear regression analyses showed that urine samples collected during the summer showed higher concentrations of phthalate metabolites than those collected during the winter. Family income levels had negative associations with the concentrations of MnBP and metabolites of di-2-ethylhexyl phthalate (DEHP) in children. The use of plastic food packaging was positively associated with mono-n-butyl phthalate (MnBP) and metabolites of DEHP in mothers. Residential visible mold or mold stains were significantly associated with higher MnBP and DEHP metabolite concentrations in children. The use of insecticide sprays was positively associated with MnBP concentrations in children. Significant associations between household environmental factors and phthalate exposure were mostly found in children, potentially indicating different exposure pathways between mothers and their children. Findings from this study provide additional information for the design of prevention strategies to protect the health of children and women.

Hidden hazards and screening policy: Predicting undetected lead exposure in Illinois

Lead exposure still threatens children’s health despite policies aiming to identify lead exposure sources. Some US states require de jure universal screening while others target screening, but little research examines the relative benefits of these approaches. We link lead tests for children born in Illinois between 2010 and 2014 to geocoded birth records and potential exposure sources. We train a random forest regression model that predicts children’s blood lead levels (BLLs) to estimate the geographic distribution of undetected lead poisoning. We use these estimates to compare de jure universal screening against targeted screening. Because no policy achieves perfect compliance, we analyze different incremental screening expansions. We estimate that 5,819 untested children had a BLL ≥5μg/dL, in addition to the 18,101 detected cases. 80% of these undetected cases should have been screened under the current policy. Model-based targeted screening can improve upon both the status quo and expanded universal screening.

Clothing as a potential exposure source of trace elements during early life

In recent years, the interest in determining the chemical composition of textile products has increased among the scientific community and regulatory agencies, driven by toxicological issues and environmental concerns. Chemical elements are naturally present in clothing as natural fibers or intentionally added during manufacture. Some of them show physical-chemical properties that allow their absorption through the skin. In addition, chronic situations increase the dermal exposure capacity. Because of age-specific behavioral characteristics and underdeveloped physiological function, children may be especially sensitive to exposure to trace elements. This study aimed to analyze the levels of twenty trace elements in 120 clothing items commercialized in Spain. Textile products for pregnant women and children <36 months old were included. The potential health implication of this dermal exposure in early life was also evaluated. Aluminum, zinc, and titanium showed the highest concentrations, with median levels of 27.6, 5.6, and 4.2 mg/kg, respectively. Since chromium is employed as a metal complex dye in synthetic fibers, high levels of this element were found in black polyester. Dermal exposure to titanium, which is a ubiquitous element in clothes made of synthetic fibers, was associated with a hazard quotient (HQ) higher than the threshold value (HQ > 1), with values of 1.13 for pregnant women and 1.22 for newborns. On the other hand, HQ values of other elements and cancer risks were lower than the recommended values. Assessing early-life exposure to toxic elements can help to identify potential sources and to prevent or reduce human exposure, mainly in vulnerable groups.

#5395 ASSOCIATION BETWEEN PARABEN EXPOSURE AND EARLY RENAL INJURY IN A MIDDLE-AGED ADULT IN TAIWAN

Abstract Background and Aims Parabens are a class of preservatives used in the cosmetics industry and are widely used in people's daily lives, including personal care products (PCPs), pharmaceuticals and food. Epidemiological studies concerning the relations of exposure to parabens with renal function were limited. We aimed to investigate the potential sources of paraben exposure, estimate the daily intake (DI) of four parabens based on their urinary levels and the association between urinary paraben and renal function in a middle-aged adult population in Taiwan. Method We recruited 591 subjects aged from ≥40 to &amp;lt;65 years old (yrs) who have participated in Taiwan Environmental Survey for Toxicants (TEST) study from 2013-2016. Urinary parabens including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben (BuP) are measured by liquid chromatography/ tandem mass spectrometry. The cross-sectional analysis of the association between urinary paraben and biomarkers of renal function have also been established. Results The urinary MeP, EtP, PrP and BuP (median) levels were measured at 442, 42.9, 107 and 5.92 μg/L, respectively, which were also 10 times higher than those in other countries. Subjects aged from ≥55 to &amp;lt;65 yrs had higher urinary MeP and EtP levels and DI than those aged from ≥40 to &amp;lt;55 yrs (Fig. 1 &amp; Fig. 2). The median of DI was higher in lotion, perfume and nail polish users than those seldom used (Fig. 3). However, there was no significant difference between DI and PCPs usage, or the cumulative usage of PCPs by gender. The median of creatinine, microalbumin, urinary protein and uric acid were significantly higher in men than in women, the albumin to creatinine ratio was significantly higher in women (3.73 mg/g) than in men (3.05 mg/g). Conclusion The urinary paraben concentration of middle-aged adults in Taiwan was significantly higher than those in US, Canada, and Korea. There was no significant difference among paraben levels, age and gender. PCPs usage was a source of paraben exposure.

Paraben exposure through drugs in the neonatal intensive care unit: a regional cohort study.

Background and objectives: Environmental factors influence the development of very preterm infants (VPIs, born at less than 32weeks of gestation). It is important to identify all potential sources of paraben exposure in these vulnerable infants. We aimed to quantify paraben exposure via drug administration in a cohort of VPI cared for in neonatal intensive care units (NICUs). Methods: A prospective, observational study was carried out over a five-year period in a regional setting (two NICUs using the same computerized order-entry system). The main outcome was exposure to paraben-containing drugs. The secondary outcomes were: time of the first exposure, daily intake, number of infants exceeding paraben acceptable daily intake (ADI: 0-10mg/kg/d), duration of exposure, and cumulative dose. Results: The cohort consisted of 1,315 VPIs [BW 1129.9 (±360.4) g]. Among them, 85.5% were exposed to paraben-containing drugs. In 40.4% of infants, the first exposure occurred during the second week of life. Mean paraben intake and duration of exposure were, respectively, 2.2 (±1.4) mg/kg/d and 33.1 (±22.3) days. The cumulative paraben intake was 80.3 (±84.6) mg/kg. The ADI was exceeded in 3.5% of exposed infants. Lower GA was associated with higher intake and longer exposure (p < 0.0001). The main molecules involved in paraben exposure were: sodium iron feredetate, paracetamol, furosemide, and sodium bicarbonate + sodium alginate. Conclusion: Commonly used drugs are potential source of parabens, and ADI can be easily exceeded in VPIs cared for in NICUs. Efforts are needed to identify paraben-free alternative formulations for these vulnerable infants.

The Past, Present and Future of Asbestos-Related Diseases in Australia: What Are the Data Telling Us?

Exposure to asbestos fibres causes asbestosis, mesothelioma and several other cancers, which together are commonly referred to as asbestos-related diseases (ARDs). The use of asbestos increased rapidly in Australia and overseas throughout the 1900s, but knowledge about the health effects of exposure and subsequent controls came about more gradually. In Australia today, an estimated 4000 people still die annually from ARDs. While most of these deaths are due to past occupational exposures, there is ongoing concern about the many potential sources of asbestos exposure remaining in homes and the broader built environment as a legacy of past use. Current evidence indicates that Australians will continue to be exposed to legacy asbestos occupationally and non-occupationally, and continue to develop ARDs, without targeted action to prevent it. Evidence of ongoing exposure highlights the importance of better understanding how and why such exposures might still occur, and how they can be effectively prevented or controlled, with the aim of preventing the disease in the future. A better characterisation of this risk is also necessary to enable effective risk management and appropriate risk communication that is relevant to the current Australian context. This article explores the past, present and future of ARDs in Australia, considers the risk of a new wave of ARDs from legacy asbestos, and identifies where further study is required so that sustainable policies and practices can be developed to prevent a future wave of diseases.

Proppant powder – the protection and the pain – lurking hazards of silicosis

Resources Safety and Health Queensland (RSHQ) is the independent regulator for safety and health in Queensland’s resources sector. The Petroleum and Gas Inspectorate (the Inspectorate) administers safety and health regulation for the petroleum and gas industry. RSHQ uses a risk-based and data-driven approach to pursue its vision of zero serious harm for resource sector workers. In Queensland, on average, there are 200 fraccing operations conducted annually on oil and gas wells. For each fraccing operation, up to 450 tonnes of proppant may be used with an estimated 16 340–23 800 tonnes pumped annually. The majority of proppant used in Queensland is refined sand and is a potential source of exposure to respirable crystalline silica (RCS) during these operations. In 2020 safe exposure levels for RCS was halved from 0.1 to 0.05 mg/m3. Exposure to levels above this threshold may increase the risk of adverse health outcomes, such as respiratory diseases including silicosis, chronic obstructive pulmonary disease and lung cancer. These diseases are progressive, and typically can take at least 10 years of prolonged exposure to develop symptoms. All silica dust-related diseases are preventable through using effective controls. This paper outlines a study on RCS exposure levels in hydraulic fracturing operations in Queensland. The objective of the study was to understand the adequacy of the current controls in place to protect workers against exposure to RCS following the reduction of the safe exposure levels.

83 Assessing Exposure to Fungal Bioaerosols in Transport Environments: Analysing Fungal Composition of Passive Dust Samples Collected in UK Railway Stations

Abstract Bioaerosols consist of a complex mixture of airborne microorganisms including fungi, bacteria, pollen, particulates and by-products of cells. While exposure to diverse microorganisms is essential for normal immune system development, bioaerosol inhalation has been associated with respiratory allergy and inflammation. Bioaerosols are ubiquitous, yet their composition within different environments is not well understood. Such information is essential for assessing exposure and associated health impacts. Here we focus on transport environments, namely railway stations (RSs), which pose a potential source of occupational and community exposure. Over 1200 passive dust samples were taken from 17 RSs across the UK from 03/2014-05/2015. Geographical Information System methods were used to provide information on population characteristics of the immediate surrounding area of the RSs. Together with information on RS layout and passenger numbers, this informed the selection of 250 samples, representing 9 RSs of varied geographical location, layout and footfall for further analysis. High throughput sequencing (HTS) with a metabarcoding approach targeting the ITS2 region was used to analyse the fungal composition of the sample subset. Such HTS techniques provide an opportunity to measure a wider range of microorganisms than traditional culture or microscopy techniques. RS characteristics were varied and included indoor/enclosed and mostly outdoor layouts. Annual footfall varied from approximately 10-148 million. The fungal composition of RS over time and relationships with different RS characteristics will be presented, identifying those driving any differences in composition.

Assessing Metal Exposures Among Children Living in Environmental Justice Communities Near Metal Recycling Facilities in Houston, Texas

Background: Children living in environmental justice (EJ) neighborhoods may be vulnerable to metal exposure from industrial facilities that are located near their homes. Methods: Working with community partners, we held 20 recruitment events and invited children aged 5–12 and their parents living in EJ communities in Houston to participate in an environmental health study. Parents completed a questionnaire about their child's diet and behaviors and urine samples were collected from children to evaluate their metal exposure. Results: During a 4-month period, we recruited 52 out of 67 (78%) eligible parent/child dyads with 96% of children providing urine samples and 90% of questionnaires complete except for data on children's height and weight. While urinary metal concentrations in our study population were generally similar compared with children aged 6–11 years in the 2015–2016 National Health and Nutrition Examination Survey, we observed higher levels among children who frequently ate Mexican candy, rice, or red meat, spent more time outdoors, played with cosmetics, had metal piercings, or lived in a home with smokers or where pesticides were used. Discussion: Our study was successful in recruiting children in EJ communities for the purpose of assessing urinary metal exposure and obtaining questionnaire data from parents to examine the potential sources of exposure. Except for chromium and cobalt, 14 metals were detected in more than half of children's urine samples. We identified potential key determinants of exposure in this population that should be further examined. Conclusion: Findings point to the need for adequately powered studies among potentially vulnerable children living in EJ communities to profile metal exposures and identify important sources of these exposures.

Biomonitoring California Protocol for Following up on Elevated Levels of Urinary Arsenic

to develop and implement a follow-up protocol for Biomonitoring California study participants with elevated levels of urinary arsenic, particularly inorganic forms. We selected 20 μg/L as the level of concern for urinary inorganic arsenic; samples with total arsenic ≥20 μg/L were speciated. Participants with elevated inorganic arsenic were notified of their level and invited to participate in a telephone survey to help determine possible exposure sources. We illustrate the protocol in four Biomonitoring California studies, which collected samples from 2010-2013 in locations across the state. 48 participants in the four studies had elevated urinary inorganic arsenic levels. Consumption of rice and rice-based products was the most commonly identified potential source of inorganic arsenic exposure. Of 48 participants with elevated inorganic arsenic, 27 would have been missed if we had used the previously published threshold of 50 µg/L total arsenic to identify urine samples for speciation. This protocol fills a gap in the clinical literature by providing a more health-protective approach to identify individuals with elevated urinary inorganic arsenic and help determine potentially significant exposure sources.

Legionnaires' Disease Outbreak Associated With a Hot Tub Display at the North Carolina Mountain State Fair, September 2019.

On September 23, 2019, the North Carolina Division of Public Health identified a legionellosis increase in western North Carolina; most patients had recently attended the North Carolina Mountain State Fair. We conducted a source investigation. Cases were fair attendees with laboratory-confirmed legionellosis and symptom onset within 2 to 14 days (Legionnaires' disease) or ≤3 days (Pontiac fever). We conducted a case-control study matching cases to non-ill fair attendees as control participants and an environmental investigation, and we performed laboratory testing (Legionella bacteria culture and polymerase chain reaction) of 27 environmental samples from fairgrounds and hot tubs and 14 specimens from case patients. We used multivariable unconditional logistic regression models to calculate adjusted odds ratios for potential Legionella exposure sources and risk factors. Of 136 people identified with fair-associated legionellosis, 98 (72%) were hospitalized and 4 (3%) died. Case patients were more likely than control participants to report walking by hot tub displays (adjusted odds ratio = 10.0; 95% CI, 4.2-24.1). Complete hot tub water treatment records were not kept, precluding evaluation of water maintenance conducted on display hot tubs. Legionella pneumophila sequence types (STs) were consistent among 10 typed clinical specimens (ST224) but distinct from the only positive environmental sample from the fair (ST7 and ST8). Hot tub displays were identified as the most likely outbreak source, making this the largest hot tub-associated Legionnaires' disease outbreak worldwide. Following the investigation, the North Carolina Division of Public Health and the Centers for Disease Control and Prevention released guidance on mitigating risk of Legionella exposure from hot tub displays. Results highlight the importance of properly maintaining equipment that aerosolizes water, including hot tubs intended for display purposes only.

Firefighters' exposure to per-and polyfluoroalkyl substances (PFAS) as an occupational hazard: A review.

The term "firefighter" and "cancer" have become so intertwined in the past decade that they are now nearly inseparable. Occupational exposure of firefighters to carcinogenic chemicals may increase their risk of developing different types of cancer. PFAS are one of the major classes of carcinogenic chemicals that firefighters are exposed to as occupational hazard. Elevated levels of PFAS have been observed in firefighters' blood serum in recent studies. Possible sources of occupational exposure to PFAS include turnout gear, aqueous film-forming foam, and air and dust at both the fire scene and fire station. Preliminary discussion on PFAS includes definition, classification, and chemical structure. The review is then followed by identifying the sources of PFAS that firefighters may encounter as an occupational hazard. The structural properties of the PFAS used in identified sources, their degradation, and exposure pathways are reviewed. The elevated level of PFAS in the blood serum and how this might associate with an increased risk of cancer is discussed. Our review shows a significant amount of PFAS on turnout gear and their migration to untreated layers, and how turnout gear itself might be a potential source of PFAS exposure. PFAS from aqueous film-forming foams (AFFF), air, and dust of fire stations have been already established as potential exposure sources. Studies on firefighters' cancer suggest that firefighters have a higher cancer risk compared to the general population. This review suggests that increased exposure to PFAS as an occupational hazard could be a potential cancer risk for firefighters.

Occupational Exposure to Antineoplastic Drugs in Twelve French Health Care Setting: Biological Monitoring and Surface Contamination

Antineoplastic drugs used in the treatment of cancers have an intrinsic toxicity, because of their genotoxic, teratogenic, and carcinogenic properties. Their use is recognized as an occupational hazard for healthcare workers (HCWs) who may be exposed. The purpose of this article is to present biological- and environmental-monitoring data collected in twelve French hospitals over eight years. Urine samples were collected from a wide range of HCWs (250 participants) from pharmacy and oncology units, including physicians, pharmacists, pharmacy technicians, nurses, auxiliary nurses, and cleaners. The investigated drugs were cyclophosphamide, ifosfamide, methotrexate, and α-fluoro-β-alanine, the main urinary metabolite of 5-fluorouracil. Wipe samples were collected from various locations in pharmacy and oncology units. More than 50% of participants, from all exposure groups, were contaminated with either drug, depending on the unit, the day, or the task performed. However, workers from oncology units were more frequently exposed than workers from pharmacy units. Significant contamination was detected on various surfaces in pharmacy and oncology units, highlighting potential sources of exposure. Risk-management measures should be implemented to reduce and maintain exposures at lowest-possible levels. In addition, regular exposure assessment, including biological and environmental monitoring, is recommended to ensure the long-term efficiency of the prevention measures.