November 10, 2009
By: John Kasprak, Senior Attorney
You asked about biomonitoring, including information on California's program, any Connecticut activities in this area, and the availability of federal funds.
Generally, “biomonitoring” refers to the process by which chemicals and their metabolites are identified and measured within different biological specimens. The federal Centers for Disease Control and Prevention (CDC) has been performing biomonitoring measurements for over 30 years. Biomonitoring has become the standard for assessing people's exposure to toxic substances and for responding to serious environmental public health problems.
Biomonitoring has many applied uses including emergencies involving exposure to toxic chemicals, responding to chemical terrorism, and identifying disease clusters. Additionally, the CDC is currently working with the National Institute of Child Health and Development on a national children's study. This study is examining the effects of the environment on children and will use biomonitoring in its work.
In 2006, California legislation created the “California Environmental Contaminant Biomonitoring Program” (CECBP), the first of its kind in the country. CECBP is a collaboration among a number of state agencies, led by the state health department. The basic purpose of the program is to monitor the presence and concentration of designated chemicals in state residents. The law creates a scientific guidance panel to assist the department. It requires the department to provide public access to the information and report to the legislature and the public. California was one of three states (New York and Washington are the others) to receive funding from the CDC for its biomonitoring program. These federal funds are part of a five-year cooperative agreement with CDC.
Also related to biomonitoring is the practice of “environmental public health tracking” (EPHT). This is the ongoing collection, integration, analysis, and dissemination of data on environmental hazards, exposures to those hazards, and health effects that may be related to the exposures. Biomonitoring is an important component of EPHT. The CDC is developing a national tracking network and has funded projects in 17 states and cities, including Connecticut. Connecticut originally received a planning grant from CDC in 2002 to begin developing the state's portion of the EPHT Network. In 2006, the state applied for and received an additional five years of funding to begin implementation.
Biomonitoring is the direct measurement of environmental chemicals in people's blood, urine, or other body tissues. It determines which chemicals, and how much of them, have gotten into individuals after they have been exposed. Biomonitoring improves health officials' ability to make timely and appropriate health decisions by providing better information on human exposure.
For the past three decades, the CDC's National Center for Environmental Health (NCEH) laboratory has used biomonitoring to determine people's exposure to chemicals and the concentrations in their bodies that are related to adverse health effects. CDC produces important data on the U.S. population's exposure to hundreds of environmental chemicals and publishes its findings in peer-reviewed literature and in CDC's National Report on Human Exposure to Environmental Chemicals.
State health officials are also interested in conducting biomonitoring assessments of chemical exposure among their residents and then comparing their results with the national data.
For more information, see http://www.cdc.gov/nceh/dls/national_biomonitoring_program.htm.
Applied Uses of Biomonitoring
There are various uses of biomonitoring according to CDC's National Biomonitoring Program, including emergencies involving exposure to toxic chemicals, responding to chemical terrorism, and disease clusters.
Emergencies Involving Exposure to Toxic Chemicals. Local, state, and international health officials who handle multiple emergencies involving chemicals have contacted CDC for assistance. For example, in the mid-1990s, CDC's environmental health laboratory assisted the Agency for Toxic Substances and Disease Registry by assessing exposure to the pesticide methyl parathion among residents of seven states in the South and Midwest whose home interiors had been illegally sprayed with the pesticide. With these measurements, health officials were able to establish which houses needed to be cleaned up and which did not, helping to lessen health concerns among homeowners. Knowing the levels of the absorbed dose of methyl parathion also helped officials determine which families needed to move immediately and those who could continue to live in their homes.
Another example involves exposure to toxic chemicals among military personnel. The CDC reports that over the years, the U.S. military has requested assistance from its laboratory to determine whether or not their personnel have been exposed to toxic chemicals in this country or abroad. The laboratory has collaborated on multiple exposure studies, most recently with the Department of Defense on the possible exposure of some members of an Army National Guard unit that had been deployed to Iraq. The unit had concerns about possible exposure to depleted uranium in its bivouac location. CDC's environmental laboratory, as well as two military-based laboratories analyzed the same samples, looking first at total uranium levels in the urine samples provided and then, depending on those test results, at isotope ratios. Ultimately, CDC scientists determined that none of the soldiers had total uranium levels that were outside the reference range of levels found in people living in the United States, and all uranium found had ratios indicating that the sources of exposure were natural and not from military use.
Responding to Chemical Terrorism. According to the CDC, the possibility of a terrorist chemical attack “underscores the need for a reliable way to determine the identity of chemical agents and find out who has and been exposed and to what extent.” CDC is using biomonitoring to protect the public in the event of a chemical incident through use of a “rapid toxic screen.” The chemical agents that can be measured using this screen include nerve agent, blistering agents, cyanide-based compounds, pesticides, metals, incapacitating agents, and other chemicals that cause significant illness or death. Test results can tell which chemical agents were used, who was and was not exposed, and how much of a particular chemical was absorbed.
Disease Clusters. Some people worry that they and their families have been exposed to chemicals that cause cancer or other debilitating illnesses. State public health departments seek CDC's help in investigating geographic clusters of cancer, birth defects, or other diseases and in determining whether the cases resulted from toxic substance exposure. CDC's environmental laboratory can measure up to 300 environmental chemicals in blood or urine to produce and exposure profile for people living in a particular area. That profile can be compared with the exposure profile of average Americans to determine whether unusual exposures have occurred among cluster residents that warrants public health action.
An example of this use of biomonitoring involved a Nevada county. The Nevada State Health Division requested technical assistance from the CDC as part of its response to the elevated number of children in Churchill County diagnosed with acute lymphocytic leukemia. The subsequent investigation conducted a cross-sectional exposure assessment to identify contaminants unique to that county.
National Children's Study
The Division of Laboratory Sciences (DLS) at CDC's National Center for Environmental Health is working with the National Institute of Child Health and Development (NICHD) on the “National Children's Study.” This study, according to the CDC, is the largest ever undertaken to assess the effects of the environment on child and adult health. It follows a representative sample of children from early life through adolescent and seeks information to prevent and treat health problems such as autism, birth defects, diabetes, heart disease, and obesity.
Specifically, this national study will examine the effects of various environmental influences on the health and development of 100,000 children across the country, following them from before birth to age 21. The study broadly defines “environment” and will consider several issues such as natural and man-made environmental factors, biological and chemical factors, physical surroundings, social factors, behavioral influences and outcomes, genetics, cultural and family influences and differences, and geographic locations.
DLS will use its biomonitoring expertise in a pilot study for the national study. Its scientists will analyze samples of blood, breast milk, and urine from 525 pregnant mothers and their infants after birth for more than 100 environmental chemicals and nutritional indicators. Samples will be collected from seven study centers (known as “vanguard centers”), established by NICHD. Sample collection began in summer 2009.
The “California Environmental Contaminant Biomonitoring Program” (CECBP), the first state level biomonitoring program, was authorized by Senate Bill 1379 and signed into law in 2006 (Chapter 599, Statutes of 2006; California Health and Safety Code § 105440-105444). CECBP is a collaborative effort among the California Department of Public Health (CDPH), the Office of Environmental Health Hazard Assessment, and the Department of Toxic Substances Control (DTSC). The law designates CDPH as the lead entity. (A copy of the legislation is attached.)
Program Goals and Elements
The goals of the program are to (1) determine baseline levels of environmental contaminants in a representative sample of Californians, (2) establish temporal trends in contaminant levels, and (3) assess the effectiveness of public health efforts and regulatory programs to reduce exposures of Californians to specific chemical contaminants.
A representative sample of state residents will be selected using a methodology similar to that used by the CDC in its National Health and Nutrition Examination Survey (NHANES). While the federal biomonitoring program has been “piggybacked” on samples obtained in NHANES, California has to create a biomonitoring sampling and field operations infrastructure as well as laboratory systems.
DCPH is contracting with CDC to provide technical assistance in multiple areas, including sample design, field protocols, and laboratory methods. It expects to recruit 2,000+ participants per two-year sampling cycle who reflect the “age, economic, racial, and ethnic composition of the state.”
Data Collection and Analysis
Data obtained from program participants includes:
1. questionnaires on demographics, health status and history, diet, occupation, potential exposures of interest, and other variables;
2. anthropometric measurements (e.g. height, weight, waist and hip size);
3. physiological measurements (blood pressure, spirometry, and others); and
4. blood and urine samples and possibly other biological specimens.
Biological specimens are sent to CDPH's Environmental Health Laboratory Branch (EHLB) where some samples will be split, with some portions archived on-site and the rest analyzed at (1) EHLB--metals and nonpersistent organic chemicals, (2) DTSC Environmental Chemistry Laboratory--persistent organic compounds, and (3) commercial laboratories--certain clinical tests, such as lipid panels (needed to interpret blood analyses of fat-soluble chemicals).
Scientific Guidance Panel
The law requires the state health department to establish a Scientific Guidance Panel (SGP) to assist the department and other agencies with the biomonitoring program. The panel must provide scientific peer review and recommendations on program design and implementation, including chemicals to analyze in human biological specimens. The SGP includes nine members, five appointed by the governor and four by the legislature.
The California program is receiving federal funds as part of a five-year cooperative agreement with the CDC. The award for year one, beginning September 1, 2009, is $2,652,487, with about 90% of this amount for hiring laboratory staff and purchasing new laboratory equipment. Funding for subsequent years of the agreement is subject to fund availability and satisfactory program progress. The goals of the agreement are:
1. expand laboratory capability and capacity to assess human exposures to environmental chemicals of greatest concern to Californians;
2. provide laboratory support for public health and exposure investigations, epidemiologic investigations, and population-based biomonitoring;
3. conduct targeted exposure investigations in collaboration with communities and interested groups;
4. determine the effectiveness of state public health actions to reduce exposures over time to specific chemicals of concern to state residents; and
5. integrate biomonitoring findings into the development and implementation of chemical policy for California under its Green Chemistry initiative.
Under the cooperative agreement, the CECBP must carry out the following:
1. acquire and install new laboratory equipment to allow sensitive analyses of multiple chemical analyses;
2. hire and train additional laboratory and other program staff;
3. undertake targeted biomonitoring field investigations in collaboration with California's Environmental Health Tracking Program, local health departments, and other community and public health partners;
4. select one or more statewide or regional biospecimen collection efforts for population-based biomonitoring; and
5. expand existing public outreach and education activities.
More information about California's biomonitoring program can be found at http://www.oehha.ca.gov/multimedia/biomon/index.html.
OTHER STATES RECEIVING FEDERAL FUNDING
In 2009, CDC awarded a total of $5 million to three states, California (discussed above), New York, and Washington, for state-based laboratory biomonitoring programs. This funding is designed to increase the capability and capacity of these states to conduct biomonitoring and
thus assess human exposure to environmental chemicals within their jurisdictions. Thirty-three states applied for funding, either individually or in partnership with other states, according to the CDC.
Program information, including the application and award process, is attached.
New York's State Department of Health received $1 million for federal FY 09 for its biomonitoring program. The state's goals are to (1) expand the range of environmental chemicals that were measured in the 2004 New York City Community Health and Nutrition Examination Survey; (2) assess exposure to depleted uranium in a population of upstate New York residents and in former workers of National Lead Industries in the Albany County area; and (3) assess exposure to methyl mercury among two Chinese communities in the state.
The Washington Department of Health received $1,347,513 from the CDC for federal FY 09. It is using the funding to focus initially on (1) measuring exposure to total and speciated arsenic, organophosphate, and pyrethroid metabolites in the general population and (2) using the CDC method to assess the general population's exposure to 25 additional metals.
ENVIRONMENTAL PUBLIC HEALTH TRACKING AND BIOMONITORING
Related to the concept of biomonitoring is “environmental public health tracking” (EPHT). EPHT is the ongoing collection, integration, analysis, interpretation, and dissemination of data on environmental hazards, exposures to those hazards, and health effects that may be related to the exposures. The goal of EPHT is to provide information that can be used to plan, apply, and evaluate actions to prevent and control environmentally related diseases. The most “health-relevant” method of determining exposure to environmental hazards, according to CDC, is biomonitoring.
CDC's biomonitoring and the CDC National Environmental Public Health Tracking programs work closely together. CDC's environmental health laboratory and its EPHT program rely on each other for scientific and technical expertise. Additionally, biomonitoring program scientists provide advice on strategies for building the national EPHT network and program.
The CDC funds public health tracking network projects in 16 states, including Connecticut, and New York City. (The other states are California, Florida, Maine, Maryland, Massachusetts, Missouri, New Hampshire, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Utah, Washington, and Wisconsin.) In March 2009, CDC received additional funding from Congress to expand EPHT to five more locations. Eventually, the CDC hopes to expand the network to all 50 states.
In July 2009, the CDC announced the launch of the Web-based EPHT network, a surveillance tool that scientists, health professionals, and the general public can use to track environmental exposures and chronic health conditions.
For more information go to www.cdc.gov/ephtracking.
In FY 02, the Connecticut Department of Public Health (DPH), in collaboration with the state Department of Environmental Protection (DEP), received a CDC planning grant to begin developing the state's portion of the national EPHT network. The state's mission in this regard is to (1) obtain an “ongoing picture of the health of Connecticut residents as it relates to their environment through a state-based EPHT system,” (2) examine the relationship between public health and environmental agents, and (3) disseminate information from the system to prevent and control environmentally-related diseases.
The first step was to convene the Connecticut Environmental Public Health Tracking Consortium to provide recommendations for planning and implementing the network in Connecticut. The consortium completed its work by publishing a final report in 2005, “A New Strategic Direction: A Plan to Implement Environmental Public Health Tracking In Connecticut.” (The report's executive summary is attached).
In 2006, the state applied for and received an additional five years of funding to begin implementing the EPHT Network. The focus of the work during this cycle is to integrate existing health and environmental data systems to allow for ongoing tracking.
Implementation of the state's EPHT Network is occurring in stages over the course of the five-year grant. Core measures will be incorporated according to CDC's schedule; additional non-core measures will be added as data becomes available. Core measures include data on asthma hospitalizations, myocardial infarction hospitalizations, ozone, particulate matter, key water contaminants, birth defects, cancer, childhood blood lead levels, and vital statistics. Non-core measures include occupational health data, carbon monoxide poisoning, and radon. Connecticut's EPHT Network will be implemented as part of the overall DPH Public Health Information Network initiative.