Lab Matters Fall 2017 | Page 12

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Maine has a higher rate of bladder cancer than New Hampshire and, in both states, it is linked to arsenic exposure. Uranium was added to the study based on past research showing that it tends to co-occur with arsenic.

One of the most interesting aspects of the New Hampshire study is the public health laboratory’ s outreach to recruit participants. Amanda Cosser, MPH, the laboratory’ s biomonitoring program manager, said“ We identified towns we want to target based on groundwater arsenic risk modeling from the US Geological Survey and picked a random set of addresses with private wells. Then we introduce the project with a postcard that gives three ways to contact us: call, e-mail or complete an online survey. If they don’ t respond, we follow up with a formal letter.”

Additional outreach comes through the involvement of town administrators, managers and selectmen. After meeting with laboratory staff, said Cosser,“ they’ ve taken it upon themselves to advertise our study in their town letters and on their websites.”

So far, 375 well water users have joined the study.

Another CDC-funded study is underway at the Virginia Division of Consolidated Laboratory Services( DCLS), under the direction of Chris Retarides, PhD, and Shane Wyatt, the lab’ s lead biomonitoring scientists. The focus here is two-part:( 1) a surveillance survey to determine baseline, local exposures to six heavy metals and perchlorate( a naturally occurring contaminant in fertilizer and a rocket fuel constituent, linked to thyroid disease) and( 2) an assessment of firefighter’ s exposure to toxic combustion products, including polycyclic aromatic hydrocarbons( PAHs) produced by burning wood and cyanide produced by burning plastics.

“ If we see high levels of PAHs and very low levels of cyanide, we know the exposure was mostly dermal,” said Retarides, since PAHs can be absorbed through the skin or inhaled, while cyanide is largely inhaled.

As in New Hampshire, community outreach is a key study component. Retarides said the researchers initially considered working through local health

New Hampshire PHL’ s technical advisory committee( TAC) reviews and provides feedback on a draft report package for the Targeted Arsenic and Uranium Public Health Study. Photo: NH PHL

departments to enlist surveillance survey participants, but found health department staff to be taxed with other important duties. Instead, they chose to recruit participants at the Commonwealth’ s 23 community colleges, knowing that most recruits would be under Virginia’ s median age of 37.

Said Retarides,“ It says on the Virginia Community College System webpage that, no matter where you are in the state, you’ re no more than 30 minutes from a community college.… These are commuter schools; people go there because they’ re convenient. And most [ community college students ] are exposed to the local environment and water systems.”

As of late September, the DCLS team had collected over 900 urine specimens for the surveillance survey and completed analyses on about 500, with no unusual findings thus far. The firefighter study is still ramping up.

A New Frontier: The Exposome

Retarides has high hopes for NBN, which he called“ a great undertaking.” Having been on the periphery of efforts to establish the network, he said,“ I know the people involved are a great treasure trove of knowledge. It will be a big help to states looking for survey methods, analytical methods and epidemiology and analytical chemistry expertise. [ Biomonitoring ] is not just about measuring samples, you have to go out and get them, and the measurements have to be meaningful.”

In addition to providing information and training, network members could also perform testing for other laboratories within or outside NBN, either as part of an emergency response or to support a biomonitoring study. Aldous said,“ It’ s not just routine testing, but testing for novel compounds that can be disseminated across the network, maybe something in commerce now that people aren’ t taking great notice of, but that needs to be looked at across the country.”

Julianne Nassif, MS, director of APHL’ s Environmental Health program, said NBN will focus initially on developing technical guidance for biomonitoring programs, a membership application process and a network structure, with tiers based on a laboratory’ s capability and activities.

NBN leaders also plan to convene additional workgroups, to begin an initiative on quality management and quality systems, and to investigate options for where to store state biomonitoring data, such as in the EPHT Network maintained by CDC or a new, stand-alone database.

In the meantime, the science of biomonitoring continues to evolve in ways big and small. The latest buzz word in the field is exposome, encompassing the entire universe of one’ s environmental exposures from the prenatal period onward, together with all the associated biological responses to those exposures throughout the lifespan. Thanks to technological advances, particularly