Lab Matters Fall 2020 - Page 34

Environmental Health individual and household information during the subject recruitment period to differentiate exposure routes and to further link them with measured environmental contaminant levels . Multiple approaches , such as collecting samples from home visits and utilizing local medical facilities , will be considered for specimen collection .
Even though each state has different situations and challenges , the NJHANES-presented approach is another example of how a population-based surveillance study can be designed to achieve the following objectives : 1 ) provide data representative of the statewide population ’ s exposure to state-specific environmental contaminants and 2 ) establish baseline data for the state . In addition , these statelevel data will help in assessing current body burden ( s ), identifying additional at-risk subpopulations , addressing disparities within the population , and possibly , disclosing currently unrecognized contaminations and exposure routes within a state .
Presenter : Elisabeth Cook , New Jersey Department of Health , Ewing , NJ , elisabeth . cook @ doh . nj . gov
Method Development for PCBs , OCPs and Toxic Metals in Dried Blood Spots — Potential Indicators for Early Detection of Autism Spectrum Disorder
S . O ’ Leary 1 , C . H . Yu 1 , E . Bind 2 , S . Du 1 , A . Steffens 1 , M . McConico 1 , D . Haltmeier 1 , Z . Fan 1 ; 1 New Jersey Department of Health , Ewing , NJ ,
New Jersey Department of Health Public Health and Environmental Laboratories
New Jersey has the highest rate of autism spectrum disorder ( ASD ) in the nation and the discrepancy continues to grow . In utero exposure to multiple environmental contaminants has been linked to pathogenesis . Early detection of these risk factors and early diagnosis are keys to maximizing the effects of life-altering therapeutic treatment and emotional management .
The New Jersey Department of Health ( NJDOH ) -Environmental and Chemical Laboratory Services ( ECLS ) was awarded a competitive state biomonitoring grant in the period of 2019 – 2024 from the US Centers for Disease Control and Prevention ( US CDC ) to conduct a research project for exploring whether the Identification of prenatal environmental stressors linked to ASD such as toxic metals and persistent organic pollutants ( POPs ) can influence on potential autism-indicative biomarker data from newborn dried blood spot ( DBS ) cards . To test this research question , the NJDOH will leverage the untested DBS cards stored in NJ Newborn Screening ( NJ NBS ) program . These residual specimens will be used to establish new testing methods for 1 ) toxic metals such as lead , cadmium and mercury ; 2 ) POPs such as organochlorine pesticides ( OCPs ); and polychlorinated biphenyls ( PCBs ). Analytical challenges are relatively low blood volume , volume variability , and background present from DBS . Sensitivity and precision will be optimized and the potential interferences will be evaluated .
These challenges will be circumvented by 1 ) optimizing sample preparation procedures , 2 ) incorporating / analyzing a blank circle for each individual DBS card , and 3 ) utilizing the most sensitive instruments . We are evaluating our approach in terms of maximizing extraction , lowering interfering background levels , as well as enhancing method sensitivity / precision . Briefly , a half-inch DBS circle ( estimating equivalent blood volume ~ 75 µ L specimen ) and a half-inch blank circle ( filter paper only ) will be cut from the same DBS card . The samples will be extracted using or modified from extraction steps described in reference methods ( CDC 3016.8-03 or EPA 200.8 for metals and CDC 6502.02 for POPs ) and subsequently analyzed by highly-sensitive instruments ( ICP-QQQ for metals and HRGC-HRMS for POPs ) at NJDOH-ECLS labs .
The newly developed new methods will be utilized to determine select environmental contaminant levels in DBS cards for metals ( n = 500-1000 ) and OCPs / PCBs ( n = 250-500 ) and obtained data will be associated with ASD-related biomarker levels previously determined by NJ NBS program in the same sample to establish if there is an influence on potential indicative biomarker data .
Presenter : Shawn O ’ Leary , New Jersey Department of Health , Ewing , NJ , shawn . oleary @ doh . nj . gov
Standard-of-Care Prenatal Screening for Lead and Mercury : A Case for Early Intervention
A . Steffens 1 , E . Bind 2 , A . Krasley 1 , M . McConico 1 , D . Haltmeier 1 , Z . Fan 1 ; 1 New Jersey Department of Health , Ewing , NJ , 2 New Jersey Department of Health Public Health and Environmental Laboratories
Lead and mercury are very harmful to growing babies since exposed mothers can pass these metals on to their babies through the umbilical cord . Lead and mercury can affect the development of the brain and body , change behavior , and cause many other problems . Developing babies are the most vulnerable to these effects . Taking steps early to reduce mothers ’ risks of exposure will help protect babies from these harmful effects .
The NJ Biomonitoring Program partnered with University Hospital ( UH ) in Newark , NJ to offer prenatal lead and mercury testing as standard-of-care to the UH patient population . All patients receive educational materials that explain the importance of screening for lead and mercury and how to minimize exposure and protect their families . An extra tube of blood is collected at the expectant mother ’ s first prenatal visit and cord blood representing the baby ’ s exposure is collected at birth . These samples are sent to the New Jersey Department of Health Metals Laboratory for testing and the results are sent back to the providers to help guide them in making any necessary medical decisions regarding their patients ’ care . These results become part of the children ’ s medical records to help ensure proper medical care as necessary throughout their lives .
Patients with elevated lead ( ≥ 5 µ g / dL ) or mercury ( ≥ 5 µ g / L ) receive medical treatment provided by UH staff as part of normal patient care protocols . NJ Poison Control is available to provide educational assistance to the patients and medical staff . Mothers ’ blood is tested throughout pregnancy to ensure that interventions are successful , and the results are compared to the results of a cord blood at sample collected birth . Patients with elevated lead levels receive case management and home inspections and , where appropriate , remediations and abatements from local departments of health . Elevated mercury samples are speciated to determine what species of mercury is present to help elucidate the exposure source of the mercury .
To date , we have analyzed samples from over 2000 individual patients . This program has helped identify several extremely high lead and mercury cases and has shown that there is a surprising percentage of patients with elevated mercury levels . Most of the elevated mercury samples are predominantly or completely methylmercury , indicating consumption of large fish as a likely source . Providing this testing at this stage of pregnancy is allowing