Lab Matters Fall 2024 | Page 48

APHL 2024 POSTER ABSTRACTS

New Jersey Biomonitoring Mercury Levels : A Comparison and Call to Action

E . Bind , S . Li , V . Chandra , C . Yu , E . Cook , C . Maceda , C . Donohoe , A . Mills , T . Fan , D . Haltmeier , New Jersey Department of Health

Chronic exposure to mercury ( Hg ) is associated with numerous adverse health outcomes in adults , including cardiovascular , reproductive and developmental toxicity . Prenatal exposure is particularly detrimental to fetuses and is associated with reduced anthropometric measures that can persist into adulthood . To better understand Hg risk in NJ , the NJ Biomonitoring team ( NJB ) implemented several projects that monitor environmental contaminant levels in the NJ population and in selected subpopulations , as described below .

The Remnant Specimen Study ( RSS ) ( 2015-2018 ) was designed to determine levels of environmental contaminants using deidentified clinical laboratory and blood bank remnant specimens from NJ adults aged 20-74 years . The NJ Health and Nutrition Examination Survey ( NJHANES ) is an ongoing statewide biomonitoring study that emulates the CDC ’ s National Health and Nutrition Examination Survey ( NHANES ) to obtain NJ- specific health and nutrition status and body burden of ~ 120 chemicals of interest . The Prenatal Screening Program ( PSP ) screens expectant mothers and newborns in selected high-risk NJ communities for toxic metals . This poster uses the NHANES dataset as a national reference for comparison with NJ-specific biomonitoring data generated by the NJB . To mitigate the complexity and differences in the NHANES and NJ datasets , unweighted geometric mean ( GM ) and median comparisons were computed and performed . Data collection , cleaning , merging , analysis and visualization were performed using the R ( version 4.3.1 ) and RStudio ( 2023.06.1 ) environments .

NJ biomonitoring data indicate Hg exposure is prevalent throughout the population at levels higher than the national average . The national GM of blood Hg is 0.56 µ g / L ( n = 12,102 ) for 2017-prepandemic years . In comparison , it is 1.01 µ g / L ( n = 2,988 ) in RSS , 1.08 µ g / L ( n = 167 ) in NJHANES , 0.81 µ g / L ( n = 6,600 ) in PSP mothers and 1.22 µ g / L ( n = 6107 ) in PSP babies . The multiple comparison tests confirmed that the median differences between PSP / RSS / NJHANES and NHANES data were all significant ( p5 µ g / L ( 8.1 % in RSS , 11.4 % in NJHANES , 3.53 % in PSP mothers and 8.65 % in PSP babies ) than in NHANES ( 3.27 %). For a level that may cause adverse health effects in babies ( defined as 1-5 µ g / L ), all NJ results showed higher exceedances ( 43.4 % in RSS , 43.1 % in NJHANES , 41.9 % in PSP mothers and 51.5 % in PSP babies ) than in NHANES ( 23.5 %). During the implementation of PSP and NJHANES , we identified several cases with very high levels of blood Hg and interventions were made immediately according to the established protocol . Two examples of the effectiveness of timely interventions successfully reducing Hg levels in participants include Participant 1 ( PSP ) blood Hg decreased from 45 µ g / dL at week 10 of pregnancy to 3.5 µ g / dL at delivery and Participant 2 ( NJHANES ) continues to decrease from 26.9 µ g / dL ).

The study results and findings indicate that the NJ population , including vulnerable populations like pregnant women and babies , are exposed to higher levels of Hg compared to national average and underscore the need for Hg screening and tracking in NJ . Also , the NJB data and approaches in place highlight the importance of a prenatal screening program and continuous biomonitoring of environmental contaminant levels for general and vulnerable subpopulations of interest to improve the public health of all .

Presenter : Sarah Li , sarah . li @ doh . nj . gov

Reporting Elevated Biomonitoring Results to Study and Project Participants

E . Cook , G . Kaur , C . Donohoe , C . Maceda , E . Irabor , C . Yu , E . Bind , T . Fan , New Jersey Department of Health

The NJ Health & Nutrition Examination Survey ( NJHANES ) is the first statewide probability-based population biomonitoring surveillance study conducted by the NJ Department of Health . NJHANES aims to examine the health , nutrition and body burden of NJ residents using questionnaires and biospecimen analysis of over 120 environmental chemicals including toxic metals , polyfluoroalkyl substances ( PFAS ) and others . A common challenge for reporting biomonitoring results to is the lack of consensus on reference ranges and critical values . These uncertainties must be communicated to participants to maximize the value of the results and empower them to make decisions about how to reduce their exposures . Varying levels of scientific literacy among participants contribute to the complexity of conveying pertinent information .

To address these challenges , the team conducted extensive research to establish reference ranges and critical values for over 100 chemicals , many of which do not have established health limits . Normal ranges were determined through comparative analysis based on data from CDC ’ s NHANES , the Agency for Toxic Substances and Disease Registry and other states . NJHANES adopted the NJ reportable levels for arsenic , cadmium , lead and mercury as critical values and set three times the 95th percentile from NHANES for other chemicals based on concern for participants ’ wellbeing and program capacity to conduct calls . Reporting templates were developed to include Clinical Laboratory Improvement Amendments requirements and to appeal to participants . The reports include background information , common exposure sources , reference ranges and an explanation of the results for each chemical . A protocol for reporting results was developed , including secure delivery of results , outlining procedures for documenting reportable findings , conducting subject matter expert ( SME ) calls and reporting partial results . Access to the Communicable Disease Reporting & Surveillance System ( CDRSS ) was obtained for mandatory reporting of the four toxic metals .

To date , NJHANES has generated 174 initial reports and 19 intermediate reports . SMEs have had 20 calls for 22 chemicals above the critical values including 4 arsenic , 4 lead and 15 mercury cases . Fourteen cases were for chemicals without established health limits . Four arsenic and three lead cases were reported to CDRSS . Participants have taken action to reduce their exposures by having their water tested for uranium and lead , retesting their blood to confirm mercury levels are decreasing and moving hazardous chemicals from the garage to the shed to reduce exposure to volatile organic compounds .

Future plans include finalizing recruitment and testing for the targeted 500 participants , continuing to modernize our data infrastructure for more accessible reporting and helping address the lack of harmonized reference values for chemicals .

Presenter : Gurleen Kaur , gurleen . kaur @ doh . nj . gov