Levels of metals and organic substances in workers at a hazardous waste incinerator: a follow-up study

Gene Expression Profiling as a New Real-Time Assay in Human Biomonitoring of Waste-to-Energy Plant Workers

Exposure to heavy metals represents one of the most important risk factors for the health of incinerator workers. Indeed, heavy metals can determine increased generation of reactive oxygen species (ROS). In this work, we introduced the use of transcription profiling of detoxifying genes, involved in redox balance and genome integrity, as a highly sensitive assay of heavy metal exposure and subsequent oxidative stress. For this purpose, blood mRNA levels of OGG1, ST13, NQO1 and MT1A genes, as well as urinary concentrations of nine heavy metals and the oxidized base 8-OHdG of 49 subjects (26 controls and 23 employees in the waste-to-energy plant of San Zeno, Arezzo, Italy) were determined. No significant difference between the two populations was observed, thus highlighting, as far as the biomarkers analysed are concerned, the absence of occupational exposure to heavy metals and systemic oxidative stress induction in the workers of the waste-to-energy plant of San Zeno. Correlation analyses underline a close association between heavy metals exposure and changes in expression levels of a number of genes, even at low exposure doses, thus remarking the greater capacity of detection of transcription profiling compared to other biomarkers and the importance of its introduction in future human biomonitoring programs.

The Use of Human Biomonitoring to Assess Occupational Exposure to PAHs in Europe: A Comprehensive Review

Polycyclic aromatic hydrocarbons (PAHs) are among the chemicals with proven impact on workers' health. The use of human biomonitoring (HBM) to assess occupational exposure to PAHs has become more common in recent years, but the data generated need an overall view to make them more usable by regulators and policymakers. This comprehensive review, developed under the Human Biomonitoring for Europe (HBM4EU) Initiative, was based on the literature available from 2008-2022, aiming to present and discuss the information on occupational exposure to PAHs, in order to identify the strengths and limitations of exposure and effect biomarkers and the knowledge needs for regulation in the workplace. The most frequently used exposure biomarker is urinary 1-hydroxypyrene (1-OH-PYR), a metabolite of pyrene. As effect biomarkers, those based on the measurement of oxidative stress (urinary 8-oxo-dG adducts) and genotoxicity (blood DNA strand-breaks) are the most common. Overall, a need to advance new harmonized approaches both in data and sample collection and in the use of appropriate biomarkers in occupational studies to obtain reliable and comparable data on PAH exposure in different industrial sectors, was noted. Moreover, the use of effect biomarkers can assist to identify work environments or activities of high risk, thus enabling preventive risk mitigation and management measures.

Occupational Exposure to Hexavalent Chromium, Nickel and PAHs: A Mixtures Risk Assessment Approach Based on Literature Exposure Data from European Countries

Hexavalent chromium (Cr(VI)), nickel (Ni) and polycyclic aromatic hydrocarbons (PAHs) are genotoxic co-occurring lung carcinogens whose occupational health risk is still understudied. This study, conducted within the European Human Biomonitoring Initiative (HBM4EU), aimed at performing a mixtures risk assessment (MRA) based on published human biomonitoring (HBM) data from Cr(VI), Ni and/or PAHs occupational co-exposure in Europe. After data extraction, Risk Quotient (RQ) and Sum of Risk Quotients (SRQ) were calculated for binary and ternary mixtures to characterise the risk. Most selected articles measured urinary levels of Cr and Ni and a SRQ > 1 was obtained for co-exposure levels in welding activities, showing that there is concern regarding co-exposure to these substances. Similarly, co-exposure to mixtures of Cr(VI), Ni and PAHs in waste incineration settings resulted in SRQ > 1. In some studies, a low risk was estimated based on the single substances’ exposure level (RQ < 1), but the mixture was considered of concern (SRQ > 1), highlighting the relevance of considering exposure to the mixture rather than to its single components. Overall, this study points out the need of using a MRA based on HBM data as a more realistic approach to assess and manage the risk at the workplace, in order to protect workers’ health.

Polychlorinated Biphenyls (PCBs) in the Environment: Occupational and Exposure Events, Effects on Human Health and Fertility

In the last decade or so, polychlorinated biphenyls (PCBs) garnered renewed attention in the scientific community due to new evidence pointing at their continued presence in the environment and workplaces and the potential human risks related to their presence. PCBs move from the environment to humans through different routes; the dominant pathway is the ingestion of contaminated foods (fish, seafood and dairy products), followed by inhalation (both indoor and outdoor air), and, to a lesser extent, dust ingestion and dermal contact. Numerous studies reported the environmental and occupational exposure to these pollutants, deriving from building materials (flame-retardants, plasticizers, paints, caulking compounds, sealants, fluorescent light ballasts, etc.) and electrical equipment. The highest PCBs contaminations were detected in e-waste recycling sites, suggesting the need for the implementation of remediation strategies of such polluted areas to safeguard the health of workers and local populations. Furthermore, a significant correlation between PCB exposure and increased blood PCB concentrations was observed in people working in PCB-contaminated workplaces. Several epidemiological studies suggest that environmental and occupational exposure to high concentrations of PCBs is associated with different health outcomes, such as neuropsychological and neurobehavioral deficits, dementia, immune system dysfunctions, cardiovascular diseases and cancer. In addition, recent studies indicate that PCBs bioaccumulation can reduce fertility, with harmful effects on the reproductive system that can be passed to offspring. In the near future, further studies are needed to assess the real effects of PCBs exposure at low concentrations for prolonged exposure in workplaces and specific indoor environments.

Concentrations of persistent organic pollutants in blood of the Spanish population: Temporal trend

The present article reviews the human biomonitoring studies conducted in Spain to assess exposure to persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs), polybrominated diphenyl ethers (PBDEs), and per- and poly-fluoroalkyl substances (PFAS). In general terms, important variations in POPs concentrations between Spanish regions and specific populations were observed, while no associations between exposure to POPs and adverse health outcomes were found. Moreover, occupational exposure seems not to be a risk factor with regards to POPs exposure in the Spanish population. The present review highlights the importance of conducting human biomonitoring studies to find possible associations between POPs and adverse health effects.

Human biomonitoring of metals in workers at the waste-to-energy incinerator of Turin: An Italian longitudinal study

Evidence of negative health effects of solid waste management is uncertain. Available reviews suggests the use of biomarkers in human biomonitoring (HBM) to detect low exposure levels. In September 2013, a waste-to-energy plant located in the Turin (Italy) went into operation. The SPoTT (acronym for Population health Surveillance in the Turin incinerator's area) monitoring program was set up to assess the potential health impact caused by the plant. The paper illustrates the results of HBM of metals in the workers before the plant went into operation and then at 1 year and 3 years. This study is one of the few focusing on workers with a longitudinal design (the first in Italy). Eighteen metals in urine and lead in blood were determined by sector field inductively coupled plasma mass spectrometry. Information on participant habits and other characteristics that could potentially affect metals concentrations were collected via a structured questionnaire. Subjects were classified according to their work role at the facility: administrative staff workers (AW); plant workers (PW). Nonparametric methods were used to evaluate the changes in metals concentration over time. Comparison of the metals concentration in the samples taken at baseline and at the following two-time points shows a general decrease in levels: urinary concentration of beryllium (Be), cobalt (Co), mercury (Hg), Ir, nickel (Ni), tin (Sn), thallium (Tl), and blood level of lead (Pb) among the PW and Ir and Pd among the AW were significantly lower at T2 versus baseline. A decrease was also recorded in arsenic (As) among the PW and in cadmium (Cd), chromium (Cr), palladium (Pd), rhodium (Rh), and zinc (Zn) for both groups, whereas the levels of copper (Cu) and vanadium (V) remained unchanged over time. The downward trend remained also after taking confounding factors into account. The only exceptions were Mn, Pt, Sb among the PW: increase levels between T0 and T2 were recorded, which cannot be specifically attributable to the plant activity. The median urinary and blood concentrations of the metals were lower than those reported in the literature and were below the occupational reference values at all three-time points. Our results are consistent with those reported for the cohort of local residents and with the ambient air measurements.

Concentrations of PCDD/Fs in Human Blood: A Review of Data from the Current Decade

Polychlorinated dibenzo-p-dioxins and polychlorinated dibenzo-p-furans (PCDD/Fs) are environmental pollutants with great persistence, the capacity of bioaccumulation, and well known important toxic effects in humans and animals. Incinerators of hazardous, municipal and medical waste, chlorine bleaching of paper pulp, cement plants, and the traffic of motor vehicles are the most frequent emission sources of these compounds. The diet, followed at a great distance by inhalation, is generally the main way of human exposure to PCDD/Fs. Human biomonitoring is of great importance to prevent potential adverse effects derived from exposure to chemicals such as PCDD/Fs. In relation to this, blood is among the most used biological monitors. In the current review, we have summarized the recent information (2000–2009) published in the scientific literature (databases: Scopus and PubMed) on the concentrations of PCDD/Fs in blood samples of non-occupationally exposed populations, as well as in some groups of occupationally exposed individuals. We have revised a number of studies conducted in various African, American, Asian and European countries, and Australia. Unfortunately, the information is quite limited. No data are available for most countries over the world. Based on the results here reviewed, where available, the current health risks for the general populations do not seem to be of concern. Moreover, taking into account the important reductions observed in the levels of PCDD/Fs in foodstuffs, new decreases in the concentrations of PCDD/Fs in blood—and other biological tissues—are very probable in the immediate years.

Quantification of eight bisphenol analogues in blood and urine samples of workers in a hazardous waste incinerator

Bisphenol A (BPA) has been widely used in the manufacture of polycarbonate plastic and epoxy resins. In recent years, producers have started replacing BPA by other chemical analogues, such as bisphenol -S (BPS) and -F (BPF), all of them under the label "BPA-free". However, despite bisphenol (BP) analogues have a very similar structure, their endocrine-disrupting properties could differ from those of BPA. Unfortunately, information regarding human exposure to BP analogues is very limited, not only as single substances, but also as chemical mixtures. The aim of this study was to determine the levels of 8 BP analogues (A, S, F, B, AF, Z, E, and AP) in biological samples from a controlled cohort of workers in a hazardous waste incinerator (HWI) located in Constantí (Catalonia, Spain). Firstly, a chemical method to analyze a mixture of those 8 analogues in total blood and urine was optimized, being samples quantified by means of gas chromatography coupled to mass spectrometry (GC-MS). Furthermore, a biomonitoring study was performed by collecting samples of total blood and urine of 29 people working in the HWI. Among the 8 BP analogues assessed, BPA presented the highest levels in both biological samples, with mean total (free + conjugated) BPA concentrations of 0.58 and 0.86 μg/L in blood and urine, respectively. Free vs. total BPA levels presented a mean percentage of 79% in blood and 19% in urine. Beyond BPA, traces of BPB were also found in a single sample of blood. Furthermore, none of the remaining BP analogues was detected in blood or urine. Despite BPA has been regulated, it is still very present in the environment, being human exposure to this chemical still an issue of concern for the public health.

Monitoring dioxins and furans in plasma of individuals living near a hazardous waste incinerator: Temporal trend after 20 years

The concentrations of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) were analyzed in 40 plasma samples of individuals living in zones under potential influence of the emissions of a hazardous waste incinerator (HWI) (Tarragona County, Catalonia, Spain). Samples corresponded to subjects of different gender, age and specific areas of residence. The levels of PCDD/Fs were compared to those obtained in a baseline study (1998), as well as in previous surveys (2002, 2007 and 2012). The current mean concentration of PCDD/Fs in plasma was 6.79 pg I-TEQ/g lipid, which was significantly lower than the baseline concentration (27.0 pg I-TEQ/g lipid). A significant decrease was also observed in comparison to the results obtained in 2002 and 2007 (15.7 and 9.4 pg I-TEQ/g, respectively), while the current PCDD/F levels were similar to those obtained in 2012 (6.18 pg I-TEQ/g lipid). This important reduction in plasma PCDD/F levels is in accordance with the decreasing trend in the daily dietary intake of PCDD/Fs, which diminished from 210.1 pg I-TEQ (baseline) to 8.54 pg WHO-TEQ (current). OCDD was the predominant congener in plasma, while 2,3,7,8-TeCDD and 1,2,3,4,7,8,9-HpCDF showed the lowest levels. Based on the above results, as well as other recent data on the levels of PCDD/Fs in human milk, we conclude that the presence of the HWI does not mean additional and significant risks -as regards to PCDD/F exposure-for the population living in the neighborhood of the facility.

Biomonitoring of toxic metals in incinerator workers: A systematic review

Exposure to chemicals released during urban waste disposal and treatment is increasingly regarded as a potential occupational health issue. Indeed, several toxic metals emitted by an incinerator, including As, Be, Cd, Cr, Pb, Mn, Hg, Ni and V, have potentially toxic properties and their exposure, therefore, may be of concern for the health of the workers involved. The levels of exposure should therefore be carefully measured. Environmental monitoring, however, may be unable, alone, to assess true exposure, due to its intrinsic limitations mainly concerning its inability to assess oral and dermal absorption. In these cases biological monitoring may represent a fundamental supplementary tool for the definition of the workers' true occupational exposure and for the prevention of the related health effects. There is, therefore, an increasing interest in developing and using, in these workers, sensitive and specific biomarkers for health risk assessment, particularly at low or even very low levels of exposure. Despite the large number of original and review articles present in the literature on the biomonitoring of workers exposed to metals, the data on subjects employed in waste treatment activities are scattered and results are sometimes inconsistent. This is the first systematic review, performed according to PRISMA methodology, of the major studies investigating the levels of different toxic metals measured in the main biological matrices (blood, urine, hair) of incinerator workers. The results show that the levels of metals measured in incinerators' workers are generally low, with some notable exceptions for Cd and Pb. These results, though, can be affected by several confounders related either to non-occupational exposure, including diet, area of residence and others, and/or by a number of methodological limitations, as we found in the reported studies. Future work should focus on an integrated approach, using ideally both biological and environmental monitoring. A particular emphasis should be given to the measurement of the different granulometric fractions of the dust containing metals, i.e. inhalable, thoracic, respirable and ultrafine fractions. Moreover, an accurate description of the work tasks and the characteristics and levels of non-occupational exposure should always be provided.

Mercury risk assessment combining internal and external exposure methods for a population living near a municipal solid waste incinerator

Risk assessments for human health have been conducted for municipal solid waste incinerators (MSWIs) in many western countries, whereas only a few risk assessments have been performed for MSWIs in developing countries such as China where the use of waste incineration is increasing rapidly. To assess the mercury exposure risks of a population living near the largest MSWI in South China, we combined internal exposure and external exposure assessment with an individual-specific questionnaire. The mercury concentrations in air, soil, and locally collected food around the MSWI were assessed. The total mercury (T-Hg) and methylmercury (MeHg) of 447 blood samples from a control group, residential exposure group, and MSWI workers were measured. The internal and external exposures of the subject population were analyzed. Significant difference in MeHg concentrations was observed between the control group and the exposed group, between the control group and the MSWI workers, and between the exposed group and the MSWI workers (median levels: 0.70 μg/L, 0.81 μg/L, and 1.02 μg/L for the control group, exposed group, and MSWI workers, respectively). The MeHg/T-Hg ratio was 0.51 ± 0.19, 0.59 ± 0.17 and 0.58 ± 0.25, respectively. Multiple linear regression analysis indicated that MeHg concentrations were positively correlated with the gaseous mercury in the air. Combining internal and external exposure assessment showed that the direct contribution of MSWI emissions was minor compared with the dietary contribution. The external and internal exposures were well matched with each other. This study also suggested that an integrated method combining internal and external exposure assessment with an individual-specific questionnaire is feasible to assess the risks for a population living near a MSWI.

Significance and Usefulness of Biomarkers of Exposure to Manganese

Manganese (Mn) accomplishes functions essential to maintaining human health, but at the same time this trace element can be toxic at low levels of exposure and accurate estimation of internal exposure is needed. A biomarker of exposure to Mn is meaningful only if there is sufficient knowledge of the toxicokinetics determining its presence in a biological medium (e.g. whole blood, plasma, urine, hair, nail). Moreover, biological monitoring of exposure to Mn is useful only when the biomarker is sufficiently specific and sensitive to distinguish exposed from non-exposed subjects, when it is dose-related to the external exposure (current, recent, or time-integrated), and when it displays reasonable dose–effect/response relationships with the occurrence of adverse effects on the central nervous system, the critical target for Mn exposure. Human investigations in which biomarkers of Mn exposure meet all these criteria are hard to locate. Overall, the available studies report poor or no associations on an individual basis between external (Mn in air or drinking water) and internal (Mn in blood, urine, hair, or nail) Mn exposure indices. This may be to some extent explained by features inherent of the Mn metabolism (homeostatic control), the Mn biomarker's half-life with respect to the exposure window, and the variable nature of external exposure scenarios. Studies particularly dealing with Mn inhalation exposure, different or poorly described methodological approaches, or air sampling strategies may render direct comparison and interpretation of results a tedious task. Nevertheless, several studies report significant dose–effect associations between biomarkers of Mn exposure and subclinical deficits of psychomotor or neuropsychological test performances. Because directly associated with the site of toxic action and providing the magnetic resonance imaging is done no later than three months after Mn exposure ceased, the Mn T1 relaxation time is potentially the better biomarker of Mn exposure in a clinical context (e.g. after long-term parenteral nutrition, chronic liver failure, methcathinone drug abuse). Magnetic resonance imaging is, however, unpractical as a tool for biological monitoring of exposure to Mn in the occupational setting (inhalation) and in the general population (air, drinking water). In conclusion, it would be inappropriate to recommend, on the basis of the currently available evidence, a reliable well-validated biomarker of exposure to Mn, or to establish a health-based threshold value for subclinical neurotoxic effects.

Body burden monitoring of dioxins and other organic substances in workers at a hazardous waste incinerator

The construction in Constantí (Tarragona County, Catalonia) of the first, and up till now the only hazardous waste incinerator (HWI) in Spain, finished in 1999. In this study, we measured the concentrations of a number of organic substances determined in blood and urine of the HWI workers. Samples of 18 men and 9 women, classified according to their respective workplaces, were collected in 2011, after approximately 12 years of regular operations in the facility. The current results were compared with those of the baseline survey, as well as with the most recent surveys performed in 2008, 2009 and 2010. Plasma analyses were carried out for hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs 28, 52, 101, 138, 153, and 180) and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), while the levels of 2,4- and 2,5-dichlorophenol (DCP), 2,4,5- and 2,4,6-trichlorophenol (TCP), pentachlorophenol (PCP) and 1-hydroxypyrene (1-HP) were measured in urine samples. In plasma, the mean concentrations were the following: 10.8μg/kg lipid for HCB; 0.8μg/kg lipid for PCB28; 0.3μg/kg lipid for PCB52; 0.5μg/kg lipid for PCB101; 42.2μg/kg lipid for PCB138; 18.5μg/kg lipid for PCB153, and 51.2μg/kg lipid for PCB180. For PCDD/Fs, the mean concentration was 4.6ng I-TEQ/kg lipid (4.7ng WHO-TEQ/kg lipid). These levels, as well as those found in urine samples, are in agreement with the data of previous surveys performed in the same area. The current results in HWI workers do not show any evident sign of occupational exposure to PCDD/Fs and other organic substances. However, these results must be considered only as an indication of potential exposure, as the study presents notable limitations, such as the reduced number of participants and the lack of data relative to the air concentrations of chemicals. Consequently, general conclusions cannot be derived and the results should not be used as a basis for the implementation of industrial hygiene measures in other HWIs.

Blood levels of dioxins, furans, dioxin-like PCBs, and TEQs in general populations: a review, 1989-2010

A comprehensive worldwide literature review of blood levels of dioxins and dioxin-like compounds in non-exposed adult general populations was performed. The studies published in 1989-2010 reporting information on polychlorinated dibenzo-para-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), non-ortho-PCBs (nPCBs), mono-ortho-PCBs (mPCBs) levels and Toxic Equivalencies (TEQs, a summary weighted measure of their combined toxicity) were reviewed. TEQs were calculated using as standard the most recent WHO 2005 reevaluation of Toxic Equivalency Factors (TEFs). Weighted multiple regression analyses adjusted for year, subject's age, type of sample analyzed, method used for values below detection limit, and central tendency measure used were performed for each congener and standardized TEQs (log-transformed). We identified 187 studies regarding 29,687 subjects of 26 countries. Year of blood collection ranged from 1985 to 2008. The studies reporting congener levels 161. In adjusted analyses, European countries showed higher levels of most dioxin-like congeners and TEQs. A strong positive association of subjects' age with most congeners and with TEQ values was found, confirming previous findings. Significant decreases over time (1985-2008) were documented for PCCDs, PCDFs, and TEQs including their contributions. No significant decrease was found for non-ortho-PCBs, notably PCB 126. Only some mono-ortho-PCBs showed clear significant declines. Accordingly, TEQs including only PCB contribution did not decrease over time. In interpreting these findings, it should be considered that for dioxin-like PCBs the analysis period was shorter (17 years), since these compounds were first measured in 1992.

Application of self-organizing maps for PCDD/F pattern recognition of environmental and biological samples to evaluate the impact of a hazardous waste incinerator

Kohonen's self-organizing maps (SOM) is one of the most popular artificial neural network models. In this study, SOM were used to assess the potential relationships between polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) congener profiles in environmental (soil, herbage, and ambient air) and biological (plasma, adipose tissue, and breast milk) samples, and the emissions of a hazardous waste incinerator (HWI) in Spain. The visual examination of PCDD/F congener profiles of most environmental and biological samples did not allow finding out any differences between monitors. However, the global SOM analysis of environmental and biological samples showed that the weight of the PCDD/F stack emissions of the HWI on the environmental burden and on the exposure of the individuals living in the surroundings was not significant in relation to the background levels. The results confirmed the small influence of the HWI emissions of PCDD/Fs on the environment and the population living in the neighborhood.