VCCEP pilot: progress on evaluating children's risks and data needs

Early-life exposure to humidifier disinfectant determines the prognosis of lung function in children

BACKGROUND

Use of humidifier disinfectants (HD) at home leads to chemical airborne exposure, causing HD associated lung injury (HDLI) with high mortality. However, the lung function in children diagnosed with HDLI is not well studied. We investigated the effect of HD exposure on lung function, prognosis, and exposure characteristics associated with the lung function phenotype in children.

METHODS

Eighty-one children diagnosed with HDLI in a nationwide cohort were tested for spirometry and diffusing capacity of the lung for carbon monoxide (DLco) from July 2013 and followed up with at five time points over 2 years. The results were compared with 122 children without HD exposure as controls. Home investigation and questionnaire analysis were conducted to assess HD inhalation exposure.

RESULTS

HDLI survivor's mean percent of predicted forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), and corrected DLco were significantly lower compared with the control group. On longitudinal assessment, FVC was within the normal range, but flattened, and spirometry showed a predominantly restrictive pattern. Corrected DLco did not normalize above 80% despite increasing age. The persistently low phenotype of lung function was associated with initial exposure age, especially less than 12 months of age. Higher density HD exposure during sleep and close distance between the bed and the humidifier were significantly associated with persistently low corrected DLco.

CONCLUSIONS

HD exposure affects prolonged decrement in lung function, especially DLco, particularly among children who are exposed within the first year of life. These results suggested that early-life HD exposure determines long-term prognosis of lung function in children.

Risk Policies in the United States: Definition and Characteristics Based on a Scoping Review of the Literature

The concept of "risk policy" is used with increasing frequency by decisionmakers, researchers, and the media. However, there is no precise, generally accepted definition of what is covered by policies in this area. Based on a scoping review of the literature published in key journals in the sector, we have identified the main characteristics of public risk policies drawn up and implemented in the United States. The sample comprised 21 articles published in six multidisciplinary journals between 2000 and 2010.

Identifying important life stages for monitoring and assessing risks from exposures to environmental contaminants: results of a World Health Organization review

•

We propose a harmonized set of age bins for assessing risks from chemical exposure.

•

The set of early life age groups will facilitate consistency with recent guidance.

•

The age bins allow results from longitudinal birth cohort studies to be combined.

•

Region-specific exposure factors and monitoring data are needed to apply the bins.

In this paper, we summarize exposure-related issues to consider in determining the most appropriate age ranges and life stages for risk assessment. We then propose a harmonized set of age bins for monitoring and assessing risks from exposures to chemicals for global use. The focus is on preconception through adolescence, though the approach should be applicable to additional life stages. A two-tiered set of early life age groups is recommended. The first tier involves the adoption of guidance similar to the childhood age groups recommended by the U.S. Environmental Protection Agency, whereas the second tier consolidates some of those age groups to reduce the burden of developing age-specific exposure factors for different regions. While there is no single “correct” means of choosing a common set of age groups to use internationally in assessing early life exposure and risk, use of a set of defined age groups is recommended to facilitate comparisons of potential exposures and risks around the globe, the collection of data and analyses of aggregate exposure and cumulative risk. Application of these age groups for robust assessment of exposure and risk for specific populations will require region-specific exposure factors as well as local environmental monitoring data.