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Chemical Incident Management – Management of Chronic Health Effects

Lookup NU author(s): Dr Robert Jefferson


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Introduction: The long-term consequences of low level, chronic exposure to chemicals and poisons are currently not well understood and there is increasing public concern about the possible impact, especially in relation to reproductive health [1] asthma [2] and cancers [3]. The same can be said regarding the chronic long term sequelae of an acute chemical event. An example of such an acute release followed by chronic health effects would be the release of methyl isocyanate in Bhopal in 1984. A further example would be the consequences of chemical weapon deployment against military and civilian targets in the Iran – Iraq war in the 1980’s. Very little data are available on monitoring health effects after chemical incidents either on an individual or population basis. Large incidents such as Bhopal & Seveso have had intense follow up; however smaller scale incidents in the UK have had ad hoc follow up, if at all. This is largely due to a number of factors including, lack of expertise, lack of appropriate environmental or biological sampling, and most significantly biological effect markers. The Chemical Hazards and Poisons Division (CHaPD) of the HPA is undertaking intensive research to improve our understanding of these issues [4]. It is important for the management of chronic health effects to have knowledge of the background levels of the chemical under study in the normal population. Developing research priorities for biological and biological effect markers of chemical exposure is a vital part of the assessment and management of chronic health effects of chemical exposure(s). This can then be used to aid in direct clinical assessment of individuals with health problems following chemical exposure(s) and also aid population based studies. Objective: To assess the background level of chemicals the UK population is exposed to, geographically map and use that data to aid in the management of chronic health effects. Methods: The UK population is exposed to a variety of chemical entities in both the environmental and occupational settings, the UK is not unique in this regard. There is currently little or no information regarding the levels of environmental chemicals in the blood and urine of any population base within the UK. There is an urgent need to address this for the UK population. Therefore a study is to start named the “Reference range study” for this purpose. A similar study is ongoing in USA [5,6] A study of this type needs to sufficiently large and over a significant number of years (decades) to yield meaningful results. There is also a need to geographically map samples so that potential “hot spots” of public health concern can be identified and further research/epidemiology work can be undertaken. The overall purpose of The Reference Range Study is to provide unique exposure information to scientists, physicians, public health practitioners and other stakeholders to help prevent disease that results from exposure to environmental chemicals. This has also been acknowledged by the EU and discussions have been started to collate biomonitoring projects throughout Europe [7]. The following chemicals will be analysed in the initial phase: Organochlorines (approximately 18-20 different compounds); Metals - including Lead, Mercury, & Cadmium; Endocrine disruptors ( a variety of different compounds); Decapolybrominated diphenyl ether (flame retardant); Benzene. These will be tested in blood samples obtained from collaboration with the National Blood Service of England and North Wales [8]. It is expected that approximately 2500 samples will be analysed in the first part of the study, initially from the North of England. As the study expands it will take in other areas of England and Wales and then cover the whole of the UK. Further chemicals will be added as and when felt necessary. The study will be broad based and over many years. It will report on a 2 yearly basis. Conclusions Specific public health uses of the exposure information in this study are: to determine which chemicals are present the UK population and at what concentrations; to determine if there are any geographical clusters of raised levels to the chemicals measured; for chemicals with a known toxicity level, to determine the prevalence of people with levels above those toxicity levels; for chemicals with a known toxicity level, to determine the geographical spread of people with levels above those toxicity levels; to establish reference ranges that can be used by physicians and scientists to determine whether a person or group has an unusually high exposure; to assess the effectiveness of public health efforts to reduce exposure of the UK population to specific chemicals. This is a long term aim; to track, over time, trends in levels of exposure of the population; to set priorities for research on human health effects.

Publication metadata

Author(s): Jefferson RD

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: XXVI Annual Congress of the European Association of Poisons Centres and Clinical Toxicologists

Year of Conference: 2006

Pages: 455-456

ISSN: 1556-3650

Publisher: Clinical Toxicology: Taylor & Francis