Samuel Dorevitch

Effectiveness of qPCR permutations, internal controls and dilution as means for minimizing the impact of inhibition while measuring Enterococcus in environmental waters

Aims:  Draft criteria for the optional use of qPCR for recreational water quality monitoring have been published in the United States. One concern is that inhibition of the qPCR assay can lead to false‐negative results and potentially inadequate public health protection. We evaluate the effectiveness of strategies for minimizing the impact of inhibition.

Water ingestion during water recreation

Quantitative risk assessments have estimated health risks of water recreation. One input to risk assessment models is the rate of water ingestion. One published study estimated rates of water ingestion during swimming, but estimates of water ingestion are not available for common limited contact water recreation activities such as canoeing, fishing, kayaking, motor boating, and rowing. In the summer of 2009 two related studies were conducted to estimate water ingestion during these activities. First, at Chicago area surface waters, survey research methods were utilized to characterize self-reported estimates of water ingestion during canoeing, kayaking, and fishing among 2705 people. Second, at outdoor swimming pools, survey research methods and the analysis of cyanuric acid, a tracer of swimming pool water, were used to characterize water ingestion among 662 people who engaged in a variety of full-contact and limited-contact recreational activities. Data from the swimming study was used to derive translation factors that quantify the volume of self-reported estimates. At surface waters, less than 2% of canoers and kayakers reported swallowing a teaspoon or more and 0.5% reported swallowing a mouthful or more. Swimmers in a pool were about 25-50 times more likely to report swallowing a teaspoon of water compared to those who participate in limited-contact recreational activities on surface waters. Mean and upper confidence estimates of water ingestion during limited-contact recreation on surface waters are about 3-4 mL and 10-15 mL, respectively. These estimates of water ingestion rates may be useful in modeling the health risks of water recreation.

Health risks of limited-contact water recreation.

Background: Wastewater-impacted waters that do not support swimming are often used for boating, canoeing, fishing, kayaking, and rowing. Little is known about the health risks of these limited-contact water recreation activities. Objectives: We evaluated the incidence of illness, severity of illness, associations between water exposure and illness, and risk of illness attributable to limited-contact water recreation on waters dominated by wastewater effluent and on waters approved for general use recreation (such as swimming). Methods: The Chicago Health, Environmental Exposure, and Recreation Study was a prospective cohort study that evaluated five health outcomes among three groups of people: those who engaged in limited-contact water recreation on effluent-dominated waters, those who engaged in limited-contact recreation on general-use waters, and those who engaged in non–water recreation. Data analysis included survival analysis, logistic regression, and estimates of risk for counterfactual exposure scenarios using G-computation. Results: Telephone follow-up data were available for 11,297 participants. With non–water recreation as the reference group, we found that limited-contact water recreation was associated with the development of acute gastrointestinal illness in the first 3 days after water recreation at both effluent-dominated waters [adjusted odds ratio (AOR) 1.46; 95% confidence interval (CI): 1.08, 1.96] and general-use waters (1.50; 95% CI: 1.09, 2.07). For every 1,000 recreators, 13.7 (95% CI: 3.1, 24.9) and 15.1 (95% CI: 2.6, 25.7) cases of gastrointestinal illness were attributable to limited-contact recreation at effluent-dominated waters and general-use waters, respectively. Eye symptoms were associated with use of effluent-dominated waters only (AOR 1.50; 95% CI: 1.10, 2.06). Among water recreators, our results indicate that illness was associated with the amount of water exposure. Conclusions: Limited-contact recreation, both on effluent-dominated waters and on waters designated for general use, was associated with an elevated risk of gastrointestinal illness.

Meeting report: Knowledge and gaps in developing microbial criteria for inland recreational waters

The U.S. Environmental Protection Agency (EPA) has committed to issuing in 2012 new or revised criteria designed to protect the health of those who use surface waters for recreation. For this purpose, the U.S. EPA has been conducting epidemiologic studies to establish relationships between microbial measures of water quality and adverse health outcomes among swimmers. New methods for testing water quality that would provide same-day results will likely be elements of the new criteria. Although the epidemiologic studies upon which the criteria will be based were conducted at Great Lakes and marine beaches, the new water quality criteria may be extended to inland waters (IWs). Similarities and important differences between coastal waters (CWs) and IWs that should be considered when developing criteria for IWs were the focus of an expert workshop. Here, we summarize the state of knowledge and research needed to base IWs microbial criteria on sound science. Two key differences between CWs and IWs are the sources of indicator bacteria, which may modify the relationship between indicator microbes and health risk, and the relationship between indicators and pathogens, which also may vary within IWs. Monitoring using rapid molecular methods will require the standardization and simplification of analytical methods, as well as greater clarity about their interpretation. Research needs for the short term and longer term are described.

Particle size fractionation and human exposure of polybrominated diphenyl ethers in indoor dust from Chicago

The objective of this study was to investigate the concentration level, the mass distribution based on dust particle size, and the associated human exposure of polybrominated diphenyl ethers (PBDEs) in indoor dust. The total concentration of 13 PBDEs Σ13(BDEs) was found to be 500–6,944 ng/g in indoor dusts, 4,000 ng/g in car interior dust, 260–300 ng/g in outdoor ambient air particles, 30 ng/g in carpet fibers, and as high as 0.5% in carpet padding. Selected dust samples were fractionated based on particle size, and over 80% of the Σ13BDEs were associated with particles < 150 μm in diameter. Mass ratios of BDE206/BDE209 are higher in both indoor and outdoor samples than in commercial deca products; and mass ratio BDE47/BDEs(85+99+100) was much higher in outdoor than in indoor samples. Using EPA software ProUCL, the exposure of Americans to PBDEs via hand-to-mouth transfer of house dust was estimated under the central tendency exposure and reasonable maximum exposure scenarios. The results suggest that ingestion of PBDE-laden house dust via hand-to-mouth contact is likely a significant exposure pathway, especially for children.

Demolition of High-Rise Public Housing Increases Particulate Matter Air Pollution in Communities of High-Risk Asthmatics

Abstract Public housing developments across the United States are being demolished, potentially increasing local concentrations of particulate matter (PM) in communities with high burdens of severe asthma. Little is known about the impact of demolition on local air quality. At three public housing developments in Chicago, IL, PM with an aerodynamic diameter <10 μm (PM10) and <2.5 μm were measured before and during high-rise demolition. Additionally, size-selective sampling and real-time monitoring were concurrently performed upwind and downwind of one demolition site. The concentration of particulates attributable to demolition was estimated after accounting for background urban air pollution. Particle microscopy was performed on a small number of samples. Substantial increases of PM10 occurred during demolition, with the magnitude of that increase varying based on sampler distance, wind direction, and averaging time. During structural demolition, local concentrations of PM10 42 m downwind of a demolition site increased 4- to 9-fold above upwind concentrations (6-hr averaging time). After adjusting for background PM10, the presence of dusty conditions was associated with a 74% increase in PM10 100 m downwind of demolition sites (24-hr averaging times). During structural demolition, short-term peaks in real-time PM10 (30-sec averaging time) occasionally exceeded 500 μg/m3. The median particle size downwind of a demolition site (17.3 μm) was significantly larger than background (3 μm). Specific activities are associated with real-time particulate measures. Microscopy did not identify asbestos or high concentrations of mold spores. In conclusion, individuals living near sites of public housing demolition are at risk for exposure to high particulate concentrations. This increase is characterized by relatively large particles and high short-term peaks in PM concentration.

A comparison of rapid and conventional measures of indicator bacteria as predictors of waterborne protozoan pathogen presence and density

E. coli and enterococci in recreational waters are monitored as indicators of fecal contamination, pathogen presence, and health risk. Quantitative polymerase chain reaction (qPCR) tests for fecal indicator bacteria can provide beach managers with same-day information about water quality, unlike culture methods which provide that information the following day. The abilities of qPCR measurements of indicator bacteria, as compared to culture measurements of indicator bacteria, as predictors of pathogen presence or density in surface waters are not well understood. The purpose of this study was to make such comparisons between water samples collected from Chicago area surface waters, including rivers, inland lakes, Lake Michigan, and the Chicago Area Waterways System, which is dominated by wastewater effluent. A total of 294 twenty-litre samples were collected and analyzed for Giardia and Cryptosporidium. qPCR and membrane filtration methods were used to quantify E. coli and enterococci. Correlation, logistic regression, and zero-inflated Poisson modeling were utilized to evaluate associations between indicators and parasites. qPCR and culture measures of the indicator bacteria were similar in their ability to predict parasite presence and density. Correlations between parasites and indicators were generally stronger at waters not dominated by effluent. Associations between indicator density and Giarida presence were observed more consistently than between indicator density and Cryptosporidium presence. Associations between enterococci and parasites were generally stronger than associations between E. coli and parasites. The use of qPCR monitoring in our setting would generate more timely results without compromising the ability to predict parasite presence or density.

Pilot study investigating the effect of the static magnetic field from a 9.4-T MRI on the vestibular system

Objective: To objectively evaluate workers’ sensory symptoms and vestibular function after exposure to a strong, new generation 9.4-T Magnetic Resonance Imaging (MRI) scanner. Method: Six MRI employees underwent standardized electronystagmographic evaluation, postural testing, and caloric function at baseline evaluation, 30 minutes postexposure to 9.4 T static field and at a 3-month follow-up. Results: All participants noted sensory symptoms after exposure. No overall deterioration in vestibular function was noted following 30-minute exposure or at a 3-month follow-up. A higher occurrence of tonic vestibular asymmetry, hyperreactive caloric responses, and spontaneous nystagmus was noted compared with that of the normal population. Conclusion: Workers exposed to the new, stronger MRIs experience sensory symptoms but it is unclear as yet whether long-term vestibular damage occurs. The higher rates of vestibular changes noted could argue for improved worker surveillance and exposure control.

Moving into green healthy housing.

BACKGROUND Green building systems have proliferated but health outcomes and associated costs and benefits remain poorly understood. OBJECTIVE To compare health before and after families moved into new green healthy housing with a control group in traditionally repaired housing. DESIGN AND SETTING Mixed methods study in 3 Chicago housing developments. PARTICIPANTS Public housing and low-income subsidized households (n = 325 apartments with 803 individuals). MAIN OUTCOME MEASURES Self-reported health status, visual assessment of housing condition, indoor air sampling, and Medicaid expenditure and diagnostic data. Medicaid expenditures and International Classification of Diseases, Ninth Revision codes were modeled using a generalized linear model with γ distribution and log-link. RESULTS Housing conditions and self-reported physical and mental health improved significantly in the green healthy housing study group compared with both the control group and the dilapidated public housing from which the residents moved, as did hay fever, headaches, sinusitis, angina, and respiratory allergy. Asthma severity measured by self-reported lost school/work days, disturbed sleep, and symptoms improved significantly, as did sadness, nervousness, restlessness, and child behavior. Medicaid data in this exploratory study were inconclusive and inconsistent with self-reported health outcomes and visual assessment data on housing quality but hold promise for future investigation. Possible sources of bias in the Medicaid data include older age in the study group, changes in Medicaid eligibility over time, controlling for Medicaid costs in an urban area, and the increased stress associated with moving, even if the move is into better housing. CONCLUSION The mixed method approach employed here describes the complex relationships among self-reported health, housing conditions, environmental measures, and clinical data. Housing conditions and self-reported physical and mental health improved in green healthy housing. Health care cost savings in Medicaid due to improved housing could not be quantified here but hold promise for future investigations with larger cohorts over a longer follow-up period.

Toxic inhalation fatalities of US construction workers, 1990 to 1999

Construction workers account for a disproportionately large number of occupational fatalities. A small percentage of these deaths is attributable to poisoning. Risk factors for such deaths using national data have not been reported previously. Construction poisoning fatalities from 1990 to 1999 in the Occupational Safety and Health Administration Integrated Management and Information System data set were analyzed. Risk and risk factors were determined using Bureau of Labor Statistics and census data. Eighty-seven poisoning deaths of construction workers are characterized, all attributable to toxic inhalation. Cellular and simple asphyxiants accounted for the largest numbers of fatalities. The majority of these deaths occurred in confined spaces. Water, sewer, and utility line workers are at increased risk for poisoning fatality. Toxic inhalation fatalities in the construction industry are preventable. Extending the Occupational Safety and Health Administration’s confined space standard could save lives, particularly among water, sewer, and utility line industry workers.