What is environmental public health tracking?
- Environmental public health tracking (EPHT) is the ongoing
collection, integration, analysis, interpretation, and dissemination of
data on environmental hazards, exposures to those hazards, and health
effects that may be related to the exposures.
- The goal of EPHT is to provide information that can be used to plan,
apply, and evaluate actions to prevent and control environmentally
related diseases.
- For more information, see http://www.cdc.gov/nceh/tracking/.
What is biomonitoring?
- Biomonitoring is the direct measurement of people’s exposure to
environmental contaminants by measuring substances or their metabolites
in blood, urine, or other specimens.
- The Environmental Health Laboratory of the National Center for
Environmental Health at the Centers for Disease Control and Prevention
(CDC) has been performing biomonitoring measurements for more than 30
years.
- Biomonitoring has become the standard for assessing people’s
exposure to toxic substances and for responding to serious environmental
public health problems.
- For more information, see
http://www.cdc.gov/nceh/dls/
national_biomonitoring_program.htm.
Biomonitoring is an essential component of the National Environmental Public Health Tracking Network.
- EPHT must include data on environmental hazards, human exposure, and
health effects. The most health-relevant method of determining human
exposure to environmental hazards is biomonitoring.
- Laboratory personnel bring new ideas and concepts to the EPHT Network (e.g., laboratory personnel can identify a different way of sampling the study population or provide new ways or techniques for analyzing the samples that would result in more reliable results).
The CDC Biomonitoring Program and the CDC National Environmental Public Health Tracking Program work closely together.
- CDC’s Environmental Health Laboratory and the National EPHT Program
rely on each other for scientific/technical expertise.
- Biomonitoring program scientists provide advice on strategies for building the National EPHT Network and Program.
Examples of EPHT/State Laboratory Collaborative Activities
- California: The California EPHT Program is a member of the
Western Tracking and Biomonitoring Collaboration (WBTC). This
collaborative includes representatives from Arizona, Colorado, Idaho,
Montana, Nevada, New Mexico, Oregon, Utah, and Washington, and Wyoming.
The focus of this collaborative effort is (1) to develop a funding
proposal for regional planning to enhance capacity (e.g., for laboratory
information management systems) and (2) to conduct joint projects (e.g.,
biomonitoring for arsenic exposure from drinking water or for mercury
exposure from fish consumption).
- Connecticut: The Connecticut EPHT Program is collaborating
with the state’s Public Health Laboratory, Maine’s Public Health and
Environmental Testing Laboratory, and Vermont’s Public Health Laboratory
in a regional effort to examine umbilical cord blood from recent
deliveries for levels of mercury, lead, cadmium, and related biomarkers.
The Connecticut EPHT will provide funding to the state laboratory for
supplies, proficiency-testing validation, sample preparation, and
transport.
- Florida: Through a partnership with the University of Miami,
the Florida EPHT section has been working with state regional
laboratories in Tampa, Jacksonville, and Miami-Dade counties (1) to link
electronically data on childhood blood lead levels (BLLs) with data from
childhood developmental disability records and (2) to analyze the
aggregate data for potential associations. The Florida EPHT has also
provided supplemental funding to the laboratory to enable it to identify
and screen uninsured children for elevated BLLs. Otherwise, these
children may not receive such screening. These activities help make the
database more complete and will help to assess the effectiveness of
interventions to reduce these children’s exposure to lead. EPHT staff
members recognize that blood lead and other biomonitoring data are
critical to identifying associations between environmental hazards and
health effects. The Florida Department of Health continues to
collaborate with Florida laboratories by involving them in EPHT
workgroup committees and coordinating efforts to gather BLL data.
- Illinois: Childhood lead poisoning prevention is one of the
priorities of the Illinois EPHT program. Illinois EPHT staff members
receive test results of childhood blood lead screening reported by the
Illinois Department of Public Health laboratories through the Child Lead
Poisoning Prevention Program. The EPHT program is creating a
risk-prediction map to allow local health departments to focus their
limited resources for screening and remediation activities on high-risk
areas. The map is being developed using a geographic information system
(GIS) model produced at Duke University in North Carolina. The map will
link the results of blood lead level tests with tax assessor and U.S.
census data. The model also maps the locations of local resources, such
as hospitals, physician offices, laboratories, neighborhood meeting
rooms, and local health departments.
- Maine: The Maine Bureau of Health (MEBOH) EPHT program is
collaborating with MEBOH’s Office of Public Health Emergency
Preparedness (OPHEP) and the Public Health and Environmental Testing
Laboratory (HETL) to establish a statewide biomonitoring program in
Maine. The efforts to establish the statewide program will be
coordinated with chemical-terrorism preparedness efforts for a Level-2
laboratory (Level-2 laboratories can analyze for selected metals in
blood and urine, for nerve agents in urine, and for cyanide in blood).
The partners are preparing a pilot study to assess the ability of new
instrumentation purchased for chemical-terrorism preparedness to analyze
children’s blood samples for lead that currently are submitted to the
state laboratory. The partners will measure blood lead, mercury, and
cadmium levels for children aged 1-6 years and assess the feasibility of
measuring arsenic and uranium 238. MEBOH EPHT staff members are (1)
taking the lead in designing this pilot study and a surveillance plan
for tracking metals in Maine’s children, and (2) supporting the purchase
and use of a new public health laboratory software system and
instruments that will facilitate the rapid conversion between public
health surveillance and incident-response functions.
- Maryland: Maryland’s EPHT Program staff work closely with the
staff of the state’s public health laboratory. The Program has used EPHT
funding to purchase equipment and train laboratory staff to perform
tests for levels of pesticide metabolites and heavy metals in human
urine. These investments have greatly enhanced the state’s biomonitoring
capacity. The Program will use this enhanced biomonitoring capacity to
establish background data on and to assess levels of pesticides and
heavy metals in urine. Physicians will be able to tap into this enhanced
capability, ordering tests that will help them better diagnose and
monitor their patients.
- Massachusetts: The Massachusetts EPHT Program is working with
the Division of Public Health’s Environmental Chemistry Laboratory at
the State Laboratory Institute on a project looking at childhood BLLs.
EPHT and laboratory staff members meet regularly to review data quality
and reporting issues. The EPHT Program also collaborates with staff of
the New England Newborn Screening Program in the University of
Massachusetts Medical School on a developmental disabilities tracking
project. This project includes evaluating newborn screening data for
thyroid hormone levels in blood. Lack of thyroid hormone can indicate
congenital hypothyroidism, a disorder which can lead to poor growth and
mental retardation. If found early and treated with thyroid medication,
a child may grow and develop normally.
- Missouri: The Missouri Department of Health and Senior
Services (DHSS) has a long-term collaboration with the state Public
Health Laboratory on biomonitoring of childhood BLLs. The laboratory is
submitting blood lead results to DHSS electronically. These results are
stored in a data warehouse. The Missouri EHPT program is developing a
means to electronically post laboratory and other results in the data
warehouse to an individual’s client record. Additionally, the DHSS
Section on Environmental Public Health and the state Public Health
Laboratory are holding ongoing discussions about the need for a
biomonitoring program, how the program would function, and what its
scope would be. Initial plans, though untested, are in place to deal
with a bioterrorist event or public health emergency.
- Montana: Montana EPHT staff members are working
collaboratively with the state’s Public Health Laboratory on several
projects, including the CDC-funded biomonitoring project (under the
Rocky Mountain Consortium). In summer 2005, the Montana EPHT will begin
fieldwork on a pilot project to assess exposure to arsenic in drinking
well water. The researchers will compare arsenic concentrations in well
water to arsenic levels in urine samples from people drinking water from
those wells. An Interagency Heavy Metal Working Group—which includes
representatives from the state laboratory, the biomonitoring project,
EPHT program, U.S. Geological Survey, Bureau of Mines, and the Montana
Department of Environmental Quality—will coordinate this project. The
group also will explore the ongoing integration and public availability
of water- quality data from all state partners. The EPHT program also is
working to improve the collection and reporting of BLLs from the state
and other laboratories. Program staff members are designing an
electronic blood lead data program that will (1) allow laboratories to
report information directly and electronically and (2) allow agencies to
better manage the data, track areas of lead exposure, and provide
information for client follow-up. As a participant in the Rocky Mountain
Biomonitoring Consortium, the Montana EPHT Program also is working
closely with the state environmental laboratory to enhance the
laboratory’s capacity for testing heavy metals. (see also, Western
Tracking and Biomonitoring Collaboration)
- New Hampshire: The New Hampshire EPHT Program has been
working with the CDC-funded biomonitoring program for the past 2 years
to better assess exposure to environmental contaminants. The New
Hampshire EPHT Program has provided epidemiologic expertise in study
method development for assessing exposure to arsenic and mercury. EPHT
has funded the purchase of equipment to improve collection, storage, and
testing of specimens from people. These specimens will be tested to
determine the level of exposure to (1) arsenic in drinking water, and
(2) mercury found in recreational fish that people eat. The New
Hampshire EPHT provided support to hire student interns to collect water
samples to test for arsenic levels in the environment. The data obtained
from the arsenic project will be used to support the EPHT project that
tracks arsenic exposure and the occurrence of bladder cancer in New
Hampshire residents. EPHT staff members are active members of
biomonitoring program workgroups focusing on mercury, arsenic,
phthalates, and brominated flame retardants. All of these activities
have been developed to produce better data for tracking trends in
hazards, exposures, and human health.
- New Jersey: New Jersey EPHT staff members are conducting a
demonstration project to examine links between geographic distributions
of lead exposure in children and adults and data on lead hazards in the
environment. The project is drawing information from existing
biomonitoring databases for human exposure to lead.
- New Mexico: The New Mexico EPHT Program is working with the
Rocky Mountain Biomonitoring Consortium (RMBC) on an arsenic exposure
project. The partners are working to determine whether a difference in
urine arsenic levels and arsenic speciation ratios can be detected in
individuals exposed to various levels of arsenic in drinking water. This
project also will provide baseline levels of arsenic and other metals in
urine for the residents of the RMBC states (New Mexico, Wyoming,
Colorado, Arizona, Utah, and Montana). The partners will use the results
to verify assumptions about drinking water that are used for EPHT. RMBC
also is evaluating the possible use of newborn screening dried blood
spots to determine the baseline exposure of the population to selected
heavy metals. The partners and others can use these baselines to help
identify where elevated exposures may be occurring. RMBC also is working
to characterize exposure to environmental tobacco smoke in populations
that do and do not have smoking statutes. These data can be used to
verify assumptions about exposure to tobacco smoke and health outcomes
such as cancer, asthma, or other respiratory diseases. RMBC is working
on two additional projects focusing on water. The first is an evaluation
of the potential for exposure to volatile organic compounds as they
evaporate into indoor air from groundwater or subsurface soil. The
second is an evaluation of the potential for exposure to radionuclides
in drinking water. Both projects will provide information and lessons
learned about linking exposure and health outcome data (see also,
Western Tracking and Biomonitoring Collaboration).
- New York City: New York City (NYC) has launched two
collaborative biomonitoring and EPHT program efforts: (1) NYC has been
collaborating with CDC and the Wadsworth Laboratories of the New York
State Department of Health and Mental Hygiene (NYS DOHMH) on a
biomonitoring study of mercury exposure in children. (2) NYC conducted
its first community health and nutrition examination survey (HANES). The
environmental biomonitoring component of NYC HANES, coordinated by the
NYC EPHT program, is enabling the NYC DOHMH to characterize and
integrate findings about residents’ exposures to organophosphates,
pyrethroids, heavy and trace metals, and environmental tobacco.
Collaborating laboratories include CDC’s Environmental Health Laboratory
and the NYS Wadsworth Laboratories. Analyses of NYC HANES data resulted
in the discovery of a patient with a high level of mercury poisoning.
Such poisoning usually indicates exposure to mercury salt or elemental
mercury. Upon further investigation, the patient was found to have used
one of several commonly available, but illegal, skin lighteners that
list mercury as the active ingredient. The NYC DOHMH launched a wider
investigation into the use of this skin lightener in the city, worked
with the U.S. Food and Drug Administration laboratory, and confirmed
heavy mercury content in six commonly available skin-lightening
products. NYC issued alerts and press releases to healthcare
practitioners. It ordered 163 stores to stop selling the products and
provide it with names of distributors. This biomonitoring effort and the
discovery and the response to the mercury exposure were made possible by
the EPHT program.
- New York State: The New York State (NYS) biomonitoring
program advises the New York State EPHT program. The programs plan to
work together on a pilot-scale biomonitoring project relating to
drinking water contaminants (e.g., trihalomethanes or other disinfection
byproducts) and birth outcome data. Additionally, the biomonitoring
program staff members are exploring development of other surveillance
tools that may be useful to EPHT. The NYS biomonitoring program has also
made significant contributions to the NYC Department of Health and
Mental Hygiene (NYC DOHMH) EPHT program. Through combined funding from
the NYC DOHMH EPHT, biomonitoring funding from CDC, and supplementary
NYS support, the state's public health laboratory has been able to
contribute quantitative exposure measurements to the NYC DOHMH
first-ever community-based Health and Nutrition Examination Survey. For
this, the state laboratory is analyzing biological specimens from
approximately 1,800 participants for serum cotinine levels (as a measure
of environmental tobacco smoke exposure), toxic metals, and levels of
mercury and other trace elements in urine. If additional support becomes
available, analyses of urinary organophosphate pesticide metabolites
will be added to the suite of NYC HANES analytes.
- Nevada: The Nevada EPHT Program is collaborating with the
Nevada State Health Laboratory and with the Department of Environmental
Sciences and Health at the University of Nevada, School of Public Health
(the Laboratory is part of the University) to support development of an
environmental health laboratory section capable of analyzing lead and
mercury in human tissues, as well as in environmental samples. Funding
for this project is already available through the University of Nevada,
School of Public Health. The Nevada State Health Division, EPHT Program,
Clark County Health District, and the University of Nevada are
identifying needed resources; developing objectives; and defining
requirements, benefits, and deliverables for this laboratory. They are
also identifying dates, numbers, types, and the priority of samples they
would start to analyze. In addition, project developers are looking into
ways to link the results of the lead and mercury analysis to current
policies, mandates, laws, or state/national objectives (Healthy People
2010 Guidelines) or other appropriate governing documents. (see also,
Western Tracking and Biomonitoring Collaboration)
- Oregon: The Oregon EPHT Program is proposing to participate
in a regional planning and capacity-building process that will allow
Oregon to develop biomonitoring capabilities more rapidly than is
currently the case. This effort will integrate and support the
epidemiologic and state laboratory components necessary for addressing
identified environmental public health issues in the state. The Oregon
Public Health Laboratory is a partner in this proposal. The capacities
of other programs in this proposed partnership can be leveraged to
greatly assist Oregon in developing an active biomonitoring program.
(see also, Western Tracking and Biomonitoring Collaboration)
- Pennsylvania: The Pennsylvania EPHT Program works with its
state laboratory to identify families with elevated BLLs. As required by
law, the state public health laboratory reports elevated BLLs in
children and adults. The data are collected from hospitals, other public
health laboratories, clinics, and physician offices. The EPHT Program
analyzes the data through Pennsylvania’s National Electronic Disease
Surveillance System (PA-NEDSS).
- Utah: Utah is a grantee for both the National EPHT Program
and the Rocky Mountain Biomonitoring Consortium (RMBC). RMBC’s goal is
to develop the capacity for and to implement a regional laboratory-based
biomonitoring program. The biomonitoring program will assess the extent
and nature of human exposures to environmental toxicants; this
information will be used to help prevent disease associated with
exposure. Participants share technical expertise and resources to
advance the common goals of EPHT and RMBC. EPHT and RMBC information
technology (IT) staff are collaborating in developing an IT
infrastructure that will support activities of both groups. (see also,
Western Tracking and Biomonitoring Collaboration)
- Washington: The Washington EPHT Program and the state’s
Public Health Laboratories have been collaborating on several
biomonitoring initiatives. They are discussing the feasibility of
hosting a state health and nutrition examination survey (State-HANES)
based on the national HANES. Washington conducts episodic biomonitoring
studies. For example, the state is involved in a study of methemoglobin
(a biomarker for nitrate exposure) among infants who drink water from
private wells. The Washington EPHT staff also is collaborating with the
state’s Department of Labor & Industries to conduct a cholinesterase
monitoring program aimed at early detection of overexposure to toxic
pesticides in farm workers. EPHT funds were used to create a
cholinesterase monitoring data system (CMDS). The Public Health
Laboratory performs the tests. Results are entered into the centralized
CMDS database at the Office of Epidemiology, which issues alerts when
overexposure thresholds are exceeded. This system was used to track more
than 3,600 blood samples from farm workers. Of 611 farm workers with at
least one follow-up test, 122 (20%) had depressed cholinesterase levels.
Of those 122 farm workers, 23 had significant enough depressions to
warrant temporary removal from their work environment to prevent illness
from the pesticide exposure. Through its Lead Poisoning Prevention
Program, Washington also conducts continuous biomonitoring on the basis
of blood lead level test results.
- Wisconsin: The Wisconsin EPHT Program has implemented a
methylmercury tracking module that involves the submission of hair
samples from volunteers to the Wisconsin State Laboratory of Hygiene.
The laboratory analyzes the hair samples for levels of methylmercury and
sends the results to the Bureau of Environmental and Occupational Health
(BEOH). BEOH compares the laboratory results to self-reports of fish
consumption and other variables. The information allows a better
understanding of methylmercury exposure from fish consumption. These
data could help public health officials make decisions about issuing
fish- consumption advisories.
- Western Tracking and Biomonitoring Collaboration (WTBC): Seven state health departments in the western United States—California, Montana, Nevada, New Mexico, Oregon, Utah, and Washington—have EPHT grants from CDC. In 2003, state public health laboratories in six western states—Arizona, Colorado, Montana, New Mexico, Utah, and Wyoming—formed the Rocky Mountain Biomonitoring Consortium (RMBC), which has also received CDC funding. In February 2005, representatives from these groups met and founded the Western Tracking and Biomonitoring Collaboration (WTBC). One additional state, Idaho, which is not CDC-funded, also has joined WTBC. The focus of this collaborative effort is (1) to develop a funding proposal for regional planning to enhance capacity (e.g., enhance capacity for laboratory information management systems), and (2) to conduct joint projects (e.g., biomonitoring for arsenic exposure from drinking water and for mercury exposure from fish consumption).
For more information on EPHT and biomonitoring, contact:
Centers for Disease Control and Prevention
National Center for Environmental Health
National Environmental Public Health Tracking Program
MS E-19
1600 Clifton Rd, Atlanta, GA 30333
1-888-232-6789
epht@cdc.gov
http://www.cdc.gov/nceh/tracking
Centers for Disease Control and Prevention
National Center for Environmental Health
Division of Laboratory Sciences, MS F-20
4770 Buford Hwy, Atlanta, GA 30341
1-888-232-6789
NCEHinfo@cdc.gov
http://www.cdc.gov/nceh/dls
Association of Public Health Laboratories
Environmental Health Program
2025 M Street NW, Suite 550
Washington, DC 20036-3320
202-822-5227
http://www.aphl.org/
[external link]
Updated: June 2005