Baseline Report on ”Biomonitoring of Children” in the framework of the European Environment and Health Strategy (COM(2003)338 final) Produced by the Technical Working Group on Integrated Monitoring subgroup Biomonitoring of children 09 January 2004 1 This report reflects the opinions of the members of the Working Group and it highlights the different opinions contained within the group where appropriate. It should not be considered as an official statement of the position of the European Commission. Further information relating to this work is available on the project website: www.brussels-conference.org or from the Technical Secretariat: Dr. Reinhard Joas BiPRO GmbH Grauertstr. 12 81545 Munich Germany Telephone +49 89 18979050 Facsimile +49 89 18979052 Email: [email protected] 1 This Baseline Report is prepared by the subgroup “Biomonitoring of Children” that has been set up by the European Commission in the framework of the “Environment & Health Strategy” (COM(2003)338final). The subgroup is chaired by Ludwine Casteleyn and co-chaired by Lisbeth E. Knudsen and Carlo Sala. The members of the subgroup are: Bedossa Adrien Bloemen Louis Boogaard Peter Casteleyn Ludwine Coppo Rosanna Fernandez Torija D. Carlos Fréry Nadine Fucic Aleksandra Harrison Paul Jakubowski Marek Knudsen Lisbeth E. Lehners Maryse Pullen Ron Ramet José Reis Maria de Fatima Calado Varela Sala Carlo Sampaio Carla Susanna Roque Bento Seifert Bernd Schoeters Greet Steenhout Anne Swanson John Tcheshmedjiev Svetoslav Tusscher Gavin W Ten Wattiez Catherine Wijnen Joop van The subgroup is assisted by Reinhard Joas from BIPRO as a technical consultant and by Birgit Van Tongelen from the European Commission, DG Environment. 2 Table of Content Executive Summary ................................................................................4 1 Preface ............................................................................................9 2 Overview........................................................................................11 2.1 Methodology of Data Collection........................................................... 11 2.2 Overview on feed back and basic data................................................11 2.3 Objectives of biomonitoring in children................................................ 12 3 Problems and deficits.....................................................................14 4 Advantages of integrated biomonitoring of children........................18 5 Requirements for an integrated EU Biomonitoring effort ................21 6 Annex I – Definitions ......................................................................22 7 Annex II – Mandate........................................................................23 8 Annex III – Questionnaire and Manual ...........................................27 9 Annex IV – Draft working document for the discussion on requirements for an integrated biomonitoring .................................31 10 Annex V – Returned questionnaires...............................................38 11 Annex VI: Written Comments on the baseline report....................387 3 Executive Summary Preface Prenatal and postnatal exposure to environmental pollutants may have large implications for children’s health and also determine morbidity occurring later in life, including asthma and allergy, cancer, mental illnesses, delayed neurodevelopment and cardiovascular diseases. Biomonitoring in children1 may increase knowledge on the link between children’s health and the environment and contribute to the development of national and international environmental health programmes and policies for preventing diseases. This report provides a preliminary overview of existing Environment & Health biomonitoring activities2 related to children being undertaken in Europe. One basis for this is a questionnaire that has been sent to institutions and researchers all over Europe. It also presents reported problems and deficits of existing biomonitoring systems and sets out advantages of an integrated approach. It starts to explore the requirements for integrated EU biomonitoring of children. At the finalisation of this report (5th December 2003) 97 completed answers to the questionnaire were available. Countries and researchers have provided different levels of detail in their response to the questions. Gaps in information clearly exist and no straightforward assessment or assumption can be made on the level of representativeness of the data at hand. Information was received for all except 2 of the Member States, for 4 Acceding Countries and also for Norway and Croatia. Evaluation of the material is not yet finalised as relevant information is still coming in or is promised to be provided soon, e.g. related to some international studies. Objective of biomonitoring in children In general, the objective of biomonitoring is to increase knowledge on the relation between human health and the environment and to use this knowledge to improve environmental health. Distinction is made between (1) activities that aim at periodical measurements in order to produce information on the prevalence of exposure to environmental agents and the related public health impact with a view to developing and evaluating policies that protect health (survey projects) and (2) activities that aim at improvement of knowledge on causal links between environmental factors and health by hypothesis generation and testing (research projects). In general, the number of study persons are small in research programs due to the exploratory character of the studies and the limitations of available resources. This very 1 Biomonitoring in children was defined by the working group as ‘monitoring activities in children, using biomarkers, that focus on environmental exposures, diseases and/or disorders and genetic susceptibility, and their potential relationships. Biomonitoring of children includes the prenatal period up to an age of 18 years and follow-up activities for monitored children into adulthood’ (see Annex I). 2 ongoing activities and activities that have been completed within the last 10 years. 4 often limits the power of the research studies, whereas surveillance programs more commonly are designed with a high number of participants. More precise objectives reported are : (1) To provide data on the distribution of exposure to a variety of environmental factors and on health effects across the entire population (applies to representative population studies) (2) To monitor trends in exposure levels over time and space (3) To obtain data which are representative for specific areas with expected different types of environmental loads (urban areas, dense traffic, intensive agriculture, industry). Biomarker data and public health data therefore to be analysed geographically and presented per geographical unit. (4) To establish reference ranges/values that can be used to identify people with unusually high exposure or the percentage of the population that has exposure above levels considered to be elevated (e.g., lead). (5) To determine which specific population groups, such as minorities, people with low incomes, children (different ages), are at high risk for exposure and adverse health effects. (6) To provide a bridge to understanding the relationships between environmental factors, exposure to these factors (including factors in food) and health problems. (7) To design and evaluate precautionary3, preventive, interventive and control strategies within the framework of policy measures related to health and environment. (8) To establish an “early warning system” based on biomarker measurements in a representative fraction of the population living in different areas that may help alert physicians, scientists, and health & environment officials to diseases that result from exposure to environmental factors. Problems and deficits Problems and deficits (non exhaustive) in conducting biomonitoring in children, as highlighted in the questionnaires and by the group members, relate to : (1) recruitment of study population (2) biomarkers addressed (3) the logistics of conducting biomonitoring (4) biosafety (5) collaboration between disciplines (6) comparability of questionnaire data (7) communication of results (8) authorisation of study 3 Issues related to the Precautionary Principle have been raised at several occasions during the discussions in the working group. An in-depth discussion on this has been postponed to Step 2 addressing options for actions and recommendations. 5 Advantages of integrated biomonitoring of children The overview demonstrates that within Europe, both nationally as internationally, a substantial amount of biomarker data on children are collected and that huge resources are devoted to these efforts. Many of the biomonitoring activities reported integrate data on environmental factors with health data. Several studies address both children and their parents (particularly their mothers, therefore integrating prenatal and postnatal exposure) and simultaneously address markers of exposure, effect and susceptibility. Overall, it is highlighted that similar aspects are addressed in biomonitoring programmes in nearly all countries. Exposures to heavy metals, PCBs and dioxins are the subject of many studies. Endpoints such as asthma, allergy and neurodevelopmental disorders, as well as exposures to genotoxic agents are covered, and multidisciplinarity is typical of many activities. In many cases establishment of biobanks (archives of biological