PFAS Progress Newsletter — December 2021

Welcome to the winter edition of the PFAS Progress Newsletter! At ATSDR, the science around PFAS and their health effects continues to evolve, and we are working hard to further increase our knowledge.

Among the information in this newsletter, you will learn about

• What the exposure assessments have identified in communities across the U.S.
• How ATSDR is supporting our partners/grantees’ efforts to launch the Multi-site Study in selected communities known to have been exposed to PFAS in drinking water.
• How our continued recruitment efforts for the Pease Study will improve our ability to assess the health effects of PFAS exposure.
• How we provide clinicians with information to help them address their patients’ concerns about PFAS.

Please read below and send us ideas for topics that interest you as well as any information about how we can improve our newsletter.

Exposure Assessments (EAs)

Release of Westfield, Hampden County, MA, PFAS Exposure Assessment Report
On November 18, 2021, CDC/ATSDR released the report for the Westfield, Hampden County, MA, PFAS exposure assessment. The exposure assessment evaluated PFAS levels in the blood and urine of Westfield residents and compared them to national PFAS levels. Tap water and indoor dust samples from a subset of households were also analyzed for PFAS. In total, 459 people from 247 households participated in the exposure assessment. Here are the key findings of the assessment.

• Blood levels of some PFAS are higher than national levels.
• Elevated levels of some PFAS may be linked with past drinking water contamination.
• Age, sex, breastfeeding, use of stain-resistant products, and blood donation were linked with some PFAS blood levels.
• Only one PFAS was detected in urine and was found at low concentrations.
• All Westfield tap water samples collected during the exposure assessment in 2019 met the U.S. Environmental Protection Agency’s Health Advisory and Massachusetts Department of Environmental Protection’s (MAssDEP’) public health guidelines for PFAS in drinking water. CDC/ATSDR does not recommend community members use alternative sources of water.
• Patterns and levels of dust contamination measured in participating EA households are comparable to those reported in selected U.S. studies.

The report also provides recommendations and actions community members and city officials can take to further reduce exposures to PFAS and protect public health. Read the full report herepdf icon. ATSDR is completing the reports of the remaining exposure assessments and will release them in order in which samples were collected.

PFAS Environmental Sampling (Supplemental Exposure Investigation at Select PFAS Exposure Assessment Sites)

CDC and ATSDR are collaborating with the US Environmental Protection Agency to learn more about PFAS exposures from non-drinking water sources at two PFAS exposure assessment sites. The agencies are finalizing the study protocol and identifying the sampling methodologies and laboratories for analyzing the samples. This work will follow up on ATSDR’s prior PFAS exposure assessment work which measured levels of PFAS in blood and urine. The investigation will collect environmental samples to evaluate levels of PFAS in the indoor and outdoor environment that may contribute to elevated levels of PFAS in blood. Samples of indoor and outdoor air, indoor dust, soil, indoor surface wipes, and locally grown produce will be collected and tested for PFAS. The PFAS environmental sampling is expected to start in spring 2022.

Pease Study (Portsmouth, NH)

Pease Study Recruitment Numbers Tick Up
The Pease Study in Portsmouth, NH, launched in fall 2019. Due to the COVID-19 pandemic, the study was paused in March 2020 and restarted in October 2020. ATSDR has extended participant recruitment until the end of 2021. As of the second week of November, 723 adults and 151 children have completed the study. The study is at 66% of the recruitment goal for adults and 29% for children. Recruitment remains a priority for the Pease Study Team as several recruitment events have been planned and advertised during the remaining months of study recruitment. The results from the Pease Study will be combined with the results of the Multi-site Health Study to learn more about the relationship between PFAS exposure and health outcomes among differing populations. The information can then be applied to communities across the nation. Please visit the Pease Study website to learn more about the Pease Study and recruitment.

Informing Clinicians in Portsmouth, NH, about PFAS
When it comes to our health, many of us want to connect with our physicians to learn the most current information. Doctors, nurses, physician assistants, and others regularly engage in activities to enhance their knowledge. ATSDR plays an important role in provider education, partnering with other organizations to provide clinicians with current information so they can assist patients in making informed decisions. In September, ATSDR partnered with the Seacoast Public Health Network, the Silent Spring Institute, and the Pediatric Environmental Health Specialty Units to share information about PFAS with clinicians in the Portsmouth, NH, area and to respond to their questions. Please visit ATSDR’s Information for Clinicians and Environmental Professionals webpage for resources.

Pease Private Well Health Consultation — Final Version

The following public health consultation was shared for public comment in April 2020: “Evaluation of Per- and Polyfluoroalkyl Substances (PFAS) Detected in Private Residential Drinking Water Wells located within 1 Mile of the Pease Tradeportpdf icon.” The public comment period closed on July 30, 2020. Please see below the following information and updates:

• Before the end of the public comment period, ATSDR conducted a virtual meeting with the town of Newington, NH, where the community was invited to participate.
• ATSDR received comments from residents, stakeholders, and interested parties. Environmental health scientists at ATSDR incorporated and addressed all comments into the final Pease Private Well Health Consultation report.
• The final Pease Private Well Health Consultation is currently in the ATSDR review process and is expected to be released in early winter 2022.
• The final report will be sent to each of the residents affected by PFAS in their drinking water wells and posted online. Additionally, ATSDR is working with the town of Newington, NH, to send copies of the final report to some former residents.

Multi-site Health Study

Most of the cooperative agreement partners of the PFAS Multi-site Study (MSS) have initiated study recruitment activities and have begun the data collection process. Most sites will be active by mid-December. The goal of the Multi-site Study is to learn more about the relationship between PFAS exposure and health outcomes among differing populations.

Study partners spent the summer of 2021 identifying clinic locations, hiring and training MSS study staff, refining COVID-19 safety procedures, preparing communications, and consulting with community advisory panels in preparation for the fall 2021 launch of the study. ATSDR staff have provided extensive support to site investigators for all aspects in preparation for study protocol implementation — especially for staff training and data and sample collection procedures. Cooperative agreement partners have the most up-to-date information about the study’s progress in each community.

The MSS cooperative agreement recipients and their local community partners have initiated meeting planning to discuss MSS implementation in local communities. The meeting, called the MSS Local Community Engagement Meeting (or LCE for short), will focus on identifying challenges and barriers to study recruitment, describing best practices for supporting local outreach and recruitment, and facilitating communication about outreach and recruitment across communities implementing the MSS.

Other CDC and ATSDR Activities

NASEM Guidance on PFAS Testing and Health Outcomes
Throughout summer 2021, the National Academies of Science, Engineering, and Medicine (NASEM) have worked with an expert committee to develop guidance for clinicians about PFAS testing and how test results should inform clinical care. The process will also examine health outcomes associated with PFAS exposure and develop principles clinicians can use for advising patients on exposure reduction.

NASEM and the expert panel conducted virtual public meetings in mid-July and mid-August to hear comments from experts and the public about the contribution of PFAS exposure sources towards human exposure to PFAS; clinical principles for advising patients on exposure reduction; health effects of PFAS; and methods for evidence synthesis and biological testing.

Recordingsexternal icon of these meetings and virtual town hall meetings held earlier this year are available on the NASEM website.

NASEM will provide CDC/ATSDR with a review of current evidence regarding human health effects of PFAS, along with recommendations regarding CDC/ATSDR PFAS clinical guidance.

Chronic Stress and Environmental Contamination Training

ATSDR has been working to better understand and develop resources to address the psychological and social impacts associated with living in a community affected by long-term environmental contamination. We are pleased to announce the launch of ATSDR’s new Chronic Stress and Environmental Contamination Training.

This self-guided, online training complements ATSDR’s Community Stress Resource Center. The training is intended for public health professionals working with communities affected by environmental contamination. It covers the biology of psychological stress, reasons why environmental contamination can be a source of chronic stress, the role of community resilience, and ways to tailor public health activities to support community psychosocial health.

CDC/NIOSH Releases New PFAS Web Portal

During summer 2021, the National Institutes of Occupational Safety and Health (NIOSH) released a web portal on PFAS. The new page is a starting point for learning about worker risks and NIOSH research on PFAS and links out to numerous sources of additional information on PFAS.

Does PFAS exposure affect people’s immune response to COVID-19 vaccines? 

To date, there are no published studies evaluating how PFAS may affect response to COVID-19 vaccines. Hence, we do not know at this time if exposure to PFAS or if any specific blood level of PFAS could interfere with a person’s immune response associated with any of the COVID-19 vaccines.

There is some evidence from human and animal studies that PFAS exposure may reduce antibody responses to other types of vaccines (not COVID-19 vaccines) and may reduce a person’s resistance to infectious disease. The mechanisms by which PFAS can affect the immune system are not fully understood and research is ongoing.

We do know that older adults and people of any age with certain underlying medical conditions, including people with weakened immune systems, are at increased risk for severe illness from the virus that causes COVID-19. COVID-19 vaccines are safe and effective. During clinical trials, vaccine safety and effectiveness results were similar in people with some underlying health conditions, including those that placed them at increased risk for severe COVID-19, compared to people without medical conditions. People with underlying medical conditions can get a COVID-19 vaccine if they have not had a severe or immediate (even if it was not severe) allergic reaction to any of the ingredients in the vaccine. If you have questions about getting COVID-19 vaccine, you should talk to your healthcare providers for advice.

More information is available on the following CDC websites:

• Vaccines for COVID-19 | CDC
• COVID-19 Vaccine Effectiveness | CDC
• COVID-19 Vaccines for People with Underlying Medical Conditions | CDC

Prior Study Participants among First Multi-site Study Participants to Enroll at New Jersey Site

In July 2021, study staff began enrolling the first dozen participants in the PFAS Multi-site Study in Paulsboro, NJ. The site is one of eleven communities in several states across the U.S. that have been working to engage interested participants. Enrollment in Paulsboro started with several community members who previously participated in locally conducted studies. Guided by an active and enthusiastic Community Advisory Panel, the main recruitment effort started in September 2021. Paulsboro is a diverse community with a population of approximately 6,000 and sits along the Delaware River in southwestern New Jersey. This area also has a legacy of petrochemical industry activity, including the manufacturing of specialty polymers using per- and polyfluoroalkyl substances (PFAS).

In 2009 and 2013, municipal water in Paulsboro was found to have levels of perfluorononanoic acid (PFNA) that greatly exceeded the current New Jersey Maximum Contaminant Level of 13 parts per trillionpdf iconexternal icon. These concentrations were among the highest levels of PFNA found in drinking water in the U.S. The contaminated public water well was shut down in 2014 due to the high PFAS levels. In 2016, Paulsboro’s public water system began using specialized filters to remove PFAS from drinking water.

Some private wells in neighboring West Deptford, NJ, an area which surrounds the polymer manufacturing site, also had high levels of PFNA.

The Multi-site Study research team at Rutgers Environmental and Occupational Health Sciences Institute and Rutgers School of Public Health are recruiting study participants from the entire Paulsboro population and households in West Deptford using private well water. Additional information on this study site is available at https://eohsi.rutgers.edu/paulsborohealthstudy/external icon.