Environmental Health and Toxicology

Outline:

Environmental Health Hazards Infectious Organisms Emergent Diseases Antibiotics and Pesticide Resistance Toxic Chemicals Distribution and Fate of Toxins Minimizing Toxic Effects Measuring Toxicity Risk Assessment Public Policy
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ENVIRONMENTAL HEALTH HAZARDS

Health - A state of complete physical, mental, and social well-being. Disease - A deleterious change in the bodys condition in response to an environmental factor. Diet and nutrition, infectious agents, toxic chemicals, physical factors, and psychological stress all play roles in morbidity (illness) and mortality (death).
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Infectious Organisms

For most of human history, the greatest health threats have been pathogenic organisms. Infectious diseases are still responsible for about 33% of all disease-related deaths. - Majority of deaths in poorer countries with poor nutrition, sanitation, and vaccination programs.

Morbidity and Quality of Life

Death rates do not tell everything about burden of disease. Total economic and social consequences of diseases are difficult to obtain. - Disability-Adjusted Life Year (DALY) combines premature deaths and loss of healthy life resulting from illness or disability.

Disability-Adjusted Life Year

WHO reports communicable diseases are responsible for nearly half of all 1.2 billion DALYs lost each year. About 90% of all DALY losses occur in developing world where one-tenth of all health care dollars are spent. - Malnutrition exacerbates many diseases.

DALYs = Disability Adjusted Life Years The sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability. . http://www.who.int/mental_health/management/depression/daly/en/

Emergent Diseases

An emergent disease is one never known before, or has been absent for at least 20 years. An important factor in the spread of many diseases is speed and frequency of modern travel. - Foot and Mouth Disease - Ebola

Foot-and-Mouth Disease
Foot-and-mouth disease or hoof-and-mouth disease (Aphthae epizooticae) is an infectious and sometimes fatal viral disease that affects cloven-hoofed animals, including domestic and wild bovids. The virus causes a high fever for two or three days, followed by blisters inside the mouth and on the feet that may rupture and cause lameness. http://en.wikipedia.org/wiki/Foot-and-mouth_disease
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Ebola
Ebola hemorrhagic fever (Ebola HF) is a severe, often-fatal disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees) that has appeared sporadically since its initial recognition in 1976.

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Emerging Ecological Diseases

Domestic animals and wildlife also experience sudden and widespread epidemics. Distemper (Seals) Chronic Wasting Disease (Deer and Elk) - Transmissible Spongiform Encephalopathies Black Band Disease (Coral)

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Chronic Wasting Disease

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Infectious Disease Outbreaks

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Antibiotic and Pesticide Resistance

Protozoan parasite that causes malaria is now resistant to most antibiotics, while the mosquitoes that transmit it have developed resistance to many insecticides. Short life spans. - Speeds up natural selection and evolution. Human tendency to overuse pesticides and antibiotics.
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Antibiotic Resistance

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CONSEQUENCES OF INCREASING ANTIBIOTIC RESISTANCE

Methicillin-resistant Staphylococcus aureus (MRSA), a strain of bacteria no longer sensitive to different forms of penicillin. It can cause complicated skin infections and pneumonia and requires stronger antibiotics such as vancomycin for treatment. Multidrug-resistant tuberculosis, which is very difficult to treat because it is caused by microorganisms that are resistant 16 to 2 of the first-choice drugs used to treat tuberculosis.

Antibiotic Use

At least half of the 100 million antibiotic doses prescribed in the US every year are unnecessary or are the wrong drug. Many people do not finish full-course. More than half of all antibiotics manufactured in the US are routinely fed to farm animals to stimulate weight gain.

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U.S. approves J&J drug-resistant tuberculosis treatment

By Toni Clarke | Reuters Mon, Dec 31, 2012

The U.S. Food and Drug Administration approved the drug, chemically known as bedaquiline and to be marketed as Sirturo, on Monday following a positive review by an advisory pane last month. Tuberculosis is an air-spread infection that usually attacks the lungs but it can also affect the brain, the spine and the kidneys.

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Pesticide Resistance

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Toxic Chemicals

Dangerous chemicals are divided into two broad categories: Hazardous - Dangerous - Flammable, explosive, irritant, sensitizer, acid, caustic. Toxic - Poisonous - Can be general or very specific. Often harmful even in dilute concentrations.

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Toxic Chemicals

Allergens - Substances that activate the immune system. Antigens - Allergens that are recognized as foreign by white blood cells and stimulate the production of specific antibodies. - Other allergens act indirectly by binding to other materials so they become antigenic.

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Toxic Chemicals

Sick Building Syndrome Headaches, allergies, and chronic fatigue caused by poorly ventilated indoor air contaminated by molds, carbon monoxide, nitrogen oxides, and other toxic chemicals. - Worker absenteeism and reduced productivity. EPA estimates $60 billion annual loss.

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NIOSH Alert: Preventing Occupational Respiratory Disease .

Research studies have shown that exposures to building dampness and mold have been associated with respiratory symptoms, asthma, hypersensitivity pneumonitis, rhinosinusitis, bronchitis, and respiratory infections. Individuals with asthma or hypersensitivity pneumonitis may be at risk for progression to more severe disease if the relationship between illness and exposure to the damp building is not recognized and exposures continue. http://www.cdc.gov/niosh/docs/201 3-102/

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Toxic Chemicals

Neurotoxins - Special class of metabolic poisons that specifically attack nerve cells. Different types act in different ways. - Heavy Metals kill nerve cells. - Anesthetics and Chlorinated Hydrocarbons disrupt nerve cell membranes. - Organophosphates and Carbamates inhibit signal transmission between nerve cells.
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Alice's Adventures in Wonderland

The phrase mad as a hatter is used to describe the chronic side effects of mercury exposure from the process of making felt hats. Lewis Carroll, author of Alice's Adventures in Wonderland, formed the 'Mad Hatter' character in the 1800s. The Hatter acts irrationally in the novel and takes a bite of a teacup in the trial of the Knave of Hearts. http://en.wikipedia.org/wiki/Mercur y_poisoning
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Organophosphate Pesticides Malathion is widely used in

agriculture, residential landscaping, public recreation areas, and in public health pest control programs such as mosquito eradication. In the US, it is the most commonly used organophosphate insecticide. Forty organophosphate pesticides are registered in the U.S., with at least 73 million pounds used in agricultural and residential settings. http://en.wikipedia.org/wiki/Organo phosphate
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Cadmium

Cadmium and its compounds are highly toxic and exposure to this metal is known to cause cancer and targets the bodys cardiovascular, renal, gastrointestinal, neurological, reproductive, and respiratory systems. Cadmium became an important metal in the production of nickelcadmium (Ni-Cd) rechargeable batteries. http://www.osha.gov/SLTC/cadmiu

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Lead
Lead overexposure is one of the most
common overexposures found in industry and is a leading cause of workplace illness. Therefore, OSHA has established the reduction of lead exposure to be a high strategic priority

Lead poisoning is the leading environmentally induced illness in children. At greatest risk are children under the
age of six because they are undergoing rapid neurological and physical development. http://www.osha.gov/SLTC/lead/index.html

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Toxic Chemicals

Mutagens - Agents that damage or alter genetic material. Radiation Teratogens - Specifically cause abnormalities during embryonic growth and development. Alcohol - Fetal Alcohol Syndrome Carcinogens - Substances that cause cancer. Cigarette smoke
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FAS

http://en.wikipedia.org/wiki/Fetal_Alcohol_Syndrome

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US Age-Adjusted Cancer Death Rates

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Endocrine Hormone Disruptors

Chemicals that disrupt normal endocrine hormone functions. Hormones are chemicals released in blood by glands to regulate development and function of tissues and organs elsewhere in the body. - Environmental Estrogens and Androgens

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Phthalates
A 2012 study suggested that high levels of phthalates may be connected to the current obesity epidemic in children. It was found that obese children show greater exposure to phthalates than non-obese children. It was reported that the obesity risk increases according to the level of the chemical found in the children's bloodstream. http://en.wikipedia.org/wiki/Ph thalate#Endocrine_disruption

Phthalates are found in some soft toys, flooring, medical equipment, cosmetics and air fresheners. They are of potential health concern because they are known to disrupt the endocrine system of animals, and some research has implicated them in the rise of birth defects of the male reproductive system.
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http://en.wikipedia.org/wiki/Endocrine_disruptor#Phthalates

Diet

Strong correlation between cardiovascular disease and the amount of salt and animal fat in an individuals diet. Highly-processed foods, fat, and smokecured, high nitrate meats appear to be associated with cancer. Nearly 2/3 of all Americans are considered overweight.

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DISTRIBUTION AND FATE OF TOXINS

Solubility - Chemicals are divided into two major groups: - Dissolve more readily in water. - Dissolve more readily in oil. Water-soluble compounds move rapidly through the environment, and have ready access to most human cells. Oil-soluble molecules generally need a carrier to move through the environment.
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Bioaccumulation and Biomagnification

Cells have special mechanisms for Bioaccumulation - Selective absorption and storage. Dilute toxins in the environment can build to dangerous levels inside cells and tissues. Biomagnification - Toxic burden of a large number of organisms at a lower trophic level is accumulated and concentrated by a predator at a higher trophic level.
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Sensitivity and Developmental Stage

Many factors help determine reaction of an individual to a given dose. Age Sex Body Weight Nutritional / Immunological Status Repair Mechanisms

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Persistence

Some chemical compounds are very unstable and degrade rapidly under most conditions, thus their concentrations decline quickly after release. Others are more persistent. Stability can cause problems as toxic effects may be stored for long period of time and spread to unintended victims. - (DDT)
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Bioaccumulation

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Chemical Interactions

Antagonistic Reaction - One material interferes with the effects, or stimulates the breakdown, of other chemicals. Additive Reaction - Effects of each chemical are added to one another. Synergistic Reaction - One substance multiplies the effect of the other.

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Synergistic Effects of Mercury with Other Toxic Metals: Extreme Synergistic Toxicity
Mercury and lead are extremely neurotoxic and cytotoxic, but their combined synergistic effect is much worse(1,4). A dose of mercury sufficient to kill 1% of tested rats, when combined with a dose of lead sufficient to kill less than 1% of rats, resulted in killing 100 % of rats tested(1a,4). Thus with combined exposure the safe dose is 1/100 as much as the dose individually.

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MECHANISMS FOR MINIMIZING TOXIC EFFECTS

Every material can be poisonous under certain conditions. Most chemicals have a safe threshold under which their effects are insignificant. Metabolic Degradation In mammals, the liver is the primary site of detoxification of both natural and introduced poisons.

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Excretion

Effects of waste products and environmental toxins reduced by eliminating via excretion. Breathing Kidneys - Urine

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MEASURING TOXICITY

Animal Testing Most commonly used and widely accepted toxicity test is to expose a population of laboratory animals to measured doses of specific toxins. - Sensitivity differences pose a problem. Dose Response Curves LD50 - Dose at which 50% of the test population is sensitive.
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LD50

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Population Sensitivity Variations

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Acute vs. Chronic Effects

Acute Effects - Caused by a single exposure and result in an immediate health problem. Chronic Effects - Long-lasting. Can be result of single large dose or repeated smaller doses. Very difficult to assess specific health effects due to other factors.

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RISK ASSESSMENT

Factors influencing risk perception: Rating risks based on agendas. Most people have trouble with statistics. Personal experiences can be misleading. We have an exaggerated view of our abilities to control our fate. News media sensationalizes rare events. Irrational fears lead to overestimation of certain dangers. - Fear of the unknown.
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Accepting Risks

Most people will tolerate a higher probability of occurrence of an event if the harm caused by that event is low. Harm of greater severity is acceptable only at low levels of frequency. - EPA generally assumes 1 in 1 million is acceptable risk for environmental hazards.

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ESTABLISHING PUBLIC POLICY

Biggest problem in making regulatory decisions is that we are usually exposed to many sources of harm, often unwillingly. May not be reasonable to demand protection from every potentially harmful contaminant in our environment, no matter how small the risk.

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ESTABLISHING PUBLIC POLICY

In setting standards for environmental toxins, need to consider: Combined effects of different exposures. Individual sensitivities within population. Effects of chronic and acute exposures.

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Summary:

Environmental Health Hazards Infectious Organisms Emergent Diseases Antibiotics and Pesticide Resistance Toxic Chemicals Distribution and Fate of Toxins Minimizing Toxic Effects Measuring Toxicity Risk Assessment Public Policy
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