Biomonitoring has many uses in the field of environmental health, including evaluation of exposure to environmental chemicals on the individual level, detection of changes at the cellular/molecular level prior to clinical diagnosis, establishment of baseline levels of exposure in the general population, comparison of exposure to environmental chemicals among different populations, and assessment of effectiveness of policies intended to reduce exposure to specific chemicals. National biomonitoring programs have been developed in many countries, including the US, Canada, France, Belgium, and Germany.
As in most European countries, there is no legislation in Israel requiring human biomonitoring in the general population. The National Nutrition and Health Survey (MABAT), which could serve as a platform for human biomonitoring in Israel, is not required to do so. Occupational biomonitoring in Israel is mandated by law for workers potentially exposed to metals (cadmium, lead, arsenic, chromium, mercury, cobalt, and nickel), organophosphate and carbamate pesticides (cholinesterase monitoring in red blood cells), aromatic hydrocarbon solvents (benzene, toluene, styrene, and xylene), and halogenated solvents (trichloroethylene, perchloroethylene, and 1,1,1-trichloroethane).
Data on Human Biomonitoring in Israel
Between 2010 and 2013 there were two major biomonitoring studies conducted in Israel:
Persistent Organic Pollutants (POPs) in Breast Milk
The study was conducted by the Ministry of Health (MoH) in collaboration with the Ministry of Environmental Protection (MoEP) as part of the World Health Organization (WHO) coordinated survey on POPs in breast milk. In 2012 breast milk was collected from 52 women who delivered at three hospitals in the central region of Israel and one pooled sample was analyzed for over 50 POPs including polybrominated dioxins and furans and polybrominated diphenyl ethers (flame retardants).
The major findings were:
- Levels of indicator compounds (chlordanes, DDT compounds, hexachlorocyclohexanes, and PCBs) were comparable to and mostly lower than those reported in European countries.
- Concentrations of indicator compounds declined significantly since 1982, with the decrease likely attributable to restrictions on agricultural, industrial, and other uses of many POPs in Israel.
Figure 1: Persistent Organic Pollutants in Breast Milk in Israel, 1982 and 2012*
Non-Persistent Environmental Contaminants in Urine
In a study conducted by the MoH in 2011, spot urine samples and detailed questionnaire data were collected from 250 adults recruited from five different geographic regions in Israel. Urine samples were analyzed for bisphenol A (BPA), phthalate metabolites, cotinine, polycyclic aromatic hydrocarbons, organophosphate metabolites, and phytoestrogens.
The major findings were:
- The study population was widely exposed to all contaminants measured in the study.
- Exposures to organophosphates and environmental tobacco smoke (ETS) were relatively high among the study participants compared to other international populations.
- In non-smokers, ETS exposure was highest in males, younger, and less educated participants.
- BPA levels among Jews were high compared to Arabs and Druze.
- Fruit consumption was a source of exposure to organophosphate pesticides.
Figure 2: Median Creatinine Adjusted Organophosphate Urinary Metabolite Concentrations (μg/g) in the Israeli Study Population and Populations in the United States, Canada, and France
Research on Human Biomonitoring in Israel
There are numerous epidemiological studies currently underway in Israel employing biomonitoring for exposure assessment, including studies on the health effects of organophosphate pesticides, phthalates, heavy metals, ETS, brominated flame retardants, and BPA.
- Researchers at the MoH and Ben-Gurion University are using biomarkers of heavy metals exposure, and examining exposure to environmental factors such as industry and home environment, to study risk of congenital anomalies in infants born to Arab-Bedouin women in southern Israel.
- Researchers at the MoH and at Ben-Gurion University are examining the effects of air pollution on cell proliferation as an indicator of subclinical pathology in fetuses of 210 Arab-Bedouin women in southern Israel.
- Researchers at the Hebrew University Center of Excellence in Agriculture and Environmental Health are using biomarkers to study the effects of organophosphate pesticides on male reproductive health and birth outcomes, as well as the effects of BPA, phthalates, and genistein on birth outcomes.
- Researchers at Hebrew University–Hadassah, Assaf Harofeh Medical Center, and Mount Sinai Hospital, NY are using biomarkers to study exposures to phthalates and ETS in children.
- Researchers at Hebrew University–Hadassah are using biomarkers (POPs in serum) to explore risk factors for non-Hodgkins lymphoma in Palestinian and Israeli adults.
- Researchers at Assaf Harofeh Medical Center, Tel Aviv Sourasky Medical Center, and Columbia University, NY are using biomarkers to measure exposures to brominated flame retardants (polybrominated diethyl ethers and hexabromocyclododecane) and phthalates in mother–infant pairs and the effects on birth outcomes and thyroid function.
- Researchers at Tel Aviv Sourasky Medical Center are measuring exposure to nano-particles in Exhaled Breath Condensate, and effects in asthmatic vs. non-asthmatic children.
- Researchers at Tel Aviv Sourasky Medical Center are using biomarkers to explore differences in exposure to endocrine disrupting chemicals (EDCs) in residents of an organic food/vegan community in northern Israel (Amirim).
- Researchers at the Hebrew University Center of Excellence in Agriculture and Environmental Health are evaluating the presence of dialkyl phosphates in edible crops and estimating exposure to organophosphate pesticides considering exposure to both parent compounds and their metabolites.
Progress and Challenges
- Data collected in human biomonitoring studies conducted by the MoH from 2010 to 2013 have implications for public health policy. Data on decreasing levels of POPs in breast milk were instrumental in showing that restrictions on use of agricultural and industrial chemicals in Israel were useful in reducing exposures in the general population. Data on relatively high levels of exposure to organophosphates were instrumental in directing policy with regard to reduction of agricultural use of organophosphates, while data on exposure to ETS were instrumental in support of implementation of smoke-free legislation in Israel.
- There has been significant progress recently in the field of biomonitoring in Israel, and much biomonitoring data will be generated by the studies currently underway. In addition, the MoH has plans to continue biomonitoring as part of the 2014–2015 National Nutrition and Health Survey (urinary cotinine and urinary organophosphate metabolites in 300 children and adults). However, to date, there is no long-term plan for biomonitoring in Israel, including target populations, target chemicals, and planned uses of biomonitoring data for public health/environmental health policy.
- Due to the absence of laboratories in Israel with proven capacity to measure low-level exposure to environmental contaminants in biological samples, human biomonitoring studies in Israel have increasingly relied on collaboration with foreign laboratories. This substantially increases the cost of human biomonitoring studies in Israel.
- Regional biomonitoring projects, such as the DEMOCOPHES study in 17 European countries, have focused on developing a harmonized approach to biomonitoring. Joining such a regional or international harmonization effort would advance the field of biomonitoring in Israel considerably and would allow for better data comparability.
This chapter and all other chapters in the report was written by a team of scientists and professionals from the Ministry of Health, in collaboration with Environment and Health Fund.
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