Four Corners States Biomonitoring Collaborative: Leveraging lab capacity toward regional health concerns

Four Corners States Biomonitoring Collaborative: Leveraging lab capacity toward regional health concerns |

By Kim Krisberg

2,4-Dichlorophenoxyacetic acid—otherwise known as 2,4-D—is the active ingredient in a variety of weed killers and one of the most common, widely used herbicides in the world. Studies in lab animals have found that high doses of 2,4-D are associated with negative health effects. Research on human exposure is more of a mixed bag.

According to the Agency for Toxic Substances and Disease Registry, it doesn’t appear that contact with small amounts of 2,4-D is harmful to people. Some studies on workers with relatively high exposure rates, such as professional herbicide applicators, have identified a possible link to cancers of the lymph system. Other studies found no strong evidence linking 2,4-D to cancers. The US Environmental Protection Agency (EPA) says there’s not enough evidence to either refute or support 2,4-D as a human carcinogen, while the International Agency for Research on Cancer has deemed 2,4-D as “possibly carcinogenic” based on “inadequate evidence.” In other words, we need more research.

One place where that research is happening is inside the public health labs of Arizona, Colorado, New Mexico and Utah, where a collaborative known as the Four Corners States Biomonitoring Consortium (4CSBC) hopes to gather new insights into environmental exposures that could impact people’s health. With funding from the Centers for Disease Control and Prevention’s (CDC) National Biomonitoring Program, 4CSBC began its work in 2014, building on the previous efforts of the Rocky Mountain Biomonitoring Consortium, of which all four states had been a member. The collaborative’s mission is to generate the data on environmental conditions and contaminants that can inform protective public health actions. It’s also an exercise in optimizing public health lab capacity toward regional environmental health risks and shared concerns regarding air and water quality.

“I think this is one of the most relevant grant-funded projects we do,” said Eric Petty, chemistry program manager within the Colorado Department of Public Health and Environment’s Laboratory Services Division and his state’s lead for 4CSBC. “It produces so much meaningful data and it’s pretty unlimited regarding the number of studies we can design. There’s so much out there that hasn’t been looked at.”

The consortium is focused on three main studies: heavy metal exposure from private well drinking water; pesticide, herbicide and phthalates exposure; and the San Luis Valley (Colorado) Children’s Study, which assesses hazardous chemical exposure among children ages 3 to 13. In each state, public health labs partner with environmental health workers and epidemiologists to find residents who want to take part, collect water and urine samples for testing, and eventually reconnect with residents to discuss results and any health-protective recommendations. The 4CSBC labs spread out the testing responsibilities according to capacity, so as to not burden any one state—for example, every state does its own metals testing; New Mexico and Utah test for metabolites of pyrethroids, a group of chemicals found in certain pesticides; Arizona handles all the testing for phthalate metabolites; and Colorado tests for 2,4-Dichlorophenol and 2,5-Dichlorophenol, the latter of which is found in household products. However, testing duties can change depending on circumstances and capacity. Testing results are interpreted, in part, by using baseline data from CDC’s National Health and Nutrition Examination Survey.

“We have similar geological settings, we all have a legacy of mining in heavy metals, we’re agricultural states, our populations can be sparse, we have common problems regarding arsenic and pesticides,” said Sanwat Chaudhuri, PhD, 4CSBC’s principal investigator and scientific advisor for chemical and environmental services at the Utah Public Health Laboratory. “It just makes more sense that we work together to try to solve our problems.”

To date, Chaudhuri said the consortium has tested more than 900 urine samples and about 500 water samples. Labs work closely with their state colleagues in epidemiology and environmental health—or in Utah and New Mexico, with CDC-funded participants in the National Environmental Public Health Tracking Program—in determining where in the states to focus their biomonitoring efforts and what kind of data gaps the consortium can help fill. Chaudhuri added that the consortium leverages its unique work to help particularly vulnerable communities reduce their risk of harmful exposure. 4CSBC’s focus on private well drinking water is a good example of that. Because such water often goes unregulated, 4CSBC can help alert residents to potential contaminants, while collecting the data that allow health officials to measure changes in environmental risk.

If lab technicians detect a particularly high concentration of a contaminant—like naturally occurring uranium that can seep into private well water—residents are notified and offered guidance about how to fix or mitigate the problem. In some instances, Chaudhuri said, local health officials are engaged and notified. 4CSBC teams regularly share data with each other, evaluate their progress and plan for the future during monthly phone calls and at two face-to-face meetings each year.

“We couldn’t have stretched [the CDC biomonitoring funds] across four states if wasn’t for our collaborations,” Chaudhuri said. “We get so much in-kind support from our environmental health and tracking partners—who else can better appreciate the need for biomonitoring data?”

On the ground, the biomonitoring collaborative not only hopes to offer new insights, but to boost capacity for more traditional public health responsibilities, such as safeguarding drinking water quality. For example, in New Mexico, about 20 percent of residents depend on drinking water sources—like private wells—that aren’t regulated by either federal or state oversight. At the same time, said Heidi Krapfl, MS, chief of the New Mexico Department of Health’s Environmental Health Epidemiology Bureau, the state’s geology means private well water drinkers may be at heightened risk of harmful arsenic and uranium exposures. Urine uranium concentrations above a certain threshold are already a notifiable condition in New Mexico.

To better understand that risk, New Mexico’s 4CSBC team partners closely with the state’s environmental health tracking program to collect and analyze water samples. To date, according to Barbara Toth, PhD, MS, epidemiologist supervisor at the New Mexico Department of Health, the biomonitoring effort in New Mexico has collected about 150 household water samples for heavy metal testing and just more than 200 urine samples for heavy metal and phthalate testing. If researchers find troubling levels in any of the specimens, they or their partners follow up with residents. So far, Toth said they haven’t detected any levels that would be deemed harmful.

“Tracking is about exposure and health outcomes,” Toth said, “and biomonitoring is the method by which we understand that exposure.”

Krapfl added: “Those three legs of the stool—tracking, biomonitoring and private well water testing—provide a strong foundation for taking supporting public health actions in the state. You really need all three.”

One of the 4CSBC’s main projects—the San Luis Valley Children’s Study—is focused on a specific community of children in Colorado. According to Petty, the 4CSBC lead in Colorado, the area has a particularly shallow water table and has a history of agricultural use. To get a clearer picture of the risk, 4SCBC is partnering with a researcher from the University of Colorado who’s already begun studying children’s exposure in the San Luis Valley. The researcher conducts the field work and collects samples, while the Colorado public health lab does the testing—to date, Petty said the lab has tested more than 200 urine samples and 100 water samples.

“The consortium is a great way to consolidate resources,” Petty said. “Ultimately, there’s so much information these studies can provide in the future.”

Well water quality is a priority issue in Arizona too, according to Jason Mihalic, chief of the Chemistry Office at the Arizona Department of Health Services and the state’s principal 4CSBC investigator. Any Arizona resident who uses well water can take part in the biomonitoring effort. But to sweeten the deal—and attract as many participants as possible—the Arizona lab offers a free water analysis for 19 metals using an EPA-approved method. The Arizona 4CSBC effort is also partnering with existing well water programs at the University of Arizona to spread word about the biomonitoring effort—for example, news of the biomonitoring testing even made it onto a local master gardener listserv®.

For many of the compounds included in 4CSBC testing—such as pyrethroid insecticides used to reduce risk of tick-borne diseases like Rocky Mountain spotted fever or the plastic chemicals known as phthalates that are now ubiquitous in our environment—biomonitoring will produce the first regional baseline data available, Mihalic noted.

And more precise data means public health can be even more effective in protecting communities against potentially harmful exposures.

“I love biomonitoring,” Mihalic said. “It’s a wonderful way for the public health lab and epidemiology to work together in tackling real-world problems.”

The post Four Corners States Biomonitoring Collaborative: Leveraging lab capacity toward regional health concerns appeared first on APHL Lab Blog.

Laboratory twinning builds strong lab systems and relationships

Laboratory twinning builds strong lab systems and relationships |

By David Mills, PhD, retired director, Scientific Laboratory Division, New Mexico Department of Health

When I first got involved in twinning, I had no idea that Halloween costumes would be part of the process. Let me explain.

During my time as director of the New Mexico public health laboratory, APHL connected my team with an equivalent lab in Paraguay. This entailed sending personnel to train their laboratorians, who later came to Albuquerque to see our work in action. Our “twin” labs developed strong bonds and this “twinning” project left a good taste in everyone’s mouth.

A year later, when APHL asked if we’d help Uganda’s Central Public Health Laboratory evolve into a national reference lab, we jumped at the chance to twin again.

Our first step was to visit Uganda to learn about their priorities and see what was truly achievable. We had an instant rapport with the Ugandan team and their director, Steven Aisu, and our discussion quickly reinforced how well matched our labs were. Our team had just moved from an old, cramped facility to a state of the art facility, just as the Ugandan team needed to do.

Because Aisu’s team was developing a new paradigm without ever seeing the process in action, our task was to help them clearly visualize the goal and then make it a reality through technical assistance, management and leadership training. We were all excited to get started.

The second step was for Sally Liska, retired director of the San Francisco public health lab, and me to hold training sessions in Kampala, the capital of Uganda. I loved doing these interactive courses because, for me, teaching is the best way to learn.

The Ugandan team was eager to know everything about how we ran our biosafety level 3 (BSL-3) lab, so the third step was for the Ugandan team to visit our facility in New Mexico. They met with experts from epidemiology to IT, quality assurance to maintenance, as well as senior officials. They were especially interested in how we worked with agricultural and environmental partners; Aisu described such collaborations as akin to bridging chasms. We shared our hard-won experiences. His team quickly gained proficiency in physical and scientific quality systems.

Just as important, we built strong relationships that will last.

I invited the team to my home for their last night in New Mexico before their return flight to Uganda. It happened to be Halloween, but we had been so busy it hadn’t come up in conversation. When the first trick-or-treaters arrived, I suddenly realized that my friends had never experienced the holiday. They were surprised and enchanted to find witches, ghosts and other costumed children at the door. It’s a good thing they were delighted—150 creatures of the night rang our bell over the next few hours! The following morning, we said farewell, but not goodbye.

I retired in 2015, but my connection to the Uganda team has continued without breaking stride. In June 2016, I went to Kampala for two weeks to help them develop strategic plans for their national health lab system and for oversight and regulation of the country’s entire health system. On my team were APHL consultants Kim Lewis and John Pfister, who has retired from the Wisconsin state lab.

A month later, we three musketeers facilitated a stakeholders’ meeting to review those plans and helped refine the strategic plan for their new facility (built by CDC) as they prepared for the September 2016 grand opening.

The New Mexico team has continued working with the Ugandan team as they transitioned into their new roles, and I have jumped in with both feet as a consultant through APHL. If they can stand my jokes, the least I can do is help them take their next steps. It’s my calling.

A Little Extra Fun…

This story isn’t directly related to my work with the laboratory, but I love telling it! While we were in Uganda, we stayed in a small hotel where the friendly manager would often come and chat. One day, she asked, “Have you ever had an avocado before?” I said, “Yes, I make guacamole with avocados.” She’d never heard of guacamole, so I described it and she grimaced, saying, “That sounds terrible!” I offered to make some anyway.

Laboratory twinning builds strong lab systems and relationships |

Two days later, I had a night off from teaching and was sitting in the lobby when the manager came up to me and said, “We’re ready! Let’s make the guacamole. The whole kitchen staff is waiting!” Sure enough, a chef with a tall white hat and his crew were lined up behind the ingredients: avocados, lemon juice, garlic, onions. I was astonished and eager to get cooking!

Together, we made a huge batch for the hotel staff and served it on fried corn tortillas. Everyone was game to try it. Although first their reactions were uniformly polite yet skeptical, they eventually grew enthusiastic.

My conclusion: Guacamole is an acquired taste.


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Responding to the Animas River disaster: Who’s testing what?

by Megan Latshaw, director, Environmental Health, APHL

It was Saturday morning and my energetic six-year-old daughter was occupied for a moment, so I had a few seconds of quiet to scroll through my Twitter newsfeed. This photo of Colorado’s Animas River caught my eye and I immediately thought, “That has to be photoshopped.” I clicked the link and saw it wasn’t.

Responding to the Animas River disaster: Who’s testing what? |“What’s going on?” I thought, as she bounded back in the room, tackling me with her typical exuberance. I squirmed up from underneath her and quickly retweeted the image, sensing it was something important.

Later the nation would learn that an EPA contractor accidentally released 3 million gallons of mine waste including metals such as lead, mercury and arsenic into the river, turning it the bright orange color that originally looked (and kind of still does) photoshopped despite being very real. (Photo by Josh Stephenson / Durango Herald)

As the story unfolded, the details revealed the seriousness of the situation. I decided to reach out to the state public health and environmental laboratories in the impacted states: Colorado, New Mexico and Utah. Were they receiving requests to test the water and soil (AKA sediment)? Were they overwhelmed? Did they plan to look for contaminants in people who may have been exposed?

This type of event sends public health and environmental laboratories in impacted states into emergency response mode. That means putting normal day-to-day work aside (and possibly even day-to-day personal life if the lab has to move to a 24/7 shift work). This sets the stage for one of the biggest challenges seen in laboratories during many emergency responses such as this one: prioritization. In this case, sample submitters went from characterizing samples as either priority 1 or 2, to labeling all samples as priority 1. So instead of being able to put some samples on hold (priority 2) in order to address the priority 1 samples, all samples must be addressed as soon as possible. This presents a challenge to an already stressed laboratory.

In an effort to assist with lab-to-lab emergency response coordination, APHL held a conference call on August 19. Here is what we heard:

– Testing was being done by multiple entities including public health labs, commercial labs and EPA.
– The Colorado public health laboratory saw more than 100 samples from surface water, sediments, irrigation canals and private well water within the first two weeks. As of the 24th, they expect to return to normal surveillance levels.
– The New Mexico public health laboratory saw between 40 and 60 river water samples submitted for a full range of testing including metals. By the time we spoke, technicians had completed work on most of the samples, sending about 500 results over the period of about one week. The laboratory expects to do biomonitoring (looking for chemicals in blood or urine).
– The Utah public health laboratory had not receive any water samples yet but they anticipated receiving some from privately owned water wells along with human specimens. With those expected samples, they will look for metals in the local population as part of a previously planned biomonitoring study by the health department.

Fortunately, the public health labs in the states affected by this spill had the ability to test not only soil and water samples, but also to look for exposure to pollution in humans. This capability is largely thanks to the testing foundation put in place by the Laboratory Response Network for Chemical Threats (LRN-C). The LRN-C, which began as a network of public health laboratories with special skills and equipment to use in the event of a chemical terrorist attack, has expanded its priorities over the last decade to include assisting in response to accidents involving chemicals. Without investments in the LRN-C, there would not have been instruments or trained personnel to do the biomonitoring that is planned.

The labs responded just as they should have – they were quick and thorough in both testing and reporting. Thanks to their hard work, we know that concentrations in the water have gone down, but we need to know more; we need to understand what potential increases in exposure mean to the people who swam, drank or otherwise came into contact with the contaminated water. Biomonitoring will help do that. My colleagues and I will be watching closely and continuing to encourage the use of biomonitoring during environmental emergencies just like this.

I keep coming back to my six-year-old and how I would feel wondering if she had been exposed to high levels of metals. If I lived in one of the affected communities, I would want to know.

If you live in a community impacted by environmental contamination, and you think a laboratory might be able to answer some of your questions, please visit APHL’s Meeting Community Needs site.




Bandelier National Monument

8755876832_11d0034d10_bAs part of the Santa Fe Science Writing Workshop, we had the opportunity to visit Bandelier National Monument in New Mexico. Bandelier is justifiably famous for its impressive Pueblo ruins. The landscape and vegetation made clear that the environment here swings between extremes – the idea of “average” is almost meaningless. Trees showed evidence of both fire and flood damage. Brown turned suddenly to green for a thin strip around a stream. It is a land of contrasts, of beauty, of life, and of death.

Click to view slideshow.

You may also run into a mule deer or two or four.

You can see all my photos from the Santa Fe Science Writing Workshop on my Flickr photostream.

You can follow all our science-y travels on the Have Science Will Travel map.Screen Shot 2013-05-20 at 9.59.08 PM