Results of the 3 pilot studies

conducted near waste incinerators

in Dorog, Forlí and Warsaw

OBJECTIVES

• to monitor and evaluate the possible environmental contamination on one side and the changes in the health status of the population on the other side, (and to act if necessary)

• to work out methodology for setting up an EHSS• to make conclusions and recommendations for

setting up an EHSS

THE STUDY AREAS

• Dorog - toxic waste incinerator• Forlí - communal waste incinerator and

hospital waste incinerator• Warsaw - communal waste incinerator

-------- ----------- --------

Different types of emission (e.g. metals)

Different regime of activity (standard vs. changing composition)

Different sizes of population

Different availability of data sources and different experiences

DOROG

• a small town with

about 13,000 inhabitants.

• It used to be a coal-mining area.

• After closing down mining activity, new job opportunities were needed

DOROG (Continued)

• In the 1980’-ies an incinerator was built here for burning wastes of a pharmaceutical plant.

• In 1996 this was converted into a big toxic waste incinerator with a capacity of 30,000 tons per year.

EXPOSURE ASSESSMENT in Dorog

• Continuous monitoring of air pollution

(PM10, SO2, NO2, CO, O3, benzene)

• Yearly average concentrations of PM2.5

and its metal components

• Dioxin and furan compounds in dustfall (collected monthly)

HEALTH OUTCOMES

• Children's acute respiratory morbidity (CHARM), using the local paediatricians' weekly report • Pregnancy outcomes (normal or preterm births,

birth weight, spontaneous abortions or stillbirths, etc) with the participation of the district nurses, • Analysis of the mortality patterns of Dorog and its

neighbourhood

Variation of air pollution in DOROG (01 1999 - 08 2004)

0

10

20

30

40

50

60

1999 2000 2001 2002 2003 2004

SO2, NO2, µg/m3

0

5

10

15

20

25

Dustfall, g/m2*30

days

SO2 NO2 Dustfall

Background• Children are an appropriate sentinel population for the

assessment of health effects of environmental pollutants, as they are more sensitive to toxic effects than adults,

they breathe more air relative to their body weight they generally do not smoke they are not exposed to workplace contaminants.

• Acute respiratory diseases (generally bacterial or viral infections) are the most common diseases in childhood. Their occurrence may be influenced by factors which– do not change much over time (e.g. genetic factors)– may change on the long run (e.g. social and cultural

environment, nutrition, life style)– show significant changes in short periods of time (air

pollution and meteorological conditions)

METHODS

Monitoring of air pollution

• on-line monitor (daily, 24-hour) data:

PM10, SO2, NO2, CO, O3, benzene, ethyl-benzene, toluene

• off-line measurements:

once a week: PM10, PM2.5, black smoke, metal content of PM2.5, chloride in PM10

once a month: dioxin and furan compounds in dustfall

METHODS

Monitoring of respiratory diseases

• 3 paediatricians in Dorog, each has to care for 450-600 children between 0-14 years living in Dorog (free choice of doctors)

• The Report Sheet gives free choice of diagnosis for the doctors, the diagnoses are grouped by us later:

- upper respiratory diseases (and complications)- acute bronchitis- diseases with allergic component (asthma attack, obstructive bronchitis, allergic rhinitis,

croup)- pneumonia

Acute respiratory diseases among children in DOROG

2005 Month:from…… till…….

Paediatrician:

0 1-2 3-5 6-14 TOTAL

Number of registered children          

ICD-10Age

group Monday Tuesday Wednesday Thursday Friday Saturday Sunday

 

0              

1-2              

3-5              

6-14              

 

0              

1-2              

3-5              

6-14              

Figure 1. Weekly mean levels of PM10 and total respiratory morbidity of 0-14 year old children in Dorog between Week 14th of 2005 and Week 10th of 2006.

0

20

40

60

80

100

120

140

160

Weeks

Pm10 (μg/m3)

Total respiratory morbidity (per thousand)

Table 1. Weekly average morbidity (%) in Dorog between 02.04.2005 and 10.03.2006.

0 year 1-2 years 3-5 years 6-14 years Together

Total respiratory morbidity 6.19 7.85 10.33 5.14 7.38

Upper respiratory infections 5.54 6.47 7.95 4.31 6.07

Upper respiratory complications 0.08 0.26 0.53 0.25 0.28

Acute bronchitis 0.17 0.42 0.75 0.28 0.40

Obstructive bronchitis 0.31 0.42 0.68 0.13 0.39

Croup 0 0.20 0.15 0.06 0.10

Allergic rhinitis 0 0 0.01 0.06 0.02

Pneumonia 0.10 0.11 0.28 0.06 0.14

Table 2. Distribution (%) of the various disease categories within the total respiratory morbidity

0 year 1-2 years 3-5 years 6-14 years Together

Total respiratory morbidity 100 100 100 100 100

Upper respiratory infections 89,5 82,42 76,96 83,85 82,25

Upper respiratory complications 1,29 3,31 5,13 4,86 3,79

Acute bronchitis 2,75 5,35 7,26 5,45 5,42

Obstructive bronchitis 5,00 5,35 6,58 2,53 5,28

Croup 0 2,55 1,45 1,17 1,36

Allergic rhinitis 0 0 0,10 1,17 0,27

Pneumonia 1,62 1,40 2,71 1,17 1,89

Disease Pollutant Concentration (ug/m3)

Incidence Rate Ratio

CO

500 600 700 800 900 1000

1.000767 1.000533 1.000391 1.000300 1.000237 1.000192

Total respiratory morbidity

PM10 20 30 40 50

1.019171 1.008476 1.004759 1.003043

CO

500 600 700 800 900 1000

1.000668 1.000464 1.000341 1.000261 1.000206 1.000167

Upper respiratory morbidity

PM10 20 30 40 50

1.021235 1.009383 1.005267 1.003368

CO

500 600 700 800 900 1000

1.002638 1.001831 1,001345 1.001030 1.000814 1.000659

Bronchitis

SO2 10 20 30

1.914354 1.383602 1.241673

Table 3. Significant associations between the measured air pollutants and the respiratory morbidity of 0-14 year old children in Dorog

Thank you for Thank you for

your attentionyour attention