Exposure to disinfection by-products in swimming pools and biomarkers of genotoxicity and respiratory damage - The PISCINA2 Study

Toxicity and underlying lipidomic alterations generated by a mixture of water disinfection byproducts in human lung cells

Complex mixtures of disinfection by-products (DBPs) are present in disinfected waters, but their mixture toxicity has been rarely described. Apart from ingestion, DBP exposure can occur through inhalation, which may lead to respiratory effects in highly exposed individuals. However, the underlying biological mechanisms have yet to be elucidated. This study aimed to investigate the toxicity of a mixture of 10 DBPs, including haloacetic acids and haloaromatics, on human alveolar A549 cells by assessing their cytotoxicity, genotoxicity, and impact on the cell lipidome. A DBP mixture up to 50 μM slightly reduced cell viability, induced the generation of reactive oxygen species (ROS) up to 3.5-fold, and increased the frequency of micronuclei formation. Exposure to 50 μM DBP mixture led to a significant accumulation of triacylglycerides and a decrease of diacylglycerides and phosphatidylcholines in A549 cells. Lipidomic profiling of extracellular vesicles (EVs) released in the culture medium revealed a marked increase in cholesterol esters, sphingomyelins, and other membrane lipids. Overall, these alterations in the lipidome of cells and EVs may indicate a disruption of lipid homeostasis, and thus, potentially contribute to the respiratory effects associated with DBP exposure.

Lifetime exposure to brominated trihalomethanes in drinking water and swimming pool attendance are associated with chronic lymphocytic leukemia: a Multicase-Control Study in Spain (MCC-Spain)

BACKGROUND

Chronic lymphocytic leukemia (CLL) etiology is poorly understood, and carcinogenic chemicals in drinking and recreational water are candidates.

OBJECTIVE

To evaluate the association between drinking-water exposure to trihalomethanes (THMs) and nitrate as well as lifetime swimming pool attendance and CLL.

METHODS

During 2010-2013, hospital-based CLL cases and population-based controls were recruited in Spain, providing information on residential histories, type of water consumed and swimming pool attendance. Average THMs and nitrate levels in drinking water were linked to lifetime water consumption. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using mixed models.

RESULTS

Final samples for residential tap water analyses and swimming pool attendance analyses were 144 cases/1230 controls and 157 cases/1240 controls, respectively. Mean (SD) values for average lifetime residential brominated THMs and chloroform in tap water (μg/L), and ingested nitrate (mg/day) were 48.1 (35.6), 18.5 (6.7) and 13.7 (9.6) respectively in controls; and 72.9 (40.7), 17.9 (5.4), and 14.1 (8.8) in CLL cases. For each 10 μg/L increase of brominated THMs and chloroform lifetime-average levels, the ORs (95% CI) were 1.22 (1.14, 1.31) and 0.54 (0.34, 0.87), respectively. For each 5 mg/day increase of ingested nitrate, the OR of CLL was 0.91 (0.80, 1.04). The OR of lifetime pool users (vs. non-users) was 2.38 (1.61, 3.52). Upon performing annual frequency of attending pools analysis through categorization, the second and third categories showed an ORs of 2.36 (1.49, 3.72) and 2.40 (1.51, 3.83), respectively, and P-trend of 0.001.

IMPACT STATEMENT

This study identifies an association of long-term exposure to THMs in drinking water, at concentrations below the regulatory thresholds and WHO guidelines, and swimming pool attendance, with chronic lymphocytic leukemia (CLL). These unprecedented findings are highly relevant since CLL is an incurable cancer with still unknown etiology and because the widespread exposure to chlorination by-products that remain in drinking and recreational water worldwide. Despite the demonstrated carcinogenicity in animals of several chlorination by-products, little is known about their potential risks on human health. This study makes a significant contribution to the search for environmental factors involved in the etiology of CLL and to the evidence of the health impact of these high prevalent water contaminants.

The acute effects of endurance exercise on epithelial integrity of the airways in athletes and non-athletes: A systematic review and meta-analysis

INTRODUCTION

Acute endurance exercise may induce airway epithelium injury. However, the response of epithelial integrity markers of the airways including club cell secretory protein (CC16) and surfactant protein D (SP-D) to endurance exercise have not been systematically reviewed. Therefore, the aim of this systematic review and meta-analysis was to assess the acute effects of endurance exercise on markers of epithelial integrity of the airways (CC16, SP-D and the CC16/SP-D ratio) in athletes and non-athletes.

METHODS

A systematic search was performed utilizing PubMed/Medline, EMBASE, Web of Science, and hand searching bibliographies of retrieved articles through to September 2022. Based on the inclusion criteria, articles with available data about the acute effects of endurance exercise on serum or plasma concentrations of CC16, SP-D and CC16/SP-D ratio in athletes and non-athletes were included. Quality assessment of studies and statistical analysis were conducted via Review Manager 5.4 software.

RESULTS

The search resulted in 908 publications. Finally, thirteen articles were included in the review. Acute endurance exercise resulted in an increase in CC16 (P = 0.0006, n = 13) and CC16/SP-D ratio (P = 0.005, n = 2) whereas SP-D (P = 0.47, n = 3) did not change significantly. Subgroup analysis revealed that the type (P = 0.003), but not the duration of exercise (P = 0.77) or the environmental temperature (P = 0.06) affected the CC16 response to endurance exercise.

CONCLUSIONS

Acute endurance exercise increases CC16 and the CC16/SP-D ratio, as markers of epithelial integrity, but not SP-D in athletes and non-athletes.

Chloroform exposure in air and water in Swedish indoor swimming pools-urine as a biomarker of occupational exposure

INTRODUCTION

Disinfection by-products are produced in water disinfected with chlorine-based products. One such group is trihalomethanes, and chloroform is the most abundant trihalomethane in swimming pool areas. Chloroform can be absorbed by inhalation, ingestion, and dermal absorption, and is classified as possibly carcinogenic.

AIM

To investigate if chloroform concentrations in air and water affect the chloroform concentration in urine samples of exposed swimming pool workers.

METHODS

Workers from 5 adventure indoor swimming pools carried personal chloroform air samplers and provided up to 4 urine samples during one workday. Chloroform concentrations were analyzed with a linear mixed model analysis to investigate a possible correlation between air and urine concentrations.

RESULTS

The geometric mean chloroform concentration was 11 μg/m3 in air and 0.009 µg/g creatinine in urine among individuals with ≤2 h at work, 0.023 µg/g creatinine among those with >2-5 working hours, and 0.026 µg/g creatinine in the group with >5-10 working hours. A risk of higher levels of chloroform in urine was associated with longer hours at work (≤2 h versus >5-10 h, odds ratio [OR] 2.04, 95% confidence interval [CI] 1.25-3.34), personal chloroform concentrations in air (≤17.00 µg/m3 versus >28.00 µg/m3, OR 9.23, 95% CI 3.68-23.13) and working at least half the working day near the swimming pools (OR 3.16, 95% CI 1.33-7.55). Executing work tasks in the swimming pool water was not associated with higher chloroform concentrations in urine compared to only working on land (OR 0.82, 95% CI 0.27-2.45).

CONCLUSION

There is an accumulation of chloroform concentrations in urine during a workday and a correlation between personal air and urine concentrations of chloroform among workers in Swedish indoor swimming pools.

Genotoxicity and endocrine disruption potential of haloacetic acids in human placental and lung cells

Chlorination of water results in the formation of haloacetic acids (HAAs) as major disinfection byproducts (DBPs). Previous studies have reported some HAAs species to act as cytotoxic, genotoxic, and carcinogenic. This work aimed at further exploring the toxicity potential of the most investigated HAAs (chloroacetic (CAA), bromoacetic (BAA), iodoacetic (IAA) acid) and HAAs species with high content of bromine (tribromoacetic acid (TBAA)), and iodine in their structures (chloroiodoacetic (CIAA) and diiodoacetic acid (DIAA)) to human cells. Novel knowledge was generated regarding cytotoxicity, oxidative stress, endocrine disrupting potential, and genotoxicity of these HAAs by using human placental and lung cells as in vitro models, not previously used for DBP assessment. IAA showed the highest cytotoxicity (EC₅₀: 7.5 μM) and ability to generate ROS (up to 3-fold) in placental cells, followed by BAA (EC₅₀: 20-25 μM and 2.1-fold). TBAA, CAA, DIAA, and CIAA showed no significant cytotoxicity (EC₅₀ > 250 μM). All tested HAAs decreased the expression of the steroidogenic gene hsd17b1 up to 40 % in placental cells, and IAA and BAA (0.01-1 μM) slightly inhibited the aromatase activity. HAAs also induced the formation of micronuclei in A549 lung cells after 48 h of exposure. IAA and BAA showed a non-significant increase in micronuclei formation at low concentrations (1 μM), while BAA, CAA, CIAA and TBAA were genotoxic at exposure concentrations above 10 μM (100 μM in the case of DIAA). These results point to genotoxic and endocrine disruption effects associated with HAA exposure at low concentrations (0.01-1 μM), and the usefulness of the selected bioassays to provide fast and sensitive responses to HAA exposure, particularly in terms of genotoxicity and endocrine disruption effects. Further studies are needed to define thresholds that better protect public health.

Advances and research needs for disinfection byproducts control strategies in swimming pools

The control of disinfection byproducts (DBPs) in swimming pools is of great significance due to the non-negligible toxicity and widespread existence of DBPs. However, the management of DBPs remains challenging as the removal and regulation of DBPs is a multifactorial phenomenon in pools. This study summarized recent studies on the removal and regulation of DBPs, and further proposed some research needs. Specifically, the removal of DBPs was divided into the direct removal of the generated DBPs and the indirect removal by inhibiting DBP formation. Inhibiting DBP formation seems to be the more effective and economically practical strategy, which can be achieved mainly by reducing precursors, improving disinfection technology, and optimizing water quality parameters. Alternative disinfection technologies to chlorine disinfection have attracted increasing attention, while their applicability in pools requires further investigation. The regulation of DBPs was discussed in terms of improving the standards on DBPs and their preccursors. The development of online monitoring technology for DBPs is essential for implementing the standard. Overall, this study makes a significant contribution to the control of DBPs in pool water by updating the latest research advances and providing detailed perspectives.

Impacts of disinfection byproduct exposures on male reproductive health: Current evidence, possible mechanisms and future needs

Disinfection byproducts (DBPs) are a class of ubiquitous chemicals in drinking water and inevitably result in widespread human exposures. Potentially adverse health effects of DBP exposures, including reproductive and developmental outcomes, have been increasing public concerns. Several reviews have focused on the adverse pregnancy outcomes of DBPs. This review summarized current evidence on male reproduction health upon exposure to DBPs from toxicological and epidemiological literature. Based on existing experimental studies, there are sufficient evidence showing that haloacetic acids (HAAs) are male reproductive toxicants, including reduced epididymal weight, decreased semen parameters and sperm protein 22, and declined testosterone levels. However, epidemiological evidence remains insufficient to support a link of DBP exposures with adverse male reproductive outcomes, despite that blood and urinary DBP biomarkers are associated with decreased semen quality. Eight potential mechanisms, including germ/somatic cell dysfunction, oxidative stress, genotoxicity, inflammation, endocrine hormones, folate metabolism, epigenetic alterations, and gut microbiota, are likely involved in male reproductive toxicity of DBPs. We also identified knowledge gaps in toxicological and epidemiological studies to enhance future needs.

Disinfection byproducts in indoor swimming pool water: Detection and human lifetime health risk assessment

Quantification of regulated and emerging disinfection byproducts (DBPs) in swimming pool water, as well as the assessment of their lifetime health risk are limited in China. In this study, the occurrence of regulated DBPs (e.g., trihalomethanes, haloacetic acids) and emerging DBPs (e.g., haloacetonitriles, haloacetaldehydes) in indoor swimming pool water and the corresponding source water at a city in Eastern China were determined. The concentrations of DBPs in swimming pool water were 1-2 orders of magnitude higher than that in source water. Lifetime cancer and non-cancer risks of DBPs stemming from swimming pool water were also estimated. Inhalation and dermal exposure were the most significant exposure routes related to swimming pool DBP cancer and non-cancer risks. For the first time, buccal and aural exposure were considered, and were proven to be important routes of DBP exposure (accounting for 17.9%-38.9% of total risk). The cancer risks of DBPs for all swimmers were higher than 10^-6 of lifetime exposure risk recommended by United States Environmental Protection Agency, and the competitive adult swimmers experienced the highest cancer risk (7.82 × 10^-5). These findings provide important information and perspectives for future efforts to lower the health risks associated with exposure to DBPs in swimming pool water.

Halogenated By-Products in Chlorinated Indoor Swimming Pools: A Long-Term Monitoring and Empirical Modeling Study

Monitoring the disinfection process and swimming pool water quality is essential for the prevention of microbial infections and associated diseases. However, carcinogenic and chronic-toxic disinfection by-products (DBPs) are formed with reactions between disinfectants and organic/inorganic matters. DBP precursors in swimming pools originate from anthropogenic sources (body secretions, personal care products, pharmaceuticals, etc.) or chemicals used in pools. Temporal (48 weeks) water quality trends of trihalomethanes (THMs), haloacetic acids (HAAs), haloacetonitriles (HANs), and halonitromethanes (HNMs) in two swimming pools (SP-A and SP-B) and precursor-DBP relationships were investigated in this study. Weekly samples were taken from swimming pools, and several physical/chemical water quality parameters, absorbable organic halides (AOX), and DBPs were determined. THMs and HAAs were the most detected DBP groups in pool water. While chloroform was determined to be the dominant THM compound, dichloroacetic acid and trichloroacetic acid were the dominant HAA compounds. The average AOX concentrations were measured to be 304 and 746 μg/L as Cl^- in SP-A and SP-B, respectively. Although the amount of AOX from unknown chlorinated by-products in SP-A did not vary temporally, a significant increase in unknown DBP concentrations in SP-B was observed over time. AOX concentrations of chlorinated pool waters were determined to be an important parameter that can be used to estimate DBP concentrations.

Swimming pool water disinfection by-products profiles and association patterns

The aim of this work was to determine and study the concentration of different groups of disinfection by-products (DBPs): trihalomethanes, haloacetic acids, haloacetonitriles, haloacetones and combined chlorine (as an indicator of chloramine levels), in the water of 175 public swimming pools in Gipuzkoa (Basque Country, Spain). The study included chlorinated and brominated pools, indoor and outdoor, used for recreational and sports purposes, and filled with water from calcareous and siliceous soils. The most abundant were haloacetic acids, followed by trihalomethanes, with chlorinated or brominated forms predominating depending on whether the pools were disinfected by chlorination or bromination, respectively. All the 75th percentiles of DBPs were below the limits established by the European Chemical Agency (ECHA), although the maximum values of trihalomethanes exceeded them. The same was true for dichloroacetonitrile in chlorinated pools and dibromoacetonitrile in brominated pools. All families of DBPs showed positive associations with each other, all being significant except for combined chlorine. Their mean levels were higher in outdoor pools than in indoor pools, significantly so in all except combined chlorine. Recreational pools showed higher levels of haloacetic acids and combined chlorine than sports pools. The concentrations of the different groups of DBPs were higher in the pools than in the mains water that fed them. This increase, especially that of the haloacetonitriles, as well as the high concentrations of brominated forms in the pools disinfected by bromination, make it necessary to focus on their toxicological implication. The differences in the DBP profiles of the filling network water were not transferred to the pool water.

Urinary trihalomethane concentrations and liver function indicators: a cross-sectional study in China

While it is known that exposure to disinfection by-products (DBPs), including trihalomethanes (THMs), impairs liver function, few epidemiological studies have explored this association. Here, we determined the concentrations of four urinary trihalomethanes (chloroform [TCM], and three Br-THMs, bromodichloromethane [BDCM], dibromochloromethane [DBCM], and bromoform [TBM]), and nine serum liver function indicators in 182 adults ≥ 18 years of age, examined at a medical examination center in Wuxi, China, in 2020 and 2021. Generalized linear model analysis revealed positive associations between urinary DBCM and alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), total protein (TP), and albumin (ALB). Urinary Br-THMs and total THMs (TTHMs) were positively associated with ALT, AST, TBIL, indirect bilirubin (IBIL), TP, and ALB (all P < 0.05). Urinary THMs were not associated with alkaline phosphatase (ALP) or glutamine transaminase (GGT) (all P > 0.05). Generalized additive model-based penalized regression splines were used to confirm these associations. In conclusion, THM exposure was associated with altered serum biomarkers of liver function.

Occurrence and Cytotoxicity of Aliphatic and Aromatic Halogenated Disinfection Byproducts in Indoor Swimming Pool Water and Their Incoming Tap Water

Disinfection byproducts (DBPs) in swimming pool water are of wide concern for public health. In this study, the occurrence of five categories of aliphatic halogenated DBPs, i.e., trihalomethanes (THMs), haloacetic acids (HAAs), haloacetonitriles (HANs), halonitromethanes (HNMs), and haloketones (HKs), and six categories of aromatic halogenated DBPs, i.e., halophenols (HPs), halonitrophenols (HNPs), halohydroxy-benzaldehydes (HBALs), halohydroxybenzoic acids (HBAs), halobenzoquinones (HBQs), and haloanilines (HAs), was examined in seven indoor swimming pool water and their incoming tap water. The correlations between the DBP concentrations and water quality parameters were explored. Moreover, the cytotoxicity of the aliphatic and aromatic halogenated DBPs was tested with human hepatoma (HepG2) cells, and the concentration-cytotoxicity contributions of different DBP categories were calculated. The results demonstrate that 24 aliphatic (5 THMs, 8 HAAs, 5 HANs, 4 HNMs, and 2 HKs) and 50 aromatic halogenated DBPs (9 HPs, 8 HNPs, 9 HBALs, 8 HBAs, 11 HBQs, and 5 HAs) were present in the swimming pool water, among which 41 aromatic halogenated DBPs were detected in swimming pool water for the first time. The average concentrations of the five categories of aliphatic halogenated DBPs in the swimming pool water were in the order of HAAs > HANs > HKs > THMs > HNMs, while those in their incoming tap water were in the order of THMs > HAAs > HKs > HANs > HNMs. The average concentrations of the aromatic halogenated DBPs in the swimming pool water were significantly lower than those of the aliphatic halogenated DBPs, following the order of HBQs > HPs > HBAs > HBALs > HAs > HNPs, while those in their incoming tap water were in the order of HBALs > HBQs > HPs > HBAs > HAs > HNPs. The average concentration-cytotoxicity contributions of different DBP categories in the swimming pool water followed the order of HAAs > HANs > HNMs > HKs > HBQs > THMs > HPs > HNPs > HBAs > HBALs > HAs, with HAAs, HANs, and HNMs possessing the main concentration-cytotoxicity contributions (93.2% in total) among all DBP categories.

HBM4EU Chromates Study-Genotoxicity and Oxidative Stress Biomarkers in Workers Exposed to Hexavalent Chromium

A study was conducted within the European Human Biomonitoring Initiative (HBM4EU) to characterize occupational exposure to Cr(VI). Herein we present the results of biomarkers of genotoxicity and oxidative stress, including micronucleus analysis in lymphocytes and reticulocytes, the comet assay in whole blood, and malondialdehyde and 8-oxo-2′-deoxyguanosine in urine. Workers from several Cr(VI)-related industrial activities and controls from industrial (within company) and non-industrial (outwith company) environments were included. The significantly increased genotoxicity (p = 0.03 for MN in lymphocytes and reticulocytes; p < 0.001 for comet assay data) and oxidative stress levels (p = 0.007 and p < 0.001 for MDA and 8-OHdG levels in pre-shift urine samples, respectively) that were detected in the exposed workers over the outwith company controls suggest that Cr(VI) exposure might still represent a health risk, particularly, for chrome painters and electrolytic bath platers, despite the low Cr exposure. The within-company controls displayed DNA and chromosomal damage levels that were comparable to those of the exposed group, highlighting the relevance of considering all industry workers as potentially exposed. The use of effect biomarkers proved their capacity to detect the early biological effects from low Cr(VI) exposure, and to contribute to identifying subgroups that are at higher risk. Overall, this study reinforces the need for further re-evaluation of the occupational exposure limit and better application of protection measures. However, it also raised some additional questions and unexplained inconsistencies that need follow-up studies to be clarified.

Disinfection byproducts in chlorinated or brominated swimming pools and spas: Role of brominated DBPs and association with mutagenicity

Although the health benefits of swimming are well-documented, health effects such as asthma and bladder cancer are linked to disinfection by-products (DBPs) in pool water. DBPs are formed from the reaction of disinfectants such as chlorine (Cl) or bromine (Br) with organics in the water. Our previous study (Daiber et al., Environ. Sci. Technol. 50, 6652; 2016) found correlations between the concentrations of classes of DBPs and the mutagenic potencies of waters from chlorinated or brominated swimming pools and spas. We extended this study by identifying significantly different concentrations of 21 individual DBPs in brominated or chlorinated pool and spa waters as well as identifying which DBPs and additional DBP classes were most associated with the mutagenicity of these waters. Using data from our previous study, we found that among 21 DBPs analyzed in 21 pool and spa waters, the concentration of bromoacetic acid was significantly higher in Br-waters versus Cl-waters, whereas the concentration of trichloroacetic acid was significantly higher in Cl-waters. Five Br-DBPs (tribromomethane, dibromochloroacetic acid, dibromoacetonitrile, bromoacetic acid, and tribromoacetic acid) had significantly higher concentrations in Br-spa versus Cl-spa waters. Cl-pools had significantly higher concentrations of Cl-DBPs (trichloroacetaldehyde, trichloromethane, dichloroacetic acid, and chloroacetic acid), whereas Br-pools had significantly higher concentrations of Br-DBPs (tribromomethane, dibromoacetic acid, dibromoacetonitrile, and tribromoacetic acid). The concentrations of the sum of all 4 trihalomethanes, all 11 Br-DBPs, and all 5 nitrogen-containing DBPs were each significantly higher in brominated than in chlorinated pools and spas. The 8 Br-DBPs were the only DBPs whose individual concentrations were significantly correlated with the mutagenic potencies of the pool and spa waters. These results, along with those from our earlier study, highlight the importance of Br-DBPs in the mutagenicity of these recreational waters.

Do DBPs swim in salt water pools? Comparison of 60 DBPs formed by electrochemically generated chlorine vs. conventional chlorine

Disinfectants are added to swimming pools to kill harmful pathogens. Although liquid chlorine (sodium hypochlorite) is the most commonly used disinfectant, alternative disinfection techniques like electrochemically generated mixed oxidants or electrochemically generated chlorine, often referred to as salt water pools, are growing in popularity. However, these disinfectants react with natural organic matter and anthropogenic contaminants introduced to the pool water by swimmers to form disinfection byproducts (DBPs). DBPs have been linked to several adverse health effects, such as bladder cancer, adverse birth outcomes, and asthma. In this study, we quantified 60 DBPs using gas chromatography-mass spectrometry and assessed the calculated cytotoxicity and genotoxicity of an indoor community swimming pool before and after switching to a salt water pool with electrochemically generated chlorine. Interestingly, the total DBPs increased by 15% upon implementation of the salt water pool, but the calculated cytotoxicity and genotoxicity decreased by 45% and 15%, respectively. Predominant DBP classes formed were haloacetic acids, with trichloroacetic acid and dichloroacetic acid contributing 57% of the average total DBPs formed. Haloacetonitriles, haloacetic acids, and haloacetaldehydes were the primary drivers of calculated cytotoxicity, and haloacetic acids were the primary driver of calculated genotoxicity. Diiodoacetic acid, a highly toxic iodinated DBP, is reported for the first time in swimming pool water. Bromide impurities in sodium chloride used to electrochemically generate chlorine led to a 73% increase in brominated DBPs, primarily driven by bromochloroacetic acid. This study presents the most extensive DBP study to-date for salt water pools.

Hypochlorous Acid: From Innate Immune Factor and Environmental Toxicant to Chemopreventive Agent Targeting Solar UV-Induced Skin Cancer

A multitude of extrinsic environmental factors (referred to in their entirety as the 'skin exposome') impact structure and function of skin and its corresponding cellular components. The complex (i.e. additive, antagonistic, or synergistic) interactions between multiple extrinsic (exposome) and intrinsic (biological) factors are important determinants of skin health outcomes. Here, we review the role of hypochlorous acid (HOCl) as an emerging component of the skin exposome serving molecular functions as an innate immune factor, environmental toxicant, and topical chemopreventive agent targeting solar UV-induced skin cancer. HOCl [and its corresponding anion (OCl-; hypochlorite)], a weak halogen-based acid and powerful oxidant, serves two seemingly unrelated molecular roles: (i) as an innate immune factor [acting as a myeloperoxidase (MPO)-derived microbicidal factor] and (ii) as a chemical disinfectant used in freshwater processing on a global scale, both in the context of drinking water safety and recreational freshwater use. Physicochemical properties (including redox potential and photon absorptivity) determine chemical reactivity of HOCl towards select biochemical targets [i.e. proteins (e.g. IKK, GRP78, HSA, Keap1/NRF2), lipids, and nucleic acids], essential to its role in innate immunity, antimicrobial disinfection, and therapeutic anti-inflammatory use. Recent studies have explored the interaction between solar UV and HOCl-related environmental co-exposures identifying a heretofore unrecognized photo-chemopreventive activity of topical HOCl and chlorination stress that blocks tumorigenic inflammatory progression in UV-induced high-risk SKH-1 mouse skin, a finding with potential implications for the prevention of human nonmelanoma skin photocarcinogenesis.

Occurrence of Disinfection By-Products in Swimming Pools in the Area of Thessaloniki, Northern Greece. Assessment of Multi-Pathway Exposure and Risk

This study investigated the occurrence of disinfection by-products (DBPs) (trihalomethanes (THMs), haloacetic acids (HAAs), halonitriles (HANs), halonitromethane (TCNM) and haloketones (HKs)) in different type of swimming pools in the area of Thessaloniki, northern Greece by employing the EPA methods 551.1 and 552.3. Moreover, general water quality parameters (pH, residual chlorine, dissolved organic carbon, UV₂₅₄ absorption, total nitrogen, alkalinity and conductivity) were also measured. The concentrations of DBPs showed great variability among swimming pools as well as within the same pool between sampling campaigns. HAAs exhibited the highest concentrations followed by THMs, HANs, TCNM and HKs. Exposure doses for four age groups (3–<6 y, 6–<11 y, 11–<16 y and adults) were calculated. Route-specific exposures varied among DBPs groups. Inhalation was the dominant exposure route to THMs and TCNM (up to 92–95%). Ingestion and dermal absorption were the main exposure routes to HAAs (40–82% and 18–59%, respectively), depending on the age of swimmers. HANs contributed up to 75% to the calculated cytotoxicity of pool water. Hazard indices for different exposure routes were <1, suggesting non-carcinogenic risk. Inhalation posed the higher carcinogenic risk for THMs, whereas risk via oral and dermal routes was low. Ingestion and dermal contact posed the higher risk for HAAs. Risk management strategies that minimise DBPs exposure without compromising disinfection efficiency in swimming pools are necessary.

Health effects of exposure to chlorination by-products in swimming pools

Concerns have been raised regarding the potential negative effects on human health of water disinfectants used in swimming pools. Among the disinfection options, the approaches using chlorine-based products have been typically preferred. Chlorine readily reacts with natural organic matter that are introduced in the water mainly through the bathers, leading to the formation of potentially harmful chlorination by-products (CBPs). The formation of CBPs is of particular concern since some have been epidemiologically associated with the development of various clinical manifestations. The higher the concentration of volatile CBPs in the water, the higher their concentration in the air above the pool, and different routes of exposure to chemicals in swimming pools (water ingestion, skin absorption, and inhalation) contribute to the individual exposome. Some CBPs may affect the respiratory and skin health of those who stay indoor for long periods, such as swimming instructors, pool staff, and competitive swimmers. Whether those who use chlorinated pools as customers, particularly children, may also be affected has been a matter of debate. In this article, we discuss the current evidence regarding the health effects of both acute and chronic exposures in different populations (work-related exposures, intensive sports, and recreational attendance) and identify the main recommendations and unmet needs for research in this area.

Making Swimming Pools Safer: Does Copper-Silver Ionization with Chlorine Lower the Toxicity and Disinfection Byproduct Formation?

Swimming pools are commonly treated with chlorine, which reacts with the natural organic matter and organic matter introduced by swimmers and form disinfection byproducts (DBPs) that are associated with respiratory-related issues, including asthma, in avid swimmers. We investigated a complementary disinfectant to chlorine, copper-silver ionization (CSI), with the aim of lowering the amount of chlorine used in pools and limiting health risks from DBPs. We sampled an indoor and outdoor pool treated with CSI-chlorine during the swimming season in 2017-2018 and measured 71 DBPs, speciated total organic halogen, in vitro mammalian cell cytotoxicity, and N-acetyl-l-cysteine (NAC) thiol reactivity as a cytotoxicity predictor. Controlled, simulated swimming pools were also investigated. Emerging DBP concentrations decreased by as much as 80% and cytotoxicity decreased as much as 70% in the indoor pool when a lower chlorine residual (1.0 mg/L) and CSI was used. Some DBPs were quantified for the first time in pools, including chloroacetaldehyde (up to 10.6 μg/L), the most cytotoxic haloacetaldehyde studied to date and a major driver of the measured cytotoxicity in this study. Three highly toxic iodinated haloacetic acids (iodoacetic acid, bromoiodoacetic acid, and chloroiodoacetic acid) were also quantified in pools for the first time. We also found that the NAC thiol reactivity was significantly correlated to cytotoxicity, which could be useful for predicting the cytotoxicity of swimming pool waters in future studies.

Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting

Inorganic chloramines are not commercially available, but monochloramine is produced in situ for disinfection or for use in chemical synthesis. Inorganic chloramines are also formed when free chlorine reacts with nitrogen containing substances, e.g. ammonia and urea, present in chlorinated water sources. Occupational exposure may, therefore, occur in e.g. swimming pool facilities and the food processing industry. Monochloramine is soluble and stable in water and the dominating inorganic chloramine in chlorinated water sources. No clinical effects were seen in healthy volunteers given monochloramine in drinking water during 4 or 12 weeks in doses of 0.043 or 0.034 mg/kg bw/day, respectively. Limited data indicate that monochloramine is weakly mutagenic in vitro but not genotoxic in vivo. One drinking water study indicated equivocal evidence of carcinogenicity in female rats but not in male rats and mice. No reproductive or developmental effects were shown in rodents in the few studies located. Dichloramine is soluble but unstable in water. In the only study located, mild histological effects in kidneys, thyroid and gastric cardia were observed in rats administered dichloramine in drinking water for 13 weeks. Trichloramine is immiscible with water and evaporates easily from water into air. Therefore, the primary exposure route of concern in the occupational setting is inhalation. Occupational exposure to trichloramine has been demonstrated in indoor swimming pool facilities and in the food processing industry where chlorinated water is used for disinfection. Exposure-response relationships between airborne levels and self-reported ocular and upper airway irritation have been shown in several studies. Exposure to trichloramine may aggravate asthma symptoms in individuals with existing asthma. The risk of developing asthma following long-term exposure to trichloramine cannot be evaluated at present. No data on genotoxic, carcinogenic, reproductive or developmental effects were located. The toxicological data for mono- and dichloramine are insufficient to recommend health-based occupational exposure limits (OELs).As regard trichloramine, the critical effect is judged to be irritation observed in several studies on pool workers, starting at approximately 0.4 mg/m³ (stationary sampling). Based on these data, a health-based OEL of 0.1 mg/m³ (8-h time-weighted average) is recommended. This corresponds to 0.2 mg/m³ for stationary measurements in swimming pool facilities. No short-term exposure limit (STEL) is recommended.

A review on the 40th anniversary of the first regulation of drinking water disinfection by-products

Water disinfection, primarily by chlorination, is one of the greatest achievements of public health. However, more than half a century after its introduction, studies in the 1970s reported that (a) chlorine interacted with organic matter in the water to form disinfection by-products (DBPs); (b) two DBPs, chloroform and bromoform, both trihalomethanes (THMs), were rodent carcinogens; (c) three brominated THMs were mutagenic; in six studies chlorinated drinking waters in the United States and Canada were mutagenic; and (d) in one epidemiological study there was an association between bladder cancer mortality and THM exposure. This led the U.S. Environmental Protection Agency to issue its first DBP regulation in 1979. Forty years later, >600 DBPs have been characterized, 20/22 have been shown to be rodent carcinogens, >100 have been shown to be genotoxic, and 1000s of water samples have been found to be mutagenic. Data support a hypothesis that long-term dermal/inhalation exposure to certain levels of the three brominated THMs, as well as oral exposure to the haloacetic acids, combined with a specific genotype may increase the risk for bladder cancer for a small but significant population group. Improved water-treatment methods and stricter regulations have likely reduced such risks over the years, and further reductions in potential risk are anticipated with the application of advanced water-treatment methods and wider application of drinking water regulations. This 40-year research effort is a remarkable example of sustained cooperation between academic and government scientists, along with public/private water companies, to find answers to a pressing public health question.

Health risks and predictive modeling of disinfection byproducts in swimming pools

Disinfection is an indispensable water treatment process used to inactivate pathogens and prevent outbreaks of infectious diseases in swimming pools. However, toxic disinfection byproducts (DBPs) are inevitably formed during the process. To improve the supervision and regulation of DBPs in swimming pools, the reliability of using trihalomethanes (THMs) as the sole indicator of organic DBPs and the possibility of using easily detectable water quality parameters as predictors of DBPs were discussed based on the occurrence of 29 typical DBPs in swimming pools. Among the target DBP categories, THMs and haloacetic acids (HAAs) were the prominent species, and the concentrations of HAAs were the highest. The risk assessment results indicated that the total risk values in most pools were higher than the acceptable value (10^-6). Compared with nitrosamines and THMs, HAAs were the main contributors to the cancer risks posed by dermal absorption and ingestion. THMs (r = 0.619; p < 0.01) and HAAs (r = 0.989; p < 0.01) were both significantly correlated with total DBPs (the sum of 29 DBPs). A stepwise multivariate regression model was developed by analyzing the correlations between total DBPs and water quality parameters, and the relationship coefficient R² was 0.756. This study provides important information and perspectives for the improvement and implementation of standards for swimming pool water.

Formation of haloacetic acids from different organic precursors in swimming pool water during chlorination

Haloacetic acids (HAAs) were reported to be the most abundant category of DBPs in swimming pool water. In this study, the formation of HAAs from different organic precursors in swimming pool water, including UV filters, human body fluids, and natural organic matter (NOM), during chlorination was examined, and the effects of chlorine dose and halide concentrations on the formation of HAAs were evaluated. The results show that the total HAA yields from benzophenone-3 (BP-3) and Suwannee River humic acid (SRHA) were the highest among the nine organic precursors, and the yields of dichloroacetic acid and bromochloroacetic acid were higher than that of the other HAA species. In all the chlorinated samples of different organic precursors, longer chlorination time enhanced HAA formation. Both chlorine dose and bromide concentration significantly affected the formation of HAAs from BP-3 and SRHA during chlorination. With the increasing chlorine dose, the total HAA yields from SRHA and BP-3 significantly increased. Besides, the proportion of trihaloacetic acids (THAAs) rose while that of dihaloacetic acids (DHAAs) and monohaloacetic acids (MHAAs) declined with the increasing chlorine dose. With the increasing bromide concentration, HAA formation from SRHA increased while that of BP-3 decreased. The bromine incorporation factor (BIF) of the formed MHAAs, DHAAs and THAAs from SRHA and BP-3 both increased with the increasing bromide concentration in the following order: BIF_DHAAs > BIF_THAAs > BIF_MHAAs, indicating that bromine was easier to be incorporated into DHAAs rather than MHAAs or THAAs. Moreover, bromide promoted the formation of Br-HAAs.

+Chlorination by-products in indoor swimming pools: Development of a pilot pool unit and impact of operating parameters

Chlorine addition in swimming pools ensures the microbiological quality of the water and the bathers' safety. However, water chlorination is associated with disinfection byproducts (DBP) formation and adverse health effects. The impact of operating parameters and innovative water treatment systems on DBPs levels has been reported in several studies, but sampling campaign in real pools remain difficult to carry out, mainly due to unexpected attendance variations. This study presents the development of a pilot pool plant allowing to perform experiments under controlled and reproducible conditions. Bathers inputs were simulated both for the organic load and for the mechanical agitation of water. Two sampling campaigns were performed during the building of the pilot, before and after the hall was closed. Key operating parameters such as chlorine dose, water temperature and attendance were controlled and monitored. DBP levels in the pilot plant were representative of French indoor swimming pools and the impact of bathers' activity was visible on volatile DBPs. Furthermore, correlations could be stated between operating parameters and DBP levels. Stripping effectively reduced volatile DBP concentrations in water. Moreover, energy consumption data, which are usually very scarce in experimental studies, showed the influence of heat pump consumption on the global energy consumption.