Concentrations and correlations of disinfection by-products in municipal drinking water from an exposure assessment perspective

Haloketones: A class of unregulated priority DBPs with high contribution to drinking water cytotoxicity

Although unregulated aliphatic disinfection byproducts (DBPs) had a much higher concentration and cytotoxicity than known aromatic DBPs, a recent study indicated that seven classes of regulated and unregulated priority DBPs (one and two-carbon-atom DBPs) just accounted for 16.2% of disinfected water cytotoxicity in the U.S., meaning some of the highly toxic aliphatic DBPs may be overlooked. Haloketones (HKs) are an essential class of priority DBPs with a 1-100 µg/L concentration in drinking water but lack cytotoxicity data. This study investigated the cytotoxicity of seven HKs using Chinese hamster ovary (CHO) cells. The order for cytotoxicity of HKs from most to least toxic was: 1,3-dichloroacetone (LC50: 1.0 ± 0.20 μM) ≈ 1,3-dibromoacetone (1.5 ± 0.19 μM) ≈ bromoacetone (1.9 ± 0.49 μM) > chloroacetone (4.3 ± 0.22 μM) > 1,1,3-trichloropropanone (6.6 ± 0.46 μM) > 1,1,1-trichloroacetone (222 ± 7.7 μM) > hexachloroacetone (3269 ± 344 μM). The cytotoxicity of HKs was higher than most regulated and priority aliphatic DBPs in mono-halogenated, di-halogenated, and tri-halogenated categories. A prediction model of HK cytotoxicity was developed based on the quantitative structure-activity relationship (QSAR), optimizing structures and computing descriptors with Gaussian 09 W. The average concentrations of HKs in representative drinking water samples from South Carolina (U.S.) and Suzhou (China) were 12.4 and 0.9 μg/L, respectively, accounting for 18.8% and 1.7% of their specific total DBPs measured (i.e. not TOX). For South Carolina drinking water, their contributions to total calculated additive cytotoxicity of aliphatic DBPs and overall drinking water cytotoxicity were 86.7% and 14.0%, respectively, demonstrating that HKs are an essential class of overlooked DBPs with a high contribution to drinking water cytotoxicity. Our study can help to explain the conflict that why regulated and priority DBPs (except HKs) just accounted for 16% of chlorinated drinking water cytotoxicity even enough they had much higher concentration and cytotoxicity than known aromatic DBPs.

Applications of artificial intelligence (AI) in drinking water treatment processes: Possibilities

In water treatment processes (WTPs), artificial intelligence (AI) based techniques, particularly machine learning (ML) models have been increasingly applied in decision-making activities, process control and optimization, and cost management. At least 91 peer-reviewed articles published since 1997 reported the application of AI techniques to coagulation/flocculation (41), membrane filtration (21), disinfection byproducts (DBPs) formation (13), adsorption (16) and other operational management in WTPs. In this paper, these publications were reviewed with the goal of assessing the development and applications of AI techniques in WTPs and determining their limitations and areas for improvement. The applications of the AI techniques have improved the predictive capabilities of coagulant dosages, membrane flux, rejection and fouling, disinfection byproducts (DBPs) formation and pollutants' removal for the WTPs. The deep learning (DL) technology showed excellent extraction capabilities for features and data mining ability, which can develop an image recognition-based DL framework to establish the relationship among the shapes of flocs and dosages of coagulant. Further, the hybrid techniques (e.g., combination of regression and AI; physical/kinetics and AI) have shown better predictive performances. The future research directions to achieve better control for WTPs through improving these techniques were also emphasized.

Insights to estimate exposure to regulated and non-regulated disinfection by-products in drinking water

BACKGROUND

Knowledge about human exposure and health effects associated with non-routinely monitored disinfection by-products (DBPs) in drinking water is sparse.

OBJECTIVE

To provide insights to estimate exposure to regulated and non-regulated DBPs in drinking water.

METHODS

We collected tap water from homes (N = 42), bottled water (N = 10), filtered tap water with domestic activated carbon jars (N = 6) and reverse osmosis (N = 5), and urine (N = 39) samples of participants from Barcelona, Spain. We analyzed 11 haloacetic acids (HAAs), 4 trihalomethanes (THMs), 4 haloacetonitriles (HANs), 2 haloketones, chlorate, chlorite, and trichloronitromethane in water and HAAs in urine samples. Personal information on water intake and socio-demographics was ascertained in the study population (N = 39) through questionnaires. Statistical models were developed based on THMs as explanatory variables using multivariate linear regression and machine learning techniques to predict non-regulated DBPs.

RESULTS

Chlorate, THMs, HAAs, and HANs were quantified in 98-100% tap water samples with median concentration of 214, 42, 18, and 3.2 μg/L, respectively. Multivariate linear regression models had similar or higher goodness of fit (R2) compared to machine learning models. Multivariate linear models for dichloro-, trichloro-, and bromodichloroacetic acid, dichloroacetonitrile, bromochloroacetonitrile, dibromoacetonitrile, trichloropropnanone, and chlorite showed good predictive ability (R2 = 0.8-0.9) as 80-90% of total variance could be explained by THM concentrations. Activated carbon filters reduced DBP concentrations to a variable extent (27-80%), and reverse osmosis reduced DBP concentrations ≥98%. Only chlorate was detected in bottled water samples (N = 3), with median = 13.0 µg/L. Creatinine-adjusted trichloroacetic acid was the most frequently detected HAA in urine samples (69.2%), and moderately correlated with estimated drinking water intake (r = 0.48).

SIGNIFICANCE

Findings provide valuable insights for DBP exposure assessment in epidemiological studies. Validation of predictive models in a larger number of samples and replication in different settings is warranted.

IMPACT STATEMENT

Our study focused on assessing and describing the occurrence of several classes of DBPs in drinking water and developing exposure models of good predictive ability for non-regulated DBPs.

Comparison of Trihalomethane exposure assessment metrics in epidemiologic analyses of reproductive and developmental outcomes

BACKGROUND

Researchers have developed exposure assessment metrics for disinfection by-products (DBPs) utilizing drinking water monitoring data and accounting for spatial and temporal variability, water consumption, and showering and bathing time with an expectation of decreasing exposure misclassification compared to the use of measured concentrations at public water supply (PWS) monitoring locations alone.

OBJECTIVE

We used exposure data collected for a previous study of DBPs to evaluate how different sources of information impact trihalomethane (THM) exposure estimates.

METHODS

We compared gestational exposure estimates to THMs based on water utility monitoring data alone, statistical imputation of daily concentrations to incorporate temporal variability, and personal water consumption and use (bathing and showering). We used Spearman correlation coefficients and ranked kappa statistics to compare exposure classifications.

RESULTS

Exposure estimates based on measured or imputed daily THM concentrations, self-reported consumption, or bathing and showering differed substantially from estimates based solely on concentrations from PWS quarterly monitoring reports. Ranked exposure classifications, high to low quartiles or deciles, were generally consistent across each exposure metric (i.e., a subject with "high" exposure based on measured or imputed THM concentrations generally remained in the "high" category across exposure metrics.) The measured concentrations and imputed daily (i.e., spline regression) concentrations were highly correlated (r = 0.98). The weighted kappa statistics comparing exposure estimates using different exposure metrics ranged from 0.27 to 0.89, with the highest values for the ingestion + bathing/showering metrics compared to metrics for bathing/showering only (0.76 and 0.89). Bathing and showering contributed the most to "total" THM exposure estimates.

IMPACT STATEMENT

We compare exposure metrics capturing temporal variability and multiple estimates of personal THM exposure with THM concentrations from PWS monitoring data. Our results show exposure estimates based on imputed daily concentrations accounting for temporal variability were very similar to the measured THM concentrations. We observed low agreement between imputed daily concentrations and ingestion-based estimates. Considering additional routes of exposure (e.g., inhalation and dermal) slightly increased agreement with the measured PWS exposure estimate in this population. Overall, the comparison of exposure assessment metrics allows researchers to understand the added value of additional data collection for future epidemiologic analyses of DBPs.

The occurrence, formation and transformation of disinfection byproducts in the water distribution system: A review

Disinfection is an effective process to inactivate pathogens in drinking water treatment. However, disinfection byproducts (DBPs) will inevitably form and may cause severe health concerns. Previous research has mainly focused on DBPs formation during the disinfection in water treatment plants. But few studies paid attention to the formation and transformation of DBPs in the water distribution system (WDS). The complex environment in WDS will affect the reaction between residual chlorine and organic matter to form new DBPs. This paper provides an overall review of DBPs formation and transformation in the WDS. Firstly, the occurrence of DBPs in the WDS around the world was cataloged. Secondly, the primary factors affecting the formation of DBPs in WDS have also been summarized, including secondary chlorination, pipe materials, biofilm, deposits and coexisting anions. Secondary chlorination and biofilm increased the concentration of regular DBPs (e.g., trihalomethanes (THMs) and haloacetic acids (HAAs)) in the WDS, while Br^- and I^- increased the formation of brominated DBPs (Br-DBPs) and iodinated DBPs (I-DBPs), respectively. The mechanism of DBPs formation and transformation in the WDS was systematically described. Aromatic DBPs could be directly or indirectly converted to aliphatic DBPs, including ring opening, side chain breaking, chlorination, etc. Finally, the toxicity of drinking water in the WDS caused by DBPs transformation was examined. This review is conducive to improving the knowledge gap about DBPs formation and transformation in WDS to better solve water supply security problems in the future.

Long-Term Exposure to Nitrate and Trihalomethanes in Drinking Water and Prostate Cancer: A Multicase-Control Study in Spain (MCC-Spain)

BACKGROUND

Nitrate and trihalomethanes (THMs) in drinking water are widespread and are potential human carcinogens.

OBJECTIVE

We evaluated the association between drinking-water exposure to nitrate and THMs and prostate cancer.

METHODS

During the period 2008-2013, 697 hospital-based incident prostate cancer cases (97 aggressive tumors) and 927 population-based controls were recruited in Spain, providing information on residential histories and type of water consumed. Average nitrate and THMs levels in drinking water were linked with lifetime water consumption to calculate waterborne ingestion. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using mixed models with recruitment area as random effect. Effect modification by tumor grade (Gleason score), age, education, lifestyle, and dietary factors was explored.

RESULTS

Mean (±standard deviation) adult lifetime waterborne ingested nitrate (milligrams per day), brominated (Br)-THMs (micrograms per day), and chloroform (micrograms per day) were 11.5 (±9.0), 20.7 (±32.4), and 15.1 (±14.7) in controls. Waterborne ingested nitrate >13.8 vs. <5.5mg/d was associated with an OR of 1.74 (95% CI: 1.19, 2.54) overall, and 2.78 (95% CI: 1.23, 6.27) for tumors with Gleason scores ≥8. Associations were higher in the youngest and those with lower intakes of fiber, fruit/vegetables, and vitamin C. Waterborne ingested THMs were not associated with prostate cancer. Residential tap water levels of Br-THMs and chloroform showed, respectively, inverse and positive associations with prostate cancer.

CONCLUSIONS

Findings suggest long-term waterborne ingested nitrate could be a risk factor of prostate cancer, particularly for aggressive tumors. High intakes of fiber, fruit/vegetables and vitamin C may lower this risk. Association with residential levels but not ingested chloroform/Br-THM may suggest inhalation and dermal routes could be relevant for prostate cancer. https://doi.org/10.1289/EHP11391.

Precursor characteristics of mono-HAAs during chlorination and cytotoxicity of mono-HAAs on HEK-293T cells

Monohaloacetic acids (mono-HAAs), a class of disinfection by-products widely occurred in drinking water, receives significant attention due to their extremely high toxicity. Many studies on the biological toxicity of mono-HAAs have been reported, yet the toxic effects of mono-HAAs on human renal cells (kidney is one of the target organs for disinfection by-products) has not been involved. Studies on organic precursors for mono-HAAs formation were also very limited due to their lower levels as compared to di-HAAs and tri-HAAs. Based on this, the formation of mono-HAAs after chlorination of some typical source water samples and their relationship with water quality parameters were investigated. Meanwhile, the cytotoxicity of monochloroacetic acid (MCAA), monobromoacetic acid (MBAA), and monoiodoacetic acid (MIAA) were tested using human embryonic kidney cells (HEK-293 T cells). The results showed that the levels of mono-HAAs formed during chlorination of source water samples were between 0.44 and 0.87 μg/L. Formation of MBAA positively (p < 0.05) correlated with bromide ion and dissolved organic carbon, but negatively (p < 0.01) correlated with SUVA₂₅₄ (specific UV absorbance at 254 nm), while formation of MCAA was only positively (p < 0.05) related with SUVA₂₅₄. These results suggested that although MCAA and MBAA both belong to the mono-HAAs, the characteristics of their organic precursors differ significantly. MCAA precursors have high aromaticity and are more hydrophobic, yet MBAA precursors have low aromaticity and are more hydrophilic. The half-lethal concentrations (LC₅₀) of MCAA, MBAA, and MIAA on HEK293T cells were 1196-1211 μM, 16.07-18.96 μM, and 6.08-6.17 μM, respectively. An in-depth analysis showed that the cytotoxicity of mono-HAAs on HEK 293 T cells could not be explained by the parameters concerning cellular uptake (e.g., logP and pKa), but the S_N2 reaction of C-X bond with cellular molecules (e.g., glyceraldehyde-3-phosphate dehydrogenase, etc) may be the relevant cause for the cytotoxicity of mono-HAAs on HEK 293 T cells.

Assessing volatile organic compounds exposure and prostate-specific antigen: National Health and Nutrition Examination Survey, 2001–2010

Background

Volatile organic compounds (VOCs) are a large group of chemicals widely used in people's daily routines. Increasing evidence revealed the VOCs' accumulating toxicity. However, the VOCs toxicity in male prostate has not been reported previously. Thus, we comprehensively evaluated the association between VOCs and prostate-specific antigen (PSA).

Methods

A total of 2016 subjects were included in our study from the National Health and Nutrition Examination Survey with VOCs, PSA, and other variables among U.S. average population. We constructed XGBoost Algorithm Model, Regression Model, and Generalized linear Model (GAM) to analyze the potential association. Stratified analysis was used to identify high-risk populations.

Results

XGBoost Algorithm model identified blood chloroform as the most critical variable in the PSA concentration. Regression analysis suggested that blood chloroform was a positive association with PSA, which showed that environmental chloroform exposure is an independent risk factor that may cause prostate gland changes [β, (95% CI), P = 0.007, (0.003, 0.011), 0.00019]. GAM observed the linear relationship between blood chloroform and PSA concentration. Meanwhile, blood chloroform linear correlated with water chloroform in the lower dose range, indicating that the absorption of water may be the primary origin of chloroform. Stratified associations analysis identified the high-risk group on the chloroform exposures.

Conclusion

This study revealed that blood chloroform was positively and independently associated with total PSA level, suggesting that long-term environmental chloroform exposure may cause changes in the prostate gland.

Potential risks and approaches to reduce the toxicity of disinfection by-product - A review

Water contamination through anthropogenic and industrial activities has led to the emergence and necessity of disinfection methods. Chlorine and bromine gases, often used to disinfect water, resulted in the by-product formation by reacting with organic matter. The Disinfectant by-products (DBP) led to the formation of Trihaloaceticacid (TAA), Trihalomethane (THM), and other minor components. The release of chemicals has also led to the outbreak of diseases like infertility, asthma, stillbirth, and types of cancer. There are new approaches that are found to be useful to compensate for the generation of toxic by-products and involve membrane technologies, namely reverse osmosis, ultrafiltration, and nanofiltration. This review mainly focuses on the toxicology effects of DBPs and various approaches to mitigate the same. The health hazards caused by different DBPs and the various treatment techniques available for the removal are discussed. In addition, a critical comparison of the different removal techniques was discussed.

Assessment of Water Quality Parameters and their Seasonal Behaviour in a Portuguese Water Supply System: a 6-year Monitoring Study

Water quality monitoring is a fundamental tool in the management of freshwater resources. The purpose of monitoring is to provide meaningful quality data for local action planning and catchment-wide decision making. The assessment of water quality is crucial to guarantee the efficient operation of the Water Treatment Plants (WTPs), promoting health conditions and contributing for a more sustainable urban water cycle. In accordance, the objective of this study was to evaluate key target chemical and microbiological water quality parameters, some of them already monitored within Portuguese/EU legal framework and others still not regulated, but with environmental and human heath relevance. A local monitoring database model, using a 6-year period (from 2014 to 2019) of water quality data, regarding water samples collected on representative sampling locations covering the freshwater abstraction sites, conventional WTPs and distribution network was assessed. This work provides new knowledge regarding occurrence and seasonal behaviour for both microbiological and chemical water quality parameters, essential to understand/manage the water supply system. Additionally, relationships between the target variables were also assessed. Particularly, strong correlations were identified between TOC and THMs formation at distribution network (r = 0.69; p ≤ 0.001); nitrates were the water quality parameter that revealed the best correlation between surface water source and treated water (r = 0.81; p ≤ 0.001), suggesting that treatment yield/performance is dependent on surface water load. The local and continuous monitoring of water systems are crucial to implement new approaches to guarantee the best quality of drinking water throughout the supply system.

Exposure to widespread drinking water chemicals, blood inflammation markers, and colorectal cancer

BACKGROUND

Trihalomethanes (THMs) and nitrate are widespread chemicals in drinking water associated with colorectal cancer risk but mechanisms are not well understood.

OBJECTIVES

We explored the association between exposure to THMs and nitrate in drinking water and inflammation markers, and the link with colorectal cancer risk.

METHODS

A subset of 198 colorectal cancer cases and 205 controls from the multicase-control study MCC-Spain were included. Average concentration of THMs (chloroform, bromodichloromethane, dibromochloromethane, bromoform) and nitrate in tap water at the residence was estimated from age 18 until 2 years before the interview ("long term") and for a recent period (3 years before diagnosis). Serum levels of EGF, eotaxin, G-CSF, IL-17E, IL-1rA, IL-8, IP-10, MDC, MPO, periostin, VEGF, and C-reactive protein (CRP) were measured. We estimated the linear association between inflammation markers and exposure among controls, and the odds ratio of colorectal cancer associated with THM and nitrate exposure, and inflammation markers. A mediation analysis was conducted to identify inflammation markers in the pathway between THM/nitrate exposure and colorectal cancer.

RESULTS

Serum concentrations of EGF, IL-8, IL-17E and eotaxin increased with recent residential levels of brominated THMs, chloroforom and/or total THM. No associations were observed for nitrate and for long-term residential THM levels. All residential exposures except chloroform were positively associated with colorectal cancer. Serum concentrations of VEGF and periostin were positively associated with colorectal cancer, while EGF was inversely associated. One protein-exposure combination (periostin-recent ingested brominated THMs) slightly mediated the association with colorectal cancer risk.

DISCUSSION

Results suggest that estimated THM exposure is involved in inflammation processes. However, the study design was limited to stablish etiologically relevant associations between the protein levels and colorectal cancer risk. The lack of association between nitrate exposure and inflammation markers suggests other biological mechanisms are involved in the link with colorectal cancer.

Predicting unregulated disinfection by-products in small water distribution networks: an empirical modelling framework

Disinfection is used to deactivate pathogens in drinking water. However, disinfectants react with natural organic matter present in water to form disinfection by-products (DBPs). While a few of these DBPs have been studied extensively and are regulated in many countries, new unregulated DBPs (UR-DBPs) have also recently been identified in drinking water. The UR-DBPs are considered to be more toxic than regulated DBPs (R-DBPs). To understand the occurrence of UR-DBPs in a water distribution network (WDN), this research presents an approach to predicting the behaviour of emerging UR-DBPs such as dichloroacetonitrile (DCAN), trichloropropanone (TCP), and trichloronitromethane (TCNM) in WDNs. Water quality data, generated by sampling and laboratory analysis of 12 small communities, was used to develop predictive models. A framework was also proposed alongside the predictive models to estimate the concentration of emerging UR-DBPs under limited water quality sampling information. Moreover, the relationship between emerging UR-DBP concentrations and their identified predictors was further observed and evaluated by developing contour profiles. DCAN and TCP predictive models have coefficient of determination (R²) > 85%, whereas for TCNM model, the R² was > 65%. Water quality parameters including water temperature, turbidity, conductivity, and dissolved organic carbon concentrations were identified as key predictors. Similarly, trichloroacetic acid and bromodichloromethane were identified as key predictors among DBP families, to predict the occurrence of emerging UR-DBPs. Developed models and relationships between the UR-DBPs and predictors can help water utilities and regulators to manage the occurrence of UR-DBPs in small WDNs.

Disinfection By-Product Exposures and the Risk of Musculoskeletal Birth Defects

Supplemental Digital Content is available in the text.

Epidemiologic studies suggest that exposure to water disinfection by-products (DBPs) may increase the risk of certain birth defects. However, evidence for musculoskeletal defects (MSDs) is limited. Previous MSD studies have not examined DBPs beyond trihalomethanes (THMs) and have not separately examined limb or diaphragm defects which may have distinct developmental etiologies.

Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union

BACKGROUND

Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk.

OBJECTIVE

We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer.

METHODS

We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records. We estimated a linear exposure-response function for average residential THM levels and bladder cancer by pooling data from studies included in the largest international pooled analysis published to date in order to estimate odds ratios (ORs) for bladder cancer associated with the mean THM level in each country (relative to no exposure), population-attributable fraction (PAF), and number of attributable bladder cancer cases in different scenarios using incidence rates and population from the Global Burden of Disease study of 2016.

RESULTS

We obtained 2005-2018 THM data from EU26, covering 75% of the population. Data coverage and accuracy were heterogeneous among countries. The estimated population-weighted mean THM level was 11.7μg/L [standard deviation (SD) of 11.2]. The estimated bladder cancer PAF was 4.9% [95% confidence interval (CI): 2.5, 7.1] overall (range: 0-23%), accounting for 6,561 (95% CI: 3,389, 9,537) bladder cancer cases per year. Denmark and the Netherlands had the lowest PAF (0.0% each), while Cyprus (23.2%), Malta (17.9%), and Ireland (17.2%) had the highest among EU26. In the scenario where no country would exceed the current EU mean, 2,868 (95% CI: 1,522, 4,060; 43%) annual attributable bladder cancer cases could potentially be avoided.

DISCUSSION

Efforts have been made to reduce THM levels in the European Union. However, assuming a causal association, current levels in certain countries still could lead to a considerable burden of bladder cancer that could potentially be avoided by optimizing water treatment, disinfection, and distribution practices, among other possible measures. https://doi.org/10.1289/EHP4495.

Occurrence and spatio-temporal variability of halogenated acetaldehydes in full-scale drinking water systems

As the third largest group of identified disinfection by-products (DBPs) by weight, halogenated acetaldehydes (HALs), were monitored for one year at numerous locations in two full-scale drinking water systems applying an ozone-chlorine sequential disinfection strategy. The HALs that were targeted included four trihalogenated acetaldehydes (THALs): chloral hydrate (CH), bromodichloroacetaldehyde (BDCAL), dibromochloroacetaldehyde (DBCAL) and tribromoacetaldehyde (TBAL). Three dihalogenated acetaldehydes (DHALs) were also included: dichloroacetaldehyde (DCAL), bromochloroacetaldehyde (BCAL) and dibromoacetaldehyde(DBAL). In addition to various sampling points in two distribution networks, this study also investigated the formation of HALs during water treatment and for the first time, reports the formation of DBAL before chlorine is applied. Low bromide levels in source waters from both systems resulted in the rare detection of DBAL and TBAL. CH accounted for >50% of total HALs (HAL7) with DHALs accounting for as little as 10% of HAL7, presumably due to the use of ozone-chlorine instead of ozone-chloramine. In the presence of chlorine residuals and with increasing water residence times, most HALs continued to form, more readily in warm water than in cold water. However, the spatial and temporal patterns for each HAL differed depending on speciation (THAL vs. DHAL) and water temperature. Compared to the relatively stable bromine incorporation factor (BIF) of THMs in the distribution systems, the decreasing BIFs of HALs according to water residence time increases suggested that bromine-containing THMs are more stable than their corresponding HALs. Re-chlorination at the extremities of the distribution networks demonstrated a significant impact on the occurrence and speciation of DBPs. In both full-scale systems, water temperature was shown to be the biggest contributing factor to HAL formation. The strong correlations between THM levels and THAL levels make it possible to predict the occurrence of THALs based on THMs.

Disinfection Byproducts in Rajasthan, India: Are Trihalomethanes a Sufficient Indicator of Disinfection Byproduct Exposure in Low-Income Countries?

The implementation of chlorine disinfection in low-income countries reduces the risk of waterborne illness but initiates exposure to disinfection byproducts (DBPs). Like high-income countries, low-income countries typically are adopting regulations focusing on trihalomethanes (THM4) as an indicator of overall DBP exposure. However, the use of impaired water sources can decouple the formation of THM4 from other DBP classes that are more potent toxins. The documentation of DBP species other than THM4 is rare in low-income countries, where water sources may be degraded by inadequate sanitation infrastructure and other uncontrolled wastewater discharges. We measured THM4 and 21 unregulated DBPs in tap waters and laboratory-treated source waters from two cities in northwestern India. The contribution of each DBP class to the cumulative toxicity was estimated by weighting each species by metrics of toxic potency; haloacetonitriles typically were the dominant contributor, while the contribution of THM4 was negligible. THM4 concentrations did not correlate with the total toxic potency-weighted DBP concentrations. Although THM4 rarely exceeded international guidelines, DBPs of greater toxicological concern were observed in high concentrations. The total toxic potency-weighted DBP concentrations in some waters were elevated compared to conventional drinking waters in high-income countries and more closely resembled chlorine-disinfected wastewater effluents. Artificial sweeteners confirmed widespread contamination of both surface and groundwaters by domestic sewage. The results suggest that THM4 may not be an adequate indicator of overall DBP exposure in impaired water supplies prevalent in some low-income nations.

Associations Between Disinfection By-Product Exposures and Craniofacial Birth Defects

OBJECTIVE

The aim of this study was to examine associations between craniofacial birth defects (CFDs) and disinfection by-product (DBP) exposures, including the sum of four trihalomethanes (THM4) and five haloacetic acids (HAA5) (ie, DBP9).

METHODS

We calculated first trimester adjusted odds ratios (aORs) for different DBPs in a matched case-control study of 366 CFD cases in Massachusetts towns with complete 1999 to 2004 THM and HAA data.

RESULTS

We detected elevated aORs for cleft palate with DBP9 (highest quintile aOR = 3.52; 95% CI: 1.07, 11.60), HAA5, trichloroacetic acid (TCAA), and dichloroacetic acid. We detected elevated aORs for eye defects with TCAA and chloroform.

CONCLUSION

This is the first epidemiological study of DBPs to examine eye and ear defects, as well as HAAs and CFDs. The associations for cleft palate and eye defects highlight the importance of examining specific defects and DBPs beyond THM4.

A one-year long survey of temporal disinfection byproducts variations in a consumer's tap and their removals by a point-of-use facility

In order to better understand the occurrence of disinfection byproducts (DBPs) in tap water and their real impacts on consumers, this study made a one-year long survey of the temporal variations of a series of DBPs before and after a point-of-use (POU) treatment facility installed in a building serving for ∼300 people. Water samples were collected every week at a fixed location and time for 1 year, and frequent samplings were carried out every 6 h a day for 1 month at selected seasons, which ultimately amounted to 322 samples. The results show that the concentrations of DBPs were higher in the summer than other seasons, with the lowest DBP levels being observed in spring. Within one week, higher levels of haloacetic acids (HAAs) were identified on weekdays than those on weekends. Diurnally, trihalomethanes, HAAs, and haloacetaldehydes were found to be higher at noon but lower in the evening. Consistent with other studies, the variations of most DBPs were somewhat positively related to the changes of temperature and organic matter, but negatively related to the quantity of free chlorine. With the use of a POU facility, which equips with two activated carbon cartridges and a boiler in sequence, most of DBPs were dramatically reduced, leading to 62-100% lower cytotoxicity for the measured DBPs. The study hence provides a real-water evidence about the DBP occurrences in a typical distribution system endpoint and the efficiency of a typical POU on mitigating DBP risks.

Exposure to disinfectant by-products and the risk of stillbirth in Massachusetts

OBJECTIVES

We examined stillbirths in relation to disinfection by-product (DBP) exposures including chloroform, bromodichloromethane (BDCM), dibromochloromethane, bromoform, trichloroacetic acid, dichloroacetic acid (DCAA), monobromoacetic acid and summary DBP measures (trihalomethanes (THM4), haloacetic acids (HAA5), THMBr (brominated trihalomethanes) and DBP9 (sum of THM4 and HAA5)).

METHODS

We randomly selected 10 controls for each of the 2460 stillbirth cases with complete quarterly 1997-2004 THM4 and HAA5 town-level drinking water data. Adjusted (aORs) were calculated based on weight-averaged second-trimester DBP exposures.

RESULTS

We detected statistically significant associations for stillbirths and the upper DCAA quartiles (aOR range: 1.50-1.71). We also found positive associations for the upper four HAA5 quintiles and different stillbirth cause of death categories that were examined including unexplained stillbirth (aOR range: 1.24-1.72), compression of umbilical cord (aOR range: 1.08-1.94), prematurity (aOR range: 1.37-2.88), placental separation and haemorrhage (aOR range: 1.44-2.01) and asphyxia/hypoxia (aOR range: 1.52-1.97). Additionally, we found positive associations between stillbirths and chloroform exposure (aOR range: 1.29 - 1.36) and unexplained stillbirths and BDCM exposure (aOR range: 1.51 - 1.78). We saw no evidence of exposure-response relationships for any categorical DBP metrics.

CONCLUSIONS

Consistent with some previous studies, we found associations between stillbirths and chloroform and unexplained stillbirth and BDCM exposures. These findings strengthen existing evidence of prenatal THM exposures increasing the risk of stillbirth. Additionally, we saw statistically significant associations between DCAA and stillbirth. Future research should examine cause-specific stillbirths in relation to narrower critical windows and additional DBP exposure metrics beyond trihalomethanes and haloacetic acids.

Long-term exposure to trihalomethanes in drinking water and breast cancer in the Spanish multicase-control study on cancer (MCC-SPAIN)

BACKGROUND

Exposure to trihalomethanes (THMs) in drinking water has consistently been associated with an increased risk of bladder cancer, but evidence on other cancers including the breast is very limited.

OBJECTIVES

We assessed long-term exposure to THMs to evaluate the association with female breast cancer (BC) risk.

METHODS

A multi case-control study was conducted in Spain from 2008 to 2013. We included 1003 incident BC cases (women 20-85years old) recruited from 14 hospitals and 1458 population controls. Subjects were interviewed to ascertain residential histories and major recognized risk factors for BC. Mean residential levels of chloroform, brominated THMs (Br-THMs) and the sum of both as total THM (TTHMs) during the adult-lifetime were calculated.

RESULTS

Mean adult-lifetime residential levels ranged from 0.8 to 145.7μg/L for TTHM (median=30.8), from 0.2 to 62.4μg/L for chloroform (median=19.7) and from 0.3 to 126.0μg/L for Br-THMs (median=9.7). Adult-lifetime residential chloroform was associated with BC (adjusted OR=1.47; 95%CI=1.05, 2.06 for the highest (>24μg/L) vs. lowest (<8μg/L) quartile; p-trend=0.024). No association was detected for residential Br-THMs (OR=0.91; 95%CI=0.68, 1.23 for >31μg/L vs. <6μg/L) or TTHMs (OR=1.14; 95%CI=0.83, 1.57 for >48μg/L vs. <22μg/L).

CONCLUSIONS

At common levels in Europe, long-term residential total THMs were not related to female breast cancer. A moderate association with chloroform was suggested at the highest exposure category. This large epidemiological study with extensive exposure assessment overcomes several limitations of previous studies but further studies are needed to confirm these results.

Drinking water disinfection by-products during pregnancy and child neuropsychological development in the INMA Spanish cohort study

BACKGROUND

Disinfection by-products (DBPs) constitute a complex mixture of prevalent chemicals in drinking water and there is evidence of neurotoxicity for some of them.

OBJECTIVES

We evaluated the association between estimates of DBP exposure during pregnancy and child neuropsychological outcomes at 1 and 4-5years of age.

METHODS

We conducted a population-based mother-child cohort study in Spain with recruitment at first trimester of gestation (INMA Project, 2003-2008). Neuropsychological development was measured at 1year of age using the Bayley Scales of Infant Development and at 4-5years with the McCarthy Scales of Children's Abilities. Modeled tap water concentrations of trihalomethanes (THM) were combined with personal ingestion, showering and bathing habits to estimate exposure as ingestion uptake, all route (showering, bathing, ingestion) uptake (μg/day) and crude levels (μg/l) in the residence. Chloroform, brominated THMs (bromodichloromethane, dibromochloromethane, bromoform) and total THMs (chloroform and brominated THMs) were analysed separately. Nine haloacetic acids levels were available in one of the areas. Linear regression was used to estimate associations in 1855 subjects adjusting for covariables.

RESULTS

The median concentration of total THMs, chloroform, brominated THMs, total haloacetic acids, dichloroacetic acid, and trichloroacetic acid were, respectively 30.3μg/L, 9.4μg/L, 11.6μg/L, 10.5μg/L, 2.7μg/L, and 3.1μg/L. The associations between THM exposure and neuropsychological outcomes were null, except for total and brominated THM uptake though all routes and the general cognitive score at 4-5years, with a decrease in -0.54 points (95%CI -1.03, -0.05) and -0.64 (95%CI -1.16, -0.12), respectively, for doubling total and brominated THM uptake. A positive association found between dichloroacetic acid and the mental score at 1year did not persist at 4-5years.

CONCLUSIONS

Minor associations observed between DBP exposure during gestation and child neuropsychological development at 1year disappeared at 4-5years. Although a suggestive association is identified for exposure to brominated THMs and the cognitive score at 4-5years, chance cannot be ruled out.

Chemical quality of tap water in Madrid: multicase control cancer study in Spain (MCC-Spain)

Chronic consumption of water, which contains contaminants, may give rise to adverse health effects. The Madrid region, covered by the population-based multicase-control (MCC-Spain) study, includes two drinking water supply areas. The different sources of the water, coupled together with the possible differences in water management, mean that there may be differences in drinking water quality. In the context of the MCC study, our aims were to describe contaminant concentrations in tap water drawn from various sampling points distributed around the region, assess these concentrations by reference to guideline values and study possible differences between the two supply areas. Tap water samples were collected from 34 sampling points in 7 towns in the Madrid region (19-29 April 2010), and 23 contaminants (metals, nitrates, disinfection by-product and Mutagen X levels) were quantified. We undertook a descriptive analysis of the contaminant concentrations in the water and compared them between the two water supply areas (Wilcoxon test). We created maps representing the distribution of the concentrations observed at water sampling points and assessed the correlations (Spearman's coefficient) between the different parameters measured. The concentrations of the contaminants were below guideline values. There were differences between the two supply areas in concentration of nitrates (p value = 0.0051) and certain disinfection by-products. While there were positive correlations (rho >0.70) among some disinfection by-products, no correlations were found in metals or nitrates. The differences in nitrate levels could be linked to differences in farming/industrial activities in the catchment areas and in disinfection by-products might be related to the existence of different treatment systems or bromine content in source waters.

Combined genotoxicity of chlorinated products from tyrosine and benzophenone-4

The toxicity of disinfection by-products (DBPs) from a single precursor was studied intensively. Here we examined the genotoxicity when two precursors (tyrosine (Tyr) and benzophenone-4 (BP-4)) were chlorinated together and separately. We sought to examine whether the genotoxicity of the mixture (GCM) could be estimated from the sum of the genotoxicities of the individual precursors (GCI), which were chlorinated separately. We determined the genotoxicity using the SOS/umu test. The results revealed that GCM was not identical to GCI. The difference in genotoxicity between GCM and GCI (G_Δ) was observed to decrease with increasing pH. GCM was higher than GCI (G_Δ>0) at pH 5.0-6.1, and lower than GCI (G_Δ<0) at pH 6.3-8.0. We found that nitrogen-containing DBPs played a dominant role in determining GCM and GCI. We propose that the total organic nitrogen (TON) ratio, TON_{(chlorinatedmixture)}/TON_{(thesumofchlorinatedindividuals)}, is useful to estimate G_Δ.

Understanding and exploring the potentials of household water treatment methods for volatile disinfection by-products control: Kinetics, mechanisms, and influencing factors

This study systematically evaluates the capabilities of five types of household water treatment (HWT) methods (including boiler heating, microwave irradiation, pouring, stirring, and shaking) on the removals of four regulated trihalomethanes (THM₄) and three iodinated halomethanes (IHMs) under a variety of conditions simulative of residential uses. Overall, the results clearly showed promising capabilities of all five HWT methods in controlling volatile disinfection by-products (DBPs), and heating with a boiler was the most effective approach among all methods due to the synergistic effects of water turbulence and bubbling phenomena. A contemporary boiler equipped with an automatic switch-off function reduced on average 92% of seven halomethanes (HM₇) at favourable conditions. The removal increased significantly with increasing initial concentrations and the rates correlated well with the logarithmic Henry's law constants and molecular weights of compounds, with triiodomethane being the most refractory species. Meanwhile, the importance of water handling habits was revealed, including power input, operation time, volume, heating/cooling speed, cooling method, and capping conditions. The findings hence explored the potentials of HWTs on DBP control and pointed out a potential limit to DBP epidemiology studies that do not consider water handling habits.

Colorectal Cancer and Long-Term Exposure to Trihalomethanes in Drinking Water: A Multicenter Case-Control Study in Spain and Italy

BACKGROUND

Evidence on the association between colorectal cancer and exposure to disinfection by-products in drinking water is inconsistent.

OBJECTIVES

We assessed long-term exposure to trihalomethanes (THMs), the most prevalent group of chlorination by-products, to evaluate the association with colorectal cancer.

METHODS

A multicenter case-control study was conducted in Spain and Italy in 2008-2013. Hospital-based incident cases and population-based (Spain) and hospital-based (Italy) controls were interviewed to ascertain residential histories, type of water consumed in each residence, frequency and duration of showering/bathing, and major recognized risk factors for colorectal cancer. We estimated adjusted odds ratios (OR) for colorectal cancer in association with quartiles of estimated average lifetime THM concentrations in each participant's residential tap water (micrograms/liter; from age 18 to 2 years before the interview) and estimated average lifetime THM ingestion from drinking residential tap water (micrograms/day).

RESULTS

We analyzed 2,047 cases and 3,718 controls. Median values (ranges) for average lifetime residential tap water concentrations of total THMs, chloroform, and brominated THMs were 30 (0-174), 17 (0-63), and 9 (0-145) μg/L, respectively. Total THM concentration in residential tap water was not associated with colorectal cancer (OR = 0.92, 95% CI: 0.66, 1.28 for highest vs. lowest quartile), but chloroform concentrations were inversely associated (OR = 0.31, 95% CI: 0.24, 0.41 for highest vs. lowest quartile). Brominated THM concentrations showed a positive association among men in the highest versus the lowest quartile (OR = 1.43, 95% CI: 0.83, 2.46). Patterns of association were similar for estimated average THM ingestion through residential water consumption.

CONCLUSIONS

We did not find clear evidence of an association between detailed estimates of lifetime total THM exposure and colorectal cancer in our large case-control study population. Negative associations with chloroform concentrations and ingestion suggest differences among specific THMs, but these findings should be confirmed in other study populations. Citation: Villanueva CM, Gracia-Lavedan E, Bosetti C, Righi E, Molina AJ, Martín V, Boldo E, Aragonés N, Perez-Gomez B, Pollan M, Gomez Acebo I, Altzibar JM, Jiménez Zabala A, Ardanaz E, Peiró R, Tardón A, Chirlaque MD, Tavani A, Polesel J, Serraino D, Pisa F, Castaño-Vinyals G, Espinosa A, Espejo-Herrera N, Palau M, Moreno V, La Vecchia C, Aggazzotti G, Nieuwenhuijsen MJ, Kogevinas M. 2017. Colorectal cancer and long-term exposure to trihalomethanes in drinking water: a multicenter case---control study in Spain and Italy. Environ Health Perspect 125:56-65; http://dx.doi.org/10.1289/EHP155.

Environmental and personal determinants of the uptake of disinfection by-products during swimming

BACKGROUND

Trihalomethanes (THMs) in exhaled breath and trichloroacetic acid (TCAA) in urine are internal dose biomarkers of exposure to disinfection by-products (DBPs) in swimming pools.

OBJECTIVE

We assessed how these biomarkers reflect the levels of a battery of DBPs in pool water and trichloramine in air, and evaluated personal determinants.

METHODS

A total of 116 adults swam during 40min in a chlorinated indoor pool. We measured chloroform, bromodichloromethane, dibromochloromethane and bromoform in exhaled breath and TCAA in urine before and after swimming, trichloramine in air and several DBPs in water. Personal determinants included sex, age, body mass index (BMI), distance swum, energy expenditure, heart rate and 12 polymorphisms in GSTT1, GSTZ1 and CYP2E1 genes.

RESULTS

Median level of exhaled total THMs and creatinine adjusted urine TCAA increased from 0.5 to 14.4µg/m(3) and from 2.5 to 5.8µmol/mol after swimming, respectively. The increase in exhaled brominated THMs was correlated with brominated THMs, haloacetic acids, haloacetonitriles, haloketones, chloramines, total organic carbon and total organic halogen in water and trichloramine in air. Such correlations were not detected for exhaled chloroform, total THMs or urine TCAA. Exhaled THM increased more in men, urine TCAA increased more in women, and both were affected by exercise intensity. Genetic variants were associated with differential increases in exposure biomarkers.

CONCLUSION

Our findings suggest that, although affected by sex, physical activity and polymorphisms in key metabolizing enzymes, brominated THMs in exhaled breath could be used as a non-invasive DBP exposure biomarker in swimming pools with bromide-containing source waters. This warrants confirmation with new studies.

Occurrence and variability of iodinated trihalomethanes concentrations within two drinking-water distribution networks

Non-iodo-containing trihalomethanes (TTHM) are frequently detected in chlorinated tap water and currently regulated against their carcinogenic potential. Iodinated THM (ITHM) may also form in disinfected with chlorine waters that are high in iodine content, but little is known about their magnitude and variability within the drinking-water pipe distribution network of urban areas. The main objective of this study was to determine the magnitude and variability of ITHM and TTHM levels and their corresponding daily intake estimates within the drinking water distribution systems of Limassol and Nicosia cities of Cyprus, using tap samples collected from individual households (n=37). In Limassol, mean household tap water ITHM and TTHM levels was 0.58 and 38 μg L(-1), respectively. Dichloroiodomethane (DCIM) was the dominant species of the two measured ITHM compounds accounting for 77% of total ITHM and in the range of 0.032 and 1.65 μg L(-1). The range of DCIM concentrations in Nicosia tap water samples was narrower (0.032 - 0.848 μg L(-1)). Mean total iodine concentration in tap water samples from the seaside city of Limassol was 15 μg L(-1) and approximately twice to those observed in samples from the mainland Nicosia city. However, iodine concentrations did not correlate with the ITHM levels. The calculated chronic daily intake rates of ITHM were low when compared with those of TTHM, but because of their widespread occurrence in tap water and their enhanced mammalian cell toxicity, additional research is warranted to assess the magnitude and variability of human ITHM exposures.

Overview of Disinfection By-products and Associated Health Effects

The presence of chemical compounds formed as disinfection by-products (DBPs) is widespread in developed countries, and virtually whole populations are exposed to these chemicals through ingestion, inhalation, or dermal absorption from drinking water and swimming pools. Epidemiological evidence has shown a consistent association between long-term exposure to trihalomethanes and the risk of bladder cancer, although the causal nature of the association is not conclusive. Evidence concerning other cancer sites is insufficient or mixed. Numerous studies have evaluated reproductive implications, including sperm quality, time to pregnancy, menstrual cycle, and pregnancy outcomes such as fetal loss, fetal growth, preterm delivery, and congenital malformation. The body of evidence suggests only minor effects from high exposure during pregnancy on fetal growth indices such as small for gestational age (SGA) at birth. Populations highly exposed to swimming pools such as pool workers and professional swimmers show a higher prevalence of respiratory symptoms and asthma, respectively, although the direction of the association, and thus causality, is not clear among professional swimmers. The risk of asthma, wheezing, eczema, and other respiratory outcomes among children attending swimming pools has been the object of extensive research. Early studies suggested a positive association, while subsequent larger studies found no correlations or showed a protective association. Future research should develop methods to evaluate the effects of the DBP mixture and the interaction with personal characteristics (e.g., genetics, lifestyle), clarify the association between swimming pools and respiratory health, evaluate the occurrence of DBPs in low- and middle-income countries, and evaluate outcomes suggested by animal studies that have not been considered in epidemiological investigations.

Development of quantitative structure activity relationship (QSAR) model for disinfection byproduct (DBP) research: A review of methods and resources

Quantitative structure-activity relationship (QSAR) models are tools for linking chemical activities with molecular structures and compositions. Due to the concern about the proliferating number of disinfection byproducts (DBPs) in water and the associated financial and technical burden, researchers have recently begun to develop QSAR models to investigate the toxicity, formation, property, and removal of DBPs. However, there are no standard procedures or best practices regarding how to develop QSAR models, which potentially limit their wide acceptance. In order to facilitate more frequent use of QSAR models in future DBP research, this article reviews the processes required for QSAR model development, summarizes recent trends in QSAR-DBP studies, and shares some important resources for QSAR development (e.g., free databases and QSAR programs). The paper follows the four steps of QSAR model development, i.e., data collection, descriptor filtration, algorithm selection, and model validation; and finishes by highlighting several research needs. Because QSAR models may have an important role in progressing our understanding of DBP issues, it is hoped that this paper will encourage their future use for this application.

Analysis of 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) and its brominated analogues in chlorine-treated water by gas chromatography coupled to triple quadrupole tandem mass spectrometry (GC-QqQ-MS/MS)

A simple, selective and sensitive method for the analysis of the strong mutagen 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) and its brominated analogues (BMXs) in chlorine-treated water has been developed. The method is based on gas chromatography coupled to triple quadrupole tandem mass spectrometry (GC-QqQ-MS/MS), previous liquid-liquid extraction (LLE) of a smaller sample volume compared to other methods and on-line derivatization with a silylation reactive. GC-QqQ-MS/MS has been raised as an alternative easier to perform than gas chromatography coupled to high resolution mass spectrometry (GC-HRMS) for the analysis of MX and BMXs, and it allows to achieve low LODs (0.3 ng/L for MX and 0.4-0.9 ng/L for BMXs). This technique had not been previously described for the analysis of MX and BMXs. Quality parameters were calculated and real samples related to 3 drinking water treatment plants (DWTPs), tap water and both untreated and chlorinated groundwater were analyzed. Concentrations of 0.3-6.6 ng/L for MX and 1.0-7.3 ng/L for BMXs were detected. Results were discussed according to five of the main factors affecting MX and BMXs formation in chlorine-treated water (organic precursors, influence of bromide ions, evolution of MX and BMXs in the drinking water distribution system, groundwater chlorination and infiltration of water coming from chlorination processes in groundwater).

The Relationship between MX [3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone], Routinely Monitored Trihalomethanes, and Other Characteristics in Drinking Water in a Long-Term Survey

MX (3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone) is a drinking water disinfection byproduct (DBP). It is a potent mutagen and is of concern to public health. Data on MX levels in drinking water, especially in the UK, are limited. Our aim was to investigate factors associated with variability of MX concentrations at the tap, and to evaluate if routinely measured trihalomethanes (THMs) are an appropriate proxy measure for MX. We conducted quarterly water sampling at consumers' taps in eight water supply zones in and around Bradford, UK, between 2007 and 2010. We collected 79 samples which were analyzed for MX using GC-HRMS. Other parameters such as pH, temperature, UV-absorbance and free chlorine were measured concurrently, and total THMs were modeled from regulatory monitoring data. To our knowledge this is the longest MX measurement survey undertaken to date. Concentrations of MX varied between 8.9 and 45.5 ng/L with a median of 21.3 ng/L. MX demonstrated clear seasonality with concentrations peaking in late summer/early fall. Multivariate regression showed that MX levels were associated with total trihalomethanes, UV-absorbance and pH. However, the relationship between TTHM and MX may not be sufficiently consistent across time and location for TTHM to be used as a proxy measure for MX in exposure assessment.

Assessing exposure and health consequences of chemicals in drinking water: current state of knowledge and research needs

BACKGROUND

Safe drinking water is essential for well-being. Although microbiological contamination remains the largest cause of water-related morbidity and mortality globally, chemicals in water supplies may also cause disease, and evidence of the human health consequences is limited or lacking for many of them.

OBJECTIVES

We aimed to summarize the state of knowledge, identify gaps in understanding, and provide recommendations for epidemiological research relating to chemicals occurring in drinking water.

DISCUSSION

Assessing exposure and the health consequences of chemicals in drinking water is challenging. Exposures are typically at low concentrations, measurements in water are frequently insufficient, chemicals are present in mixtures, exposure periods are usually long, multiple exposure routes may be involved, and valid biomarkers reflecting the relevant exposure period are scarce. In addition, the magnitude of the relative risks tends to be small.

CONCLUSIONS

Research should include well-designed epidemiological studies covering regions with contrasting contaminant levels and sufficient sample size; comprehensive evaluation of contaminant occurrence in combination with bioassays integrating the effect of complex mixtures; sufficient numbers of measurements in water to evaluate geographical and temporal variability; detailed information on personal habits resulting in exposure (e.g., ingestion, showering, swimming, diet); collection of biological samples to measure relevant biomarkers; and advanced statistical models to estimate exposure and relative risks, considering methods to address measurement error. Last, the incorporation of molecular markers of early biological effects and genetic susceptibility is essential to understand the mechanisms of action. There is a particular knowledge gap and need to evaluate human exposure and the risks of a wide range of emerging contaminants.

CITATION

Villanueva CM, Kogevinas M, Cordier S, Templeton MR, Vermeulen R, Nuckols JR, Nieuwenhuijsen MJ, Levallois P. 2014. Assessing exposure and health consequences of chemicals in drinking water: current state of knowledge and research needs. Environ Health Perspect 122:213–221; http://dx.doi.org/10.1289/ehp.1206229

The occurrence of disinfection by-products in municipal drinking water in China's Pearl River Delta and a multipathway cancer risk assessment

Disinfection byproducts were measured in the finished drinking water from ten water treatment plants in three Chinese cities - Guangzhou, Foshan and Zhuhai. A total of 155 water samples were collected in 2011 and 2012. The median (range) of trihalomethane (THM) and haloacetic acid (HAA) levels were 17.7 (0.7-62.7) μg/L and 8.6 (0.3-81.3) μg/L, respectively. Chloroform, dichloroacetic acid and trichloroacetic acid were the dominant species observed in Guangzhou and Foshan water, while brominated THMs predominated in water from Zhuhai. Haloacetonitriles, haloketones, chloral hydrate and trichloronitromethane were usually detected at levels ranging from unquantifiable (<0.2μg/L) to 12.2μg/L (choral hydrate). THMs and HAAs showed clear seasonal variations with the total concentrations higher in winter than in summer. Correlations among DBP levels varied, with the strongest linear correlation observed between chloroform and chloral hydrate levels (R(2)=0.77). The risk of cancer from ingestion, inhalation and dermal contact exposure to THMs was estimated. CHCl2Br contributed the highest percentage of the cancer risk from ingestion pathway and CHCl3 contributed the highest of cancer risk from inhalation pathway.

Combined exposure to 3-chloro-4-dichloromethyl-5-hydroxy-2(5H)-furanone and microsytin-LR increases genotoxicity in Chinese hamster ovary cells through oxidative stress

The disinfection byproducts 3-chloro-4-dichloromethyl-5-hydroxy-2(5H)-furanone (MX) and microcystins-LR (MC-LR), which are common contaminants in drinking water, often occur together in water sources in areas with high gastrointestinal tract cancer risks. While often studied alone, combination effects of these compounds are unknown. Here, we examine combined genotoxic responses to mixtures of MX and MC-LR using the Ames test, a cytokinesis-block micronuclei assay, and the comet assay with analysis for interactions by fractional analysis. We also evaluated a possible mechanism of genotoxicity by examining effects of the compounds on markers of oxidative stress. MX and MC-LR administrated jointly at noncytotoxic concentrations demonstrated significant interactions in the Ames test, the micronuclei assay, and the comet assay showing responses greater than those expected for additivity. Moreover, coexposure to MX and MC-LR significantly increased luciferase antioxidant response element activity, intracellular superoxide dismutase, catalase, glutathione, and reactive oxygen species production. In comparison with exposure to either compound alone, the mixtures of MX and MC-LR caused a less than additive effect on oxidative stress. Taken together, these results indicate that MC-LR exacerbates MX genotoxicity in low-dose combined exposure. This interaction may be enhanced by oxidative stress in the combined exposures.