Association between Daily Hydrogen Sulfide Exposure and Incidence of Emergency Hospital Visits: A Population-Based Study

Chronic inhalation of H2S in low concentration induces immunotoxicity and inflammatory effects in lung tissue of rats

Hydrogen sulfide (H2S) is a typical odour compound mainly causing respiratory and central nervous system symptoms. However, the immunotoxicity of inhaled H2S and the underlying mechanisms remain largely unknown. In this study, a low-dose inhalation exposure to H2S was arranged to observe inflammatory response and immunotoxicity in lung tissue of rats. Low concentrations of H2S exposure affected the immune level of pulmonary tissue and peripheral blood. Significant pathological changes in lung tissue in the exposure group were observed. At low concentration, H2S not only induced the upregulation of AQP-4 and MMP-9 expression but also stimulated immune responses, initiating various anti-inflammatory and inflammatory factors, altering tissue homeostatic environments. The TNF and chemokine signaling pathway played an important role which can promote the deterioration of pulmonary inflammatory processes and lead to lung injury and fibrosis. Excessive immune response causes an inflammatory effect and blood-gas barrier damage. These data will be of value in evaluating future occupational health risks and providing technical support for the further development of reliable, sensitive, and easy-to-use screening indicators of exposure injury.

Respiratory and nervous system effects of a hydrogen sulfide crisis in Carson, California

BACKGROUND

In October 2021, many residents in Carson, California experienced malodors, headaches, and respiratory symptoms. Hydrogen sulfide (H2S), a toxic odorous gas, was measured in Carson at concentrations up to 7000 parts per billion (ppb) and remained above California's acute air quality standard of 30 ppb for about a month. Research on how low- and medium-level H2S exposure affects the respiratory and nervous systems has yielded conflicting results, and few studies have examined the effects of subacute H2S exposure.

METHODS

We calculated daily rates of emergency department (ED) visits with various respiratory and nervous systems diagnosis codes in Carson area ZIP codes (≤6 km from event's epicenter) and in Los Angeles County ZIP codes >15 km from event's epicenter (control area). Using controlled interrupted time series, we compared ED visit rates during the month of the H2S crisis in Carson to the predicted rates had the incident not occurred, based on 2018-2021 ED trends, and controlling for ED visit rate changes in the control area.

RESULTS

We observed a 24 % increase in ED visit rate for all respiratory system diseases (rate ratio = 1.24, 95 % CI: 1.16, 1.32), a 38 % increase for asthma (RR = 1.38, 95 % CI: 1.26, 1.50), a 26 % increase for acute upper respiratory infections (RR = 1.26, 95 % CI: 1.13, 1.38), a 21 % increase for dizziness (RR = 1.21, 95 % CI: 1.04, 1.38), and a 25 % increase for migraines and headaches (RR = 1.25, 95 % CI: 1.13, 1.36) in the Carson area during the first month of the H2S event compared to the expected rates.

CONCLUSIONS

This H2S crisis was associated with increased ED visit rates for multiple respiratory and nervous system outcomes. Reducing H2S exposure and improving to response during H2S episodes may improve public health.

Low level exposure to hydrogen sulfide: a review of emissions, community exposure, health effects, and exposure guidelines

Hydrogen sulfide (H2S) is a toxic gas that is well-known for its acute health risks in occupational settings, but less is known about effects of chronic and low-level exposures. This critical review investigates toxicological and experimental studies, exposure sources, standards, and epidemiological studies pertaining to chronic exposure to H2S from both natural and anthropogenic sources. H2S releases, while poorly documented, appear to have increased in recent years from oil and gas and possibly other facilities. Chronic exposures below 10 ppm have long been associated with odor aversion, ocular, nasal, respiratory and neurological effects. However, exposure to much lower levels, below 0.03 ppm (30 ppb), has been associated with increased prevalence of neurological effects, and increments below 0.001 ppm (1 ppb) in H2S concentrations have been associated with ocular, nasal, and respiratory effects. Many of the studies in the epidemiological literature are limited by exposure measurement error, co-pollutant exposures and potential confounding, small sample size, and concerns of representativeness, and studies have yet to consider vulnerable populations. Long-term community-based studies are needed to confirm the low concentration findings and to refine exposure guidelines. Revised guidelines that incorporate both short- and long-term limits are needed to protect communities, especially sensitive populations living near H2S sources.

Ambient nitrogen dioxide is associated with emergency hospital visits for atrial fibrillation: a population-based case-crossover study in Reykjavik, Iceland

BACKGROUND

In Iceland air quality is generally good; however, previous studies indicate that there is an association between air pollution in Reykjavik and adverse health effects as measured by dispensing of medications, mortality, and increase in health care utilisation. The aim was to study the association between traffic-related ambient air pollution in the Reykjavik capital area and emergency hospital visits for heart diseases and particularly atrial fibrillation and flutter (AF).

METHODS

A multivariate time-stratified case-crossover design was used to study the association. Cases were those patients aged 18 years or older living in the Reykjavik capital area during the study period, 2006-2017, who made emergency visits to Landspitali University Hospital for heart diseases. In this population-based study, the primary discharge diagnoses were registered according to International Classification of Diseases, 10th edition (ICD-10). The pollutants studied were NO₂, PM₁₀, PM_2.5, and SO_2, with adjustment for H₂S, temperature, and relative humidity. The 24-h mean of pollutants was used with lag 0 to lag 4.

RESULTS

During the study period 9536 cases of AF were identified. The 24-h mean NO₂ was 20.7 μg/m³. Each 10 μg/m³ increase in NO₂ was associated with increased risk of heart diseases (ICD-10: I20-I25, I44-I50), odds ratio (OR) 1.023 (95% CI 1.012-1.034) at lag 0. Each 10 μg/m³ increase in NO₂ was associated with an increased risk of AF (ICD-10: I48) on the same day, OR 1.030 (95% CI: 1.011-1.049). Females were at higher risk for AF, OR 1.051 (95% CI 1.019-1.083) at lag 0, and OR 1.050 (95% CI 1.019-1.083) at lag 1. Females aged younger than 71 years had even higher risk for AF, OR 1.077 (95% CI: 1.025-1.131) at lag 0. Significant associations were found for other pollutants and emergency hospital visits, but they were weaker and did not show a discernable pattern.

CONCLUSIONS

Short-term increase in NO₂ concentrations was associated with heart diseases, more precisely with AF. The associations were stronger among females, and among females at younger age. This is the first study in Iceland that finds an association between air pollution and cardiac arrhythmias, so the results should be interpreted with caution.

Air Pollution and Cardiac Arrhythmias: From Epidemiological and Clinical Evidences to Cellular Electrophysiological Mechanisms

Cardiovascular disease is the leading cause of death worldwide and kills over 17 million people per year. In the recent decade, growing epidemiological evidence links air pollution and cardiac arrhythmias, suggesting a detrimental influence of air pollution on cardiac electrophysiological functionality. However, the proarrhythmic mechanisms underlying the air pollution-induced cardiac arrhythmias are not fully understood. The purpose of this work is to provide recent advances in air pollution-induced arrhythmias with a comprehensive review of the literature on the common air pollutants and arrhythmias. Six common air pollutants of widespread concern are discussed, namely particulate matter, carbon monoxide, hydrogen sulfide, sulfur dioxide, nitrogen dioxide, and ozone. The epidemiological and clinical reports in recent years are reviewed by pollutant type, and the recently identified mechanisms including both the general pathways and the direct influences of air pollutants on the cellular electrophysiology are summarized. Particularly, this review focuses on the impaired ion channel functionality underlying the air pollution-induced arrhythmias. Alterations of ionic currents directly by the air pollutants, as well as the alterations mediated by intracellular signaling or other more general pathways are reviewed in this work. Finally, areas for future research are suggested to address several remaining scientific questions.

The Scientific Basis for Occupational Exposure Limits for Hydrogen Sulphide-A Critical Commentary

OBJECTIVES

Occupational exposure limits for hydrogen sulphide (H₂S) vary considerably; three expert group reports, published from 2006 to 2010, each recommend different limits. Some jurisdictions are considering substantial reductions.

METHODS

This review assesses the scientific evidence used in these recommendations and presents a new systematic review of human studies from 2006-20, identifying 33 studies.

RESULTS

The three major reports all give most weight to two sets of studies: of physiological effects in human volunteers, and of effects in the nasal passages of rats and mice. The human studies were done in one laboratory over 20 years ago and give inconsistent results. The breathing style and nasal anatomy of rats and mice would make them more sensitive than humans to inhaled agents. Each expert group applied different uncertainly factors. From these reports and the further literature review, no clear evidence of detrimental health effects from chronic occupational exposures specific to H₂S was found. Detailed studies of individuals in communities with natural sources in New Zealand have shown no detrimental effects. Studies in Iceland and Italy show some associations; these and various other small studies need verification.

CONCLUSIONS

The scientific justification for lowering occupational exposure limits is very limited. There is no clear evidence, based on currently available studies, that lower limits will protect the health of workers further than will the current exposure limits used in most countries. Further review and assessment of relevant evidence is justified before exposure limits are set.

Hydrogen sulfide and cardiovascular disease: Doubts, clues, and interpretation difficulties from studies in geothermal areas

Hydrogen sulfide (H₂S) represents one of the main pollutants originating from both geologic phenomena such as volcanoes, geysers, fumaroles and hot springs, and geothermal plants that produce heat and electricity. Many increasing data suggest that H₂S retains a variety of biological properties, and modulates many pathways related to cardiovascular pathophysiology although its role as beneficial/adverse determinant on cardiovascular disease (CVD) is not clearly established. In this review, the current knowledge on the association between H₂S exposure and risk of CVD in geothermal areas has been examined. The few epidemiological studies carried out in geothermal areas suggest, in some cases, a protective role of H₂S towards CVD, while in others a positive association between exposure to H₂S and increased incidence of CVD. Most of the studies have an ecological design that does not allow to produce evidence to support a causal relationship and also often lack for an adequate adjustment for individual CVD risk factors. The review has also considered the potential role of two other aspects not sufficiently explored in this relationship: the production of endogenous H₂S that is a gasotransmitter producing beneficial effects on cardiovascular function at low concentration and the intake of H₂S-releasing drugs for the treatment of patients affected by hypertension, inflammatory diseases, and CVD. Thus, a threshold effect of H₂S and the shift of action as beneficial/adverse determinant given by the synergy of exogenous exposure and endogenous production cannot be excluded. In this complex scenario, an effort is warranted in the future to include a more comprehensive evaluation of risk for CVD in relation to H₂S emissions, especially in geothermal areas.

Estimating exposure to hydrogen sulfide from animal husbandry operations using satellite ammonia as a proxy: Methodology demonstration

Husbandry trace gases that have climate change implications such as carbon dioxide (CO₂), methane (CH₄) and ammonia (NH₃) can be quantified through remote sensing; however, many husbandry gases with health implications such as hydrogen sulfide (H₂S), cannot. This pilot study demonstrates an approach to derive H₂S concentrations by coupling in situ and remote sensing data. Using AMOG (AutoMObile trace Gas) Surveyor, a mobile air quality and meteorology laboratory, we measured in situ concentrations of CH₄, CO₂, NH₃, H₂S, and wind at a southern California university research dairy. Emissions were 0.13, 1.93, 0.022 and 0.0064 Gg yr^-1; emission factors (E_F) were 422, 6333, 74, and 21 kg cow^-1 yr^-1, respectively, for the 306 head herd. Contributing to these strong E_F were spillway emissions from a grate between the main cowshed and the waste lagoon identified in airborne remote sensing data acquired by the hyperspectral thermal infrared imager, Mako. NH₃ emissions from the Chino Dairy Complex, also in southern California, were calculated from Infrared Atmospheric Sounding Interferometer (IASI) satellite data for 2008-2017 using average morning winds, yielding a flushing time of 2.7 h, and 8.9 Gg yr^-1. The ratio of E_F(H₂S) to E_F(NH₃) for the research dairy from AMOG data were applied to IASI NH₃ emissions to derive H₂S exposure concentration maps for the Chino area, which ranged to 10-30 ppb H₂S for many populated areas. Combining remote sensing with in situ concentrations of multiple emitted gases can allow derivation of emissions at the sub-facility, facility, and larger scales, providing spatial and temporal coverage that can translate into exposure estimates for use in epidemiology studies and regulation development. Furthermore, with high fidelity information at the sub-facility level we can identify best practices and opportunities to sustainably and holistically reduce husbandry emissions.

The health of communities living in proximity of geothermal plants generating heat and electricity: A review

Since the 1990s, in areas with natural geothermal manifestations studies on the association between exposure to pollutants and health effect have become increasingly relevant. These emissions consist of water vapor mixed with carbon dioxide, hydrogen sulfide (H₂S), methane and, to a lesser extent, rare gases and trace elements in volatile forms. Considering the indications of the World Health Organization and the growth in the use of geothermal energy for energy production, this review aims to report studies exploring the health status of the populations living in areas where geothermal energy is used to produce heat and electricity. Studies on the health effects of the general population exposed to emissions from both natural geothermal events and plants using geothermal energy at domestic or commercial level have been considered between 1999 and 2019. Studies were classified into those based on health indicators and those based on proxy-individual level exposure metrics. Both statistically significant results (p<0.05) and interesting signals were commented. The 19 studies selected (New Zealand, Iceland and Italy) provide heterogeneous results, with an increased risk for several tumor sites. Exposure to H₂S low concentrations is positively associated with an increment of respiratory symptoms, anti-asthma drugs use, mortality for respiratory diseases and lung cancer. Exposure to H₂S high levels is inversely related to cancer mortality but associated with an increase in hospitalization for respiratory diseases, central nervous system disorders and cardiovascular diseases. The results indicate that the health of populations residing in areas rich in geothermal emissions presents some critical elements to be explored. The two major limitations of the studies are the ecological design and the inadequate exposure assessment. The authors suggested the prosecution and the systematization of health surveillance and human biomonitoring activities associated with permanent control of atmospheric emissions from both industrial and natural plants.

Health effects associated with short-term exposure to hydrogen sulfide from geothermal power plants: a case-crossover study in the geothermal areas in Tuscany

OBJECTIVE

Thirty-four geothermal power plants for the production of electricity are currently active in the geothermal areas in Tuscany. The present study aimed to investigate the association between short-term exposure to hydrogen sulfide (H₂S) and acute health outcomes.

METHODS

This study used individual data on non-accidental, cardiovascular and respiratory mortality, urgent hospital admissions (HA) and emergency department (ED) visits for cardiorespiratory diseases occurring from 2000 to 2017. All cases were georeferenced and matched to daily H₂S data, derived from 18 monitoring sites. A case-crossover design following the matched pair interval approach was applied and conditional logistic regression models were fitted to estimate odds ratios and their 90% confidence intervals, adjusting for a set of time-dependent variables, such as influenza epidemics, holidays and temperature.

RESULTS

A total of 8054 deaths, 30,527 HA and 15,263 ED visits occurred. Mortality for non-accidental (OR = 1.11, 90% CI 1.02-1.22) and cardiovascular causes (OR = 1.22, 90% CI 1.03-1.44) were associated with an increase of 10 µg/m³ of H₂S daily levels only among men. Hospital admissions for respiratory diseases were positively associated with H₂S exposure: OR = 1.11 (90% CI 1.00-1.22) among women. No associations were observed in ED visits analyses.

CONCLUSIONS

In this case-crossover study in the Tuscan geothermal areas, short-term exposure to H₂S was weakly associated with some mortality and morbidity outcomes. Our findings did not show a clear pattern as the results were not homogeneous between mortality and morbidity data or between men and women.

Photopaper as a Tool for Community-Level Monitoring of Industrially Produced Hydrogen Sulfide and Corrosion

Scientific instrumentation driven by academic, military, and industrial applications tends to be high cost, designed for expert use, and "black boxed". Community-led citizen science (CLCS) is creating different research instruments with different measurement goals and processes. This paper identifies four design attributes for CLCS tools: affordability, accessibility, builds community efficacy and provides actionable data through validating a community method for monitoring the neurotoxic and corrosive gas Hydrogen Sulfide (H2S). For $1 per sample, the semi-quantitative method provides an affordable and easily interpretable data for communities to compare H2S concentrations and silver corrosion in their home environments to those in a major municipal sewage treatment plant. H2S is a leading cause of workplace injury in the U.S. and commonly found in oil and gas production, sewage treatment plants, and concentrated animal feeding operations (CAFOs). Communities neighboring such sources tend to be socio-economically marginalized with little access to scientific or political resources. Consequently, health risks and material degradation from corrosion are well studied in workplaces while community exposures are under-studied. Existing commercial H2S detection methods are prohibitively expensive for low-income communities and often require the support of professional scientists. This paper describes a simple and inexpensive semi-quantitative H2S measurement method that uses photopaper. Photopaper passively measures H2S as its silver halide layer linearly reacts with H2S between concentrations of 60 ppb to 1 ppm, discoloring the paper from white to brown. We develop a colorimetric scale for this discoloration for visual estimation of H2S concentration and overall corrosion. The scale is based on comparing silver sulfide (Ag2S) measured by Purafil Corrosion Classification Coupons (CCCs) and H2S concentrations measured with the industry standard tool a Jerome Meter to silver and sulfur bound to the photopaper as measured with X-Ray Fluorescence (XRF). We conduct our validation studies in a major municipal sewage treatment plant to provide real-world occupational benchmarks for comparison to community results. This community science method is affordable, accessible, designed to build collective efficacy and to create actionable data to flag the need for follow-up research.

Pro-arrhythmic Effects of Hydrogen Sulfide in Healthy and Ischemic Cardiac Tissues: Insight From a Simulation Study

Hydrogen sulfide (H₂S), an ambient air pollutant, has been reported to increase cardiac events in patients with cardiovascular diseases, but the underlying mechanisms remain not elucidated. This study investigated the pro-arrhythmic effects of H₂S in healthy and ischemic conditions. Experimental data of H₂S effects on ionic channels (including the L-type Ca²⁺ channel and ATP-sensitive K⁺ channel) were incorporated into a virtual heart model to evaluate their integral action on cardiac arrhythmogenesis. It was shown that H₂S depressed cellular excitability, abbreviated action potential duration, and augmented tissue’s transmural dispersion of repolarization, resulting in an increase in tissue susceptibility to initiation and maintenance of reentry. The observed effects of H₂S on cardiac excitation are more remarkable in the ischemic condition than in the healthy condition. This study provides mechanistic insights into the pro-arrhythmic effects of air pollution (H₂S), especially in the case with extant ischemic conditions.

Hydrogen sulphide exposure in waste water treatment

Background

The aims of this study was to assess exposure to hydrogen sulphide (H₂S) among waste water treatment workers (WWWs), and achieve a better measure of the risks of H₂S exposure than only using the eight-hour average value and the ceiling value because the exposure pattern of H₂S for WWWs is dominated by short-term peaks.

Methods

Ninety-three measurements of H₂S from 56 WWWs in three cities and three rural areas were collected. All exposure measurements were carried out from the start of the day until lunch time (sampling time 4–5 h) when most of the practical work was performed. The type of tasks and extent of flushing were registered. H₂S was measured using direct-reading instruments with logging: OdaLog L2/LL, Dräger X-am 5000 and Dräger Pac 7000 (0.1–200 ppm). Number and duration of peaks for different work tasks, seasons, places and extent of flushing were combined in an exposure index (IN), and evaluated in a mixed-model analysis, building a model aimed to predict exposure for different job tasks.

Results

Nine Percent (8 of 93) of all H₂S measurements have peaks above 10 ppm; in addition, 15% (14 of 93) have peaks of 5–10 ppm, 35% (33 of 93) have peaks of 1–5 ppm and 65% (62 of 93) have peaks of 0.1–1 ppm. 29% of the measurements of hydrogen sulphide showed no registered level > 0.1 ppm.

From the mixed-model analyses we see that exposure level, expressed as H₂S index IN, varied between places, work type, season and degree of flushing. For the work in a plant in the capital, the exposure index varied from 0.02 for working in spring doing some flushing, to 0.7 for working at the same plant in winter doing flushing more than three times or more than 10 min. Collecting sewage from cesspools in city 2 in winter doing a lot of flushing gave a hydrogen sulphide index of 230.

Conclusions

The use of a H₂S index, taking into consideration peak height, duration and number of peaks, could be a tool for exposure assessment for H₂S.

Volcanogenic SO2, a natural pollutant: Measurements, modeling and hazard assessment at Vulcano Island (Aeolian Archipelago, Italy)

Sulfur dioxide (SO₂) is a major component of magmatic gas discharges. Once emitted in the atmosphere it can affect the air and land environment at different spatial and temporal scales, with harmful effects on human health and plant communities. We used a dense dataset of continuous SO₂ flux and meteorological measurements collected at Vulcano over an 8-year period spanning from May 2008 to February 2016 to model air SO₂ concentrations over the island. To this end, we adopted the DISGAS (DISpersion of GAS) numerical code coupled with the Diagnostic Wind Model (DWM). SO₂ concentrations in air were determined for three different SO₂ emission rates: a reference SO₂ flux of ∼18 t/d (the median of more than 800 measurements), an enhanced SO₂ flux of 40 t/d (average of all measurements plus 1 σ), and a maximum SO₂ flux of 106 t/d (maximum value measured in the investigated period). Maximum SO₂ concentrations in air were estimated at the crater, near the high-T fumarole field that is the source of the gas, and ranged from 2000 ppb to ∼24,000 ppb for the reference flux, from 2000 ppb to 51,000 ppb for the enhanced flux and from 5000 ppb to 136,000 ppb for the maximum flux, with peak values in limited areas at the bottom of the crater. These concentrations pose a hazard for people visiting the crater, for sensitive individuals in particular. Based on estimated SO₂ concentrations in air, we also consider the phytotoxic effects of SO₂ on local vegetation.

Sulphurous Mineral Waters: New Applications for Health

Sulphurous mineral waters have been traditionally used in medical hydrology as treatment for skin, respiratory, and musculoskeletal disorders. However, driven by recent intense research efforts, topical treatments are starting to show benefits for pulmonary hypertension, arterial hypertension, atherosclerosis, ischemia-reperfusion injury, heart failure, peptic ulcer, and acute and chronic inflammatory diseases. The beneficial effects of sulphurous mineral waters, sulphurous mud, or peloids made from sulphurous mineral water have been attributed to the presence of sulphur mainly in the form of hydrogen sulphide. This form is largely available in conditions of low pH when oxygen concentrations are also low. In the organism, small amounts of hydrogen sulphide are produced by some cells where they have numerous biological signalling functions. While high levels of hydrogen sulphide are extremely toxic, enzymes in the body are capable of detoxifying it by oxidation to harmless sulphate. Hence, low levels of hydrogen sulphide may be tolerated indefinitely. In this paper, we review the chemistry and actions of hydrogen sulphide in sulphurous mineral waters and its natural role in body physiology. This is followed by an update of available data on the impacts of exogenous hydrogen sulphide on the skin and internal cells and organs including new therapeutic possibilities of sulphurous mineral waters and their peloids.

Materializing Exposure: Developing an Indexical Method to Visualize Health Hazards Related to Fossil Fuel Extraction

How can STS researchers collaborate with communities to design environmental monitoring devices that more effectively express their experiences and address gaps in regulation? This paper describes and shows the results of a novel method of visualizing environmental emissions of corrosive gases such as hydrogen sulfide (H₂S) exposure using photographic paper. H₂S is a neurotoxic and flammable gas that smells like rotten eggs and is frequently associated with oil and natural gas extraction. Communities living with oil and gas development in Wyoming report odors of rotten eggs and describe symptoms of H₂S exposure. H₂S is recognized as an acute and chronic threat to human and environmental health and oil and gas companies are required to have plans in place to prevent and respond to accidental, high concentration releases of H₂S. They are not, however, required to monitor, report or prevent routine daily emissions. Yet 15-25% of the oil and gas wells in the US are predicted to contain H₂S, and some communities surrounded by multiple wells report chronic, routine exposure. Chronic exposure is difficult to represent with current tools for monitoring H₂S because they are designed to measure acute workplace exposure. Informed by STS theories of black boxes and regimes of imperceptibility that focus on the need to revise not only regulations but also material tools of science, this paper describes the development of an indexical approach to visualizing this hazard. In indexical design, the reactive sensing element of a scientific instrument is brought to the foreground. The silver in the photopaper is an index as it tarnishes with H₂S exposure. Discolored tests strips can be arranged together to form data-rich maps of the exposure landscape where this discoloration both represents how the gas spreads through a space and is a physical trace of the gas. Preliminary results in the form of data-rich maps show that regulating H₂S emissions as primarily accidental is inappropriate and fails to adequately protect human health.