Summary of Immune Effects

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Evaluating the Association between Serum Concentrations of Per- and Polyfluoroalkyl Substances (PFAS) and Symptoms and Diagnoses of Selected Acute Viral Illnesses

Summary of Immune Effects

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Protocol, PFAS/viral infection, v1.0

Last Revised: August 23, 2021

Appendix F – Summary of Immune Effects

The following table summarizes the findings of previous epidemiological studies of PFAS and immune-related effects – specifically hospitalization due to infectious diseases, risk of respiratory tract infections, and decreased vaccine response. These studies include occupational exposure studies, studies of communities living near a PFOA manufacturing facility with high levels of PFOA in the drinking water, and studies of populations exposed to background levels of perfluoroalkyls (referred to as general population studies). This summary reflects the relevant available literature as of 2/16/2021, including some studies that suggest PFAS exposure may impact the immune system and susceptibility to viral infections.



Compound

Acronym

CAS Registry Number

Perfluorooctanoic acid

PFOA

335-67-1

Perfluorononanoic acid

PFNA

375-95-1

Perfluorodecanoic acid

PFDA

335-76-2

Perfluoroundecanoic acid

PFUnA

2058-94-8

Perfluorododecanoic acid

PFDoDA

375-73-5

Perfluorohexane sulfonic acid

PFHxS

1763-23-1

Perfluorooctane sulfonic acid

PFOS

754-91-6

N-Methylperfluorooctane sulfonamidoacetic acid

MeFOSAA

2355-31-9





Study Overview

Serum PFAS Levels

Outcome

Results

Abraham et al. 2020


Cross-sectional study of 101 healthy 1-year old children (21 formula-fed and 80 breastfed)at the end of the 1990s; specific vaccine antibodies for tetanus, diptheria, and Haemophilus. influence type b (Hib) were measured

Mean child serum PFAS levels

PFOA, formula-fed: 3.8 µg/L

PFNA, formula-fed: 0.2 µg/L

PFHxS, formula-fed: 1.7 µg/L

PFOS, formula-fed: 6.8 µg/L


PFOA, breastfed: 16.8 µg/L

PFNA, breastfed: 0.6 µg/L

PFHxS, breastfed: 2.1 µg/L

PFOS, breastfed: 15.2 µg/L

Correlation between PFAS levels and specific vaccine antibodies for tetanus, diptheria, and Haemophilus.

Correlation between adjusted antibody levels and PFOA

Hib: r = -0.32, p = 0.001

Tetanus: r = -0.25, p = 0.01

Diphtheria: r = -0.23, p = 0.02


There were no significant correlations of levels of PFOS, PFHxS, and PFNA with levels of the vaccine antibodies

Ait Bamai et al. 2020


Prospective cohort study of 2,689 children enrolled in the Hokkaido Study from 2003-2012; children were monitored for physician-diagnosed infectious disease up to 7 years of age.


Median maternal serum PFAS levels

PFOA: 1.94 ng/mL

PFNA: 1.14 ng/mL

PFDA: 0.51 ng/mL

PFUnA: 1.43 ng/mL

PFDoDA: 0.17 ng/mL

PFTrDA: 0.33 ng/mL

PFHxS: 0.30 ng/mL

PFOS: 5.12 ng/mL

Risk of infectious diseases in early life, based on mothers’ self-administered questionnaire:

Chickenpox

Otitis media

Pneumonia

RSV

PFOA: OR (95% CI)

Pneumonia: 1.17 (1.01, 1.37)


PFDoDA: OR (95% CI)

Chicken Pox: 0.85 (0.72, 1.00)


No other significant associations were observed between maternal PFAS levels and any of the infectious diseases.

Bulka et al. 2021


Cross-sectional study of 8778 participants (3189 adolescents, 5589 adults) in NHANES 1999-2016; looked at presence of antibodies to cytomegalovirus, Epstein Barr, hepatitis C and E, herpes simplex 1 and 2, HIV, T. gondii, and Toxacara spp.; Seropositivity was summed to calculate a pathogen burden score reflecting the total number of infections.

Mean serum PFAS levels by pathogen burden


Adolescents

PFOA, uninfected: 2.16 ng/mL

PFOA, 3+ pathogens: 3.30ng/mL

PFNA, uninfected: 0.72 ng/mL

PFNA, 3+ pathogens: 0.89ng/mL

PFHxS, uninfected: 1.51 ng/mL

PFHxS, 3+ pathogens: 1.93ng/mL

PFOS, uninfected: 5.58 ng/mL

PFOS, 3+ pathogens: 16.14ng/mL


Adults

PFOA, uninfected: 2.63 ng/mL

PFOA, 3+ pathogens: 2.75ng/mL

PFNA, uninfected: 0.82 ng/mL

PFNA, 3+ pathogens: 0.93ng/mL

PFHxS, uninfected: 1.53 ng/mL

PFHxS, 3+ pathogens: 1.35ng/mL

PFOS, uninfected: 8.14 ng/mL

PFOS, 3+ pathogens: 12.69ng/mL


Presence of antibodies to cytomegalovirus, Epstein Barr, hepatitis C and E, herpes simplex 1 and 2, HIV, T. gondii, and Toxacara spp.; Seropositivity was summed to calculate a pathogen burden score reflecting the total number of infections.

Prevalence Ratio (95% CI) per doubling increase in serum PFAS, in adults (20-49 years)

PFOA

Herpes 1: 1.03 (1.01, 1.06)

Herpes 2: 1.11 (1.05, 1.17)

PFNA

Herpes 1: 1.05 (1.02, 1.08)

Toxocara spp.: 1.40 (1.13, 1.73)

PFHxS

Toxocara spp.: 1.21 (1.06, 1.37)

PFOS

Herpes 1: 1.04 (1.01, 1.06)

Toxocara spp.: 1.57 (1.26, 1.96)


No significant associations between persistent infections were found in adolescents.


Total Pathogen Burden, adults (20-49 years); OR (95% CI)

PFOA: 1.09 (1.06, 1.12)

PFNA: 1.03 (1.00, 1.05)

PFHxS: 1.02 (1.00, 1.05)

PFOS: 1.10 (1.07, 1.12)


Total Pathogen Burden, adolescents (12-19 years); OR (95% CI)

PFOA: 1.36 (1.27, 1.45)

PFNA: 1.11 (1.03, 1.19)

PFHxS: 1.11 (1.06, 1.15)

PFOS: 1.30 (1.25, 1.36)

Dalsager et al. 2016


Prospective cohort study of 359 children (aged 1–4 years) participating in the Odense Child Cohort in Denmark (women enrolled 2010-2012); parents responded to texts every other week regarding the child’s symptoms of infection.

Median maternal serum PFAS level (measured at gestational age 10-16 weeks)

PFOA: 1.68 ng/mL

PFOS: 8.07 ng/mL

PFHxS: 0.32 ng/mL

PFNA: 0.70 ng/mL

PFDA: 0.27 ng/mL

The following outcomes were evaluated both as odds of number of days above median and number of days (incidence rate):

Fever (>101.3°F)

Cough

Nasal Discharge

Diarrhea

Vomiting

Odds of number of days above median, Fever:

PFOA: OR 1.97 (1.07–3.62), 3rd tertile

PFOS: OR 2.35 (1.34–4.11), 3rd tertile


Rate of number of days, Fever:

PFOS: IRR 1.65 (1.24–2.18), 3rd tertile


Odds of number of days above median, Nasal Discharge:

PFNA: OR 0.53 (0.31–0.92), 2nd tertile; OR 0.55 (0.31–0.97), 3rd tertile


No significant associations (p>0.05) between maternal serum levels of PFAS and any other outcomes.

Dalsager et al. 2021


Prospective cohort study of 1,503 mother-child pairs (aged 1–5 years) participating in the Odense Child Cohort in Denmark (women enrolled 2010-2012); admission to hospital with an ICD-10 code for infection was collected through end of August 2015.


Median maternal serum PFAS level (measured at gestational age 10-16 weeks)

PFOA: 1.68 ng/mL

PFOS: 7.52 ng/mL

PFHxS: 0.36 ng/mL

PFNA: 0.64 ng/mL

PFDA: 0.29 ng/mL

Risk of hospitalizations for infectious disease categorized as:

Upper respiratory tract infections (URTI)

Lower respiratory tract infections (LRTI)

Gastrointestinal infections (GI)

Other infections

Hazard ratios (95% CI) for hospitalization per doubling of maternal PFAS concentrations


Any infection

PFOS: 1.23 (1.05, 1.44)


LRTI

PFOA: 1.27 (1.01, 1.59)

PFOS: 1.54 (1.11, 2.15)


No significant associations (p>0.05) between maternal serum levels of PFAS and any other outcomes.

Fei et al. 2010


Prospective cohort study of 1,400 pregnant women participating in the Danish National Birth cohort study; offspring were monitored for hospitalization due to infections in early childhood (average age 8.2 years).

Mean maternal serum PFAS level (measured at gestation week 12)

PFOA: 5.6 ng/mL

PFOS: 35.3 ng/mL


Rate of hospitalization for infectious disease in young children

PFOA:

IRR 0.96 (0.87–1.06) for trend

IRR 1.21 (1.04–1.42) for trend, girls

IRR 0.83 (0.73–0.95) for trend, boys


PFOS:

IRR 1.00 (0.91–1.09) for trend

IRR 1.18 (1.03–1.36) for trend, girls

IRR 0.90 (0.80–1.12) for trend, boys

Goudarzi et al. 2017


Prospective cohort study of 1,558 participants in the Hokkaido Study on Environmental and Children’s Health; children were monitored for physician-diagnosed infectious disease up to 4 years of age.

Mean maternal serum PFAS level (measured at 28-32 weeks of gestation)

PFOA: 2.71 ng/mL

PFOS: 5.46 ng/mL

PFHxS: 0.32 ng/mL

PFNA: 1.40 ng/mL

PFDA: 0.58 ng/mL

PFUnA: 1.53 ng/mL

PFDoDA: 0.19 ng/mL

Risk of “total infectious diseases” in early life, based on mothers’ self-administered questionnaire. “Total infectious diseases” was defined as at least one of these four common infectious diseases:

Otitis media

Pneumonia

Varicella

RSV

PFOA: p=0.39 for trend, OR (95% CI)

4th quartile: 1.11 (0.806–1.54)


PFOS: p=0.008 for trend, OR (95% CI):

2nd quartile: 1.44 (1.06–1.96)

3rd quartile: 1.28 (0.949–1.73)

4th quartile: 1.61 (1.18–2.21)


PFHxS: p=0.93 for trend, OR (95% CI)

4th quartile: 0.96 (0.73–1.41)


PFNA: p=0.92 for trend, OR (95% CI)

4th quartile: 0.92 (0.67–1.25)


PFDA: p=0.11 for trend, OR (95% CI)

4th quartile: 0.80 (0.59–1.08)


PFUnA: p=0.79 for trend, OR (95% CI)

4th quartile: 1.03 (0.76–1.40)


PFDoDA: p=0.50 for trend, OR (95% CI)

4th quartile: 1.07 (0.79–1.46)


Grandjean et al. 2012


Prospective cohort study of children living in the Faroe Islands; children were examined prior to receiving vaccine boosters (5 years of age, n=532) for tetanus and diphtheria, 4 weeks after receiving the 5-year vaccine booster (n=456), and at age 7 (n=464).

Geometric mean maternal serum PFAS levels

PFOA: 3.20 ng/mL

PFOS: 27.3 ng/mL

PFHxS: 4.41 ng/mL

PFNA: 0.60 ng/mL

PFDA: 0.28 ng/mL


Median serum PFAS levels at age 5

PFOA: 4.1 ng/mL

PFOS: 17.3 ng/mL

PFHxS: 0.6 ng/mL

PFNA: 1.00 ng/mL

PFDA: 0.28 ng/mL


Median serum PFAS levels at age 7

PFOA: 4.4 ng/mL

PFOS: 15.5 ng/mL

PFHxS: 0.5 ng/mL

PFNA: 1.1 ng/mL

PFDA: 0.4 ng/mL

Tetanus and Diphtheria antibody levels at ages 5 and 7

Changes in antibodies were assessed per two-fold increases in PFAS level.


Tetanus antibody at age 5, β

PFOS (age 5): -28.5% (-45.4, -6.1)

PFHxS (age 5): -19.0% (-29.8, -6.6)

PFDA (age 5): -19.9% (-33.1, -3.9)


Tetanus antibody at age 7, β

PFOA (age 5): -35.8% (-51.9, -14.2)

PFHxS (age 5): -19.7% (-31.6, -5.7)

PFHxS (age 7): -22.3% (-36.3, -5.2)

PFDA (age 5): -22.3% (-35.8, -5.8)


Diphtheria antibody at age 5, β

PFNA (age 5): -16.1% (-28.8, -1.0)


Diphtheria antibody at age 7, β

PFOA (age 5): -25.2% (-42.9, -2.0)

PFOA (age 7): -25.4% (-40.9, -5.8)

PFOS (age 5): -27.6% (-45.8, -3.3)

PFOS (age 7): -30.3% (-47.3, -7.8)


No other significant associations were noted between maternal or child (ages 5 or 7 years) PFAS levels and antibody levels


Grandjean et al. 2017


Prospective study of 516 children living in the Faroe Islands; serum antibodies to diphtheria and tetanus were measured at age 13 and compared to serum perfluoroalkyl levels at age 7 and 13.

Median serum PFAS levels at age 7

PFOA: 4.4 ng/mL

PFOS: 15.3 ng/mL

PFHxS: 0.5 ng/mL

PFNA: 1.1 ng/mL

PFDA: 0.4 ng/mL


Median serum PFAS levels at age 13

PFOA: 2.0 ng/mL

PFOS: 6.7 ng/mL

PFHxS: 0.4 ng/mL

PFNA: 0.7 ng/mL

PFDA: 0.3 ng/mL

Tetanus and Diphtheria antibody levels at ages 7 and 13

Significant association between serum PFDA and antibodies for tetanus at age 7 (p=0.022), but not at age 13 (p=0.258).


No other significant associations reported between any serum PFAS levels at ages 7 or 13 and diphtheria or tetanus antibody levels.

Granum et al. 2013


Prospective birth cohort study, subcohort of the Norwegian Mother and Child Cohort study, 56 children examined annually to age 3 years; exclusion criteria included maternal use of steroids or anti-inflammatory drugs during pregnancy, as well as maternal autoimmune disease.

Maternal median serum PFAS levels (measured at delivery)

PFOA: 1.1 ng/mL

PFOS: 5.5 ng/mL

PFHxS: 0.3 ng/mL

PFNA: 0.3 ng/mL

Rubella antibody levels

Hemophilus influenza type B antibody levels

Tetanus antibody levels

Number of episodes of common cold (3-year period)

Wheezing

Rubella antibody levels, β

PFOA: -0.40 (-0.64, -0.17)

PFOS: -0.08 (-0.14, -0.02)

PFHxS: -0.38 (-0.66, -0.11)

PFNA: -1.38 (-2.35, -0.40)


Number of episodes of common cold, β

PFOA: 0.42 (0.21, 0.62)

PFNA: 0.74 (0.05, 1.43)


No other significant associations were reported between any PFAS and outcome

Huang et al. 2020


Prospective birth cohort, Shanghai Prenatal Cohort; mothers were enrolled at 29-41 weeks of gestation and children were followed-up at 5 years of age (n=344).

Median cord blood PFAS levels

PFOA: 6.68 ng/mL

PFOS: 2.44 ng/mL

PFHxS: 0.16 ng/mL

PFNA: 0.63 ng/mL

PFDA: 0.35 ng/mL

PFUnA: 0.39 ng/mL

PFDoDA: 0.09 ng/mL

Respiratory tract infections (RTIs) (both lower and upper) in the first 5 years of life. Assessed through self-report from parents, review of medical records, and IgG and IgE levels as biomarkers of humoral immunity

There were no significant associations between any PFAS and total number of RTIs, nor were there any significant associations between PFAS levels and incidence of recurrent respiratory tract infections. There were no associations between PFAS and IgG or IgE concentrations.

Impinen et al. 2018


Prospective study of 641 infants participating in the Environment and Childhood Asthma study in Norway; health outcomes were evaluated at 2 and 10 years of age.

Mean cord PFAS levels:

PFOA: 1.8 ng/mL

PFOS: 5.6 ng/mL

PFHxS: 0.3 ng/mL

PFNA: 0.2 ng/mL

PFUnA: 0.1 ng/mL


Number of common colds (0-2 years of age)

Number of lower respiratory infections (0-10 years of age)

Common Cold, β

PFUnA: 0.11 (0.08, 0.14)


LRTI, β

PFOA: 0.28 (0.22, 0.35)

PFOS: 0.50 (0.42, 0.57)

PFNA: 0.09 (0.03, 0.14)

PFUnA: 0.18 (0.13, 0.23)

Impinen et al. 2019


Prospective birth cohort, subcohort of the Norwegian Mother and Child Cohort Study enrolled between 1999-2008. Children were followed-up at 3 years (n=1,270) and 7 years (n=972).

Median maternal serum PFAS levels (collected mid-pregnancy)

PFOA: 2.54 ng/mL

PFOS: 12.87 ng/mL

PFHxS: 0.65 ng/mL

PFNA: 0.45 ng/mL

PFUnA: 0.20 ng/mL

Parent-reported number of episodes of infections from 0-3 years of age and from 6-7 years of age. Infections included common cold (3 years only) and bronchitis/RS-virus/pneumonia (3 and 7 years)

Common cold, RR (95% CI)

PFOA: 0.96 (0.94, 0.99)

PFOS: 0.94 (0.92, 0.97)


Bronchitis/pneumonia at 3 years of age, RR (95% CI)

PFOA: 1.27 (1.12, 1.43)

PFOS: 1.20 (1.07, 1.34)

PFHxS: 1.15 (1.06, 1.24)


No other associations were found for PFAS and episodes of infection.

Kvalem et al. 2020


Prospective birth cohort, the Environment and Childhood Asthma (ECA) study; PFAS exposure measured at age 10 and health outcomes collected at age 16 for 378 children.

Mean serum PFAS levels at 10 years of age

PFOA: 4.62 ng/mL

PFOS: 20.9 ng/mL

PFHxS: 3.33 ng/mL

PFNA: 0.63 ng/mL

PFDA: 0.19 ng/mL

PFUnA: 0.18 ng/mL

Parent reported number of episodes of common cold and number of episodes of bronchitis and pneumonia between 10-16 years of age and in last 12 months

Number of common colds in last 12 months at age 16, OR (95% CI) per IQR increase in PFAS from multinomial logistic regression models

≥3 vs. 0 colds, PFOS: 0.67 (0.47, 0.96)

≥3 vs. 0 colds, PFNA: 0.63 (0.44, 0.91)

≥3 vs. 0 colds, PFDA: 0.56 (0.37, 0.84)

≥3 vs. 0 colds, PFUnA: 0.64 (0.44, 0.92)


LRTI between 10-16 years of age, RR (95% CI) per IQR increase in PFAS

PFOA: 1.10 (1.02, 1.19)

PFOS: 1.34 (1.17, 1.55)


No other significant associations found between PFAS and common cold or LRTI

Kielsen et al. 2016


Prospective study of 12 adults in Denmark administered a booster vaccine for tetanus and diphtheria; antibody concentrations were measured 4- and 10-days post-vaccination.

Median serum PFAS levels

PFOA: 1.69 ng/mL

PFOS: 9.52 ng/mL

PFHxS: 0.37 ng/mL

PFNA: 0.66 ng/mL

PFDA: 0.30 ng/mL

PFUnA: 0.21 ng/mL

PFDoDA: 0.039 ng/mL

Tetanus and diphtheria antibody levels


Diphtheria

PFOS: inverse association (p=0.044), unadjusted

PFNA: Inverse association (p=0.004), unadjusted

PFDA: Inverse association (p=0.009), unadjusted

PFUnA: Inverse association (p=0.036), unadjusted

PFDoDA: Inverse association (p=0.038), unadjusted


Tetanus

PFUnA: Inverse association (p=0.039), unadjusted

PFDoDA: Inverse association (p=0.038), unadjusted

Looker et al. 2014


Cross-sectional study of 411 adults participating in a follow-up study to the C8 Health Project; all participants received an influenza vaccine and were examined prior to vaccination and 21 days post vaccination; 755 adults in the follow-up study participated in a survey evaluating self-reported colds and influenza episodes.

Geometric mean serum PFOA: 33.74 ng/mL

  • 1st quartile: 0.25–13.7 ng/mL

  • 2nd quartile: 13.8–31.5 ng/mL

  • 3rd quartile: 31.6–90 ng/mL

  • 4th quartile: 90.4–2,140 ng/mL


Geometric mean serum PFOS: 8.32 ng/mL

Seroprotection from influenza A H3N2 virus

Seroprotection from influenza A H1N1 virus

Seroprotection from influenza type B virus

Cold or flu infection

Frequency of colds

Influenza A H3N2 virus seroprotection, OR (95% CI)

PFOA Q2: 0.34 (0.14, 0.83)

PFOA Q3: 0.28 (0.11, 0.70)

PFOA Q4: 0.39 (0.15, 0.99)


No other significant associations were reported for PFAS levels (continuous or categorical) and the outcomes of interest.

Manzano-Salgado et al. 2019


Prospective cohort – Spanish INMA birth cohort study (2003-2008) – of children with follow-ups at 1.5 years (n=1,188), 4 years (n=1,188) and 7 years (n-1,071).

Mean maternal serum PFAS levels (collected during first trimester)

PFOA: 2.67 ng/mL

PFOS: 6.41 ng/mL

PFHxS: 0.67 ng/mL
PFNA: 0.74 ng/mL

Mother-reported occurrence of LRTI at 1.5, 4, and 7 years of age (defined as occurrence of bronchitis, bronchiolitis, or pneumonia)

There were no associations between LRTIs and log-transformed PFAS levels.

Okada et al. 2012


Prospective cohort study of 343 pregnant women in Japan; cord blood samples collected at delivery to measure total IgE levels; infant allergies and infectious disease information collected during first 18 months of age.

Median maternal serum PFAS (measured after second trimester)

PFOA: 1.3 ng/mL

PFOS: 5.2 ng/mL


Infectious disease during the first 18 months of life

There were no statistically significant associations between maternal serum PFAS levels and infectious diseases during the first 18 months of life.

Pilkerton et al. 2018


Cross-sectional study of participants (≥ 12 years of age) from NHANES 1999-2000 and 2003-2004 data (n=581 women and 621 men adults [19-49 years], and 1012 youth [12-18 years]).

Mean serum PFAS

PFOA

Men: 6.0 ng/mL

Women: 4.3 ng/mL

Youth: 4.8 ng/mL

PFOS

Men: 28.1 ng/mL

Women: 22.1 ng/mL

Youth: 25.1 ng/mL

Rubella IgG titers (log titers in analyses)

Adults, β

Men

PFOA Q3: -0.55 (-0.81, -0.28)

PFOA Q4: -0.45 (-0.84, -0.05)


No significant associations with Rubella titers for PFOA or PFOS in youth or in adult women. No associations between PFOS and Rubella titers in adult men.

Shih et al. 2021


Prospective cohort study of adults (28 years old) in the Faroese Island cohort recruited in 1986-1987; blood samples collected in cord blood, at 7, 14, 22, and 28-years; 401 cohort members for Hepatitis A and B and 281 cohort members for tetanus and diphtheria were included.


Median serum PFAS concentrations at birth

PFOA:1.11 ng/mL

PFNA: 0.11 ng/mL

PFDA: 0.07 ng/mL

PFHxS: 0.21 ng/mL

PFOS: 5.96 ng/mL


Median serum PFAS concentrations at age 28 years

PFOA: 1.28 ng/mL

PFNA: 0.98 ng/mL

PFDA: 0.34 ng/mL

PFHxS: 0.41 ng/mL

PFOS: 6.85 ng/mL

Serum antibody concentrations for Hepatitis A, Hepatitis B, Diphtheria, and Tetanus; assessed 6 months after the booster for diphtheria and tetanus and 6 months after the completion of the 3-dose hepatitis vaccine.

No significant associations between PFAS collected at any age were found with HAV or HB at age 28 years.


Positive associations of diphtheria were found with cord-blood PFAS and PFAS at ages 22 and 28 years.


No evidence of associations was observed for tetanus.

Stein et al. 2016a


Cross-sectional study of 78 healthy adults in New York city vaccinated during the 2010–2011 season with the intranasal FluMist influenza vaccine.

Geometric mean serum PFAS

PFOA: 2.28 ng/mL

PFOS: 5.22 ng/mL

PFHxS: 1.1 ng/mL

PFNA: 0.77

Serum cytokines (IFN-α2, IFN-γ, TNF-α, IP 10) and chemokines (MCP-1, MIP1a) were measured pre-vaccination and 3- and 30-days post vaccination; nasal cytokine (IP-10), chemokine (MCP-1), and nasal mucosal IgA were measured 3- and 30-days post vaccination

Significant associations between serum PFHxS and changes in the serum cytokines IFN-γ (p=0.05) and TNF-α (p=0.04).


No other associations between serum PFAS and seroconversion as measured by hemagglutinin inhibition or immunohistochemistry. No other associations between serum PFAS and changes in serum cytokine or chemokine levels or nasal cytokine, chemokine, or IgA levels.

Stein et al. 2016b


Cross-sectional study of adolescents (12–19 years of age) utilizing NHANES 1999–2000 and 2003–2004 data (n=1,191).

Geometric mean serum PFAS

PFOA: 4.13 ng/mL

PFOS: 20.8 ng/mL

PFHxS: 2.47 ng/mL

PFNA: 0.765 ng/mL


Antibody titers for measles, mumps, and rubella in whole cohort as well as in seropositive subcohort

Full Cohort, β per 2-fold increase in PFAS

Mumps

PFOS: -7.4% (-12.8, -1.7)


Seropositive subcohort, β per 2-fold increase in PFAS

Mumps

PFOA: -6.6% (-11.7, -1.5)

PFOS: -5.9% (-9.9, -1.6)


Rubella

PFOA: -8.9% (-14.6, -2.9)

PFOS: -13.3% (-19.9, -6.2)

PFHxS: -6.0% (-9.6, -2.2)


No other significant associations were observed in the full cohort or subcohort.

Timmermann et al. 2020


Subset analysis of RCT of early measles vaccination conducted in Guinea-Bissau from 2012-2015 (n=237). Intervention (n=135) included two doses of measles vaccine (at 4-7 months and at 9 months); control (n=102) included the usual single vaccination (at 9 months).


Median serum PFAS levels collected from children at baseline (4-7 months of age)

PFOA: 0.68 ng/mL

PFOS: 0.77 ng/mL

PFHxS: 0.10 ng/mL

PFNA: 0.21 ng/mL

PFDA: 0.19 ng/mL

PFUnA: 0.12 ng/mL

Measles antibody titers at baseline (no measles vaccination), 9-month visit (1 measles vaccination in intervention vs. none in controls), and at 2 years of age (2 measles vaccinations in intervention vs. 1 measles vaccination in control) with a doubling of serum PFAS at inclusion.


Presence of fever, coughing, diarrhea, and any morbidity at inclusion and at 9-month visit with doubling of serum PFAS concentrations at baseline

9-month visit, control, β

PFOS: -27% (-44, -4)


9-month visit, intervention, β

PFOS: -20% (-35, -1)

PFDA: -25% (-42, -4)


No other significant associations between percentage difference in measles antibody concentrations for any PFAS at any time points.


Coughing, OR (95% CI)

PFOA: 1.87 (1.02, 3.45)

PFHxS: 2.15 (1.17, 3.97)


Any Morbidity, OR (95% CI)

PFOA: 2.02 (1.20, 3.41)

PFHxS: 1.82 (1.06, 3.11)

Zeng et al. 2019


201 mother-infant pairs in the Guangzhou Birth Cohort Study, enrolled in 2013.

Cord blood serum PFAS levels

PFOA: 1.22 ng/mL

PFNA: 0.16 ng/mL

PFDA: 0.12 ng/mL

PFUnA: 0.13 ng/mL

PFDoDA: 0.05 ng/mL

PFHxS: 3.96 ng/mL

PFOS: 3.17 ng/mL

Total PFAS: 10.56 ng/mL


Antibody titers against 2 Hand, Foot, and Mouth Disease (HFMD) viruses, enterovirus 71 (EV71) and coxsackievirus A 16 (CA16), were assessed in cord blood and blood serum at 3 months of age

CA16 antibody in cord blood, OR (95%CI)

PFOA: 1.56 (1.13, 2.14)

PFOS: 1.75 (1.16, 2.63)
Total PFAS: 2.24 (1.30, 3.85)


CA16 antibody in 3-month infants, OR (95%CI)

PFOA: 1.73 (1.08, 2.75)

PFNA: 1.50 (1.04, 2.17)

PFDA: 2.22 (1.42, 3.47)

PFUnA: 1.45 (1.02, 2.08)

PFOS: 1.71 (1.12, 2.60)

Total PFAS: 2.74 (1.33, 5.61)


EV71 antibody in cord blood, OR (95%CI)

PFOA: 1.49 (1.09, 2.05)

PFNA: 1.44 (1.02, 2.02)

PFDA: 1.49 (1.03, 2.16)

PFOS: 1.66 (1.12, 2.45)

Total PFAS: 1.90 (1.14, 3.16)


EV71 antibody in cord blood, OR (95%CI)

PFOA: 2.11 (1.27, 3.48)

PFNA: 1.01 (1.04, 2.16)

PFDA: 2.05 (1.33, 3.18)

PFUnA: 1.48 (1.04, 2.10)

PFHxS: 1.49 (1.06, 2.10)

PFOS: 2.25 (1.44, 3.51)

Total PFAS: 4.55 (2.06, 10.06)

Zeng et al. 2020


Cross-sectional study of 605 participants from the Isomer C8 Health Project in China (2015-2016). The population included 509 participants who were HBsAb seropositive and 96 participants who were HBsAb seronegative

Median serum concentrations of PFAS among seropositive

PFOA: 5.10 ng/mL

PFOS: 10.1 ng/mL


Median serum concentrations of PFAS among seronegative

PFOA: 5.54 ng/mL

PFOS: 14.1 ng/mL

Change in hepatitis B surface antibody (HBsAb) per log serum PFAS.

Mean difference (95% CI) in serum HBsAb

PFOS: -0.51 (-0.84, -0.18)


No associations were found for PFOA

OR=odds ratio, IRR=incidence rate ratio, IQR=interquartile range















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