- Be aware of environmental health hazards found in Yakima County, including PFAS, Nitrate, Coliform Bacteria, Lead, and Arsenic.
- Be aware of the health effects associated with these contaminants and clinical care recommendations.
- Provide education to patients with a history of exposure.
PFAS (polyfluoroalkyl substances) are human made chemicals that can be found in products such as food packaging, outdoor clothing, non-stick pans, and firefighting foam. PFAS can enter the environment through production or waste streams and can build up in animals, fish, birds, plants, and people.
People are primarily exposed to PFAS by consuming water or food containing PFAS, or by using products that contain PFAS.
Scientists are still studying how PFAS affects people’s health. According to some human studies, higher exposure to PFAS may lead to:
- Increased cholesterol levels
- Decreased birth weights
- Decreased immune response to vaccines
- Changes in liver enzymes that indicate liver damage
- Increased risk of blood pressure problems during pregnancy
- Increased risk of thyroid disease
- Increased risk of testicular and kidney cancer
Blood Testing for PFAS
People who have been exposed to PFAS may consider talking to their health care provider about getting a PFAS blood test. A blood test for PFAS can:
- Measure the amount of PFAS in your blood at the time of the test
- Determine whether your PFAS levels are elevated and that might cause side effects
- Serve as a baseline to monitor changes in levels if there is subsequent or ongoing exposure by testing again with knowledge of additional exposure
A blood test for PFAS cannot:
- Tell you when and how you were exposed
- Determine if PFAS have affected your health or predict your health outcomes in the future
- Most people in the U.S. have one or more specific PFAS in their blood, especially more common PFAS such as PFOS and PFOA.
- There is no specific treatment that can remove the PFAS in your body. Prevention of future exposures is the best approach if your detected level is above the expected range.
Information for Healthcare Providers
According to new recommendations by the National Academies of Sciences, clinicians are advised to provide education and blood testing to patients who are likely to have a history of significant exposure to PFAS. Elevated PFAS test results will lead to recommendations for reducing exposure, for example, using an alternative water source, being aware of local consumption advisories for fish and game, and avoiding products with PFAS chemicals.
Healthcare providers should calculate the serum or plasma concentrations based on the sum of seven PFAS* to determine if PFAS levels after suspected exposure, to initiate recommended interventions.
Healthcare providers who are not familiar with environmental health hazards including PFAS, are encouraged to review additional information on these topics. Washington state providers can also access consultations with other providers regarding patient concerns about PFAS by calling 1-206-221-8671 or emailing firstname.lastname@example.org.
- PFAS – Resources for Healthcare Providers
- Clinician-to-Clinician Consultations Regarding Environmental Exposure Concerns
- National Academies of Science, PFAS Guidance Highlights, August 2022
- Guidance on PFAS Exposure, Testing, and Clinical Follow-Up
- PFAS Blood Testing Flyer for People in PFAS-Impacted Communities and Occupations- English, Spanish
- Yakima Training Center PFAS Information
- Yakima Health District: PFAS
Nitrate is a chemical found in most fertilizers, manure, and liquid waste discharged from septic tanks. Natural bacteria in soil can convert nitrogen into nitrate. Rain or irrigation water can carry nitrate down through the soil into groundwater.
Increased concentration of serum nitrates affects the ability of red blood cells to carry oxygen. In most adults and children, these red blood cells rapidly return to normal function when nitrate concentration falls. However, in infants it can take much longer for the blood cells to return to normal function once the nitrated level falls. Infants who drink water with high levels of nitrate (or eat foods made with nitrate-contaminated water) may develop a serious health condition due to the lack of oxygen. This condition is called methemoglobinemia or “blue baby syndrome.”
Signs of Blue Baby Syndrome
Moderate to serious blue baby syndrome may cause brownish-blue skin tone due to lack of oxygen. This condition may be hard to detect in infants with dark skin. For infants with dark skin, look for a bluish color inside the nose and mouth, on the lips, or fingernail and toenail beds. Mild to moderate blue baby syndrome may cause symptoms like a cold or other infection (fussy, tired, diarrhea or vomiting). While there is a blood test to diagnose blue baby syndrome, doctors may not think to do this test for babies with mild to moderate symptoms.
Nitrate in Adults
With a decrease in nitrate concentration red blood cells quickly return to normal function, although, certain underlying medical illnesses can make people more susceptible to health problems from nitrate. Individuals with the following health conditions should not drink water with more than 10 mg/L of nitrate:
- Individuals who don’t have enough stomach acids.
- Individuals with an inherited lack of the enzyme that converts affected red blood cells back to normal (methemoglobin reductase).
- Women who are pregnant or trying to become pregnant. High nitrate levels may increase the risk of spontaneous abortion or certain birth defects.
- WA DOH: Nitrate in Drinking Water
- Questions & Answers: Nitrate in Drinking Water- English, Spanish
- Agency for Toxic Substances and Disease Registry: Nitrates and Nitrites Toxicity
Lead is a metal naturally found in rock and the surrounding soil. Use of lead in various products and their production, can introduce lead into air, clean soil, water, and inside our homes. Lead-based paint and lead dust are the main sources of lead poisoning. Homes built before 1978 are likely to have lead-based paint. Other sources of lead can include drinking water, toys and jewelry, workplace and hobby hazards, aluminum or glazed ceramic cookware, imported spices, and traditional home remedies and cosmetics.
Lead can adversely affect almost every organ and system in your body. Children six years old and younger are the most severely affected by lead exposure. A child’s growing body can absorb more lead than adults, and brains and nervous systems of children are more sensitive to the damaging effects of lead. Lead in young children can cause behavior and learning problems, lower IQ, and hearing problems. Lead can also cause slow growth and anemia in children. In adults, including pregnant women, lead can cause hypertension and increased blood pressure. Lead can also cause kidney and reproductive problems in both men and women. In pregnant women, lead can be passed to the unborn baby. In rare cases, lead can cause seizures, coma, and even death.
Babies and children may be exposed to lead by:
- Breathing or swallowing lead dust from lead-based paint or lead-contaminated soil.
- Putting their hands and other objects, which may harbor lead dust, into their mouths.
- Eating and drinking food or water contaminated with lead.
- Using cookware, dishes, or glasses that contain lead.
- Playing with toys that have lead paint.
Adults, including pregnant women, may be exposed to lead by:
- Breathing lead dust in areas where lead-based paint is breaking down, or during renovation or repair work that disturbs painted surfaces in older homes and buildings.
- Eating and drinking food or water contaminated with lead.
- Using cookware, dishes, or glasses that contain lead.
- Jobs or hobbies where lead is used, such as battery manufacturing or shooting firearms.
Blood Testing for Lead
Testing blood for lead remains the only way to know for sure if a child has been exposed to lead. If criteria are met, the child could be at risk for lead poisoning and parents should talk to their health care provider about a blood lead test. A health care provider will test the child’s blood for lead.
The amount of lead found in a child’s blood is called a blood lead level. There is no totally safe level of lead for children. The blood lead level will tell if your child has been exposed to lead in the last month. Blood lead levels can range from typical (below 2 µg/dL) to very dangerous (above 20 µg/dL).
More information on blood test results:
Child’s Lab Test Results- English, Spanish
- WA DOH: Lead- English, Spanish
- WA DOH: Testing for Lead Poisoning- English, Spanish
- Child’s Lab Test Results- English, Spanish
Coliform bacteria are organisms in the feces of all warm-blooded animals including humans. Normal flora coliform bacteria will not cause illness unless the bacteria are outside of the intestinal tract or produce toxins. The toxin producing strains may cause nausea vomiting and diarrhea. The presence of toxin producing bacteria in drinking water would indicate that the municipal water system is contaminated at some point. Most pathogens that can contaminate water supplies come from the feces of humans or animals. There are three different groups of coliform bacteria; each has a different level of risk: total coliform counts in the tested water, the fecal coliform count, and E. coli coliform count.
Symptoms of Waterborne Illness
Disease-causing organisms in water can cause diarrhea, stomach cramps, bloating, gas, fatigue, weight loss, nausea, vomiting, and/or fever. Symptoms may appear as early as a few hours to several days after infection and may last more than two weeks. If individuals exhibit with these symptoms, they should contact their health care provider
Arsenic is an element that is present throughout the environment in present in small amounts is water, soil, dust, air, and food. Levels of arsenic can vary from place to place due to farming and industrial activity as well as natural geological processes. Everyone has daily exposure to arsenic. The greater your exposure, the greater the risk of illness. People may be exposed to arsenic by:
- Drinking water, eating food, or ingesting other things that contain arsenic.
- People often swallow small amounts of soil and dust. Young children will put hands, toys, pacifiers, and other things in their mouths that can have dust or dirt on the surface. Arsenic isn’t absorbed well through the skin, but if hands are dirty, adults and children can swallow contaminated soil while eating. Dust that is carried by the wind can be trapped in the nose and mouth and be ingested.
- Breathing air, dust, or fumes that contain arsenic is not a major route of exposure. However, dust and fumes from sawing or burning arsenic-treated wood can be a danger when inhaled.
Arsenic can cause health problems in people, but it is difficult to predict how arsenic will affect a specific individual. Similar arsenic exposures may cause serious health problems for some people and may have no effect on others. The types of health problems that may occur are influenced by the amount of arsenic to which a person is exposed, the length of time exposure occurs, and an individual’s sensitivity to the harmful effects of arsenic.
Several types of tests are available to measure exposure to arsenic, but they cannot predict whether the arsenic in an individual’s body will affect their health. Each test has certain limitations that should be considered when deciding the need to be tested, which test to use, and how to interpret the results.
Arsenic can be cleared from the body quickly. Measuring the level of arsenic in urine is the best way to evaluate exposure that occurred in the last 1-2 days. Two types of urine tests are available. The most common test measures the total amount of arsenic and does not distinguish between the toxic inorganic forms of arsenic found in soil and ground water that are a health concern and the less toxic organic forms of arsenic that are found in seafood and shellfish. An elevated arsenic level could occur by eating foods with high levels of the less toxic organic arsenic compounds 1-2 days before the test. The second type of test, for “speciated” or “fractionated” arsenic, measures exposure to just the very toxic inorganic forms of arsenic and better for evaluating an exposure that might have caused the above listed side effects.
Measurement of arsenic levels in hair or fingernails can be useful to evaluate longer-term exposure, but these tests can be difficult to interpret because there are no standardized procedures for conducting the tests and there are no widely accepted standard values to distinguish “normal” from “elevated” test results.