NC Department of Health and Human Services Health

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NC Department of Health and Human Services Health Effects from PFAS Exposure Ricky Langley,

NC Department of Health and Human Services Health Effects from PFAS Exposure Ricky Langley, MD Medical Consultant Occupational and Environmental Epidemiology Branch December 4, 2018 NCDHHS, Division of Public Health | Health Effects from PFAS Exposure | December 4, 2018 1

What are PFAS? • PFAS = Per- and polyfluoroalkyl substances • Man-made for variety

What are PFAS? • PFAS = Per- and polyfluoroalkyl substances • Man-made for variety of uses − − Fire fighting foam (AFFF) Polishes, waxes, and paint Stain repellants Non-stick coatings • PFAS generally occur as mixtures • Most well-studied PFAS are PFOA (C 8) and PFOS − Half-life in human body is several years − Not known to degrade in the environment PFOA (C 8) PFOS References: ATSDR 2018, EPA 2016 a, EPA 2016 b NCDHHS, Division of Public Health | Health Effects from PFAS Exposure | December 4, 2018 2

How are people exposed to PFAS? • Drinking contaminated water • Eating contaminated food

How are people exposed to PFAS? • Drinking contaminated water • Eating contaminated food − Produce − Fish • Note: no NC fish consumption advisories based on PFAS at this time − Food packaged in materials containing PFAS • Household dust • Consumer products • Occupational exposure References: ATSDR 2018, EPA 2016 a, EPA 2016 b NCDHHS, Division of Public Health | Health Effects from PFAS Exposure | December 4, 2018 3

What are potential health effects from PFAS exposure? • Developmental and Reproductive Effects: −

What are potential health effects from PFAS exposure? • Developmental and Reproductive Effects: − Decreased fertility − Pregnancy-induced hypertension and preeclampsia − Decreased birth weight − Affect growth, learning, and behavior of infants and older children References: ATSDR 2018, EPA 2016 a, EPA 2016 b NCDHHS, Division of Public Health | Health Effects from PFAS Exposure | December 4, 2018 4

What are potential health effects from PFAS exposure? • Other Effects: − Thyroid disease

What are potential health effects from PFAS exposure? • Other Effects: − Thyroid disease − Liver damage - increases in serum enzymes and decreases in serum bilirubin − Increased cholesterol levels − Decreased vaccine response − Increased risk of certain types of cancers (PFOA - testicular and kidney cancer) References: ATSDR 2018, EPA 2016 a, EPA 2016 b NCDHHS, Division of Public Health | Health Effects from PFAS Exposure | December 4, 2018 5

What levels have been set to protect health? • EPA Lifetime Health Advisory –

What levels have been set to protect health? • EPA Lifetime Health Advisory – PFOA/PFOS − 70 ng/L or parts per trillion (ppt) in drinking water for PFOS and PFOA, either individually or combined − Not a regulatory level (not enforceable) − Not a bright line between “safe” and “unsafe” • The Agency for Toxic Substances and Disease Registry (ATSDR) and other states have established other health values for PFOA/PFOS and other PFAS Reference: EPA 2016 a, EPA 2016 b NCDHHS, Division of Public Health | Health Effects from PFAS Exposure | December 4, 2018 6

How can exposure be reduced? • If drinking water has PFAS above the health

How can exposure be reduced? • If drinking water has PFAS above the health advisory, consider using alternative or treated water sources for drinking, cooking, brushing teeth, and making formula − Okay to use water for bathing, laundry, washing dishes, etc. • Read consumer product labels and avoid those with PFAS NCDHHS, Division of Public Health | Health Effects from PFAS Exposure | December 4, 2018 7

Questions? NCDHHS, Division of Public Health | Health Effects from PFAS Exposure | December

Questions? NCDHHS, Division of Public Health | Health Effects from PFAS Exposure | December 4, 2018 8