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Original site: www.cdc.gov/mmwr/volumes/68/wr/mm6829a4.htm | RestoredCDC.org is an independent project, not affiliated with CDC or any federal entity. Visit CDC.gov for free official information. Due to archival on January 6, 2025, recent outbreak data is unavailable. Videos are not restored. Access data.restoredcdc.org for restored data. Use of this site implies acceptance of this disclaimer.[More]About Us Report Bug Compare ContentSkip directly to searchEspañol | Other LanguagesHere's how you knowAn official website of the United States government Here's how you knowMorbidity and Mortality Weekly Report (MMWR)Morbidity and Mortality Weekly Report (MMWR)Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People Morbidity and Mortality Weekly Report (MMWR)SearchSearch Menu Navigation MenuSubmitMorbidity and Mortality Weekly Report (MMWR)* MMWR* Reports by Topic* Publications+ BACKPublications+ Weekly Reporto BACKWeekly Reporto BACKPublications Weekly Reporto Past Volumes (1982-2023)o Past Volumes (1982-2024)o Morbidity and Mortality Weekly Report (MMWR) Home+ Recommendations and Reportso BACKRecommendations and Reportso BACKPublications Recommendations and Reportso Past Volumes (1990-2022)o Past Volumes (1990-2024)o Morbidity and Mortality Weekly Report (MMWR) Home+ Surveillance Summarieso BACKSurveillance Summarieso BACKPublications Surveillance Summarieso Past Volumes (1983-2023)o Past Volumes (1983-2024)o Morbidity and Mortality Weekly Report (MMWR) Home+ Supplementso BACKSupplementso BACKPublications Supplementso Past Volumes (1985-2023)o Morbidity and Mortality Weekly Report (MMWR) Home+ Archive (1952-1981)+ Notifiable Infectious Diseases+ Notifiable Noninfectious Conditions+ Morbidity and Mortality Weekly Report (MMWR) Home* Vital Signs* Visual Abstracts* Podcasts* Continuing Education* MMWR Clinical Pearls* Metrics* For Authors* About+ BACKAbout+ Staff+ Editorial Board+ Morbidity and Mortality Weekly Report (MMWR) Home* Subscribe+ BACKSubscribe+ RSS Feed+ Morbidity and Mortality Weekly Report (MMWR) Home* Morbidity and Mortality Weekly Report (MMWR) HomeMorbidity and Mortality Weekly Report (MMWR)Morbidity and Mortality Weekly Report (MMWR) HomeNotes from the Field: Targeted Biomonitoring for GenX and Other Per- and Polyfluoroalkyl Substances Following Detection of Drinking Water Contamination — North Carolina, 2018Weekly / July 26, 2019 / 68(29);647–648Related PagesJamie R. Pritchett, MTox1; Jessica L. Rinsky, PhD1; Beth Dittman, MS1; Ariel Christensen, MPH1; Rick Langley, MD1; Zack Moore, MD1; Aaron T. Fleischauer, PhD1,2; Kate Koehler1; Antonia M. Calafat, PhD3; Rachel Rogers, PhD4; Laconial Esters5; Rodney Jenkins5; Faye Collins6; Debra Conner6; Patrick Breysse, PhD3,4 (View author affiliations)View suggested citationArticle MetricsAltmetric:Citations: 14See more detailsViews: 899X (6)Facebook (1)Mendeley (42)Citations: 15Views: 3,999Views equals page views plus PDF downloadsMetric DetailsTableRelated Materials* PDF [78K]In June 2017, local health departments asked the North Carolina Department of Health and Human Services (NCDHHS) to provide health information and guidance regarding 2,3,3,3,-tetrafluoro-2-(1,1,2,2,3,3,3-heptafluoropropoxy)-propanoate (GenX) and other per- and polyfluoroalkyl substances (PFAS) that had been detected in the Cape Fear River, an important drinking water source (1). PFAS are a group of man-made chemicals that have been used in industry and consumer products worldwide since the 1950s. Most PFAS do not break down in the environment and can accumulate over time, resulting in increased human exposures. Limited studies in humans have indicated that some PFAS might affect reproduction, development, and the immune system and increase the risk for certain types of cancer (2). The source of GenX and other PFAS contamination in the Cape Fear River was a PFAS chemical manufacturing facility. After further investigation, the North Carolina Department of Environmental Quality identified GenX and other PFAS in surface water, air, and private wells close to the facility. As of April 2018, 837 private wells within a 5-mile radius of the facility had been tested; 207 (25%) had GenX levels exceeding the NCDHHS provisional drinking water health goal of 140 parts per trillion (ppt),* with a maximum measured GenX concentration of 4,000 ppt. The manufacturer began providing bottled water to residents living in homes with a well that exceeded the NCDHHS provisional drinking water health goal. In August 2018, NCDHHS worked with local health departments and asked CDC to quantify GenX and other PFAS in serum and urine specimens from a convenience sample of residents near the facility.NCDHHS identified households near the facility with the highest concentrations of GenX in their private drinking water wells. One adult and, if available, one minor (aged 12–17 years) from each household were invited to participate. Participants had to have lived in their home full-time, used their well as their primary drinking water source before GenX detection (2017), and had no known occupational PFAS exposure. NCDHHS staff members made three call attempts to each household before contacting the next eligible household. Because the investigation was deemed to be public health epidemiologic surveillance and not research, this work was deemed exempt from institutional review board review.Participants provided blood and spot urine specimens and completed a structured interview regarding demographics, residence history, and potential sources of PFAS exposure. CDC analyzed serum for 17 PFAS and urine for 16 PFAS. All laboratory analyses were conducted using CDC laboratory methods and established procedures for quality assurance and control (3). When possible, participants’ PFAS concentrations were compared with population estimates from the National Health and Nutrition Examination Surveys (NHANES) from 2015–2016 or 2013–2014 (4).Among 47 contacted households, 25 (53%) were eligible and agreed to participate. Thirty residents (25 adults and five minors) participated. Participants ranged in age from 14 to 79 years (median = 52 years); half were male. All participants had lived in the county for at least 10 years and had been using bottled water for drinking for 4–14 months before specimen collection.GenX was not detected in serum (Table) or urine of any participants. Nine PFAS were detected in serum. Median serum concentrations of perfluorohexane sulfonic acid (PFHxS, 2.1 μg/L) and linear perfluorooctane sulfonic acid (n-PFOS, 5.5 μg/L) were markedly higher than were those in NHANES participants (1.2 μg/L and 3.2 μg/L, respectively). The remaining seven PFAS were found at concentrations similar to or lower than those in NHANES specimens. Serum PFAS concentrations did not differ by sex, age, or number of years living in the county. One PFAS (perfluorohexanoic acid) was detected in one participant’s urine (0.4 μg/L) close to the limit of detection (5); the other 15 PFAS tested in urine were not detected.GenX was not detected in specimens from participants with documented drinking water exposure. This might be because participants had switched to bottled water months earlier and might indicate that GenX has a relatively short half-life in humans. Compared with the general population, the higher concentrations of two historically used PFAS (PFHxS and n-PFOS) with relatively long biologic half-lives might reflect residents’ higher past or ongoing environmental exposures.The results of this investigation provided community members with information about what was detectable in their blood and urine after learning that their drinking water was contaminated with PFAS and how to discuss their results with their primary health care provider. In addition, participants were provided general information about potential health effects from PFAS exposures. These findings might be useful to community members, public health agencies, and researchers investigating PFAS exposures and potential human health implications in the future.TopCorresponding author: Jamie R. Pritchett, jamie.pritchett@dhhs.nc.gov, 919-707-5912.Top1Division of Public Health, North Carolina Department of Health and Human Services; 2Division of State and Local Readiness, Center for Preparedness and Response, CDC; 3Division of Laboratory Sciences, National Center for Environmental Health, CDC; 4Agency for Toxic Substances and Disease Registry; 5Cumberland County Department of Public Health, Fayetteville, North Carolina; 6Bladen County Health Department, Elizabethtown, North Carolina.TopAll authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.Top* https://ncdenr.s3.amazonaws.com/s3fs-public/GenX/NC%20DHHS%20Risk%20Assessment%20FAQ%20Final%20Clean%20071417%20PM.pdf.TopReferences1. Sun M, Arevalo E, Strynar M, et al. Legacy and emerging perfluoroalkyl substances are important drinking water contaminants in the Cape Fear River watershed of North Carolina. Environ Sci Technol Lett 2016;3:415–9. CrossRef2. Agency for Toxic Substances and Disease Registry. What are PFAS? Atlanta, GA: US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry; 2018. https://www.atsdr.cdc.gov/pfas/overview.html3. Kato K, Kalathil AA, Patel AM, Ye X, Calafat AM. Per- and polyfluoroalkyl substances and fluorinated alternatives in urine and serum by on-line solid phase extraction-liquid chromatography-tandem mass spectrometry. Chemosphere 2018;209:338–45. CrossRef PubMed4. CDC. Fourth national report on human exposure to environmental chemicals: updated tables, January 2019, volume one. Atlanta, GA: US Department of Health and Human Services, CDC; 2019. https://www.cdc.gov/exposurereport/pdf/FourthReport_UpdatedTables_Volume1_Jan2019-508.pdf5. North Carolina Department of Health and Human Services. Biological sampling for GenX and other per- and polyfluoroalkyl substances (PFAS)—North Carolina, 2018. Raleigh, NC: North Carolina Department of Health and Human Services; 2018. https://epi.dph.ncdhhs.gov/oee/pfas/NCDHHS_PFAS%20Biomonitoring%20Report_8Nov2018.pdfTopTABLE. Comparison of serum concentrations of per- and polyfluoroalkyl substances (PFAS) in the U.S. population with concentrations among participants (N = 30) residing near a PFAS manufacturing facility where PFAS were detected — North Carolina, 2018PFAS Abbreviation Limit of detection (LOD) Serum concentrations (μg/L)Participants (N = 30) U.S. population*Median Minimum Maximum Median 95th percentile2,3,3,3,-tetrafluoro-2-(1,1,2,2,3,3,3-heptafluoropropoxy)-propanoate GenX 0.1 —† — — Not measuredperfluorobutane sulfonic acid PFBS 0.1 — — — — —perfluorohexanoic acid PFHxA 0.1 — — — Not measuredperfluorobutanoic acid PFBA 0.1 — — — Not measuredperfluoroheptanoic acid PFHpA 0.1 — — 0.6 — 0.2perfluoropentanoic acid PFPeA 0.1 — — — Not measured4,8-dioxa-3H-perfluorononanoat ADONA 0.1 — — — Not measured9-chlorohexadecafluoro-3-oxanonane-1-sulfonate 9Cl-PF3ONS 0.1 — — — Not measured2-(N-methyl-perfluorooctane sulfonamido) acetic acid MeFOSAA 0.1 — — 0.6 — 0.6perfluorohexane sulfonic acid PFHxS 0.1 2.1 0.7 6.7 1.2 4.9linear perfluorooctanoic acid n-PFOA 0.1 1.8 0.4 7.3 1.5 4.1branched perfluorooctanoic acids Sb-PFOA 0.1 — — — — —perfluorodecanoic acid PFDA 0.1 0.2 — 1.3 0.1 0.7perfluoroundecanoic acid PFUnDA 0.1 — — 0.5 — 0.4perfluoromethylheptane sulfonic acids (methyl branched PFOS) Sm-PFOS 0.1 1.2 0.2 7.4 1.5 5.7linear perfluorooctane sulfonic acid n-PFOS 0.1 5.5 1.4 34.6 3.2 12.8perfluorononanoic acid PFNA 0.1 0.6 — 2.1 0.6 1.9* CDC. Fourth national report on human exposure to environmental chemicals: updated tables, January 2019, volume one. Atlanta, GA: US Department of Health and Human Services, CDC; 2019. https://www.cdc.gov/exposurereport/pdf/FourthReport_UpdatedTables_Volume1_Jan2019-508.pdf.† Below the LOD (applies to all of the dashes in cells of the table).TopSuggested citation for this article: Pritchett JR, Rinsky JL, Dittman B, et al. Notes from the Field: Targeted Biomonitoring for GenX and Other Per- and Polyfluoroalkyl Substances Following Detection of Drinking Water Contamination — North Carolina, 2018. MMWR Morb Mortal Wkly Rep 2019;68:647–648. DOI: http://dx.doi.org/10.15585/mmwr.mm6829a4.MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services.Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.View Page In: PDF [78K]Last Reviewed: July 25, 2019Source: Centers for Disease Control and Prevention* Syndicate* MMWR* Reports by Topic* Publications plus icon+ Weekly Report plus icono Past Volumes (1982-2023)o Past Volumes (1982-2024)+ Recommendations and Reports plus icono Past Volumes (1990-2022)o Past Volumes (1990-2024)+ Surveillance Summaries plus icono Past Volumes (1983-2023)o Past Volumes (1983-2024)+ Supplements plus icono Past Volumes (1985-2023)+ Archive (1952-1981)+ Notifiable Infectious Diseases+ Notifiable Noninfectious Conditions* Vital Signs* Visual Abstracts* Podcasts* Continuing Education* MMWR Clinical Pearls* Metrics* For Authors* About plus icon+ Staff+ Editorial Board* Subscribe plus icon+ RSS FeedMetric DetailsCloseViewsView data is collected and posted time period. Page views include both html and pdf views of an article.Views since publication* Page Views: 863* Page Views: 3,878* Page Downloads: 36* Page Downloads: 121* Total Views: 899* Total Views: 3,999View ActivityFirst 30 Days Total ViewsCitations: 14Citations: 15AltmetricsClick a source for Altmetric detailsWhat is the Altmetric Attention Score?The Altmetric Attention Score for a research output provides an indicator of the amount of attention that it has received. 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