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Childhood PFAS exposure and immunotoxicity: a systematic review and meta-analysis of human studies
Evangelia E Antoniou1, Wolfgang Dekant2
1Epicurus-Reviews, MetaAnalyses.Com, Heesstraat 80, Bilzen, Belgium. e.antoniou@epicurus-reviews.com.
Insights
Exposure to poly- and perfluoroalkyl substances (PFAS) may weaken infant and child immunity. This review found suggestive evidence linking PFAS to infections but limited evidence for reduced vaccine antibody responses.
Area of Science:
- Environmental Health
- Immunology
- Pediatrics
Background:
- Poly- and perfluoroalkyl substances (PFAS) are environmental contaminants linked to potential immunosuppression in infants and children.
- Existing epidemiological data on PFAS exposure, vaccine response, and infection risk in children are inconclusive.
- This systematic review addresses the need for a comprehensive summary of PFAS effects on pediatric immune health.
Purpose of the Study:
- To systematically review and synthesize human studies on the association between prenatal/childhood PFAS exposure and vaccine antibody response.
- To examine the relationship between PFAS exposure and the incidence of infectious diseases in children.
- To assess the overall impact of PFAS on infant and childhood immune system function.
Main Methods:
- A systematic literature search of MEDLINE/Pubmed was conducted for human studies published up to February 1, 2023.
- Included studies were epidemiological, analyzing gestational or childhood PFAS exposure against pediatric vaccine antibody levels or infectious disease occurrence.
- Data on exposure levels, timing, and outcomes were extracted, and meta-analyses were performed to calculate effect sizes.
Main Results:
- Seventeen articles met the inclusion criteria for the meta-analysis.
- A slight decrease in antibody response was generally observed with PFAS exposure.
- Associations between PFAS exposure and increased childhood infections were noted.
Conclusions:
- PFAS exposure may impact infant and childhood immune health, particularly concerning infections.
- Suggestive evidence links specific PFAS (PFOS, PFOA, PFHxS, PFNA) to increased infection risk.
- Evidence for PFAS-induced reduction in antibody titers is moderate to limited.
Background:
Exposure to poly- and perfluoroalkyl substances (PFAS) may affect infant and childhood health through immunosuppression. However, the findings of epidemiological literature examining relationships between prenatal/childhood PFAS exposure and vaccine response and infection in humans are still inconclusive. The aim of this review was to examine the effects of PFAS exposure on vaccine antibody response and infection in humans.
Methods:
The MEDLINE/Pubmed database was searched for publications until 1 February 2023 to identify human studies on PFAS exposure and human health. Eligible for inclusion studies had to have an epidemiological study design and must have performed logistic regression analyses of gestational or childhood exposure to PFAS against either antibody levels for pediatric vaccines or the occurrence of children's infectious diseases. Information on baseline exposure to PFAS (in ng/mL), the age of PFAS exposure (gestational or in years), and the outcome was measured, potentially leading to multiple exposure-outcome comparisons within each study was collected. Percentage change and standard errors of antibody titers and occurrence of infectious diseases per doubling of PFAS exposure were calculated, and a quality assessment of each study was performed.
Results:
Seventeen articles were identified matching the inclusion criteria and were included in the meta-analysis. In general, a small decrease in antibody response and some associations between PFAS exposure and childhood infections were observed.
Conclusions:
This meta-analysis summarizes the findings of PFAS effects on infant and childhood immune health. The immunosuppression findings for infections yielded suggestive evidence related to PFAS exposure, particularly PFOS, PFOA, PFHxS, and PFNA but moderate to no evidence regarding antibody titer reduction.
Systematic Review Registration:
The research protocol of this systematic review is registered and accessible at the Open Science Framework ( https://doi.org/10.17605/OSF.IO/5M2VU ).
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