Immunotoxicity of perfluoroalkyl substances (PFAS) in a register-based cohort of children: leveraging the Ronneby PFAS catastrophe to advance science and policy on the global scale

Exposure to perfluoroalkyl substances (PFAS), a widely-used class of persistent chemicals, has been linked to an array of adverse health outcomes, including immunotoxic effects like reduced antibody response to vaccination.

Early-life exposures may be particularly harmful, as the prenatal and early postnatal periods are critical for adaptive immune system development and changes during these periods may persist through the life-course. The COVID-19 pandemic has highlighted the serious implications of PFAS immunotoxicity.

However, there is a lack of epidemiological research on potential associations between PFAS and clinically relevant  immune outcomes in children.I will investigate the potential immunotoxic effects of developmental PFAS exposures using a globally-unique cohort of children with well-defined PFAS exposures and detailed medical records.

In 2013, it was discovered that one of two municipal water supplies in Ronneby, Sweden had delivered PFAS-contaminated water to residents for several decades.

I will leverage this unfortunate natural experiment to create a register-based longitudinal cohort of children born in Blekinge county between 2004-2013 (n = 15,700).

Using healthcare records from the Blekinge Healthcare Register and residential addresses as a proxy for PFAS exposure, I will evaluate whether high PFAS exposures are associated with clinical outcomes related to immunosuppression (e.g., counts of common childhood infections) and hypersensitivity (e.g., incidence of asthma, allergy, and eczema).

Recent studies indicate that PFAS exposures may be associated with increased COVID-19 severity and mortality.

Therefore, I will also investigate whether high prenatal and childhood PFAS exposures are associated with childhood COVID-19 incidence.

Results from my research will provide necessary evidence for future risk assessments, guide public health decisions, and provide critical information to health practitioners caring for highly-exposed individuals.