Introduction

The immunosuppressive properties of PFASs are widely recognized. Early-life exposure to PFAS has been linked to reduced immune response to childhood vaccinations and increased rates of common infectious diseases, but implications for hospitalizations are unclear.

Objectives

To investigate the association between maternal serum concentrations of five PFASs during pregnancy and the child’s rate of hospitalization due to common infectious diseases between birth and 4 years of age.

Methods

Serum samples from first trimester pregnant women from the Odense Child Cohort (OCC) collected in 2010–2012 were analyzed for concentrations of perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA) and three other PFASs. Data on child hospitalizations with an ICD-10 code for infectious disease was obtained from the Danish National Patient Register. The following were identified: upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), gastrointestinal infections (GI), and other infections. The Andersen-Gill Cox proportional hazard model for recurrent events was used to investigate the association between PFAS exposure and hospitalizations. The resulting estimates were hazard ratios (HRs), which express the relative change in the instantaneous risk of hospitalization with a doubling in maternal PFAS concentration.

Results

A total of 1,503 mother–child pairs were included, and 26% of the children were hospitalized at least once for infectious disease. A doubling in maternal PFOS concentration was associated with a 23% increase in the risk of hospitalization due to any infection (HR: 1.23 (95% CI: 1.05, 1.44). There was indication of an interaction between child sex and PFOS (p = 0.07) and PFDA (p = 0.06), although in opposite directions. Further, every doubling of PFOA or PFOS increased the risk of LRTI by 27% (HR: 1.27 (1.01, 1.59)) and 54% (HR: 1.54 (1.11, 2.15)), respectively. Similar tendencies were seen for URTI and the group of other infections. For GIs, the opposite pattern of association was seen as HR’s were consistently below 1 (PFOA, HR: 0.55 (0.32, 0.95)).

Discussion

We found an association between PFOS and the overall risk of infectious disease, and between PFOS and PFOA exposures and the risk of LRTI’s. These results are in agreement with previous findings from the OCC, in which maternal PFOS and PFOA concentrations were positively associated with the number of days that the children experienced fever, thereby suggesting that PFOS and PFOA may affect the prevalence of both mild and more severe infectious diseases even in a rather low-exposed population.

中文翻译：

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胎儿期接触全氟烷基物质和儿童时期因传染病住院：对来自欧登塞儿童队列的 1,503 名儿童进行的研究

介绍

PFAS 的免疫抑制特性已得到广泛认可。早年接触 PFAS 与儿童接种疫苗的免疫反应降低和常见传染病发病率增加有关，但对住院治疗的影响尚不清楚。

目标

调查孕期母体血清中五种 PFAS 浓度与儿童出生至 4 岁期间因常见传染病住院率之间的关系。

方法

对 2010 年至 2012 年收集的来自欧登塞儿童队列 (OCC) 的孕早期孕妇的血清样本进行了全氟辛烷磺酸 (PFOS)、全氟辛酸 (PFOA) 和其他三种 PFAS 浓度分析。带有 ICD-10 传染病代码的儿童住院数据是从丹麦国家患者登记处获得的。确定了以下疾病：上呼吸道感染 (URTI)、下呼吸道感染 (LRTI)、胃肠道感染 (GI) 和其他感染。复发事件的 Andersen-Gill Cox 比例风险模型用于调查 PFAS 暴露与住院之间的关联。得出的估计值是风险比 (HR)，

结果

共纳入 1,503 对母子，其中 26% 的儿童至少因传染病住院一次。母体 PFOS 浓度加倍与因任何感染引起的住院风险增加 23% 有关（HR：1.23（95% CI：1.05，1.44））。有迹象表明儿童性别与 PFOS 之间存在相互作用（p = 0.07) 和 PFDA (p = 0.06)，尽管方向相反。此外，PFOA 或 PFOS 每增加一倍，LRTI 的风险就会增加 27% (HR: 1.27 (1.01, 1.59)) 和 54% (HR: 1.54 (1.11) , 2.15)）。URTI 和其他感染组也有类似的趋势。对于 GI，相反的关联模式被视为 HR 始终低于 1（PFOA，HR：0.55（0.32，0.95））。

讨论

我们发现 PFOS 与传染病的总体风险之间存在关联，并且 PFOS 和 PFOA 暴露与 LRTI 风险之间存在关联。这些结即使是在相当低的暴露人群中也能感染疾病。