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- Exposure of the Portuguese adult population to arsenic: preliminary results of a human biomonitoring studyPublication . Namorado, Sónia; Coelho, Inês; Ventura, Marta; Gueifão, Sandra; Rego, Andreia; Castanheira, Isabel; Alves Alves, Clara; Castilho, Emília; Cordeiro, Eugénio; Dinis, Ana; Gouveia, Bruna; Prokopenko, Tamara; Vargas, Patrícia; Silva, Susana; Gaio, Vânia; Nunes, Baltazar; Matias Dias, CarlosBACKGROUND AND AIM:Although arsenic is an element naturally present in the environment, it is highly toxic in its inorganic forms. Exposure can occur through consumption of drinking water and contaminated food. Long-term exposure was shown to be associated with negative health outcomes. Nevertheless, data on the Portuguese population’s exposure to arsenic is scarce. As such, the aim of this work was to assess the exposure to Arsenic in the Portuguese population using samples collected in the study "Exposure of the Portuguese Population to Environmental Chemicals: a study nested in INSEF 2015" (INSEF-ExpoQuim), developed as an aligned study of the European Human Biomonitoring Initiative (HBM4EU). METHODS: INSEF-ExpoQuim was an epidemiologic study nested in INSEF 2015 including 270 participants aged 28-39 years,living in Portugal for more than 12 months and able to follow an interview in Portuguese. Fieldwork was developed between June 2019 and February 2020. First morning urine samples were collected along with data on socio-demographic characteristics, living conditions and residential history, habits/lifestyle, nutrition, health, occupation and substance specific information covering nearly all exposure pathways. Procedures followed the guidelines of the HBM4EU project. Total urinary arsenic is currently being determined by inductively coupled plasma mass spectrometry. RESULTS:Preliminary results for 38 samples yielded total urinary arsenic concentrations ranging from 11 to 462 μg/L with an average of 86 ± 94 μg/L. After completion of the determination of the urinary arsenic levels for all the samples a complete analysis of the data will be performed. CONCLUSIONS:Results from this study will contribute to the knowledge on the Portuguese population’s exposure to arsenic and may support the development and implementation of policy measures aimed at minimizing exposure to this chemical and improving the health of the population.
- Mercury exposure in Portuguese adolescentsPublication . Namorado, Sónia; Gomes, Diogo; Iria, Diogo; Cestelli, Federico; Mota, Afonso; Alves, Bernardo; Leal, João; Luz, Andreia; Gomes, João; Barros, Rafael; Pastorinho, M. Ramiro; Sousa, Ana C.A.The possible health effects related to exposure to hazardous chemicals have let to citizens interest in environmental health. Mercury, in particular, has been recognized as a chemical of concern, due to its well-known neurotoxicity and endocrine disrupting potential. In this work a group of teenagers from a school in Lisbon together with their teachers and researchers from the academia conducted a human biomonitoring survey on mercury levels in the students from their school. Recruitment was performed in a private school in Lisbon by a group of students from the 11th and 12th grade under the supervision of biology teachers and after having received training from researchers from the academia. All participants answered a questionnaire with specific questions on possible mercury exposure sources (e.g. seafood consumption, dental amalgams). Hair samples were collected and analysed using atomic absorption spectrometry with thermal decomposition and gold amalgamation alongside with human hair certified reference material. The study protocol was approved by the Pedagogical Board of the school and authorized by the National Data Protection Commission. From the 92 students recruited, with ages ranging from 12 to 18 years, 56.5% were females, most lived in urban areas (91.3%) and the majority (97.8%) did not have dental amalgam fillings. Participants Body Mass index (BMI) ranged from 15.1 to 28.4 kg/m2, with a mean of 20.6 ± 2.6 kg/m2. Total mercury in hair ranged from 0.01 to 3.32 μg/g, with a mean of 1.09 ± 0.66 μg/g. Around 40% of the students had mercury levels higher the US EPA reference limit of 1 μg/g, while 9.8% exhibit levels higher than the reference dose set by the WHO (2 μg/g). Levels of mercury above the US EPA reference limit are significantly associated with higher consumption of fish (more than once a week), but not with shellfish and seaweed consumption.
- Pregnancy during COVID-19: social contact patterns and vaccine coverage of pregnant women from CoMix in 19 European countriesPublication . Wong, Kerry L.M.; Gimma, Amy; Paixao, Enny; Paolotti, Daniela; Karch, André; Jäger, Veronika; Baruch, Joaquin; Melillo, Tanya; Hudeckova, Henrieta; Rosińska-Bukowska, Magdalena; Niedźwiedzka-Stadnik, Marta; Fischer, Krista; Vorobjov, Sigrid; Sõnajalg, Hanna; Althaus, Christian; Low, Nicola; Reichmuth, Martina L.; Auranen, Kari; Nurhonen, Markku; Petrović, Goranka; Makaric, Zvjezdana Lovric; Namorado, Sónia; Caetano, Constantino; Santos, Ana João; Röst, Gergely; Oroszi, Beatrix; Karsai, Márton; Fafangel, Mario; Klepac, Petra; Kranjec, Natalija; Vilaplana, Cristina; Casabona-Barbarà, Jordi; FAES, Christel; Beutels, Philippe; Hens, Niel; Jarvis, Christopher; Edmunds, JohnBackground: Evidence and advice for pregnant women evolved during the COVID-19 pandemic. We studied social contact behaviour and vaccine uptake in pregnant women between March 2020 and September 2021 in 19 European countries. Methods: In each country, repeated online survey data were collected from a panel of nationally-representative participants. We calculated the adjusted mean number of contacts reported with an individual-level generalized additive mixed model, modelled using the negative binomial distribution and a log link function. Mean proportion of people in isolation or quarantine, and vaccination coverage by pregnancy status and gender were calculated using a clustered bootstrap. Findings: We recorded 4,129 observations from 1,041 pregnant women, and 115,359 observations from 29,860 non-pregnant individuals aged 18-49. Pregnant women made slightly fewer contacts (3.6, 95%CI = 3.5-3.7) than non-pregnant women (4.0, 95%CI = 3.9-4.0), driven by fewer work contacts but marginally more contacts in non-essential social settings. Approximately 15-20% pregnant and 5% of non-pregnant individuals reported to be in isolation and quarantine for large parts of the study period. COVID-19 vaccine coverage was higher in pregnant women than in non-pregnant women between January and April 2021. Since May 2021, vaccination in non-pregnant women began to increase and surpassed that in pregnant women. Interpretation: Limited social contact to avoid pathogen exposure during the COVID-19 pandemic has been a challenge to many, especially women going through pregnancy. More recognition of maternal social support desire is needed in the ongoing pandemic. As COVID-19 vaccination continues to remain an important pillar of outbreak response, strategies to promote correct information can provide reassurance and facilitate informed pregnancy vaccine decisions in this vulnerable group.
- Application of human biomonitoring data to support policy development, raise awareness and environmental public health protection among countries within the HBM4EU projectPublication . Ubong, Dorothy; Stewart, Lorraine; Sepai, Ovnair; Knudsen, Lisbeth E.; Berman, Tamar; Reynders, Hans; Van Campenhout, Karen; Katsonouri, Andromachi; Van Nieuwenhuyse, An; Ingelido, Anna Maria; Castaño, Argelia; Pedraza-Díaz, Susana; Eiríksdóttir, Ása Valgerður; Thomsen, Cathrine; Hartmann, Christina; Gjorgjev, Dragan; De Felip, Elena; Tolonen, Hanna; Santonen, Tiina; klanova, Jana; Norström, Karin; Kononenko, Lijana; Silva, Maria João; Uhl, Maria; Kolossa-Gehring, Marike; Apel, Petra; Jõemaa, Merli; Jajcaj, Michal; Estokova, Milada; Luijten, Mirjam; Lebret, Erik; von Goetz, Natalie; Holcer, Natasa Janev; Probst-Hensch, Nicole; Cavaleiro, Rita; Barouki, Robert; Tarroja, Elena; Balčienė, Rosita Marija; Strumylaite, Loreta; Latvala, Siiri; Namorado, Sónia; Szigeti, Tamás; Ingi Halldorsson, Thorhallur; Olafsdottir, Kristin; Wasowicz, Wojciech; Viegas, Susana; Alvito, PaulaMost countries have acknowledged the importance of assessing and quantifying their population’s internal exposure from chemicals in air, water, soil, food and other consumer products due to the potential health and economic impact. Human biomonitoring (HBM) is a valuable tool which can be used to quantify such exposures and effects. Results from HBM studies can also contribute to improving public health by providing evidence of individuals’ internal chemical exposure as well as data to understand the burden of disease and associated costs thereby stimulating the development and implementation of evidence-based policy. To have a holistic view on HBM data utilisation, a multi-case research approach was used to explore the use of HBM data to support national chemical regulations, protect public health and raise awareness among countries participating in the HBM4EU project. The Human Biomonitoring for Europe (HBM4EU) Initiative (https://www.hbm4eu.eu/) is a collaborative effort involving 30 countries, the European Environment Agency (EEA) and the European Commission (contracting authority) to harmonise procedures across Europe and advance research into the understanding of the health impacts of environmental chemical exposure. One of the aims of the project was to use HBM data to support evidence based chemical policy and make this information timely and directly available for policy makers and all partners. The main data source for this article was the narratives collected from 27 countries within the HBM4EU project. The countries (self-selection) were grouped into 3 categories in terms of HBM data usage either for public awareness, policy support or for the establishment HBM programme. Narratives were analysed/summarised using guidelines and templates that focused on ministries involved in or advocating for HBM; steps required to engage policy makers; barriers, drivers and opportunities in developing a HBM programme. The narratives reported the use of HBM data either for raising awareness or addressing environmental/public health issues and policy development. The ministries of Health and Environment were reported to be the most prominent entities advocating for HBM, the involvement of several authorities/institutions in the national hubs was also cited to create an avenue to interact, discuss and gain the attention of policy makers. Participating in European projects and the general population interest in HBM studies were seen as drivers and opportunities in developing HBM programmes. A key barrier that was cited by countries for establishing and sustaining national HBM programmes was funding which is mainly due to the high costs associated with the collection and chemical analysis of human samples. Although challenges and barriers still exist, most countries within Europe were already conversant with the benefits and opportunities of HBM. This article offers important insights into factors associated with the utilisation of HBM data for policy support and public awareness.
- Revised report on national needs, objectives of a long-term HBM4EU inventory of funding mechanisms and recommendations for a sustainable HBM initiative in Europe and its organisationPublication . Vicente, Joana Lobo; Katsonouri, Andromachi; Reynders, Hans; Van Campenhout, Karen; Mampaey, Maja; Tarroja, Elena; Louro, Henriqueta; Isidro, Glória; Silva, Maria João; Namorado, Sónia; Bourqui, Martine; von Goetz, Natalie; Virgolino, Ana; Sepai, Ovnair; Hopson, AmyThis report aims to provide a revision on the national needs (T6.1), the funding mechanisms (T6.2) and the long-term sustainability of HBM4EU (T6.3). Therefore, this report is divided in the three above-mentioned sections, for which the different tasks within work package 6 (WP 6) provided input. Concerning national needs, a survey is conducted annually by the national hub (NH) coordinator to monitor and evaluate the progress and development of all National Hubs involved in HBM4EU. With 2020 being the fourth year of the HBM4EU project, the survey followed many of the questions of previous years. Most NHs are satisfied with their current HBM4EU involvement, but have expressed their concerns regarding the communication, funding and lack of direct involvement. The follow-up to HBM4EU, PARC, was mentioned and the necessary involvement of all countries as well as the importance of communication between NHs and National Hub Contact Points (NHCPs) was highlighted. Inclusivity of smaller countries seems to be a problem through both lack of funding and adequate tasks. Regarding funding mechanisms, the initial list of financing mechanisms in the HBM and environmental health area at national and international level was updated and is available on the HBM4EU website under the “Funding Opportunities” tab. This intends to be an inventory that can be used not only by the HBM4EU consortium but by the entire scientific community to provide an overview of existing funding sources. It comprises of a set of targeted strategies for identification and dissemination of funding which are explained in further detail in section 6 Funding mechanisms. A systematic literature review was also undertaken to understand what the primary funding source of projects in HBM was. The results are not available yet. As part of T6.3 on the long-term sustainability, a citizen survey was developed together with T4.1 – mapping of needs. This survey was initially used for focus groups to better understand their awareness and concerns of chemical exposure and Human Biomonitoring. It was updated to harvest more EU-wide results including chemical exposure during the COVID-19 pandemic. The survey took place between September 2020 and February 2021 and the results were organised to cover the same regions as the aligned studies to allow for the organisation of results in a similar way for coherence. In order to produce a short report summarising the outcome of the survey, the questions were grouped for quicker analysis. The majority of the respondents considers HBM a tool that produces important results on human exposure to chemicals and that it should be performed more often and in a more coordinated way. This was a non-representative survey and future work should focus on wider dissemination in other population groups and on understanding how perceptions change over time. The survey’s answers were also distributed to the NHs, so they can produce internal communication briefs on their own data for further dissemination.
- Estimativa do risco cardiovascular na população portuguesa: aplicação do novo SCORE2Publication . Santos, Maria Manuel; Sousa-Uva, Mafalda; Namorado, Sónia; Gonçalves, Teresa; Matias Dias, Carlos; Gaio, VâniaIntrodução: As doenças cardiovasculares continuam a ser a principal causa de morte globalmente. A estimativa do risco cardiovascular (RCV) é útil para a prevenção precoce através da identificação dos indivíduos com necessidade de intervenção no estilo de vida e, eventualmente, na terapêutica medicamentosa. De acordo com um estudo prévio realizado na população portuguesa, que utilizou o Systematic Coronary Risk Evaluation (SCORE), a estimativa do risco a 10 anos de doença cardiovascular fatal na população portuguesa foi 17,1%. Objetivos: O presente estudo teve como objetivo estimar e caraterizar o RCV a 10 anos em Portugal, no ano de 2015, nos indivíduos com idade entre os 40 e 69 anos, utilizando o novo SCORE2 desenvolvido em 2021, pela Sociedade Europeia de Cardiologia. Metodologia: Foram usados os dados gerados pelo 1º Inquérito Nacional de Saúde com Exame Físico (INSEF 2015) considerando como critérios de inclusão à data do inquérito: idade entre os 40 e 69 anos, ausência de gravidez, informação disponível sobre o sexo, idade, consumo de tabaco, pressão arterial sistólica, colesterol total e lipoproteína de alta densidade. Foram excluídos da análise os participantes com as seguintes doenças ativas: doença cardiovascular, diabetes, doença renal crónica, ou com terapêutica medicamentosa para enfarte agudo do miocárdio, acidente vascular cerebral, diabetes e doença renal crónica (n = 2817). A prevalência de RCV alto ou muito alto foi estratificada por sexo, grupo etário, estado civil, nível de escolaridade, atividade profissional, grau de urbanização, região de residência e quintil de rendimento. Resultados: Em Portugal, no ano de 2015, 36,7% (IC95%: 34,2 a 39,0) e 6,1% (IC95%: 4,9 a 8,0) dos indivíduos com idades compreendidas entre os 40 e os 69 anos tinha um RCV alto e muito alto, respetivamente. A prevalência de risco cardiovascular alto ou muito alto era superior nos homens, entre os 60 e 69 anos, nos indivíduos sem escolaridade ou com o 1º ciclo do ensino básico e com baixa qualificação da atividade profissional (por exemplo: agricultores, trabalhadores da indústria e construção). Conclusões: Verificou-se uma elevada prevalência de risco alto ou muito alto de vir a desenvolver doença cardiovascular (fatal ou não fatal) nos 10 anos seguintes (42,8%) na população portuguesa com idade entre os 40 e os 69 anos, em 2015. Dada esta prevalência e considerando os grupos populacionais mais suscetíveis, é premente identificar precocemente e monitorizar estes indivíduos, nomeadamente, ao nível dos Cuidados de Saúde Primários, o que poderá contribuir para a redução da mortalidade e morbilidade por doença cardiovascular na população portuguesa.
- Time Trends of Acrylamide Exposure in Europe: Combined Analysis of Published Reports and Current HBM4EU StudiesPublication . Poteser, Michael; Laguzzi, Federica; Schettgen, Thomas; Vogel, Nina; Weber, Till; Zimmermann, Philipp; Hahn, Domenica; Kolossa-Gehring, Marike; Namorado, Sónia; Van Nieuwenhuyse, An; Appenzeller, Brice; Halldorsson, Thorhallur; Eiríksdóttir, Ása; Haug, Line Småstuen; Thomsen, Cathrine; Barbone, Fabio; Rosolen, Valentina; RAMBAUD, Loic; RIOU, Margaux; Göen, Thomas; Nübler, Stefanie; Schäfer, Moritz; Haji-Abbas-Zarrabi, Karin; Gilles, Liese; Rodriguez Martin, Laura; Schoeters, Greta; Sepai, Ovnair; Govarts, Eva; Moshammer, HannsMore than 20 years ago, acrylamide was added to the list of potential carcinogens found in many common dietary products and tobacco smoke. Consequently, human biomonitoring studies investigating exposure to acrylamide in the form of adducts in blood and metabolites in urine have been performed to obtain data on the actual burden in different populations of the world and in Europe. Recognizing the related health risk, the European Commission responded with measures to curb the acrylamide content in food products. In 2017, a trans-European human biomonitoring project (HBM4EU) was started with the aim to investigate exposure to several chemicals, including acrylamide. Here we set out to provide a combined analysis of previous and current European acrylamide biomonitoring study results by harmonizing and integrating different data sources, including HBM4EU aligned studies, with the aim to resolve overall and current time trends of acrylamide exposure in Europe. Data from 10 European countries were included in the analysis, comprising more than 5500 individual samples (3214 children and teenagers, 2293 adults). We utilized linear models as well as a non-linear fit and breakpoint analysis to investigate trends in temporal acrylamide exposure as well as descriptive statistics and statistical tests to validate findings. Our results indicate an overall increase in acrylamide exposure between the years 2001 and 2017. Studies with samples collected after 2018 focusing on adults do not indicate increasing exposure but show declining values. Regional differences appear to affect absolute values, but not the overall time-trend of exposure. As benchmark levels for acrylamide content in food have been adopted in Europe in 2018, our results may imply the effects of these measures, but only indicated for adults, as corresponding data are still missing for children.
- Prevalence, awareness, treatment and control of diabetes in Portugal: Results from the first National Health Examination Survey (INSEF 2015)Publication . Barreto, Marta; Kislaya, Irina; Gaio, Vânia; Rodrigues, Ana Paula; Santos, Ana João; Namorado, Sónia; Antunes, Liliana; Gil, Ana Paula; Boavida, José Manuel; Ribeiro, Rogério Tavares; Silva, Ana Clara; Vargas, Patrícia; Prokopenko, Tamara; Nunes, Baltazar; Matias Dias, Carlos; INSEF Research GroupAims: Diabetes Mellitus is a major public health threat worldwide and continues to increase in numbers and significance. Estimates of diabetes prevalence, awareness, treatment and control are essential to effectively monitor its trends, plan and evaluate interventions. Methods: We conducted a nationwide health examination survey in the population residing in Portugal aged between 25 and 74 years old in 2015. It consisted in a cross sectional prevalence study which included the measurement of HbA1c, a physical examination and a general health interview of a probabilistic sample of 4911 individuals (Authorization n°9348/2010 of the National Committee for Data Protection). Results: The overall prevalence of diabetes was 9.9% (95%CI: 8.4; 11.5). It was higher in males than in females (12.1% vs 7.8%). Diabetes was more prevalent among individuals of lower education and without any professional activity. The majority of persons with diabetes was aware of their condition (87.1%) and was taking antidiabetic medication (79.7%). Of these, 63.2% had glycated hemoglobin levels lower than 7.0% (53 mmol/mol), but the majority failed to comply with the LDL and blood pressure recommended clinical targets (71.9% and 59.0%). Similarly, the prevalence of prediabetes was 16%, higher among women than men (17.5% vs 14.4%). Conclusion: The prevalence of diabetes and prediabetes remains higher than the global and European estimates, although there is increasing awareness of this disorder.
- Consumo adicional de sal em Portugal: resultados do Inquérito Nacional de Saúde com Exame Físico 2015Publication . Salvador, Mário Rui; Kislaya, Irina; Namorado, Sónia; Rodrigues, Ana Paula; Santos, Ana João; Santos, Joana; Barreto, Marta; Gaio, Vânia; Nunes, Baltazar; Matias Dias, CarlosIntrodução Nas últimas décadas, estudos epidemiológicos têm demonstrado a associação entre o elevado consumo de sódio e o aumento da pressão arterial e outros eventos cardiovasculares. Apesar da OMS recomendar a ingestão de 5g de sal/dia, o estudo PHYSA realizado em 2012 mostrou que o consumo da população Portuguesa era de 10,7g de sal/dia. Tendo a redução do consumo de sal sido identificada com uma das intervenções mais custo-efetivas na redução da carga de doença crónica, é importante a caracterização dos padrões de consumo na população com vista ao planeamento de estratégias de redução de consumo de sal em diferentes grupos populacionais. Métodos Foi realizado um estudo epidemiológico transversal com base nos dados do Inquérito Nacional de Saúde com Exame Físico (INSEF). O consumo adicional de sal foi avaliado numa amostra probabilística representativa da população portuguesa (n=4911), com a questão “Costuma adicionar sal no prato da sua comida? (Sim/Não)”. Foi estimada a prevalência do consumo de sal e os respetivos intervalos de confiança a 95% para o total de população e estratificada por sexo, grupo etário, região, escolaridade, situação perante o trabalho e diagnóstico de hipertensão arterial. Resultados O consumo adicional de sal foi reportado por 17,7% [IC: 14,2; 21,9] da população. O consumo adicional de sal foi mais frequente entre os homens (20,9% [IC: 16,2; 26,5]), nos residentes na região do Algarve (35,8% [IC: 32,5; 39,3]) e entre os indivíduos empregados (19,6% [IC: 15,4; 24,6]) e variou com a idade de 22% [IC: 17,2; 27,6] no grupo etário mais jovem a 14% [IC: 10,6; 18,3] no grupo etário dos 65-74 anos. Os resultados revelam, ainda, que 13,7% [IC: 9,4; 19,5] da população com diagnóstico de hipertensão arterial refere um consumo adicional de sal. Conclusões Os resultados obtidos permitem concluir que a prevalência de consumo adicional de sal é maior em homens, em grupos etários mais jovens, em indivíduos empregados e na região do Algarve. O consumo adicional de sal nos indivíduos com diagnóstico de hipertensão arterial mostra um comportamento contrário às orientações preconizadas para controlo dos valores de pressão arterial nesta população. Os serviços de saúde pública deverão, neste sentido, centrar as estratégias de redução de consumo de sal nestes grupos populacionais, particularmente em indivíduos com diagnóstico de hipertensão arterial e que estão, por isso, sob maior risco de eventos cardiocerebrovasculares.
- HBM4EU-MOM: intervene to raise awareness to specific dietary recommendations and reduceprenatal mercury exposurePublication . Namorado, Sónia; Assunção, Ricardo; Santiago, Susana; Esteban López, Marta; Dominguez Morueco, Noelia; Ingi Halldórsson, Þórhallur; Jacobsen, Eva; Gabriel, Catherine; Karakitsios, Spyros; Giannadaki, Despina; Xatjipanagi, Adamos; Anastasi, Elena; Thoma, Chrysanthi; Snoj Tratnik, Janja; Horvat, Milena; Sarigiannis, Denis; Katsonouri, AndromachiBACKGROUND AND AIM:Mercury and its compounds are toxic and are among the substances of higher concern globally.Toxicity depends on mercury compounds, route of exposure and duration. The European population is mostly exposed to organic mercury (methylmercury) due to fish consumption; while exposure to inorganic and elemental mercury is largely associated with dental amalgams, accidental spills of elemental mercury and food produced in contaminated sites. Previous studies have shown that mercury levels in European population are higher in countries with higher fish consumption.However, because of the beneficial nutrients they provide, fish are an essential component of the human diet. In order to reduce exposure and avoid adverse health effects, it is extremely important to balance the risks and benefits of eating fish,especially in vulnerable groups such as pregnant women. Most European countries do not have official guidelines for the consumption of fish during pregnancy, and even if these guidelines exist, they are often not communicated to pregnant women in an appropriate way. As such, under the European Human Biomonitoring Initiative (HBM4EU) an intervention study – HBM4EU-MOM – is being developed in five European countries with high fish consumption (Cyprus, Greece, Iceland, Portugal, Spain) to help reduce prenatal exposure to mercury,while ensuring the nutritional benefits of fish by developing and raising awareness to specific recommendations for fish consumption during pregnancy. METHODS:This presentation will highlight the work already performed, including the harmonized development of the intervention and support materials to be implemented in the five countries. RESULTS:Preliminary results on the implementation of the developed intervention and its evaluation using Human Biomonitoring will also be presented. CONCLUSIONS:This study's results will support the definition of policies to protect human health in vulnerable populations. HBM4EU has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 733032.