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Thomas M Krauss
Ana Maria C B Braga
Global Monitoring Plan
Brazilian Contribution
POPs in Human Milk
Fundação Oswaldo Cruz Escola Nacional de Saúde Pública Centro de Estudos da Saúde do Trabalhador e Ecologia Humana
Analytical Capacity Sample Preparation: Freeze dryer, Centrifuge
Extraction: Classic Soxhlet Extractor, Liquid-Liquid
Cleanup: Open Columns (Biobeads, Silica, Florisil, etc.)
Instrumental: HRGC/LRMS and HRGC/µ-ECD
Matrixes:
Soil (PCDD/F, Indicator PCBs, Pesticides, PAHs)
Sediment (PCDD/F, Indicator PCBs, Pesticides, PAHs)
Air Particles (PCDD/F, Indicator PCBs, PAHs)
Human Milk (Indicator PCBs, Pesticides)
Human Blood (Indicator PCBs, Pesticides)
Personal: At the moment only one Chemist for POPs
GMP Phase 1
Second Study 2011 - 2014
Fifth Study of Persistent
Organic Pollutants in Human
Milk coordinated by WHO in
collaboration with UNEP
First study was conducted in 2002 attending the call for participation in the
Third Round of Exposure Studies – PCDD/Fs and PCBs in Human Milk
coordinated by WHO/European Center for Environment and Health
GMP Phase 1
Contact by the Department for Climate Change and
Environmental Quality of the Ministry of Environment
(MMA), focal point of the Stockholm Convention in
Brazil.
Project elaboration for monitoring of POPs in Human
Milk in order to fulfill the obligations of the convention
and introduce Brazil in the GMP.
Approval of the project e financial support by the
ministry – Collaboration between FIOCRUZ and MMA.
National Coordination: Ana Maria C. B. Braga e Thomas
M. Krauss.
GMP Phase 1 Elaboration of the national protocol for human milk sampling
based on the WHO guidelines (2007) and the protocol of the first
study.
National Protocol used as Base for Standard Operating
Procedure for human milk sampling in the Grulac region.
http://www.ccbasilea-crestocolmo.org.uy/wp-
content/uploads/2010/11/SOP-Regional-de-Muestreo-de-
COP-en-Leche-materna.pdf
http://www.ccbasilea-crestocolmo.org.uy/wp-
content/uploads/2010/11/ing1.final_.SOP-POP-Regional-
Sampling-Breast-Milk-1.pdf
Sampling Locations Second Study (2011 – 2013) – GMP1
Grande Região 1 Grande Região 2 Grande Região 3
Rio Branco/Acre (3) Maceió/Alagoas (9) Brasília/ Distrito Federal
Macapá/Amapá Salvador/Bahia (10) Goiás/Goiânia (11)
Manaus/Amazônia Fortaleza/Ceará Belo Horizonte/Mina Gerais (12)
Belém/Pará (5) São Luis/Maranhão (6) Vitória/Espírito Santo
Porto Velho/Rondônia (2) João Pessoa/Paraíba (7) Rio de Janeiro/ Rio de Janeiro (13)
Boa Vista/Roraima (4) Recife/Pernambuco (8) São Paulo/São Paulo (14)
Palmas/Tocantins Teresina/Piauí Curitiba/Paraná
Cuiabá/Mato Grosso (1) Natal/Rio Grande do Norte Porto Alegre/Rio Grande do Sul
Campo Grande/Mato Grosso do Sul Aracaju/Sergipe Florianópolis/Santa Catarina (15)
Sampling Strategy - GMP Phase 1 Volunteer collaboration of human milk banks which are part of the
Brazilian Network of Human Milk Banks
Seeking of donors (eligibility criteria)
Application of the questionnaire
Human milk sampling
Human milk banks have the following vantages:
Sampling is done by professional that are accustomed with human
milk sampling handling of the samples;
Milk banks have the infrastructure for adequate storage of the
samples;
Professional are aware about the importance of breastfeeding.
All participating banks were visited and the staff trained for the special
purpose of the study. Delivery of all material (prepared sample bottles,
eligibility guide, consent form, questionnaire and a manual with
detailed instructions.
Type, number and volume of samples
150 individual samples collected – 100 mL
15 local pool samples - 350 mL (+ 150 mL reserve)
analysis of dioxins, PCBs, POPs pesticides and
PBDEs at the reference laboratory
3 regional pool samples - 750 mL analysis of all
POPs at the reference laboratory
150 individual samples - 35 mL analysis of DDT
and metabolites, and indicator PCBs at the
laboratory of FIOCRUZ.
Substâncias analisadas Compound/Compound group Regional pool (n = 3) Local pool (n = 15) Individual sample (n = 160)
Antigos POPs
PCDDs SIM SIM
PCDFs SIM SIM
dl-PCBs SIM SIM
PCBs indicadores SIM SIM SIM
DDT SIM SIM SIM
Clordano SIM SIM
Heptacloro SIM SIM
Aldrin SIM SIM
Dieldrin SIM SIM
Endrin SIM SIM
Toxafeno SIM SIM
Hexaclorobenzeno (HCB) SIM SIM
Mirex SIM SIM
Novos POPs
Hexaclorociclohexano (HCH) SIM SIM
Clordecona SIM
Hexabromobifenila SIM SIM
Pentaclorobenzeno SIM SIM
Endosulfam SIM SIM
Ácido perfluorooctanosulfônico (PFOS) SIM SIM
Polibromodifenil éteres (PBDEs) SIM SIM
Candidatos POPs
Parafinas cloradas de cadeia curta (SCCPs) SIM
Hexabromociclododecano (HBCD) SIM
Outras substâncias não POPs
Polibromodibenzo-p-dioxinas (PBDDs) SIM
Polibromodibenzofuranos (PBDFs) SIM
Dibenzo-p-dioxinas polihalogenadas (PXDDs) SIM
Dibenzofuranos polihalogenados (PXDFs)d SIM
Substâncias perfluoradas (PFCs) SIM SIM
Results – PCDDs/PCDFs e dl-PCBs
PCDD/Fs and dl-PCBs Medians - First study 2002
0
5
10
15
20
25
30
35
pg
EQT-
OM
S 19
98/g
de
go
rdu
ra
País
PCDDs/PCDFs dl-PCBs
Results– Indicator PCBs
Indicador PCBs Medians - First study 2002
0
50
100
150
200
250
300
350
400
450
500
550
ng/
g d
e g
ord
ura
País
PCBs indicadores
Results – PCDD/Fs Average levels of PCDD/Fs found in human milk of de 23 countries in ther period
of de 2008/2009 compared to average level found in Brazil in 2012
Average Brasil 2012:
2,38 pg EQT-OMS2005/g de gordura
2,73 pg EQT-OMS1998/g de gordura
0
5
10
15
20
25
pg
EQT-
OM
S 19
98/g
de
go
rdu
ra
País
PCDDs/PCDFs
Results – dl-PCBs Average levels of dl-PCBs found in human milk of de 23 countries in ther period of
de 2008/2009 compared to average level found in Brazil in 2012
Average Brasil 2012:
0,82 pg EQT-OMS2005/g de gordura
1,14 pg EQT-OMS1998/g de gordura
0
2
4
6
8
10
12
14
pg
EQT-
OM
S 19
98/g
de
go
rdu
ra
País
dl-PCBs
Results – IndicatorPCBs
Average levels of indicator PCBs found in human milk of de 23 countries in ther
period of de 2008/2009 compared to average level found in Brazil in 2012
0
10
20
30
40
50
60
70
80
90n
g/g
de
go
rdu
ra
País
PCBs indicadores
Average = 5,03 ng/g de gordura
GMP 1 Benefits and Problems
Stimulating the execution of national projects
Fincancial support – unfortunately low
Support with consumables, eg HT-8 for PCBs analysis
Proficiency test
Complicated bureaucratic procedures for establishing
formal collaborations – international and national level.
Long sampling times – other sampling strategy?
Restriction of donors maximum age
Challenges and expectations for the GMP-2 project
Increase of sample number – sampling in all state capitals of
Brazil including the Federal District – at least 270 individual
samples – maintain three regional pools with 90 individual
samples.
Involve stakeholders of the Ministry of Health on state or
municipality level – commitment of a local staff for seeking
donors – only sampling and storage at human milk banks.
Increase laboratorial capacity
Equipment for analysis of dioxins and other POPs of
complex analysis HRGC/HRMS and HRGC/MS/MS.
Contract technicians
Acknowledgement
The study coordinators are grateful to all the coordinators of the participating banks of
the Brazilian Network of Human Milk Banks and their staffs for their voluntary work
and great effort to identify donors and collect human milk samples. Without the support
of these banks it would not have been possible to collect samples all over the national
territory with such a large dimension.
In particular, we thank all the donors for the availability to answer the questionnaire and
the kindness to grant the collection of their milk for this research.
Contacts
Ana Maria C. B. Braga - [email protected]
Thomas M. Krauss - [email protected]