Susceptibility to COVID-19 after High Exposure to Perfluoroalkyl Substances from Contaminated Drinking Water: An Ecological Study from Ronneby, Sweden

Abstract

There is concern that immunotoxic environmental contaminants, particularly perfluoroalkyl substances (PFAS), may play a role in the clinical course of COVID-19 and epidemiologic studies are needed to answer if high-exposed populations are especially vulnerable in light of the ongoing pandemic. The objective was, therefore, to determine if exposure to highly PFAS-contaminated drinking water was associated with an increased incidence of COVID-19 in Ronneby, Sweden, during the first year of the pandemic. We conducted an ecological study determining the sex- and age-standardized incidence ratio (SIR) in the adult population relative to a neighboring reference town with similar demographic characteristics but with only background levels of exposure. In Sweden, COVID-19 is subject to mandatory reporting, and we retrieved aggregated data on all verified cases until 3 March 2021 from the Public Health Agency of Sweden. The SIR in Ronneby was estimated at 1.19 (95% CI: 1.12; 1.27). The results suggest a potential link between high PFAS exposure and susceptibility to COVID-19 that warrants further research to clarify causality.

Antibody response to COVID-19 vaccines among workers with a wide range of exposure to per- and polyfluoroalkyl substances

“…Patients with COVID-19 have been shown to have renal dysfunction and the higher urine PFAS concentrations among cases in the case-control study may have been due to decreased reabsorption in the nephron ( Kormann et al, 2020 ). In the ecologic studies ( Catelan et al, 2021 , Nielsen and Jöud, 2021 ), it was not possible to establish that exposure to PFAS was greater among the individuals who had or died from COVID-19; the relative incidence (standardized incidence ratio 1.19, 95% CI 1.12-1.27) or mortality (relative risk, 1.6, 90% CI 0.94-2.51) of the disease in PFAS-exposed communities may have been due to factors other than PFAS.…”

“…A positive association between COVID-19 occurrence and PFAS was found in a case-control study ( Ji et al, 2021 ) and two ecologic studies of incidence or mortality ( Catelan et al, 2021 , Nielsen and Jöud, 2021 ). None of these studies evaluated COVID-19 titer suppression after vaccinations.…”

Cross-species Transcriptomics Analysis Highlights Conserved Molecular Responses to Per- and Polyfluoroalkyl Substances (PFAS)

“…More scientific literature supports the fact PFAS exposure impairs immune reactions, antibody production and vaccination responses, particularly in children exposed to PFAS during prenatal and postnatal periods [23][24][25]. This immunotoxicity has been observed not only in humans but also in other animals [23][24][25] and can increase the incidence and severity of many pathologies, including COVID-19 [99][100][101]. In addition, PFAS exposure increases the serum concentration of inflammatory and oxidative stress markers, potentially promoting the development of systemic diseases as liver injury and cardiovascular diseases, including atherosclerosis and thromboembolic events [102][103][104].…”

Cross-species Transcriptomics Analysis Highlights Conserved Molecular Responses to Per- and Polyfluoroalkyl Substances (PFAS)

“…More scientific literature supports the fact PFAS exposure impairs immune reactions, antibody production and vaccination responses, particularly in children exposed to PFAS during prenatal and postnatal periods [23][24][25]. This immunotoxicity has been observed not only in humans but also in other animals [23][24][25] and can increase the incidence and severity of many pathologies, including COVID-19 [100][101][102]. In addition, PFAS exposure increases the serum concentration of inflammatory and oxidative stress markers, potentially promoting the development of systemic diseases as liver injury and cardiovascular diseases, including atherosclerosis and thromboembolic events [103][104][105].…”