Gestion du plomb dans l eau potable l approche québécoise de santé publique

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1 Gestion du plomb dans l eau potable l approche québécoise de santé publique Management of lead in drinking water - the public health approach in Québec 16th Canadian National Conference on Drinking Water Gatineau, Québec, October 29, 2014

2 Gauvin Denis, INSPQ Brault Nathalie, DSP Montérégie Savard Michel, DSP Laurentides Beausoleil Monique, DSP Montréal Campagna Céline, INSPQ Levallois Patrick, INSPQ with the collaboration of the Comité permanent sur l eau de la Table nationale de concertation en santé environnementale

3 Lead and Health Lead is a toxic metal widely distributed in the environment WHO, EPA, Health Canada: effects associated with lead exposure include neurodevelopmental, neurodegenerative, cardiovascular, renal and reproductive effects Effects in children are of particular concern

4 Lead and Children Children aged under 6 years are a vulnerable subpopulation for lead exposure : Greater gastrointestinal absorption than adults Less effective renal excretion Developmental susceptibility

5 Lead and Children Specific behaviours increase exposure: hand-to-mouth contact mouthing behaviour oral intake of paint chips, dust, soil, etc. Fetuses are also vulnerable

6 Number of reported cases 1400 Blood lead level: Notifiable diseases Environmental and occupational blood lead level (> 10 µg/dl) in Québec MADO (notifiable diseases) Occupational Environmental

7 Notifiable diseases in Québec: Blood lead level (> 10 µg/dl) in Children Aged 0 4 years Usually, not attributable to drinking water: dust, paint, contaminated soil, some jewelry, toy, traditional medicine, etc.

8 Blood lead level - children

9 Lead and drinking water Usually drinking water is not a major source of lead Under certain circumstances (eg. lead service line + aggressive water), lead intake may be important

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12 Blood Lead level (µg/dl) 20 Blood Lead Level (µg / dl) in young children in the Montreal area according to the lead concentration in water after 5 minutes of flushing (µg/l) Geo Mean : 1,35 µg/dl Lead level in water after 5 min. of flushing (µg/l)

13 Blood Lead level (µg/dl) 20 Blood Lead Level (µg / dl) in young children in the Montreal area according to the lead concentration in water after 5 minutes of flushing (µg/l) Lead level in water after 5 min. of flushing (µg/l) 13

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15 Modèle IEUBK Risque à la santé 15 Source : Monique Beausoleil, DSP Montréal

16 Lead in drinking water Public health approach

17 Lead in drinking water and Public Health MDDELCC RQEP (2012) Pb et Cu Groupe scientifique sur l eau de l INSPQ Comité de soutien plomb: INSPQ et DSP Comité permanent sur l eau Comité de travail sur le plomb et le cuivre

18 CPE Lead Subcommittee and INSPQ Several committee meetings Agree with the sampling protocol of the MDDELCC: 5-min flushing + re-sampling with 30-min stagnation if greater than the standard of 10 µg / L Sampling method: is less sensitive, but more specific : target problematic cases (lead pipe) 18

19 CPE Lead Subcommittee and INSPQ Several committee meetings Impact of drinking water on blood lead level is usually small Actions must primarily target vulnerable populations: children under 6 years and pregnant women 19

20 CPE Lead Subcommittee and INSPQ Production of tools for public health authorities Avis info santé : Telephone advice for the population Specific recommendations for PHA Management guide of lead and copper exceedances for the PHA (in preparation) Health risk associated with lead Exposure via drinking water Recommendations to PHA Communication tools 20

21 Lead in large buildings - schools RQEP: Special sampling requirement for buildings with children 6 years and under (eg. schools) INSPQ review of North American management practices of lead in drinking water in schools by public health authorities Contact with Health Officers of some provinces : BC, NB, Ont. Contact with various organizations: Health Canada, National Collaborating Centre for Environmental Health, Environmental Protection Agency Consultation of scientific papers and reports 21

22 Lead in large building - school Findings Disparity in management approaches across organizations Variable involvement of the health organizations Few health risk assessments in schools Communication is a key element in the management process No evaluation post recommendation There must be specific approaches for this type of establishment: involvement of the building owner, PHA and MDDELCC 22

23 Management of water samples Each site where there has been sampling receives its results with appropriate recommendations Exceedance of the standard (> 10 µg/l after 5 min. flushing) requires the intervention of the DSP : Contact MDDELCC and the owner of the distribution system The magnitude of lead concentrations and the number of problem residences will determine what measures should be taken: re-sampling, individual information, public health recommendations, etc.

24 Management of water samples If presence of a potential source of lead (between 2-10 µg /L after 5 min. flushing): General information for water consumption Let run the water after a long period of stagnation Use cold water tap Regularly clean the aerator placed in the drinking water tap If > 10 µg/l after 5 min. flushing : Recommendations for pregnant women and children under 6 years: Using a filter certified filter Bottled water

25 Conclusion PHA agrees with the measures put in place to reduce the exposure of the population to lead: the efforts must continue Implementation of management strategies requires the involvement of several organizations Collaboration between PHA and other organizations is needed to determine appropriate management measures

26 Conclusion Management approaches adopted must be flexible and adaptable to new knowledge Important role of public health for adequate risk communication about the health risks associated with lead in drinking water and the exposure reduction

27 Thank you for your interest