1. Results of the 3 pilot studies conducted near waste incinerators in Dorog, Forlí and Warsaw

2. OBJECTIVES to monitor and evaluate the possible environmental contamination on one side and the changes in the health status of the population on the other side, (and to act if necessary) to work out methodology for setting up an EHSS to make conclusions and recommendations for setting up an EHSS

3. THE STUDY AREAS Dorog - toxic waste incinerator Forlí - communal waste incinerator and hospital waste incinerator Warsaw - communal waste incinerator -------- ----------- -------- Different types of emission (e.g. metals) Different regime of activity (standard vs. changing composition) Different sizes of population Different availability of data sources and different experiences

4. DOROG a small town with about 13,000 inhabitants. It used to be a coal- mining area. After closing down mining activity, new job opportunities were needed

5. DOROG (Continued) In the 1980’-ies an incinerator was built here for burning wastes of a pharmaceutical plant. In 1996 this was converted into a big toxic waste incinerator with a capacity of 30,000 tons per year.

6. EXPOSURE ASSESSMENT in Dorog Continuous monitoring of air pollution (PM 10, SO 2, NO 2, CO, O 3, benzene) Yearly average concentrations of PM 2.5 and its metal components Dioxin and furan compounds in dustfall (collected monthly)

7. HEALTH OUTCOMES Children's acute respiratory morbidity (CHARM), using the local paediatricians' weekly report Pregnancy outcomes (normal or preterm births, birth weight, spontaneous abortions or stillbirths, etc) with the participation of the district nurses, Analysis of the mortality patterns of Dorog and its neighbourhood

9. Background Children are an appropriate sentinel population for the assessment of health effects of environmental pollutants, as they are more sensitive to toxic effects than adults, they breathe more air relative to their body weight they generally do not smoke they are not exposed to workplace contaminants. Acute respiratory diseases (generally bacterial or viral infections) are the most common diseases in childhood. Their occurrence may be influenced by factors which –do not change much over time (e.g. genetic factors) –may change on the long run (e.g. social and cultural environment, nutrition, life style) –show significant changes in short periods of time (air pollution and meteorological conditions)

10. METHODS Monitoring of air pollution on-line monitor (daily, 24-hour) data: PM 10, SO 2, NO 2, CO, O 3, benzene, ethyl-benzene, toluene off-line measurements: once a week: PM 10, PM 2.5, black smoke, metal content of PM 2.5, chloride in PM 10 once a month: dioxin and furan compounds in dustfall

11. METHODS Monitoring of respiratory diseases 3 paediatricians in Dorog, each has to care for 450-600 children between 0-14 years living in Dorog (free choice of doctors) The Report Sheet gives free choice of diagnosis for the doctors, the diagnoses are grouped by us later: - upper respiratory diseases (and complications) - acute bronchitis - diseases with allergic component (asthma attack, obstructive bronchitis, allergic rhinitis, croup) - pneumonia

12. Acute respiratory diseases among children in DOROG 2005Month: from…… till……. Paediatrician: 01-23-56-14 TOTAL Number of registered children ICD-10 Age groupMondayTuesdayWednesdayThursdayFridaySaturdaySunday 0 1-2 3-5 6-14 0 1-2 3-5 6-14 0 1-2 3-5 6-14

16. Table 3. Significant associations between the measured air pollutants and the respiratory morbidity of 0-14 year old children in Dorog

17. Thank you for your attention