Associations of mid-childhood per- and polyfluoroalkyl substances and early childhood metals with mid-childhood antibody titers

Authors

• Anna Smith, Department of Epidemiology and Population Health, Stanford University, Stanford, California.
• Pi-I D. Lin, Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
• Sheryl L. Rifas-Shiman, Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
• Diane R. Gold, Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
• Abby F. Fleisch, Center for Interdisciplinary Population and Health Research, Maine Health Institute for Research, Westbrook, Maine.
• Marie-France Hivert, Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
• Emily Oken, Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
• Andres Cardenas, Department of Epidemiology and Population Health, Stanford University, Stanford, California.

Document Type

Article

Publication Date

4-2026

Institution/Department

Center for Interdisciplinary Population and Health Research

Journal Title

Environmental epidemiology (Philadelphia, Pa.)

Abstract

BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) and nonessential metals impair immune responses, while essential metals promote immune maintenance. We evaluated associations of childhood PFAS and metal mixtures with measles, mumps, rubella (MMR), pertussis, diphtheria, and tetanus antibody titers. METHODS: We measured mid-childhood (age 7.7 years, interquartile range 7.4, 8.4) plasma PFAS (perfluorooctanoate, perfluorooctane sulfonate, perfluorodecanoate, perfluorohexane sulfonate, 2-(N-methyl-perfluorooctane sulfonamide) acetate, and perfluorononanoate) and early childhood (3.2 years, interquartile range 3.0, 3.5) blood levels of nonessential (arsenic, barium, cadmium, cesium, lead, mercury, strontium, and tin), and essential (cobalt, copper, magnesium, manganese, molybdenum, selenium, and zinc) metals in children from the Project Viva cohort, recruited prenatally between 1999 and 2000 in Massachusetts, United States. We measured plasma MMR, pertussis, diphtheria, and tetanus titers, and the analytical sample of children with all measurements ranged from n = 493-507 for PFAS and n = 179-185 for metals analyses. We used adjusted quantile g-computation and regression models to estimate mixture- and individual PFAS or metal associations, respectively. RESULTS: Approximately 48% of the children were female, and children received their last MMR or diphtheria, tetanus, pertussis vaccination dose about 3 years before blood antibody titer collection. Contrary to our hypothesis, a one-quartile increase in the mid-childhood PFAS mixture was associated with higher mid-childhood measles [β = 0.06 antibody (Ab) index, 95% confidence interval (CI): 0.02, 0.1], rubella (β = 2.6 IU/mL, 95% CI: 0.5, 4.8), pertussis (log-β = 0.2 IU/mL, 95% CI: 0.2, 0.5), and tetanus (log-β = 0.2 IU/mL, 95% CI: 0.04, 0.4) antibody titers. A one-quartile increase in the early childhood essential metals mixture was associated with lower mid-childhood rubella antibody titers (β = -4.9 IU/mL, 95% CI: -9.0, -0.8). Individual PFAS and metals were associated with pertussis, diphtheria, and tetanus antibody titers in directions contrary to our initial hypotheses. CONCLUSIONS: Our results suggest that mid-childhood blood PFAS and early childhood metals may influence antibody titers, although additional prospective studies are needed.

First Page

e471

Recommended Citation

Smith, Anna; Lin, Pi-I D.; Rifas-Shiman, Sheryl L.; Gold, Diane R.; Fleisch, Abby F.; Hivert, Marie-France; Oken, Emily; and Cardenas, Andres, "Associations of mid-childhood per- and polyfluoroalkyl substances and early childhood metals with mid-childhood antibody titers" (2026). MaineHealth Maine Medical Center. 4396.
https://knowledgeconnection.mainehealth.org/mmc/4396