title: Short-term health effects in the general population following a major train accident with acrylonitrile in Belgium.
abstract: Following a train derailment, several tons of acrylonitrile (ACN) exploded, inflamed and part of the ACN ended up in the sewage system of the village of Wetteren. More than 2000 residents living in the close vicinity of the accident and along the sewage system were evacuated. A human biomonitoring study of the adduct N-2-cyanoethylvaline (CEV) was carried out days 14-21 after the accident.
  
  
  
  (1) To describe the short-term health effects that were reported by the evacuated residents following the train accident, and (2) to explore the association between the CEV concentrations, extrapolated at the time of the accident, and the self-reported short-term health effects.
  
  
  
  Short-term health effects were reported in a questionnaire (n=191). An omnibus test of independence was used to investigate the association between the CEV concentrations and the symptoms. Dose-response relationships were quantified by Generalized Additive Models (GAMs).
  
  
  
  The most frequently reported symptoms were local symptoms of irritation. In non-smokers, dose-dependency was observed between the CEV levels and the self-reporting of irritation (p=0.007) and nausea (p=0.007). Almost all non-smokers with CEV concentrations above 100pmol/g globin reported irritation symptoms. Both absence and presence of symptoms was reported by non-smokers with CEV concentrations below the reference value and up to 10 times the reference value. Residents who visited the emergency services reported more symptoms. This trend was seen for the whole range of CEV concentrations, and thus independently of the dose.
  
  
  
  The present study is one of the first to relate exposure levels to a chemical released during a chemical incident to short-term (self-reported) health effects. A dose-response relation was observed between the CEV concentrations and the reporting of short-term health effects in the non-smokers. Overall, the value of self-reported symptoms to assess exposure showed to be limited. The results of this study confirm that a critical view should be taken when considering self-reported health complaints and that ideally biomarkers are monitored to allow an objective assessment of exposure.
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium. Electronic address: koen.simons@vub.ac.be.
authors.forename: K
authors.initials: K
authors.lastname: Simons
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium. Electronic address: tom.desmedt@wiv-isp.be.
authors.forename: T
authors.initials: T
authors.lastname: De Smedt
authors.affiliation: Ghent University, Laboratory of Toxicology, Department of Bioanalysis, Ghent, Belgium. Electronic address: christophe.stove@ugent.be.
authors.forename: C
authors.initials: C
authors.lastname: Stove
authors.affiliation: Ghent University Hospital, Department of Emergency Medicine, Ghent, Belgium. Electronic address: peter.depaepe@ugent.be.
authors.forename: P
authors.initials: P
authors.lastname: De Paepe
authors.affiliation: BASF SE, Occupational Medicine & Health Protection, Ludwigshafen, Germany. Electronic address: michael.bader@basf.com.
authors.forename: M
authors.initials: M
authors.lastname: Bader
authors.affiliation: Katholieke Universiteit Leuven, Department of Public Health and Primary Care, Centre for Environment and Health, Leuven, Belgium. Electronic address: ben.nemery@med.kuleuven.be.
authors.forename: B
authors.initials: B
authors.lastname: Nemery
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium. Electronic address: christiane.vleminckx@wiv-isp.be.
authors.forename: C
authors.initials: C
authors.lastname: Vleminckx
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium. Electronic address: koen.decremer@wiv-isp.be.
authors.forename: K
authors.initials: K
authors.lastname: De Cremer
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium. Electronic address: ilse.vanovermeire@wiv-isp.be.
authors.forename: I
authors.initials: I
authors.lastname: Van Overmeire
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium. Electronic address: sebastien.fierens@wiv-isp.be.
authors.forename: S
authors.initials: S
authors.lastname: Fierens
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium. Electronic address: birgit.mertens@wiv-isp.be.
authors.forename: B
authors.initials: B
authors.lastname: Mertens
authors.affiliation: University of Erlangen-Nuremberg, Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Erlangen, Germany. Electronic address: thomas.goeen@ipasum.med.uni-erlangen.de.
authors.forename: T
authors.initials: T
authors.lastname: Göen
authors.affiliation: RWTH Aachen University, Institute for Occupational and Social Medicine, Medical Faculty, Aachen, Germany. Electronic address: tschettgen@ukaachen.de.
authors.forename: T
authors.initials: T
authors.lastname: Schettgen
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium. Electronic address: herman.vanoyen@wiv-isp.be.
authors.forename: H
authors.initials: H
authors.lastname: Van Oyen
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium. Electronic address: joris.vanloco@wiv-isp.be.
authors.forename: J
authors.initials: J
authors.lastname: Van Loco
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium. Electronic address: an.vannieuwenhuyse@wiv-isp.be.
authors.forename: A
authors.initials: A
authors.lastname: Van Nieuwenhuyse
mesh_terms: D000181:Acrylonitrile / Q000633:toxicity*; D000328:Adult; D001530:Belgium; D055884:Chemical Hazard Release; D003367:Cotinine / Q000652:urine; D004305:Dose-Response Relationship, Drug; D004784:Environmental Monitoring; D005260:Female; D006261:Headache / Q000139:chemically induced; D006801:Humans; D007509:Irritants / Q000633:toxicity*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D011890:Railroads; D057566:Self Report; D012907:Smoking / Q000097:blood / Q000652:urine; D011795:Surveys and Questionnaires; D014202:Tremor / Q000139:chemically induced; D014633:Valine / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D007509:Irritants; C091192:N-(2-cyanoethyl)valine; D014633:Valine; D003367:Cotinine; D000181:Acrylonitrile
keywords: Accident; Acrylonitrile; General population; Health effects; Human biomonitoring; Sewage