Invited Perspective: Per- and Polyfluoroalkyl Substances and Impaired Antibody Response to Vaccination-Who Is Affected?

By Anne P Starling
Environ Health Perspect
August 14, 2023
DOI: 10.1289/EHP12971

Per- and polyfluoroalkyl substances (PFAS), synthetic chemicals used in a wide array of consumer and industrial products since the 1940s, are now found almost everywhere. PFAS have been detected in groundwater,¹ surface water,² indoor dust,³ ambient particulate matter,⁴ packaged food,⁵ and freshwater fish⁶ and other wildlife^7,8 on six continents, including north of the Arctic Circle. The ubiquitous presence of PFAS in the environment leads to human exposure through a variety of routes, most commonly via contaminated drinking water or food.⁹

PFAS exposures have been linked to adverse health effects in adults, children, and infants.^10–12 Gestational exposures to PFAS are suspected to affect the developing child’s immune system; multiple epidemiological studies have shown that prenatal PFAS levels predict lower antibody levels to routine vaccinations in childhood.¹³ This is consistent with findings from animal studies that PFAS exposure impairs the T-cell–dependent antibody response.¹⁴ In generating new interim health advisories for four PFAS in drinking water, the U.S. Environmental Protection Agency considered decreased antibody levels after vaccination in children as a critical effect for setting maximum safe levels of exposure.¹⁵ However, it remains unclear whether PFAS exposure in adulthood leads to impaired antibody response to routine vaccination, because only a handful of epidemiological studies have been conducted on this topic, with mixed results.^16–20

An important contribution to this literature is the new study in this issue by Andersson et al.,²¹ who investigated associations between serum PFAS concentrations and antibody response to vaccination against SARS-CoV-2 in a cohort of adults in Ronneby, Sweden, who had received highly PFAS-contaminated drinking water for decades, and adults in a neighboring community without evidence of water contamination. The outcome measure was serum concentration of immunoglobulin G (IgG) antibodies against SARS-CoV-2 spike protein; levels of these antibodies following vaccination have been identified as markers of protection against symptomatic COVID-19 disease.^22,23 Antibodies were measured before primary vaccination, then again at 5 wk (indicating peak response) and 6 months (indicating long-term persistence) after the completion of the two-dose series. Prior exposure to the virus, a potential effect modifier, was addressed by excluding participants with evidence of previous infection at the time of antibody measurement.

View on EHP

View on PubMed