Assessing capabilities of conducted ambient air pollution health effects studies in 22 Eastern Mediterranean countries to adopt air quality standards: a review.

Purpose: The Eastern Mediterranean Region (EMR) countries suffer from exposure to high levels of ambient air pollutants due to dust storms and have unique climatic as well as topographic and socio-economic conditions which lead to adverse health effects on humans. The purpose of the review was to evaluate the quantity and quality of published articles on air pollution and health-based studies in 22 EMR countries to determine if they can be applied to adopting air quality standards. Methods: We designed a review based on a broad search of the literature in the Scopus, PubMed, and web of science (WOS) databases published from January 1, 2000, to January 2, 2022, using combinations of the following relevant terms: air pollution, health, and EMR countries. The generic eligibility criteria for this review were based on the population, exposure, comparator, outcome, and study design (PECOS) statement. Results: The search results showed that following the PRISMA approach, of 2947 identified articles, 353 studies were included in this review. The analysis of the types of studies showed that about 70% of the studies conducted in EMR countries were Health Burden Estimation studies (31%), Ecological and time trend ecological studies (23%), and cross-sectional studies (16%). Also, researchers from Iran participated in the most published relevant studies in the region 255 (~ 63%) and just 10 published documents met all the PECOS criteria. Conclusion: The lack of sufficient studies which can meet the PECOS appraising criteria and the lack of professionals in this field are some of the issues that make it impossible to use as potential documents in the WHO future studies and adopt air quality standards. Supplementary Information: The online version contains supplementary material available at 10.1007/s40201-023-00862-1.

Ambient Air Quality Standards and Policies in Eastern Mediterranean Countries: A Review.

Objectives: National ambient air quality standards (NAAQS) are critical tools for controlling air pollution and protecting public health. We designed this study to 1) gather the NAAQS for six classical air pollutants: PM2.5, PM10, O3, NO2, SO2, and CO in the Eastern Mediterranean Region (EMR) countries, 2) compare those with the updated World Health Organizations Air Quality Guidelines (WHO AQGs 2021), 3) estimate the potential health benefits of achieving annual PM2.5 NAAQS and WHO AQGs per country, and 4) gather the information on air quality policies and action plans in the EMR countries. Methods: To gather information on the NAAQS, we searched several bibliographic databases, hand-searched the relevant papers and reports, and analysed unpublished data on NAAQS in the EMR countries reported from these countries to the WHO/Regional office of the Eastern Mediterranean/Climate Change, Health and Environment Unit (WHO/EMR/CHE). To estimate the potential health benefits of reaching the NAAQS and AQG levels for PM2.5, we used the average of ambient PM2.5 exposures in the 22 EMR countries in 2019 from the Global Burden of Disease (GBD) dataset and AirQ+ software. Results: Almost all of the EMR countries have national ambient air quality standards for the critical air pollutants except Djibouti, Somalia, and Yemen. However, the current standards for PM2.5 are up to 10 times higher than the current health-based WHO AQGs. The standards for other considered pollutants exceed AQGs as well. We estimated that the reduction of annual mean PM2.5 exposure level to the AQG level (5 µg m-3) would be associated with a decrease of all natural-cause mortality in adults (age 30+) by 16.9%-42.1% in various EMR countries. All countries would even benefit from the achievement of the Interim Target-2 (25 µg m-3) for annual mean PM2.5: it would reduce all-cause mortality by 3%-37.5%. Less than half of the countries in the Region reported having policies relevant to air quality management, in particular addressing pollution related to sand and desert storms (SDS) such as enhancing the implementation of sustainable land management practices, taking measures to prevent and control the main factors of SDS, and developing early warning systems as tools to combat SDS. Few countries conduct studies on the health effects of air pollution or on a contribution of SDS to pollution levels. Information from air quality monitoring is available for 13 out of the 22 EMR countries. Conclusion: Improvement of air quality management, including international collaboration and prioritization of SDS, supported by an update (or establishment) of NAAQSs and enhanced air quality monitoring are essential elements for reduction of air pollution and its health effects in the EMR.

Source apportionment, identification and characterization, and emission inventory of ambient particulate matter in 22 Eastern Mediterranean Region countries: A systematic review and recommendations for good practice.

Little is known about the main sources of ambient particulate matter (PM) in the 22 Eastern Mediterranean Region (EMR) countries. We designed this study to systematically review all published and unpublished source apportionment (SA), identification and characterization studies as well as emission inventories in the EMR. Of 440 articles identified, 82 (11 emission inventory ones) met our inclusion criteria for final analyses. Of 22 EMR countries, Iran with 30 articles had the highest number of studies on source specific PM followed by Pakistan (n = 15 articles) and Saudi Arabia (n = 8 papers). By contrast, there were no studies in Afghanistan, Bahrain, Djibouti, Libya, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen. Approximately 72% of studies (51) were published within a span of 2015-2021.48 studies identified the sources of PM2.5 and its constituents. Positive matrix factorization (PMF), principal component analysis (PCA) and chemical mass balance (CMB) were the most common approaches to identify the source contributions of ambient PM. Both secondary aerosols and dust, with 12-51% and 8-80% (33% and 30% for all EMR countries, on average) had the greatest contributions in ambient PM2.5. The remaining sources for ambient PM2.5, including mixed sources (traffic, industry and residential (TIR)), traffic, industries, biomass burning, and sea salt were in the range of approximately 4-69%, 4-49%, 1-53%, 7-25% and 3-29%, respectively. For PM10, the most dominant source was dust with 7-95% (49% for all EMR countries, on average). The limited number of SA studies in the EMR countries (one study per approximately 9.6 million people) in comparison to Europe and North America (1 study per 4.3 and 2.1 million people respectively) can be augmented by future studies that will provide a better understanding of emission sources in the urban environment.

Determination of metals and BTEX in different components of waterpipe: charcoal, tobacco, smoke and water.

BACKGROUND: The main objective of this study was to evaluate the concentrations of heavy metals and BTEX (benzene, toluene, ethylbenzene and xylene) in smoke and water bowl of 5-most commonly used tobacco brand in waterpipe in Tehran, the capital of Iran. METHODS: Five types of conventional tobacco in Tehran were investigated. Heavy metals and BTEX were analyzed in waterpipe smoke, tobacco, charcoal and water bowl prior to and after smoking by using ICP-OES and GC-MS, respectively. RESULTS: Our results indicated that Khansar and Al Fakher brands had the maximum and minimum concentrations of metals among tobacco consumed, respectively. The results showed that there was a significant difference between content of heavy metals in burned and unburned tobacco. The highest and lowest concentrations of metals were related to Fe and Hg, respectively. CONCLUSION: Results showed that tobacco, charcoal and smoke of waterpipe contained significant contents of toxic metals and BTEX, and exposure to these components could be the main reason for the concerns about waterpipe smoking.

A field indoor air measurement of SARS-CoV-2 in the patient rooms of the largest hospital in Iran.

The coronavirus disease 2019 (COVID-19) emerged in Wuhan city, China, in late 2019 and has rapidly spread throughout the world. The major route of transmission of SARS-CoV-2 is in contention, with the airborne route a likely transmission pathway for carrying the virus within indoor environments. Until now, there has been no evidence for detection of airborne severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and this may have implication for the potential spread of the COVID-19. We investigated the air of patient rooms with confirmed COVID-19 in the largest hospital in Iran, on March 17, 2020. To collect the SARS-CoV-2 particles, ten air samples were collected into the sterile standard midget impingers containing 20 mL DMEM with 100 µg/mL streptomycin, 100 U/mL penicillin and 1% antifoam reagent for 1 h. Besides, indoor particle number concentrations, CO2, relative humidity and temperature were recorded throughout the sampling duration. Viral RNA was extracted from samples taken from the impingers and Reverse-Transcription PCR (RT-PCR) was applied to confirm the positivity of collected samples based on the virus genome sequence. Fortunately, in this study all air samples which were collected 2 to 5 m from the patients' beds with confirmed COVID-19 were negative. Despite we indicated that all air samples were negative, however, we suggest further in vivo experiments should be conducted using actual patient cough, sneeze and breath aerosols in order to show the possibility of generation of the airborne size carrier aerosols and the viability fraction of the embedded virus in those carrier aerosols.

Spatial homogeneity and heterogeneity of ambient air pollutants in Tehran.

To investigate spatial inequality of ambient air pollutants and comparison of their heterogeneity and homogeneity across Tehran, the following quantitative indicators were utilized: coefficient of divergence (COD), the 90th percentile of the absolute differences between ambient air pollutant concentrations and coefficient of variation (CV). Real-time hourly concentrations of particulate matter (PM) and gaseous air pollutants (GAPs) of twenty-two air quality monitoring stations (AQMSs) were obtained from Tehran Air Quality Control Company (TAQCC) in 2017. Annual mean concentrations of PM2.5, PM10-2.5, and PM10 (PMX) ranged from 21.7 to 40.5, 37.3 to 75.0 and 58.0 to 110.4 µg m-3, respectively. Annual mean PM2.5 and PM10 concentrations were higher than the World Health Organization air quality guideline (WHO AQG) and national standard levels. NO2, O3, SO2 and CO annual mean concentrations ranged from 27.0 to 76.8, 15.5 to 25.1, 4.6 to 12.2 ppb, and 1.9 to 3.8 ppm over AQMSs, respectively. Our generated spatial maps exhibited that ambient PMX concentrations increased from the north into south and south-western areas as the hotspots of ambient PMX in Tehran. O3 hotspots were observed in the north and south-west, while NO2 hotspots were in the west and south. COD values of PMX demonstrated more results lower than the 0.2 cut off compared to GAPs; indicating high to moderate spatial homogeneity for PMX and moderate to high spatial heterogeneity for GAPs. Regarding CV approach, the spatial variabilities of air pollutants followed in the order of O3 (87.3%) > SO2 (65.2%) > CO (61.8%) > PM10-2.5 (52.5%) > PM2.5 (48.9%) > NO2 (48.1%) > PM10 (42.9%), which were mainly in agreement with COD results, except for NO2. COD values observed a statistically (P < 0.05) positive correlation with the values of the 90th percentile across AQMSs. Our study, for the first time, highlights spatial inequality of ambient PMX and GAPs in Tehran in detail to better facilitate establishing new intra-urban control policies.

Temporal variations of atmospheric benzene and its health effects in Tehran megacity (2010-2013).

The main aims of the present research were (1) investigation of the temporal trends of atmospheric benzene concentrations in Tehran city during the period 2010 to 2013 and (2) assessment of carcinogenic and non-carcinogenic health risks of inhalation exposure to benzene. For the first objective, the data of ambient air benzene concentrations were derived from 15 air quality monitoring stations (AQMSs) in Tehran during the years 2010 to 2013 and they were temporally investigated after data cleaning and missing data imputation. The excess lifetime cancer risk (ELCR) and hazard quotient (HQ) were estimated to reveal the carcinogenic and non-carcinogenic health effects of exposure to ambient benzene. Our findings indicated that over 2010-2013, annual mean concentrations of benzene were in the range of 1.84 to 2.57 µg m-3, and the highest annual mean concentration was observed in 2011 with a mean of 2.57 µg m-3. The four-year average concentration of benzene during the period from 2010 to 2013 was 2.14 µg m-3. Furthermore, the HQ for inhalation exposure to ambient benzene was lower than the acceptable risk level (HQ < 1) over the study time period which indicated that the non-carcinogenic effects are very unlikely to happen. In addition, health risk assessment for ELCR showed that the potential cancer risk for inhalation exposure to benzene was 1.67 × 10-5 over the study period, which is significantly higher than the limits recommended by the U.S. EPA (1 × 10-6). Our study clearly proves that the ambient benzene concentration in Tehran has substantially higher carcinogenic effects on the population. Appropriate sustainable control measures should be taken to reduce air benzene concentration and protect public health.

Long-term trends and health impact of PM2.5 and O3 in Tehran, Iran, 2006-2015.

The main objectives of this study were (1) investigation of the temporal variations of ambient fine particulate matter (PM2.5) and ground level ozone (O3) concentrations in Tehran megacity, the capital and most populous city in Iran, over a 10-year period from 2006 to 2015, and (2) estimation of their long-term health effects including all-cause and cause-specific mortality. For the first goal, the data of PM2.5 and O3 concentrations, measured at 21 regulatory monitoring network stations in Tehran, were obtained and the temporal trends were investigated. The health impact assessment of PM2.5 and O3 was performed using the World Health Organization (WHO) AirQ+ software updated in 2016 by WHO European Centre for Environment and Health. Local baseline incidences in Tehran level were used to better reveal the health effects associated with PM2.5 and O3. Our study showed that over 2006-2015, annual mean concentrations of PM2.5 and O3 varied from 24.7 to 38.8 µg m-3 and 35.4 to 76.0 µg m-3, respectively, and were significantly declining in the recent 6 years (2010-2015) for PM2.5 and 8 years (2008-2015) for O3. However, Tehran citizens were exposed to concentrations of annual PM2.5 exceeding the WHO air quality guideline (WHO AQG) (10 µg m-3), U.S. EPA and Iranian standard levels (12 µg m-3) during entire study period. We estimated that long-term exposure to ambient PM2.5 contributed to between 24.5% and 36.2% of mortality from cerebrovascular disease (stroke), 19.8% and 24.1% from ischemic heart disease (IHD), 13.6% and 19.2% from lung cancer (LC), 10.7% and 15.3% from chronic obstructive pulmonary disease (COPD), 15.0% and 25.2% from acute lower respiratory infection (ALRI), and 7.6% and 11.3% from all-cause annual mortality in the time period. We further estimated that deaths from IHD accounted for most of mortality attributable to long-term exposure to PM2.5. The years of life lost (YLL) attributable to PM2.5 was estimated to vary from 67,970 to 106,706 during the study period. In addition, long-term exposure to O3 was estimated to be responsible for 0.9% to 2.3% of mortality from respiratory diseases. Overall, long-term exposure to ambient PM2.5 and O3 contributed substantially to mortality in Tehran megacity. Air pollution is a modifiable risk factor. Appropriate sustainable control policies are recommended to protect public health.

Estimating national dioxins and furans emissions, major sources, intake doses, and temporal trends in Iran from 1990-2010.

BACKGROUND: Polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDFs) are highly toxic persistent organic pollutants (POPs), which can cause various health outcomes, such as cancer. As a part of the National and Sub-national Burden of Disease Study (NASBOD), we aimed to estimate dioxins and furans national emissions, identify their main sources, estimate daily intake doses, and assess their trend from 1990-2010 in Iran. METHODS: The Toolkit for Identification and Quantification of Releases of Dioxins, Furans and Other Unintentional POPs, which is developed by the United Nations Environment Programme (UNEP 2013), was used to estimate the emissions of PCDD/PCDFs from several sources into the air, water, land, residue, and other products. The daily intake doses were estimated using a linear regression of estimated emissions by UNEP Toolkit and average intake doses in other countries. Finally, the trend of PCDD/PCDFs emissions and daily intake doses were explored from 1990-2010. RESULTS: The total emissions were estimated as 960 g Toxic Equivalents (g TEQ) for 1990 and 1957 g TEQ for 2010 (18.2 and 26.8 g TEQ per million capita, respectively). The estimations suggest that albeit contribution of open burning to PCDD/PCDFs emissions has been declining from 1990 to 2010, it remained the major source of emissions in Iran contributing to about 45.8% out of total emissions in 1990 to 35.7% in 2010. We further found that PCDD/PCDFs are mostly emitted into the ambient air, followed by residue, land, products, and water. The daily intake doses were estimated to be 3.1 and 5.4 pg TEQ/kg bw/day for 1990 and 2010, respectively. We estimated an increasing trend for PCDD/PCDFs emissions and intake doses in Iran from 1990-2010. CONCLUSIONS: The high levels of emissions, intake doses, and their increasing trend in Iran may pose a substantial health risk to the Iranian population. Further studies with more rigorous methods are recommended but this should not circumvent taking appropriate policy actions against these pollutants. Currently, Iran has no standard for dioxins and furans. Adaptation of the World Health Organization recommended guidelines might be an appropriate starting point to control dioxins and furans emissions.

Bioaerosol exposure and circulating biomarkers in a panel of elderly subjects and healthy young adults.

Numerous studies have found that risk of cardiovascular diseases is associated with increased blood levels of circulating markers of systemic inflammation. We investigated associations of acute exposure to bioaerosols (bacteria and fungi) with blood markers of inflammation and coagulation using panels of elderly subjects and healthy young adults. We conducted a panel study of 44 nonsmoker elderly subjects in a retirement communities and a panel study of 40 healthy young adults living in a school dormitory within Tehran city, Iran. Blood sample biomarkers were measured weekly over 6weeks and including high sensitive C-reactive protein (hsCRP), tumor necrosis factor-soluble receptor-II (sTNF-RII), von Willebrand factor (vWF), white blood cells (WBC) count and interleukin-6 (IL-6). We found significant positive associations for IL-6 and WBC with exposure to Aspergillus spp. (As), Cladosporium spp. (Cl), Penicillium spp. (Pe), total fungi (TF) and Micrococcus spp. (MI); vWF with Cl and MI; sTNF-RII with Staphylococcus spp. (ST) in healthy young adults from the current-day and multiday averages. For elderly subjects, we observed significant positive associations for hsCRP, sTNF-RII and WBC with exposure to MI, but not with ST and total bacteria (TB). Our results showed the strongest significant positive associations for IL-6 with MI, ST and TB in elderly people. In addition, IL-6 was also positively associated with As, Cl and Pe in elderly. Also, the results showed that increase of vWF was significantly associated with bacterial and fungal aerosols, except Bacillus spp. (BA) at some lags in elderly subjects. Pooled results support the pivotal role of bioaerosols in increasing the level of some of inflammatory biomarkers, especially IL-6 and WBC in healthy young adults but possibly also in elderly people.

Short-term effects of particle size fractions on circulating biomarkers of inflammation in a panel of elderly subjects and healthy young adults.

Systemic inflammation biomarkers have been associated with risk of cardiovascular morbidity and mortality. We aimed to clarify associations of acute exposure to particulate matter (PM10 (PM < 10 µm), PM2.5-10 (PM 2.5-10 µm), PM2.5 (PM < 2.5 µm), PM1-2.5 (PM 1-2.5 µm), and PM1 (PM < 1 µm)) with systemic inflammation using panels of elderly subjects and healthy young adults. We followed a panel of 44 nonsmoking elderly subjects living in a retirement home and a panel of 40 healthy young adults living in a school dormitory in Tehran city, Iran from May 2012 to May 2013. Blood biomarkers were measured one every 7-8 weeks and included white blood cells (WBC), high sensitive C-reactive protein (hsCRP), tumor necrosis factor-soluble receptor-II (sTNF-RII), interleukin-6 (IL-6), and von Willebrand factor (vWF). We measured hourly indoor and outdoor exposure to PM10, PM2.5-10, PM2.5, PM1-2.5, and PM1 mass concentration to derive weighted averages of personal exposure based on simultaneously collected time-activity data. The random intercept linear mixed effects model was used for data analysis. We observed significant positive associations for WBC and IL-6 with exposure to PM10, PM2.5-10, PM2.5, PM1-2.5, and PM1; sTNF-RII with PM2.5, PM1-2.5, and PM1; hsCRP with PM2.5 and PM1; and vWF with PM10 and PM2.5-10, PM2.5, and PM1-2.5 mass concentration in elderly subjects from the current-day and multiday averages. For healthy young adults, we found significant positive associations for WBC and IL-6 with exposure to PM10, PM2.5-10, PM2.5, and PM1-2.5, but no with PM1. The results showed that increase of hsCRP, sTNF-RII, and vWF were not significantly associated with any of the PM sizes investigated in the healthy young subjects. Our results provided some evidence that short-term exposure to PM10, PM2.5-10, PM2.5, PM1-2.5, and PM1 was associated with inflammation and coagulation blood markers, but associations were depended on PM size and also differed across the various time lag.

Characterization of PAHs and metals in indoor/outdoor PM10/PM2.5/PM1 in a retirement home and a school dormitory.

In the present work, we investigated the characteristics of polycyclic aromatic hydrocarbons (PAHs) and metal(loid)s in indoor/outdoor PM10, PM2.5, and PM1 in a retirement home and a school dormitory in Tehran from May 2012 to May 2013. The results indicated that the annual levels of indoor and outdoor PM10 and PM2.5 were much higher than the guidelines issued by the World Health Organization (WHO). The most abundant detected metal(loid)s in PM were Si, Fe, Zn, Al, and Pb. We found higher percentages of metal(loid)s in smaller size fractions of PM. Additionally, the results showed that the total PAHs (Æ©PAHs) bound to PM were predominantly (83-88%) found in PM2.5, which can penetrate deep into the alveolar regions of the lungs. In general, carcinogenic PAHs accounted for 40-47% of the total PAHs concentrations; furthermore, the smaller the particle size, the higher the percentage of carcinogenic PAHs. The percentages of trace metal(loid)s and carcinogenic PAHs in PM2.5 mass were almost twice as high as those in PM10. This can most likely be responsible for the fact that PM2.5 can cause more adverse health effects than PM10 can. The average BaP-equivalent carcinogenic (BaP-TEQ) levels both indoors and outdoors considerably exceeded the maximum permissible risk level of 1 ng/m(3) of BaP. The enrichment factors and diagnostic ratios indicated that combustion-related anthropogenic sources, such as gasoline- and diesel-fueled vehicles as well as natural gas combustion, were the major sources of PAHs and trace metal(loid)s bound to PM.

Health impact assessment of air pollution in megacity of Tehran, Iran.

The aims of the present study were to provide quantitative data on the impact of air pollution on the health of people living in Tehran city, the most populated city of Iran. The approach proposed by the World Health Organization (WHO) was applied using the AirQ 2.2.3 software developed by the WHO European Centre for Environment and Health, Bilthoven Division. Concentrations of ozone, nitrogen dioxide, sulfur dioxide and particulate matter of aerodynamic diameter ≤ 10 µm (PM10) were used to assess human exposure and health impacts in terms of attributable proportion of the health outcome, annual number of excess cases of mortality for all causes, and cardiovascular and respiratory diseases. The annual average of PM10, SO2, NO2 and O3 in Tehran were 90.58, 89.16, 85 and 68.82 µg/m3, respectively. Considering short-term effects, PM10 had the highest health impact on the 8,700,000 inhabitants of Tehran city, causing an excess of total mortality of 2194 out of 47284 in a year. Sulfur dioxide, nitrogen dioxide and ozone caused about, respectively, 1458, 1050 and 819 excess cases of total mortality. Results indicate that the magnitude of the health impact estimated for the city of Tehran underscores the need for urgent action to reduce the health burden of air pollution.

Emissions of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/PCDFs) in Iran.

The aim of this study was estimation of PCDD/PCDFs emissions from various sources in Iran. The results indicated total PCDD/PCDFs emissions in Iran in 2010, was 1,957 g TEQ. Of this amount, about 705.8, 0.5, 463.5, 144.1 and 643.2 g TEQ/year was released to air, water, land, products, and in residues, respectively. Open burning processes and metal production are the major contributors to be known environmental sources of PCDD/PCDFs that contribute to about 70% of total PCDD/PCDFs emissions in Iran. The results showed that total PCDD/PCDFs emissions in Iran per inhabitant were about 26.5 g TEQ/million that is high relatively.