Summary: Recent cases of acute kidney injury due to Seoul hantavirus infection from exposure to wild or pet fancy rats suggest this infection is increasing in prevalence in the UK. We conducted a seroprevalence study in England to estimate cumulative exposure in at-risk groups with contact with domesticated and wild rats to assess risk and inform public health advice. From October 2013 to June 2014, 844 individual blood samples were collected. Hantavirus seroprevalence amongst the pet fancy rat owner group was 34.1% (95% CI 23·9–45·7%) compared with 3·3% (95% CI 1·6–6·0) in a baseline control group, 2·4% in those with occupational exposure to pet fancy rats (95% CI 0·6–5·9) and 1·7% with occupational exposure to wild rats (95% CI 0·2–5·9). Variation in seroprevalence across groups with different exposure suggests that occupational exposure to pet and wild rats carries a very low risk, if any. However incidence of hantavirus infection among pet fancy rat owners/breeders, whether asymptomatic, undiagnosed mild viral illness or more severe disease may be very common and public health advice needs to be targeted to this at-risk group.

There is increasing appreciation of the proportion of the health burden that is attributed to modifiable population exposure to environmental health hazards. To manage this avoidable burden in the United Kingdom (UK), government policies and interventions are implemented. In practice, this procedure is interdisciplinary in action and multi-dimensional in context. Here, we demonstrate how Multi Criteria Decision Analysis (MCDA) can be used as a decision support tool to facilitate priority setting for environmental public health interventions within local authorities. We combine modelling and expert elicitation to gather evidence on the impacts and ranking of interventions. To present the methodology, we consider a hypothetical scenario in a UK city. We use MCDA to evaluate and compare the impact of interventions to reduce the health burden associated with four environmental health hazards and rank them in terms of their overall performance across several criteria. For illustrative purposes, we focus on heavy goods vehicle controls to reduce outdoor air pollution, remediation to control levels of indoor radon, carbon monoxide and fitting alarms, and encouraging cycling to target the obesogenic environment. Regional data was included as model evidence to construct a ratings matrix for the city. When MCDA is performed with uniform weights, the intervention of heavy goods vehicle controls to reduce outdoor air pollution is ranked the highest. Cycling and the obesogenic environment is ranked second. We argue that a MCDA based approach provides a framework to guide environmental public health decision makers. This is demonstrated through an online interactive MCDA tool. We conclude that MCDA is a transparent tool that can be used to compare the impact of alternative interventions on a set of pre-defined criteria. In our illustrative example, we ranked the best intervention across the equally weighted selected criteria out of the four alternatives. Further work is needed to test the tool with decision makers and stakeholders.

Unintentional non-fire related (UNFR) carbon monoxide (CO) poisoning continues to cause fatalities. The narrative verdicts from coroners concerning fatal UNFR CO poisoning in England and Wales, 1998–2019, were collated by the Office for National Statistics. Search terms related to CO exposure were used to obtain information regarding the circumstances of death. Findings were grouped by the location of death, the source of CO, and the reason or behaviour underlying the exposure. There were 750 deaths (77% male). The annual number of deaths decreased over the period studied. Two thirds (68%) of the deaths occurred in the autumn or winter. From the records with information, 59% of deaths occurred within a dwelling (67% male). Males also predominated deaths within vehicles (91%) and garages or outbuildings (95%). From the deaths with information, domestic piped gas was the most common source of CO (36%) and the most frequent underlying factor was inadequate ventilation of exhaust gases (39%, 91% male). Despite the decrease in the annual number of deaths over the study period, there remains a clear need for measures that raise awareness of the dangers of CO poisoning, especially amongst men working alone in garages or outbuildings. Education campaigns and fitting and maintaining CO alarms in high-risk areas should be encouraged.

Carbon monoxide (CO) is a toxic gas, and faulty gas appliances or solid fuel burning with incomplete combustion are possible CO sources in households. Evaluating household CO exposure models and measurement studies is key to understanding where CO exposures may result in adverse health outcomes. This assists the assessment of the burden of disease in high- and middle-income countries and informs public health interventions in higher-risk environments. We conducted a literature review to identify themes that characterise CO exposure in household dwellings. A keyword-structured search using literature databases was conducted to find studies published in the period of 1 January 2010–5 June 2024. We focused on studies from high- and middle-income countries, excluding animal and biomass studies, and narratively synthesised themes. We identified 5294 papers in the literature search and included 22 papers from thirteen countries in the review. Most measured CO levels were below the WHO or country guidance levels, with sporadic peaks of measured CO linked to fuel-burning activities. To understand CO exposure in households, we identified sixteen themes grouped into five main categories: dwelling characteristics, source characteristics, temporal variation, environmental characteristics, and socioeconomic status of occupants. Seasonal variation (temporal variation), size of room and ventilation (dwelling characteristics), and cooking and outdoor CO levels (source characteristics) had the most evidence. These themes characterising CO exposure in household dwellings are important to aid the development of indoor exposure models and for understanding where CO exposures result in adverse health outcomes. These themes should be validated by household CO monitoring studies, which will enable the identification of higher-risk household dwellings and inform public health actions.

Approximately one million people in the UK are served by private water supplies (PWS) where main municipal water supply system connection is not practical or where PWS is the preferred option. Chronic exposure to contaminants in PWS may have adverse effects on health. South West England is an area with elevated arsenic concentrations in groundwater and over 9000 domestic dwellings here are supplied by PWS. There remains uncertainty as to the extent of the population exposed to arsenic (As), and the factors predicting such exposure. We describe a hazard assessment model based on simplified geology with the potential to predict exposure to As in PWS. Households with a recorded PWS in Cornwall were recruited to take part in a water sampling programme from 2011 to 2013. Bedrock geologies were aggregated and classified into nine Simplified Bedrock Geological Categories (SBGC), plus a cross-cutting “mineralized” area. PWS were sampled by random selection within SBGCs and some 508 households volunteered for the study. Transformations of the data were explored to estimate the distribution of As concentrations for PWS by SBGC. Using the distribution per SBGC, we predict the proportion of dwellings that would be affected by high concentrations and rank the geologies according to hazard. Within most SBGCs, As concentrations were found to have log-normal distributions. Across these areas, the proportion of dwellings predicted to have drinking water over the prescribed concentration value (PCV) for As ranged from 0% to 20%. From these results, a pilot predictive model was developed calculating the proportion of PWS above the PCV for As and hazard ranking supports local decision making and prioritization. With further development and testing, this can help local authorities predict the number of dwellings that might fail the PCV for As, based on bedrock geology. The model presented here for Cornwall could be applied in areas with similar geologies. Application of the method requires independent validation and further groundwater-derived PWS sampling on other geological formations.