Harmonized European human biomonitoring in small countries: Challenges, opportunities and lessons learned in Cyprus and Luxembourg from the DEMOCOPHES study

A. Katsonouri 1 , M.E. Fischer 2 , A. Hadjipanayis 4 , M. Arendt 5 , G. Lavranos 3 , L. Hoffmann 6 , K. Maurer-Chronakis 3 , C. Guignard 6 , C. Fragopoulou 3 , E. Cocco 6 , E. Anastasi 3 , D. Pilavakis 3 , E. Efstathiou 3 , L. Demetriou 3 , A. Hadjiefthychiou 3 , E. Demetriou 3 , D. Aerts 7 , L. Casteleyn 8 , P. Biot 7 , M. Kolossa-Gehrin 9 , E. Den Hond 10 , G. Schoeters 10 , A. Castaño 11 , M. Esteban 11 , U. Fiddicke 9 , K. Exley 12 , O. Sepai 12  and A.C. Gutleb 6
  • 1 Human Biomonitoring and Industrial Products Laboratory, Cyprus State General Laboratory, Ministry of Health, 44 Kimonos Str., 1451 Nicosia, Cyprus
  • 2 Laboratoire National de la Santé (LNS), Dudelange, Luxembourg
  • 3 State General Laboratory (SGL), Ministry of Health, Republic of Cyprus
  • 4 Larnaca General Hospital, Ministry of Health, Republic of Cyprus
  • 5 Initiativ Liewensufank, Itzig, Luxembourg
  • 6 Luxembourg Institute of Science and Technology, (LIST), Belvaux, Luxembourg
  • 7 Federal Public Service Health, Food chain safety and Environment, Belgium
  • 8 KU Leuven, Belgium
  • 9 Umweltbundesamt (UBA), Berlin, Germany
  • 10 Flemish Institute for Technological Research (VITO), Environmental Risk and Health, Belgium
  • 11 Instituto de Salud Carlos III, Madrid, Spain
  • 12 Public Health England, United Kingdom


Background: To advance human biomonitoring (HBM) for policy support in Europe, a harmonized approach was developed (COPHES project, FP7 2009- 2012) and evaluated in 17 countries (DEMOCOPHES project, Life+, 2010-2012). Cyprus (CY) and Luxembourg (LU) tested the hypothesis that the COPHES European Protocol is applicable to small countries.Materials and methods: In 2011-12, the European Protocol was adopted and tested by CY and LU for the harmonized biomonitoring of 60 children and their mothers for cadmium, phthalates and cotinine in urine and for mercury in scalp hair in two sampling areas (urban, rural). Results: Both small countries achieved the preset goals for recruitment, sample collection and analysis, which allowed for the first time the assessment of children’s and mothers’ exposures to the selected chemicals in comparison with other countries. Capacity building was accomplished and communication actions were particularly effective, with both countries taking advantage of their small size to access participants, policy makers, other stakeholders and the press. Time constrains and requirements for capacity building were limiting factors. Conclusion: The COPHES European Protocol for HBM surveys is attainable in small countries. The following elements are fundamental in the design of a harmonized European HBM program, from the perspective of small countries: (a) consultation with and active involvement of the implementing countries, (b) flexibility for national decisions, while not compromising harmonization, (c) elaboration of standardized methods, procedures and documents (d) quality assurance mechanisms, (e) means of training and support.

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