Vanadium in groundwater aquifers increases the risk of MAC pulmonary infection in O’ahu, Hawai’i

Abstract

Rationale: Hawai’i has the highest prevalence of nontuberculous mycobacterial (NTM) pulmonary disease in the United States. Previous studies indicate that certain trace metals in surface water increase the risk of NTM infection. Objective: To identify whether trace metals influence the risk of NTM infection in O’ahu, Hawai’i. Methods: A population-based ecologic cohort study was conducted using NTM infection incidence data from patients enrolled at Kaiser Permanente Hawai’i during 2005–2019. We obtained sociodemographic, microbiologic, and geocoded residential data for all Kaiser Permanente Hawai’i beneficiaries. To estimate the risk of NTM pulmonary infection from exposure to groundwater constituents, we obtained groundwater data from three data sources: (1) Water Quality Portal; (2) the Hawai’i Department of Health; and (3) Brigham Young University, Department of Geological Science faculty. Data were aggregated by an aquifer and were associated with the corresponding beneficiary aquifer of residence. We used Poisson regression models with backward elimination to generate models for NTM infection risk as a function of groundwater constituents. We modeled two outcomes: Mycobacterium avium complex (MAC) species and Mycobacterium abscessus group species. Results: For every 1-unit increase in the log concentration of vanadium in groundwater at the aquifer level, infection risk increased by 22% among MAC patients. We did not observe significant associations between water-quality constituents and infection risk among M. abscessus patients. Conclusions: Concentrations of vanadium in groundwater were associated with MAC pulmonary infection in O’ahu, Hawai’i. These findings provide evidence that naturally occurring trace metals influence the presence of NTM in water sources that supply municipal water systems.

The risk of pulmonary NTM infections and water-quality constituents among persons with cystic fibrosis in the United States, 2010–2019

“…This study confirms our previous findings, and further strengthens the evidence for the increased risk of NTM infection with vanadium and/or molybdenum that we have observed in both CF and non-CF populations. 17–20 Increasing concentrations of vanadium in Oregon surface water 19 and Hawai’i groundwater 20 were significantly associated with increased risk of MAC infection, while increasing concentrations of molybdenum in surface water in both Colorado 17,18 and Oregon 19 were significantly associated with increased risk of M. abscessus infection. Interestingly, in our current study, sulfate demonstrated the strongest risk association for MAC while vanadium was only borderline significant.…”

“…While the database providing the patient data did not identify those individuals whose water source is groundwater rather than surface water, we observed that vanadium was highly associated with MAC infection in both Oregon surface water 19 and Hawaiian groundwater. 20 In both states, basalt is a primary rock formation, which contains high concentrations of vanadium. Ultimately as rocks weather and soil erodes, minerals, like molybdenum and vanadium, are naturally released into our waterways.…”

“…In areas like these, we infer that surface waters interact with similar materials as groundwater, although the longer water-rock contact times in aquifers may result in higher solute leaching. 20,29…”

“…In areas like these, we infer that surface waters interact with similar materials as groundwater, although the longer water-rock contact times in aquifers may result in higher solute leaching. 20,29 Vanadium geochemistry A source for elevated vanadium (V) in streams includes rocks and sediments that are vanadium rich and have contact with stream waters. Such rocks include basalts and shales, which can be the most enriched of any common rock type (Supplemental Figure 1; http://links.lww.com/EE/A235).…”

“…12,16 Recent studies have demonstrated consistent and robust associations between trace metals in environmental water sources and increased risk of NTM PI. These studies, conducted in three US states (Colorado, Oregon, and Hawaii), [17][18][19][20] found that molybdenum in surface water was associated with an increased…”