Systematic review of human biomonitoring studies of ethylenethiourea, a urinary biomarker for exposure to dithiocarbamate fungicides.

Toxicological and epidemiological studies implicate exposure to dithiocarbamate (DTC) fungicides in adverse health outcomes. However, there is limited information about human exposure to these chemicals. This systematic review determined to which extent human populations worldwide, including children, pregnant women, and adults, are exposed environmentally or occupationally to DTC pesticides and how these exposures compare to the NHANES 2003-2008 population, using urinary ETU data as an outcome measure. PubMed, Embase, and SciFinder were searched using the keywords "ethylenethiourea" or CAS No.: 96-45-7, and urine or urinary. Duplicates and irrelevant studies were removed from the search results based on predetermined exclusion criteria. This screening process identified 17 relevant papers. One additional paper was found independent of this search. Data from studies were extracted using a pre-established data collection form. Ten, two, and five manuscripts reported urinary levels in environmentally exposed adults, children, and pregnant women, respectively. Median ETU levels ranged from 0.15 to 4.7 μg/g creatinine in adults (1994-2017), 0.24-0.83 μg/g creatinine in children (2011), and 2.6-5.24 ng/ml in pregnant women (2011). Eight studies reported urinary ETU levels in mostly agriculturally exposed populations, with median ETU levels ranging from 0.42 to 49.6 μg/g creatinine (1999-2011). With one exception, all studies were conducted between 1994 and 2011. ETU levels in the NHANES 2003-2008 population appeared to be generally lower than most studies identified in this review. This finding suggests that, historically, DTC fungicide exposures in the general population of high-income countries, such as the US, were low, whereas agricultural populations may have experienced higher exposure. Unfortunately, more recent exposure data are missing, especially in countries where DTC pesticides are not being phased out.