Childhood PFAS Exposure and Immunotoxicity: A Systematic Review and Meta-Analysis of Human Studies
Open accessAbstract
BACKGROUND: Exposure to poly- and perfluoroalkyl substances (PFAS) may affect infant and childhood health through immunosuppression. However, the findings of epidemiological literature examining relationships between prenatal/childhood PFAS exposure and vaccine response and infection in humans are still inconclusive. The aim of this review was to examine the effects of PFAS exposure on vaccine antibody response and infection in humans. METHODS: The MEDLINE/Pubmed database was searched for publications until 1 February 2023 to identify human studies on PFAS exposure and human health. Eligible for inclusion studies had to have an epidemiological study design and must have performed logistic regression analyses of gestational or childhood exposure to PFAS against either antibody levels for pediatric vaccines or the occurrence of children's infectious diseases. Information on baseline exposure to PFAS (in ng/mL), the age of PFAS exposure (gestational or in years), and the outcome was measured, potentially leading to multiple exposure-outcome comparisons within each study was collected. Percentage change and standard errors of antibody titers and occurrence of infectious diseases per doubling of PFAS exposure were calculated, and a quality assessment of each study was performed. RESULTS: Seventeen articles were identified matching the inclusion criteria and were included in the meta-analysis. In general, a small decrease in antibody response and some associations between PFAS exposure and childhood infections were observed. CONCLUSIONS: This meta-analysis summarizes the findings of PFAS effects on infant and childhood immune health. The immunosuppression findings for infections yielded suggestive evidence related to PFAS exposure, particularly PFOS, PFOA, PFHxS, and PFNA but moderate to no evidence regarding antibody titer reduction. SYSTEMATIC REVIEW REGISTRATION: The research protocol of this systematic review is registered and accessible at the Open Science Framework ( https://doi.org/10.17605/OSF.IO/5M2VU ).
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A recent meta-analysis found possible associations-particularly with PFOS, PFOA, PFHxS, and PFNA-between PFAS exposure and higher infection risk in infants and children, although evidence for suppressed antibody responses remains modest.
“A recent meta-analysis reinforces these concerns, finding possible associations—particularly with PFOS, PFOA, PFHxS, and PFNA—between PFAS exposure and higher infection risk in infants and children, although the evidence for suppressed antibody responses remains modest [86].”
From Exposure to Per- and Polyfluoroalkyl Substances (PFASs) in Healthcare: Environmental and Clinical Insights (2025) · cites this paper as [86]
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- Authors
- Antoniou, E. E., & Dekant, W.
- Affiliations
- University of Würzburg (DE)
- Corresponding author
- Antoniou, Evangelia E.
- Venue
- Systematic Reviews
- Published
- 2024-07-09
- Volume
- 13
- Issue
- 1
- Pages
- 176-176
- ISSN
- 2046-4053 (ISSN-L)
- PMC
- PMC11232141
- OpenAlex
- W4400460673
- Cited by
- 38
- References
- 36
- Citations by year
- 2026: 23 · 2025: 13 · 2024: 2
- FWCI
- 1.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Systematic Reviews (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- 3M
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Life Sciences › Immunology and Microbiology › Immunology › Immunotoxicology and immune responses
- Physical Sciences › Materials Science › Polymers and Plastics › Synthesis and properties of polymers
- Keywords
- PFAS, per- and polyfluoroalkyl substances, children's exposure, prenatal exposure, immunotoxicity, immunosuppression, vaccine antibody response, vaccine antibody titers, pediatric infection, PFOS, perfluorooctanoic acid, PFHxS, PFNA, endocrine disruptors
- MeSH terms
- Antibody Formation, Child, Child, Preschool, Environmental Exposure, Environmental Pollutants, Female, Fluorocarbons, Humans, Infant, Pregnancy, Prenatal Exposure Delayed Effects, Vaccines
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