Fourth, among the group ‘others’, the majority of the workers with CEV concentrations above the reference value belonged to companies involved in the waste water management of the accident. All these observations together may be suggestive of exposure via the sewage system. This remains, however, selleck screening library speculative because no information was available on the specific tasks that were carried out, and that may be different for a same function. The use of respiratory protection did not appear as a determinant of the CEV concentrations among the non-smokers in this study. The question included was respiratory

protection (yes/no) per day between May 4–10. More detailed information on the continuous or effective use of the respiratory protection material was not available. A potential effect of this factor may thus remain undetected because of the less precise question and, as such, no interpretations on the usefulness of respiratory protection may be deduced from this observation. Other routes of exposure may have played a role, but given the circumstances of the

accident Smad2 phosphorylation (fire) and the nature of the substance (highly volatile), inhalation appears to have been the major route of exposure. Biological monitoring following chemical disasters has been recommended as part of disaster management in order to objectivate the internal human exposure (Scheepers et

al., 2011). To the authors’ knowledge, two previous studies have reported on biological monitoring of CEV following accidental ACN exposure in occupational populations. Following the death of a cleaning worker after decontamination of an ACN containing tank wagon, Bader and Wrbitzky (Bader and Wrbitzky, 2006) reported CEV concentrations of 679 pmol/g globin (non-smoker) and 768–2424 pmol/g globin (smokers) in the co-workers. In the rescue workers and medical staff who tried to resuscitate the person, no increased CEV concentrations were observed. In another German study (Leng, 2014), C1GALT1 CEV monitoring was carried out on 600 persons from fire brigades, police and rescue organizations after a fire in an ACN tank of a chemical plant in 2008. In 99% of the sampled population, body burden was <40.8 pmol/g globin for non-smokers and <612 pmol/g globin for smokers. In another paper (De Smedt et al., 2014, this issue), we have reported on the results of the human biomonitoring study following the train accident of May 4 in the residents of Wetteren with the highest suspected exposure to ACN. In summary, we concluded that: (1) ACN overexposures, as determined by the CEV biomarker, were high in the residents with 37.3% of the non-smokers and 40.