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Domestic use of bleach and infections in children: a multicentre cross-sectional study
  1. Lidia Casas1,2,3,4,
  2. Ana Espinosa2,3,4,5,
  3. Alícia Borràs-Santos2,3,4,
  4. José Jacobs6,
  5. Esmeralda Krop6,
  6. Dick Heederik6,
  7. Benoit Nemery1,
  8. Juha Pekkanen7,8,
  9. Anne Hyvärinen7,
  10. Martin Täubel7,
  11. Jan-Paul Zock9,2,3
  1. 1Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
  2. 2Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  3. 3CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  4. 4University Pompeu Fabra (UPF), Barcelona, Spain
  5. 5Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
  6. 6Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
  7. 7Department of Health Protection, National Institute for Health and Welfare (THL), Kuopio, Finland
  8. 8Department of Public Health, University of Helsinki, Helsinki, Finland
  9. 9Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
  1. Correspondence to Lidia Casas, Department of Public Health and Primary Care—Centre for Environment and Health, KU Leuven, Herestraat 49, Leuven 3000, Belgium; lcasas{at}


Objective To report the effects of bleach use at home on the frequency of infections in 9102 school-age children participating in the HITEA project.

Methods Parents of pupils aged 6–12 years from schools in Barcelona province (Spain), Utrecht province (the Netherlands) and Eastern and Central Finland were administered a questionnaire including questions on the frequency of infections (influenza, tonsillitis, sinusitis, otitis, bronchitis and pneumonia) in the past 12 months and bleach use at home. We developed multivariable mixed-effects multilogistic regression models to obtain relative risk ratios (RRR) and their 95% CI per country, and combined the RRR using random-effects meta-analyses.

Results Bleach use was common in Spain (72%, n=1945) and uncommon in Finland (7%, n=279). Overall, the prevalence of infections (recurrent or once) was higher among children of bleach users. Significant combined associations were shown for influenza only once (RRR=1.20, 95% CI 1.04 to 1.38), recurrent tonsillitis (RRR=1.35, 95% CI 1.07 to 1.71) and any infection (RRR=1.18, 95% CI 1.01 to 1.38).

Conclusions Passive exposure to cleaning bleach in the home may have adverse effects on school-age children's health by increasing the risk of respiratory and other infections. The high frequency of use of disinfecting irritant cleaning products may be of public health concern, also when exposure occurs during childhood.

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