text: People who work at fluorochemical production plants and in manufacturing industries that use PFASs in the industrial process can be exposed to PFASs in the workplace. Much of what we know about PFASs exposure and health effects began with medical surveillance studies of workers exposed to PFASs at fluorochemical production facilities. These studies began in the 1940s and were conducted primarily at U.S. and European manufacturing sites. Between the 1940s and 2000s, thousands of workers exposed to PFASs participated in research studies that advanced scientific understanding of exposure pathways, toxicokinetic properties, and adverse health effects associated with exposure.
  The first research study to report elevated organic fluorine levels in the blood of fluorochemical workers was published in 1980. It established inhalation as a potential route of occupational PFAS exposure by reporting measurable levels of organic fluorine in air samples at the facility. Workers at fluorochemical production facilities have higher levels of PFOA and PFOS in their blood than the general population. Serum PFOA levels in fluorochemical workers are generally below 20,000 ng/mL but have been reported as high as 100,000 ng/mL, whereas the mean PFOA concentration among non-occupationally exposed cohorts in the same time frame was 4.9 ng/mL. Among fluorochemical workers, those with direct contact with PFASs have higher PFAS concentrations in their blood than those with intermittent contact or no direct PFAS contact. Blood PFAS levels have been shown to decline when direct contact ceases. PFOA and PFOS levels have declined in U.S. and European fluorochemical workers due to improved facilities, increased usage of personal protective equipment, and the discontinuation of these chemicals from production. Occupational exposure to PFASs in manufacturing continues to be an active area of study in China with numerous investigations linking worker exposure to various PFASs.