A systematic review of human studies assessing the health effects of unburned kerosene-based jet fuels and products across diverse populations and settings

Petroleum hydrocarbons are significant environmental health concerns globally, due to their extensive use and environmental release, including water contamination events such as the 2021 Red Hill jet fuel spill. Research on kerosene and kerosene-based jet fuels is limited, with prior reviews often focused on occupational and post-combustion exposures. No previous systematic review has focused specifically on pre-combustion exposures. Thus, we systematically reviewed evidence of human health impacts associated with these raw fuels across all exposure settings and population groups. Search strategies and eligibility criteria were developed and executed following PRISMA reporting guidelines and informed by OHAT procedures for systematic reviews. PubMed and Web of Science databases were searched (2017–2024) for eligible literature. Data extraction, analyses, quality assessment and risk of bias appraisals were conducted. Four reviewers participated in these processes. A total of 28 articles were included. Respiratory outcomes were frequently observed following acute kerosene ingestion, whereas neurological outcomes were common with chronic occupational, dermal and inhalation exposure to jet fuel. Evidence of gastrointestinal and dermal outcomes were also documented. Current literature did not allow outcomes with long latency to be assessed. Limited analytical studies and data heterogeneity challenge the ability to establish robust conclusions. Considering the global health implications of kerosene and kerosene-based jet fuel, and recent water contamination events, this review is novel and timely in its focus on unburned fuel. Current evidence on the human health consequences of these fuels is limited. We thus provide recommendations for future studies, including exposure assessment methods, study designs, and prioritization of underrepresented populations.