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1
TRAINING FOR HEALTH CARE PROVIDERSTRAINING FOR HEALTH CARE PROVIDERS
Children's Health and the Environment
CHEST Training Package for the Health Sector
MERCURY
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
LEARNING OBJECTIVESLEARNING OBJECTIVES
Health hazards associated with exposure to the 3 different species of mercury (Hg)
How to diagnose and manage mercury exposure and poisoning
Public health implications
How to prevent and reduce exposure
To understand, recognize and knowTo understand, recognize and know
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
MERCURYMERCURY
Is persistent and cycles globallyIs persistent and cycles globally
Continues to be widely usedContinues to be widely used
Exposure has serious effectsExposure has serious effects
Has an impact on global fishingHas an impact on global fishing
May generate bigger problems in less-May generate bigger problems in less-developed regionsdeveloped regions
Interventions can be successfulInterventions can be successful
UNEP. Global Mercury Assessment, December 2002: www.chem.unep.ch/mercury/default.htm
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
OVERVIEWOVERVIEW
Environmental origin, transport and fate
Routes of exposure
Toxicokinetics
Toxicodynamics
Target organs/systems
Treatment
Prevention
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
ORIGINORIGIN
One element
3 species Elemental Inorganic Organic
Different
toxicity profiles!
pearl1.lanl.gov/periodic/default.htm
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
ENVIRONMENTAL SOURCES OF EXPOSURE ENVIRONMENTAL SOURCES OF EXPOSURE
Chloralkali production Artisanal gold and
silver mining Mercury mining,
smelting and use Burning fossil fuels Waste incinerators Volcanoes
© Stephan Boese-O´Reilly 2003Goldman, Pediatrics (2001) 108:197
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
- Natural background- Natural background- Volcanic- Volcanic -- Gold rushGold rush-- World War IIWorld War II-- IndustrializationIndustrialization
Hg released in the last 100 Hg released in the last 100 years: 70% man madeyears: 70% man made
http://toxics.usgs.gov/pubs/FS-051-02/
A man made problemA man made problem
Major atmospheric releases Major atmospheric releases detected in the ice coredetected in the ice core
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
A LARGE ENVIRONMENTAL PROBLEMA LARGE ENVIRONMENTAL PROBLEM
In small scale gold mining areas Hg is used to extract In small scale gold mining areas Hg is used to extract gold from ore (amalgamation process)gold from ore (amalgamation process)
1 to 2 kg of Hg are used to process 1 kg of gold1 to 2 kg of Hg are used to process 1 kg of gold Most Hg is released into the environment (soil, air, Most Hg is released into the environment (soil, air,
water)water)
More than 50% workersMore than 50% workers have high levels have high levels
……and their children?and their children?
© Stephan Boese-O´Reilly 2003
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Drasch , Wiley VHC, Verlag, 2004, all data in metric tons
Continent
Stationary Combustion
Pig iron & steel production
Cement production
Waste disposal
Non-ferrous metal production
Artisanal gold mining
Sum quantified sources
Europe 186186 1010 2626 1212 1515 250250
Africa 197197 0.50.5 5.25.2 7.97.9 210210
Asia 860860 1212 8282 3333 8787 10751075
North America
105105 4.64.6 1313 6666 2525 210210
South America
2727 1.41.4 5.55.5 2525 6060
Australia &Oceania
100100 0.30.3 0.80.8 0.10.1 4.44.4 105105
Sum, quantified sources 1995
14701470 3030 130130 110110 170170 ~1900~1900
Worldwide 300-100300-100
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
TRANSPORT: GLOBAL CYCLE OF MERCURYTRANSPORT: GLOBAL CYCLE OF MERCURY
Hg is emitted into Hg is emitted into the atmosphere the atmosphere and circulated and circulated globallyglobally
EPA EPA
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
TRANSPORT: GLOBAL CYCLE OF MERCURYTRANSPORT: GLOBAL CYCLE OF MERCURY
EPA
Ultimately enters water bodies and depositsUltimately enters water bodies and deposits Close to source Long distance from source global pollution
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Hg in sediments converts into methyl-mercury (MeHg)
MeHg enters the aquatic food chain: fish, marine and freshwater
MeHg uptake by humans through fish consumption
Metabolic conversion and Metabolic conversion and bio-accumulation bio-accumulation through “food-chain”through “food-chain”
FATEFATE
EPA
13
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
ELEMENTALELEMENTAL (METALLIC) MERCURY – (METALLIC) MERCURY – ""QUICKSILVER"QUICKSILVER"
Sources of exposureSources of exposure
Environmental: Volcanic explosions, rock weathering, degassing
Anthropogenic inadvertent: Combustion: fossil fuels (coal), waste incineration Industrial: gold/silver mining, chloralkali plants, batteries,
switches, fluorescent lights, thermometers, sphyngomanometers
Anthropogenic intentional: Dental amalgams Ritual and folk-medicine use
14
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Routes of exposureRoutes of exposure
Inhalation (volatile at room temp): 75-85% absorption Ingestion and skin: almost no absorption
Elimination Elimination Urine and Feces
ToxicityToxicity Lungs, eyes, gingival, skin Also: Central nervous system, kidneys, immune
system
ELEMENTALELEMENTAL MERCURY - QUICKSILVER MERCURY - QUICKSILVER
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Sources of ExposureSources of Exposure
Environmental None
Industrial products Vapor lamps, embalming, Photography Latex paint (pre 1990s) Disinfectants, antimicrobials Alternative medicines, cosmetics
INORGANICINORGANIC MERCURY MERCURY
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Routes of ExposureRoutes of Exposure Ingestion - 10% absorbed Skin - can be high and deadly
EliminationElimination Renal
ToxicityToxicity Primary: kidneys, gastrointestinal tract Secondary: Central nervous system
INORGANICINORGANIC MERCURY MERCURY
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Sources of ExposureSources of Exposure
Environmental conversion: Fish and shellfish (methyl-mercury)
Industrial production: Fungicides, bactericides (phenylmercury) Vaccine preservatives (thimerosal)
ORGANICORGANIC MERCURY MERCURY
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Routes of ExposureRoutes of Exposure Gastrointestinal - rapid & complete absorption Parenteral - 100% absorbed Transplacental – Bioconcentrated
EliminationElimination Feces- T1/2 45 to70 days in adults
ToxicityToxicity Primary: Central nervous system Secondary: Cardiovascular
ORGANICORGANIC MERCURY MERCURY
19
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
MercuryMercury SourcesSources Routes of Routes of exposureexposure
EliminationElimination ToxicityToxicity
Elemental Elemental (metallic)(metallic)
Volcanoes Combustion Waste incineration
Thermometers
Amalgams
Folk remedies
Inhalation Urine and faeces
CNS
Kidney
Lungs
Skin (Acrodynia in children)
Inorganic Inorganic (mercuric (mercuric chloride)chloride)
Lamps
Photography
Disinfectants
Cosmetics
Folk medicine
Ingestion
Dermal
Urine CNS
Kidney
GI tract
Skin (Acrodynia in children)
Organic Organic (methyl; (methyl; ethyl)ethyl)
Fish
Fungicides
Preservatives
Ingestion
Parenteral
Transplacental
Faeces CNS
Cardiovascular
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
MERCURY: ACRODYNIAMERCURY: ACRODYNIA
Uncommon syndrome "Pink disease":
Pain in the extremities
Pinkish discoloration and desquamation
Hypertension
Sweating
Insomnia, irritability, apathy
Considered as idiosyncratic reaction.
Schwarz,
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
v. Muhlendahl
v. Muhlendahl
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Muhlendahl
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
CHILD EXPOSURE IN INDUSTRIALIZED CHILD EXPOSURE IN INDUSTRIALIZED COUNTRIESCOUNTRIES
Methylmercury Methylmercury Consumption of contaminated fish & shellfish Emitted to atmosphere by electric generation Transplacental Breast milk
EthylmercuryEthylmercury Thimerosal
Elemental - vaporsElemental - vapors Ritual and folk-medicine use Amalgam (minor source)
24
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
CHILD EXPOSURE IN DEVELOPING COUNTRIESCHILD EXPOSURE IN DEVELOPING COUNTRIES
Regional cultural usesRegional cultural uses
Eating contaminated fishEating contaminated fish
High exposure may cause overtHigh exposure may cause overt
symptomssymptoms
© Stephan Boese-O´Reilly 2003
““Occupational” exposures from gold/silver miningOccupational” exposures from gold/silver mining
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
MERCURY: TOXIC EFFECTSMERCURY: TOXIC EFFECTS
Neurotoxicity
Nephrotoxicity
Teratogenicity: MeHg is a teratogen (Minamata disease)
CVS: elevated risk of heart attack, hypertension
Carcinogenicity: MeHg is a possible human carcinogen
Mutagenesis: Hg seems not to be mutagen
Reproduction: no clear evidence of effect
Immunotoxicity: under scientific discussion
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
PEDIATRIC EXPOSURE - FISHPEDIATRIC EXPOSURE - FISH
Major source of mercury burden for children in most countries
Fish may contain methyl-mercury
Children exposed By eating fish Transplacentally Via breast milk Rice field in the Philippines, irrigated with
tailing sediments containing mercury © Stephan Boese-O´Reilly 1999
27
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
METHYLMERCURY LEVELS IN FISHMETHYLMERCURY LEVELS IN FISH
www.cfsan.fda.gov/~frf/sea-mehg.html
Ocean Fish with high levels of mercury
SpeciesSpeciesMercury concentration (PPM)Mercury concentration (PPM) N° of N° of
samplessamplesMeanMean MedianMedian MinMin MaxMax
Mackerel King
0.73 NA 0.23 1.67 213
Shark 0.99 0.83 ND 4.54 351
Swordfish 0.97 0.86 0.10 3.22 605
Tilefish 1.45 NA 0.65 3.73 60
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
METHYLMERCURY LEVELS IN FISHMETHYLMERCURY LEVELS IN FISH
Drasch,, Wiley VHC Verlag, 2004: Adapted from US EPA (1997)
Typical average mercury concentration in marine fish
SpeciesSpecies mg Hg/kgmg Hg/kg SpeciesSpecies mg Hg/kgmg Hg/kg
HerringHerring 0.0130.013 Sea BassSea Bass 0.1450.145
SalmonSalmon 0.0350.035 TunaTuna 0.2060.206
MackerelMackerel 0.0810.081 HalibutHalibut 0.2500.250
PerchPerch 0.1160.116 SnapperSnapper 0.2500.250
CodCod 0.1210.121 SharkShark 1.3271.327
29
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
METHYLMERCURY: POWERFUL METHYLMERCURY: POWERFUL NEURODEVELOPMENTAL TOXICANT NEURODEVELOPMENTAL TOXICANT
Impedes nerve cell division Impedes nerve cell division and migration and migration
Binds with microtubules Binds with microtubules required for neuronal required for neuronal developmentdevelopment
Binds to and distorts DNA & Binds to and distorts DNA & RNARNA EHP
30
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
EFFECTS OF PRENATAL EXPOSUREEFFECTS OF PRENATAL EXPOSURE
Mental retardation Ataxia & cerebral palsy Seizures Vision & hearing loss Delayed developmental milestones Language disorders Deficits in fine motor function Visual spatial disabilities Memory problems High blood pressure low cardiac rate variability
DOSEDOSE
31
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
CONGENITAL MINAMATA DISEASE: CONGENITAL MINAMATA DISEASE: METHYLMERCURY EXPOSURE IN PREGNANCYMETHYLMERCURY EXPOSURE IN PREGNANCY
Mothers often asymptomatic!
Microcephaly
Cerebral palsy/spasticity
Mental deficits
Malformation of ears,
heart, skeleton, eyes
Minamata Bay, Japan
© Stephan Boese-O´Reilly 2001
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
NEURODEVELOPMENTNEURODEVELOPMENT
Rice, EHP, 2000 108 (3): 511
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
EXAMPLE OF EXAMPLE OF “TREMOR MERCURIALIS”“TREMOR MERCURIALIS”
Hand-writing of Hand-writing of a 9 year old girl in a 9 year old girl in monthly intervals after monthly intervals after an accidental intake of an accidental intake of mercury containing mercury containing seed preservativesseed preservatives
Boese, Paediat Prax (1993) 45: 183
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
SUBCLINICAL EFFECTSSUBCLINICAL EFFECTS
Susceptibility of the fetal brain is very high
Altered neuro-psychological tests postpartum, if prenatal Hg-burden was raised by whale fish consumption (Faroe Islands study)
No effects found in a similar study (Seychelles study)
Recommendations EPA recommendation: 0,1 μg of methyl Hg/kg body
weight/day WHO recommendation: 1.6 µg/kg body weight/week
35
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
FAROE STUDYFAROE STUDY Cohort of 1022 children born 1986-1987 Exposure to methyl-mercury from:
Pilot whale meat - episodic, and potentially high Fish consumption - continuous, but low
At age 7: neuropsychological tests At age 14: neurophysiologic tests Neuropsychological dysfunctions
Language Attention Memory
Neurophysiologic tests Delayed brainstem auditory evoked potentials Decreased autonomic heart rate variability
Attributed to pre-natal exposure
36
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
SEYCHELLES STUDYSEYCHELLES STUDY
Cohort of 779 mother-infant pairs
Exposure from mothers with high fish consumption
At age 9: neuropsychological tests
No support for any mercury related neurodevelopmental risks due to prenatal MeHg exposure
37
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
ANOTHER ORGANIC MERCURY: THIMEROSALANOTHER ORGANIC MERCURY: THIMEROSAL
A mercury preservative used in Eye drops, antiseptics, other pharmaceuticals Multidose vaccinations
It is metabolized to ethyl-mercury T1/2 ~7 days in babies
Crosses blood brain barrier Neurotoxic in high doses, “Safe dose” unknown
38
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
PEDIATRIC EXPOSURE TO PEDIATRIC EXPOSURE TO THIMEROSAL IN IMMUNIZATIONSTHIMEROSAL IN IMMUNIZATIONS
Vaccine practices in the 1990s raised the body Vaccine practices in the 1990s raised the body burden of mercury for small and preterm babies*burden of mercury for small and preterm babies*
Thimerosal free vaccinations for neonates ** Thimerosal free vaccinations for neonates ** In the US, all infant vaccinations are thimerosal free since March
2001, except some influenza Still used to prevent microbial contamination of multidose vials in
some countries
No harmful effect of thimerosal proven in infants ***No harmful effect of thimerosal proven in infants ***
* Stajich, 2000, ** Ball, 2001, 2001, *** Heron, 2004
39
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
CHILD LABOUR WITH MERCURYCHILD LABOUR WITH MERCURY
In small scale mining areas, children may work with In small scale mining areas, children may work with mercurymercury
This is Child Labour at its worst limits:This is Child Labour at its worst limits: Physically very hard and dangerous High risk of injury Major health hazard
40
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Hg in urine of Hg in urine of children aged 8 children aged 8 to 13, who live to 13, who live and/or work in and/or work in the areathe area
TATELU (INDONESIA) – EXPOSED CHILDRENTATELU (INDONESIA) – EXPOSED CHILDREN
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
TATELU (INDONESIA) – DYSDIADOCHOKINESIATATELU (INDONESIA) – DYSDIADOCHOKINESIA
Cerebellar Cerebellar effects in effects in children aged children aged 8 to 13, who 8 to 13, who live or work live or work and live in and live in the areathe area
Children from Tatelu (Sulawesi)
0,0%
5,0%
10,0%
15,0%
20,0%
25,0%
30,0%
35,0%
40,0%
Fre
qu
ency
of
Dys
dia
do
cho
kin
esia
controlN = 31
not workingN = 22
working with HgN = 42
42
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
SYMPTOMS AND SIGNS OF HG EXPOSURESYMPTOMS AND SIGNS OF HG EXPOSURE
Typical symptoms of Typical symptoms of chronic metallic mercury chronic metallic mercury intoxication are:intoxication are: Tremor Ataxia Coordination problems Excessive salivation Metallic taste
(© Stephan Boese-O´Reilly 1999)
43
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
OUTCOME
EFFECTS:
Brain
Kidney
Multi-systemic
Acrodynia
SUSCEPTIBILITIES
Foetus
Newborn
Young children
ENVIRONMENTAL EXPOSURE TO HG ENVIRONMENTAL EXPOSURE TO HG HAZARDS:
IndustryFish
Folk
Medicine
Cosmetics
Spills
MEDIA: Food, Air, Soil
SETTINGSHome
School
Outdoors
ACTIVITIES: Eating, Playing, Working
(© Stephan Boese-O´Reilly 2004)
44
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
DIAGNOSIS: HAVE A HIGH INDEX OF SUSPICION!DIAGNOSIS: HAVE A HIGH INDEX OF SUSPICION!
Careful history taking: food, activities, environment, … Clinical observation
Typical signs and symptoms
+ Increased mercury body burden
Urine Hg: inorganic exposure Blood Hg: organic exposure Hair mercury reflects long term exposure
MERCURY
INTOXICATION
45
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
TREATMENT TREATMENT
STOP EXPOSURESTOP EXPOSURE
Chelating agents may reduce the body burden of Chelating agents may reduce the body burden of mercury and may improve some symptomsmercury and may improve some symptoms
DMPS simple to use (orally), has few side effects DMPS is effective in "mixed" and "combined" Hg exposures DMSA may have some advantages in Me-Hg poisoning
Symptomatic treatmentSymptomatic treatment
Rehabilitation Rehabilitation
46
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
TO CHELATE OR NOT TO CHELATE?TO CHELATE OR NOT TO CHELATE?
YESYES Acute elemental Chronic elemental Acute inorganic Chronic inorganic
MAYBEMAYBE Acute organic
- Phenylmercury
- Methoxymercury
NONO Chronic low grade
methyl-Hg
- No ion to grab
- Redistributes
NEVERNEVER Oral EDTA Herbals To “cure” autism
Consult the Poisons Centre!Consult the Poisons Centre!
47
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
POSSIBLE CONTROL MECHANISMSPOSSIBLE CONTROL MECHANISMS
UNEP, 2002
48
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
WHAT HEALTH CARE PROVIDERS CAN DOWHAT HEALTH CARE PROVIDERS CAN DO
SECONDARY PREVENTIONSECONDARY PREVENTION Fish consumption advice
PRIMARY PREVENTIONPRIMARY PREVENTION Mercury free office and hospital Mercury free communities
Thermometer exchange Hazardous waste education Change high-risk behaviors
Folk medicines, cottage industries, …
Get politically active Request emission controls on power plants, incinerators Prevent childhood exposure to artisanal mining
NOAA Photo Gallery, Tuna
49
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
EXAMPLE OF FISH CONSUMPTION GUIDELINESEXAMPLE OF FISH CONSUMPTION GUIDELINES
For women and young children in the USA (USEPA/FDA)For women and young children in the USA (USEPA/FDA)
1. Do not eat Shark, Swordfish, King Mackerel, or Tilefish
2. Eat up to 12 ounces (2 average meals) a week of a variety of fish and shellfish that are lower in mercury
Shrimp, canned light tuna, salmon, pollock, and catfish are examples
Albacore ("white") tuna has more mercury than canned light tuna, you may eat up to 6 ounces (one average meal) per week.
3. Check local advisories. If no advice is available, eat up to 6 ounces (one average meal) per week of fish you catch, but don't consume any other fish during that week.
...to your young child, serve smaller portions!
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Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
For women and young children in developing countries, where diets are based on fish that may have high levels of Hg
WHO
Recognize neurodevelopmental problems in children::
•Determine amount, type and frequency of fish consumption and provide advise
Encourage consumption of fish low in methyl mercury, but:
•Limit intake of larger, predatory fish.•Greatly limit intake of marine mammals.•Encourage consumption of "light" or "chunk light" tuna
EXAMPLE OF FISH CONSUMPTION GUIDELINESEXAMPLE OF FISH CONSUMPTION GUIDELINES
51
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
PRIMARY PREVENTION PRIMARY PREVENTION
In the medical domain:
Avoid the use of Hg mercury thermometers and manometers.
Indicate/promote Hg-free vaccines
Consider non-Hg amalgams
52
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Primary prevention at home
Avoid ritual use of quicksilver
Eliminate equipment with mercury
Avoid having children play with “quicksilver”
Dispose safely of mercury-containing products (old batteries and thermometers).
PRIMARY PREVENTION PRIMARY PREVENTION
53
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
In case of metallic mercury spill
DO NOT clean yourself if amount is greater than that contained in a thermometer: Call local health or environmental agencies.
NEVER VACUUM or use a broom
NEVER put mercury down the drain
NEVER wash mercury-contaminated items in a washing machine
NEVER walk around if your shoes might be contaminated with mercury.
Beware of contaminated clothes too.
www.epa.gov/epaoswer/hazwaste/mercury/spills.htm#cleanmercuryspills
PRIMARY PREVENTION PRIMARY PREVENTION
54
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
PRIMARY PREVENTIONPRIMARY PREVENTION
Regulatory measures
Control and reduction of Hg release into the environment
Regulation/Eradication of child labour with mercury
Environmental quality standards
Standards, actions and programs on Hg exposure
55
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Global Mercury Assessment (UNEP, Dec 2002)
Mercury is present throughout the environment Is persistent and cycles globally Has serious effects Interventions can be successful
Global actions are required because: Hg's global cycling increases the problem Hg has an impact on global fishing Hg may be more problematic in less-developed regions Hg is subject to significant international use and commerce
Calls for international coordinated actions
PREVENTION AND REGULATIONSPREVENTION AND REGULATIONS
56
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
Diagnose and treatDiagnose and treat Publish, do researchPublish, do research
Sentinel cases Community-based interventions
EducateEducate Patients and families Colleagues and students
AdvocateAdvocate Role modelRole model
HEALTH AND ENVIRONMENT PROFESSIONALSHEALTH AND ENVIRONMENT PROFESSIONALSPLAY A CRITICAL ROLE:PLAY A CRITICAL ROLE:
WHO
57
Mercury and Children's Environmental Health (DRAFT)Mercury and Children's Environmental Health (DRAFT)
POINTS FOR DISCUSSIONPOINTS FOR DISCUSSION