Technical report: mercury in the environment: implications for pediatricians

Evaluation of two in vitro protocols for determination of mercury bioaccessibility: influence of mercury fractionation and soil properties

Soil ingestion by children can be a significant exposure pathway to mercury (Hg). Unfortunately, no reliable in vivo results for Hg oral bioavailability determination in soils have been published. In vitro extractions enable the assessment of metals' bioaccessibility, which is an estimate of oral bioavailability. Therefore, the goal of this study was to evaluate two in vitro protocols (CDM (Camp Dresser and Mc Kee Inc.) and IVG (In Vitro Gastrointestinal)) for determination of Hg bioaccessibility in soils using pure Hg-compounds, reference materials (CRM 025-050 and ERM-CC580), and field-collected soils with elevated Hg concentrations. The influence of Hg fractionation and soil properties on Hg bioaccessibility was also investigated. In the field-collected soils, IVG bioaccessibility ranged from 1.5 to 7.5%, and was always below 3.15%, using the CDM method. Mercury bioaccessibility in CRM 025-050 was 61.5 and 34.7%, using IVG and CDM protocols, respectively, whereas Hg bioaccessibility was much lower in the certified sediment sample ERM-CC580 (<7%). Overall, the CDM protocol resulted in lower Hg bioaccessibility values. The water-soluble and exchangeable Hg fraction was highly correlated with gastrointestinal bioaccessibility (r=0.99, p<0.001 for both methods) and this fraction could be a potentially good indicator of Hg bioaccessibility. Because the IVG method is less time-consuming than the CDM protocol and includes organic physiological components which seem to increase Hg bioaccessibility, it might be preferred for determination of Hg bioaccessibility.

Mercury exposure, nutritional deficiencies and metabolic disruptions may affect learning in children

Among dietary factors, learning and behavior are influenced not only by nutrients, but also by exposure to toxic food contaminants such as mercury that can disrupt metabolic processes and alter neuronal plasticity. Neurons lacking in plasticity are a factor in neurodevelopmental disorders such as autism and mental retardation. Essential nutrients help maintain normal neuronal plasticity. Nutritional deficiencies, including deficiencies in the long chain polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, the amino acid methionine, and the trace minerals zinc and selenium, have been shown to influence neuronal function and produce defects in neuronal plasticity, as well as impact behavior in children with attention deficit hyperactivity disorder. Nutritional deficiencies and mercury exposure have been shown to alter neuronal function and increase oxidative stress among children with autism. These dietary factors may be directly related to the development of behavior disorders and learning disabilities. Mercury, either individually or in concert with other factors, may be harmful if ingested in above average amounts or by sensitive individuals. High fructose corn syrup has been shown to contain trace amounts of mercury as a result of some manufacturing processes, and its consumption can also lead to zinc loss. Consumption of certain artificial food color additives has also been shown to lead to zinc deficiency. Dietary zinc is essential for maintaining the metabolic processes required for mercury elimination. Since high fructose corn syrup and artificial food color additives are common ingredients in many foodstuffs, their consumption should be considered in those individuals with nutritional deficits such as zinc deficiency or who are allergic or sensitive to the effects of mercury or unable to effectively metabolize and eliminate it from the body.

Accumulation of mercury in ovaries of mice after the application of skin-lightening creams

Skin-lightening creams are being increasingly used by women in particular, worldwide in an attempt to whiten their skin. Men and older people use these creams to remove age spots or other pigmentation disorders. Several studies have reported the presence of high mercury levels in skin-lightening cream. Women, especially pregnant and nursing mothers, who use these creams are at risk of mercury toxicity because long-term exposure can cause permanent neurological damage, nephrological disorders, fertility problems, and birth defects. Early exposure usually has no clinical symptoms. Mercury levels were measured in a total of 49 ovary tissue samples. The mean mercury contents in the ovaries of non-treated mice (11.70 +/- 13.38 ng/g) were compared to mice treated with Rose skin-lightening cream samples (2,471.92 +/- 1,336.31 ng/g) and those treated with Fair & Lovely skin-lightening creams (58.47 +/- 39.51 ng/g). The mercury content in the ovary tissues increased with number of cream applications and were highest in the ovaries of mice treated twice a day with Fair & Lovely (87.79 +/- 26.20 ng/g) and once a day with Rose (3,515.61 +/- 1,099.78 ng/g). Our data indicate that dermal exposure to mercury can result in a significant accumulation in the ovaries of mice following the application of skin-lightening cream. This may cause alterations in reproductive behavior and contribute to infertility or ovarian failure. Of course, these results need to be confirmed by further research. Imported or locally made skin-lightening creams are widely available in Saudi market. It would be ideal to ban the sale of these creams but unfortunately, advertisements in the mass media presenting celebrities and beauty specialists make these products more popular. Alternatively, public health authorities should encourage more reliance on prescribed creams for the treatment of skin pigmentation problems.

Comparative evaluation of adenosine deaminase activity in cerebral cortex and hippocampus of young and adult rats: effect of garlic extract (Allium sativum L.) on their susceptibility to heavy metal exposure

Adenosine plays an important neuromodulatory role in the central nervous system, and adenosine deaminase is an important enzyme in the degradation of adenine nucleotides. Methylmercury is the most prevalent form of mercury found in the environment. Methylmercury neurotoxicity has been correlated to the production of reactive oxygen species. In this study, its potential pathogenic effects were investigated in vitro in cerebral cortex and hippocampus of rats. We first observed that adenosine deaminase activity was higher in young rat brains when compared to the 60-day-old rats and was higher in hippocampus when compared to the cortex. Methylmercury (0.1, 1.0, 20 microM) inhibited adenosine deaminase activity in 7- and 60-day-old rats in a concentration-dependent manner. We have demonstrated that methylmercury-induced inhibition was antagonized by garlic alcoholic extract, but sodium selenate did not alter enzyme activity. In addition, glutathione and dithiothreitol restored the methylmercury-induced decrease of adenosine deaminase activity. These results demonstrated that there are age-related changes in adenosine deaminase activity and that thiol agents may contribute to the maintenance of adenosine deaminase activity and may be important in the neuromodulation of adenosine. Garlic alcoholic extract may be effective in reducing the effect of methylmercury-induced adenosine deaminase, which may be due to its sulphur-containing compounds.

The built environment: designing communities to promote physical activity in children

An estimated 32% of American children are overweight, and physical inactivity contributes to this high prevalence of overweight. This policy statement highlights how the built environment of a community affects children's opportunities for physical activity. Neighborhoods and communities can provide opportunities for recreational physical activity with parks and open spaces, and policies must support this capacity. Children can engage in physical activity as a part of their daily lives, such as on their travel to school. Factors such as school location have played a significant role in the decreased rates of walking to school, and changes in policy may help to increase the number of children who are able to walk to school. Environment modification that addresses risks associated with automobile traffic is likely to be conducive to more walking and biking among children. Actions that reduce parental perception and fear of crime may promote outdoor physical activity. Policies that promote more active lifestyles among children and adolescents will enable them to achieve the recommended 60 minutes of daily physical activity. By working with community partners, pediatricians can participate in establishing communities designed for activity and health.

Prenatal and early childhood exposure to mercury and methylmercury in Spain, a high-fish-consumer country

Exposure to mercury, a risk factor for neurodevelopmental toxicity, was assessed in Spanish children (preschool children and newborns, n = 218) in a four-locations survey by performing mercury determination in hair. To assess the prenatal and children's exposure and its potential risk, total mercury (THg) and methylmercury (MeHg) were analyzed and examined for associations with maternal sociodemographic characteristics and dietary intake through interviews and food frequency questionnaires. The mean THg in hair was 0.94 microg/g, ranging from 0.19 to 5.63 microg/g in preschool children and 1.68 microg/g (0.13-8.43 microg/g) in newborns. Associations between mercury levels in hair and fish consumption frequency were found regardless of the group evaluated. Neither other food item nor maternal covariates were associated with mercury levels in the newborn group. In children, the mean THg values among frequent fish consumers (more than four times per week) were almost threefold higher compared with non-consumers (1.40 vs. 0.49 microg/g). Newborns from mothers who had intake of fish two or more times per week exhibited nearly threefold higher hair levels than those who rarely or never consumed fish (2.26 vs. 0.78 microg/g). Finally, mercury levels in hair exceeded the EPA reference dose (RfD) of 0.1 microg Hg/kg body weight per day (equivalent to 1 microg Hg/g hair) in 42% of the population studied. Overall, we conclude that levels of mercury in Spain are among the highest in the non-exposed populations probably because of the relatively high fish consumption.

Genetic engineering to enhance mercury phytoremediation

Most phytoremediation studies utilize merA or merB genes to modify plants via the nuclear or chloroplast genome, expressing organomercurial lyase and/or mercuric ion reductase in the cytoplasm, endoplasmic reticulum or within plastids. Several plant species including Arabidopsis, tobacco, poplar, rice, Eastern cottonwood, peanut, salt marsh grass and Chlorella have been transformed with these genes. Transgenic plants grew exceedingly well in soil contaminated with organic (approximately 400 microM PMA) or inorganic mercury (approximately 500 microM HgCl(2)), accumulating Hg in roots surpassing the concentration in soil (approximately 2000 microg/g). However, none of these plants were tested in the field to demonstrate real potential of this approach. Availability of metal transporters, translocators, chelators and the ability to express membrane proteins could further enhance mercury phytoremediation capabilities.

Mercury from chlor-alkali plants: measured concentrations in food product sugar

Mercury cell chlor-alkali products are used to produce thousands of other products including food ingredients such as citric acid, sodium benzoate, and high fructose corn syrup. High fructose corn syrup is used in food products to enhance shelf life. A pilot study was conducted to determine if high fructose corn syrup contains mercury, a toxic metal historically used as an anti-microbial. High fructose corn syrup samples were collected from three different manufacturers and analyzed for total mercury. The samples were found to contain levels of mercury ranging from below a detection limit of 0.005 to 0.570 micrograms mercury per gram of high fructose corn syrup. Average daily consumption of high fructose corn syrup is about 50 grams per person in the United States. With respect to total mercury exposure, it may be necessary to account for this source of mercury in the diet of children and sensitive populations.

Effects of methyl-, phenyl-, ethylmercury and mercurychlorid on immune cells of harbor seals (Phoca vitulina)

Mercury (Hg) is present in the marine environment as a natural metal often enhanced through human activities. Depending on its chemical form, Hg can cause a wide range of immunotoxic effects. In this study, the influence of methyl-, ethyl- and phenylmercury as well as mercurychloride on immune functions was evaluated. Two parameters of cellular immunity, proliferation and mRNA cytokine expression of interleukin-2, -4, and transforming growth factor beta, were investigated in harbor seal lymphocytes after in vitro exposure to Hg compounds. While all Hg compounds had a suppressive effect on proliferation, differences between juvenile and adult seals were found. Lymphocytes from juveniles showed a higher susceptibility to the toxic effect compared to lymphocytes from adults. Furthermore, the degree of inhibition of proliferation varied among the four Hg compounds. The organic compounds seem to be more immunotoxic than the inorganic compound. Finally, for the cytokine expression of methylmercury-incubated lymphocytes, time-dependent changes were observed, but no dose-dependency was found. Marine mammals of the North Sea are burdened with Hg, and lymphocytes of harbor seals may be functionally impaired by this metal. The present in vitro study provides baseline information for future studies on the immunotoxic effects of Hg on cellular immunity of harbor seals.

Detection of mercury in aquatic environments using EPRE reporter zebrafish

It has been proposed that transgenic zebrafish could be designed to detect low levels of chemical contaminants that cause oxidative stress in aquatic environments, such as heavy metals or pesticides. In this paper, we describe such a transgenic zebrafish that produces a luciferase-green fluorescent protein (LUC-GFP) fusion protein under conditions of oxidative stress. The reporter gene expression is under the regulation of the electrophile responsive element (EPRE), which activates gene expression in response to oxidative stressors. The GFP component of this fusion protein allows us to visually detect reporter gene activity in live animals to determine if activity is localized to a particular tissue. The luciferase component is capable of returning a quantitative assessment of reporter gene activity that allows us to determine if reporter gene activity is directly correlated to the concentration of the chemical inducer. We have tested this reporter construct in both transient and stable transgenic fish after exposure to a range of HgCl(2) concentrations. GFP expression from the EPRE-LUC-GFP construct was inducible in transient assays but was below the limit of detection in stable lines. In contrast, we observed inducible luciferase activity in both transient assays and stable lines treated with HgCl(2). We conclude that the EPRE is capable of driving reporter gene expression in a whole animal assay under conditions of oxidative stress. Furthermore, expression was induced at HgCl(2) concentrations that do not result in obvious morphological defects, making this approach useful for the detection of low levels of oxidative contaminants in aquatic environments.

Mercury (Hg) and lead (Pb) in interior and exterior New Orleans house paint films

Pre-1992, latex paint was formulated with mercury (Hg) as phenylmercuric acetate (PMA). Hg vaporizes reducing its content, and lead (Pb) is stable and remains unchanged. The objective of this study is to describe the content of Hg and Pb in existing paint coatings. Forty paint chip samples were collected from both interior and exterior surfaces of homes in metropolitan New Orleans and analyzed for Hg and Pb. The median Hg in exterior paints is 26.9 mg kg(-1) (0.8-214.0) compared with 7.1 mg kg(-1) (0.03-39.2) for interior paints. The median Pb content is 76603 mg kg(-1) (464-317151) and 416 mg kg(-1) (24-63313) respectively, for exterior and interior paints. The Spearman correlation coefficients for Hg and Pb are -0.312 (P=0.13) and -0.471 (P=0.07) respectively, in exterior and interior samples. Hg and Pb vary independently with each other in paint films. Median Hg in exterior paints is four times larger than for interior paints. Median Pb in exterior paints is 184 times larger than interior paints. The Pb and Hg content in exterior and interior paint chips are significantly different (Mann-Whitney Rank Sum Test, P0.001 and P=0.006, respectively). Only 1 of the 25 exterior paints contained less than the current 5000 mg kg(-1) US standard for Pb, the criteria for exemption from the power-sanding restrictions of the New Orleans Lead Ordinance. Prior to banning PMA in paint, Hg poisonings presented as acrodynia were reported for children living in homes freshly painted with latex paint. Because of the affinity of Hg and Pb for sulfur-containing amino acid proteins, their presence in paint coatings poses an increased hazard when released as dust.

Noninfectious dermatological diseases associated with chronic exposure to mine tailings in a Peruvian district

BACKGROUND

Mine tailings are metallic wastes which are deposited in the environment due to mining activity. Long-term exposure to these metals is harmful to human health.

OBJECTIVE

To determine if chronic exposure to mine tailings constitutes a risk factor for the development of dermatological diseases in the district of San Mateo de Huanchor (Lima, Peru).

METHODS

An observational case-control study was carried out in the communities of Mayoc, Daza and Tamboraque (exposed to mine tailings, case group) located in the district of San Mateo de Huanchor, and also in the communities of Choccna and Caruya (not exposed to mine tailings, control group) located in the same district. Out of 230 adults, 121 were exposed and 109 were not exposed to mine tailings and out of 135 children, 71 were exposed and 64 were not exposed to mine tailings.

RESULTS

In the adult group, 71% of the exposed cases had some noninfectious dermatological disease while in the nonexposed group the frequency was 34% [P < 0.001; odds ratio (OR) 5.40; 95% confidence interval (CI) 3.02-9.68]. A statistically significant difference between groups was found for arsenical dermatitis, nonpruritic papulovesicular eruption, atopic dermatitis, contact dermatitis, seborrhoeic dermatitis and xerosis. In the paediatric population, 71 exposed and 64 nonexposed children were evaluated. Sixty-nine per cent of the exposed group had some noninfectious dermatological disease vs. 30% in the nonexposed group (P < 0.001; OR 6.00; 95% CI 2.71-13.31). A statistically significant difference between groups was found for xerosis and atopic dermatitis.

CONCLUSION

Chronic exposure to mine tailings represents a risk factor for development of noninfectious dermatological diseases in both adults and children.

Effects of prenatal exposure to coal-burning pollutants on children's development in China

BACKGROUND

Environmental pollutants such as polycyclic aromatic hydrocarbons (PAHs), lead, and mercury are released by combustion of coal and other fossil fuels.

OBJECTIVES

In the present study we evaluated the association between prenatal exposure to these pollutants and child development measured by the Gesell Developmental Schedules at 2 years of age.

METHODS

The study was conducted in Tongliang, Chongqing, China, where a seasonally operated coal-fired power plant was the major source of ambient PAHs and also contributed lead and mercury to the air. In a cohort of nonsmoking women and their newborns enrolled between March 2002 and June 2002, we measured levels of PAH-DNA adducts, lead, and mercury in umbilical cord blood. PAH-DNA adducts (specifically benzo[a]pyrene adducts) provided a biologically relevant measure of PAH exposure. We also obtained developmental quotients (DQs) in motor, adaptive, language, and social areas.

RESULTS

Decrements in one or more DQs were significantly associated with cord blood levels of PAH-DNA adducts and lead, but not mercury. Increased adduct levels were associated with decreased motor area DQ (p = 0.043), language area DQ (p = 0.059), and average DQ (p = 0.047) after adjusting for cord lead level, environmental tobacco smoke, sex, gestational age, and maternal education. In the same model, high cord blood lead level was significantly associated with decreased social area DQ (p = 0.009) and average DQ (p = 0.038).

CONCLUSION

The findings indicate that exposure to pollutants from the power plant adversely affected the development of children living in Tongliang; these findings have implications for environmental health policy.

The environmental health of children: priorities in Europe

OBJECTIVES

To evaluate existing research on the environmental health of children and provide a prioritised list of risk factors and policy recommendations for action, the Policy Interpretation Network on Children's Health and Environment (PINCHE) was set up within EU FP5 (QLK4-2002-02395). The project focused on air pollutants, carcinogens, neurotoxicants and noise. PINCHE was a multidisciplinary and multinational network of representatives from science, industry, NGOs, and consumer and patient organisations in Europe.

MATERIALS AND METHODS

A literature search was performed using the Pubmed, Embase and Toxline databases. The quality of the gathered articles was assessed and their information and relevance was interpreted within a systematic framework. Information related to exposure, epidemiology, and toxicology was analysed separately and then a risk evaluation of particular environmental factors was made. Socioeconomic factors were specifically taken into account. The results were compiled, and considering the present regulatory situation, policy recommendations for action were made. Finally, the risk factors and policy recommendations were prioritised through a process of discussion between all the partners.

RESULTS AND CONCLUSIONS

PINCHE concluded that outdoor air pollutants (especially traffic-related), environmental tobacco smoke, allergens, and mercury were high priorities with an urgent need for action. Brominated flame retardants, lead, PCBs and dioxins, ionising and solar radiation, and some noise sources were classified as being of medium priority. Some toxins were given low priority, based on few exposed children, relatively mild health effects or an improving situation due to past policy measures. We recognise the shortcomings of such a prioritisation and, though some measures are more urgent than others, emphasise that ideally all policy measures should be carried out without delay for all toxins. This priority list must be continuously revised, the precautionary principle should be central to all decisions, and the focus should be on safe exposure levels for children.

Phytoremediation of mercury and organomercurials in chloroplast transgenic plants: enhanced root uptake, translocation to shoots, and volatilization

Transgenic tobacco plants engineered with bacterial merA and merB genes via the chloroplast genome were investigated to study the uptake, translocation of different forms of mercury (Hg) from roots to shoots, and their volatilization. Untransformed plants, regardless of the form of Hg supplied, reached a saturation point at 200 microM of phenylmercuric acetate (PMA) or HgCl2, accumulating Hg concentrations up to 500 microg g(-1) with significant reduction in growth. In contrast, chloroplast transgenic lines continued to grow well with Hg concentrations in root tissues up to 2000 microg g(-1). Chloroplasttransgenic lines accumulated both the organic and inorganic Hg forms to levels surpassing the concentrations found in the soil. The organic-Hg form was absorbed and translocated more efficiently than the inorganic-Hg form in transgenic lines, whereas no such difference was observed in untransformed plants. Chloroplast-transgenic lines showed about 100-fold increase in the efficiency of Hg accumulation in shoots compared to untransformed plants. This is the first report of such high levels of Hg accumulation in green leaves or tissues. Transgenic plants attained a maximum rate of elemental-Hg volatilization in two days when supplied with PMA and in three days when supplied with inorganic-Hg, attaining complete volatilization within a week. The combined expression of merAB via the chloroplast genome enhanced conversion of Hg2+ into Hg,0 conferred tolerance by rapid volatilization and increased uptake of different forms of mercury, surpassing the concentrations found in the soil. These investigations provide novel insights for improvement of plant tolerance and detoxification of mercury.

Molecular mechanisms triggered by mercury

Mercury is an ubiquitous environmental toxin that causes a wide range of adverse health effects in humans. Three forms of mercury exist: elemental, inorganic and organic. Each of them has its own profile of toxicity. Exposure to mercury typically occurs by inhalation or ingestion. Mercury can be an indoor air pollutant, however industry emission remains the most important source of inhaled mercury. Furthermore, fresh water and ocean fish may contain large amounts of mercury and dental amalgam can be another important source of inorganic and mercury vapor. The present review discusses the current information on mercury toxicity and the distinct toxicologic profile of the three forms of mercury. The existing therapeutics, new therapeutics development or agents for treating mercury poisoning will also discussed. Since in general low levels of mercurial are tolerable, herein, we also discuss the defensive mechanisms developed by the cell to protect itself against mercury injury. This aspect may be useful to provide a biological protection against toxic effects exerted by mercury or by specific forms of mercury in view of a medicinal purposes.

Prenatal exposure to mercury and neurobehavioral development of neonates in Zhoushan City, China

Exposure to hazardous Hg can adversely affect children's neurodevelopment. However, few data are available on either Hg levels in neonates and their mothers or the impact of prenatal exposure to Hg on neonates' neurobehavioral development in the Chinese population. Therefore, this study examined Hg levels in neonates and their mothers and the relationship between prenatal exposure to Hg and neonates' neurobehavioral development in Zhoushan City, Zhejiang Province, China. Between August and October 2004, 417 women who delivered their babies at Zhoushan Women's and Children's Health Hospital, an island city in east China were invited to take part in this study. A total of 408 complete questionnaires, 405 maternal hair samples, and 406 umbilical cord samples were collected. Neonatal behavioral neurological assessments (NBNA) were conducted for 384 neonates. The geometric mean (GM) of Hg level in cord blood was 5.58 microg/L (interquartile range: 3.96-7.82 microg/L), and the GM of maternal hair Hg level was 1246.56 microg/kg (interquartile range: 927.34-1684.67 microg/kg), a level much lower than other reported fish-eating populations, indicating Hg exposure in Zhoushan city is generally below those considered hazardous. However, according to the reference dose of Hg levels (RfD 5.8 microg/L) derived by EPA, 69.9% of newborns had levels at or above the RfD, an estimated level assumed to be without appreciable harm. There was a strong correlation between maternal hair and cord blood Hg levels (r = 0.82, P < 0.01). Frequency of fish consumption was associated with hair Hg (r = 0.48, P < 0.01) and cord blood Hg levels (r = 0.54, P < 0.01). Increased prenatal Hg exposure was associated with decreased behavioral ability for males (OR = 1.235, 95%CI of OR = 1.078-1.414, P < 0.001), but not for females. Our results provide some support for the hypothesis that there is neurodevelopmental risk for males from prenatal MeHg exposure resulting from fish consumption. But the findings of this study may be due to chance, and long-term follow-up research is needed to evaluate cumulative effects of exposure to mercury.

Reduced tubulin tyrosination as an early marker of mercury toxicity in differentiating N2a cells

The aims of this work were to compare the effects of methyl mercury chloride and thimerosal on neurite/process outgrowth and microtubule proteins in differentiating mouse N2a neuroblastoma and rat C6 glioma cells. Exposure for 4h to sublethal concentrations of both compounds inhibited neurite outgrowth to a similar extent in both cells lines compared to controls. In the case of N2a cells, this inhibitory effect by both compounds was associated with a fall in the reactivity of western blots of cell extracts with monoclonal antibody T1A2, which recognises C-terminally tyrosinated alpha-tubulin. By contrast, reactivity with monoclonal antibody B512 (which recognises total alpha-tubulin) was unaffected at the same time point. These findings suggest that decreased tubulin tyrosination represents a neuron-specific early marker of mercury toxicity associated with impaired neurite outgrowth.

Maternal dental history, child's birth outcome and early cognitive development

Prenatal exposure to high levels of mercury, radiation and inflammation have been associated with adverse reproductive outcomes such as increases in preterm delivery, low birthweight and delayed neurodevelopment. Few data are available to evaluate the potential effects of prenatal low-level exposure to these factors as may occur during dental care. We evaluated maternal dental history prior to and during pregnancy in relation to birth outcomes and early communicative development among offspring in a large cohort (n = 7375) of British children born in 1991-92. Dental history was assessed by questionnaire. The child's communicative development was assessed using the MacArthur Communicative Development Inventory at 15 months of age. Total mercury was measured in umbilical cord tissue for a subset of the children. Overall, dental care, including amalgam fillings, was not associated with birth outcomes or language development. Having X-rays taken during pregnancy was not associated with birthweight measured continuously (b = 14.7, P = 0.4), but was associated with slightly increased odds of having a term, low-birthweight baby (OR 1.9, [95% confidence interval 1.0, 3.4]). More detailed evaluation of the potential adverse effects of elective dental treatment during pregnancy, particularly dental X-rays, may be warranted.

Exposure assessment of a mercury spill in a Nevada school -- 2004

BACKGROUND

Although mercury is toxic, few studies have measured exposure in children who handled elemental mercury briefly. In 2004, a student spilled approximately 60 milliliters of mercury at a Nevada school. Within 12 hours, all students were removed from the source of exposure. We conducted an exposure assessment at the school.

METHODS

We administered questionnaires and obtained urine samples from students. Using two-sample t-tests, we compared urine mercury levels from students who self-reported exposure to mercury levels of other students.

RESULTS

Two-hundred students participated, including 55/62 (89%) who were decontaminated. The students' geometric mean urine mercury level was 0.36 microg/L (95% confidence interval 0.32-0.40 microg/L). The student who brought the mercury to school was the only one to have an elevated urine mercury level (11.4 microg/L).

CONCLUSION

Despite environmental contamination, mercury exposure may have been minimized because of rapid identification of the elemental mercury spill and decontamination.

Reversed-phase high-performance liquid chromatographic separation of inorganic mercury and methylmercury driven by their different coordination chemistry towards thiols

Since mercuric mercury (Hg(2+)) and methylmercury (CH(3)Hg(+)) display different toxicological properties in mammals, methods for their quantification in dietary items must be available. Employing Hg-specific detection, we have developed a rapid, isocratic, and affordable RP-HPLC separation of these mercurials using thiol-containing mobile phases. Optimal separation was achieved with a 50mM phosphate-buffer containing 10mM L-cysteine at pH 7.5. The separation is driven by the on-column formation of complexes between each mercurial and L-cysteine, which are then separated according to their different hydrophobicities. The developed method is compatible with inductively coupled plasma atomic emission spectrometry and was applied to analyze spiked human urine.

Managing mercury in the great lakes: an analytical review of abatement policies

Mercury, a toxic metal known to have several deleterious affects on human health, has been one of the principal contaminants of concern in the Great Lakes basin. There are numerous anthropogenic sources of mercury to the Great Lakes area. Combustion of coal, smelting of non ferrous metals, and incineration of municipal and medical waste are major sources of mercury emissions in the region. In addition to North American anthropogenic emissions, global atmospheric emissions also significantly contribute to the deposition of mercury in the Great Lakes basin. Both the USA and Canada have agreed to reduce human exposure to mercury in the Great Lakes basin and have significantly curtailed mercury load to this region through individual and joint efforts. However, many important mercury sources, such as coal-fired power plants, still exist in the vicinity of the Great Lakes. More serious actions to drastically reduce mercury sources by employing alternative energy sources, restricting mercury trade and banning various mercury containing consumer products, such as dental amalgam are as essential as cleaning up the historical deposits of mercury in the basin. A strong political will and mass momentum are crucial for efficient mercury management. International cooperation is equally important. In the present paper, we have analyzed existing policies in respective jurisdictions to reduce mercury concentration in the Great Lakes environment. A brief review of the sources, occurrence in the Great Lakes, and the health effects of mercury is also included.

Correlation between blood mercury levels in mothers and newborns in Itaituba, Pará State, Brazil

This study evaluated transplacental mercury transfer by measuring Hg in blood samples of mothers and newborns (umbilical cord) in hospitals in the municipality (county) of Itaituba, Pará State, Brazil. Epidemiological and mercury exposure data were collected, besides clinical birth data. Mercury tests were performed by cold-vapor atomic absorption spectrophotometry. A total of 1,510 women and an equal number of their newborns participated in the study. Mean blood mercury was 11.53µg/L in mothers and 16.68µg/L in newborns (umbilical cord). The highest Hg levels were in the 31-40-year maternal age group and their newborns, with 14.37µg/L and 21.87µg/L, respectively. However, in all age groups the mean mercury level was higher in newborns than in mothers. There was a strong positive correlation between Hg levels in newborns and mothers (r = 0.8019; p = 0.000), with a significant linear regression model (r = 0.5283; p = 0.000). The results highlight the importance of monitoring pregnant women exposed to mercury as part of public health surveillance.

Children's health and mercury exposure

The reason why mercury is dangerous is that once released into the environment it cannot be removed and is rapidly transformed by microorganisms into organic compounds that tend to bioaccumulate and biomagnify in animals. The principal organic compound is methylmercury (MeHg). The primary route of exposure to MeHg for humans is consumption of fish. The safe dose (reference dose, RfD) of MeHg that can be consumed without neurotoxicological consequences is 0.1 microg per kg b.w./day. According to available data, the whole population of certain European countries or people who consume large quantities of fish are exposed to doses of MeHg that exceed the RfD. Given this level of mercury exposure, in order to avoid or reduce the expected neurotoxic consequences on foetuses we propose the following strategy: 1) At present the most reasonable solution for pregnant women (and small children) is to reduce substantially or completely avoid fish intake. 2) In the medium term the European Community should evaluate the technical and economic feasibility of breeding uncontaminated fish in order to reduce the drawbacks of banning fish consumption. 3) In the long term there is no alternative to substantially reducing mercury emissions worldwide.

Proposed Guidelines for Skin-to-Skin Treatment of Neonatal Hypothermia

Hypothermia is not uncommon in full-term, low-risk newborns during the first days of life. Standard care for treating hypothermia often involves the separation of the mother and the newborn while the infant is placed under a warmer and observed in the nursery. Because one important role of the postpartum nurse is to promote mother-infant attachment by encouraging the mother to spend time "getting to know" her infant, this separation can be problematic. This article proposes that skin-to-skin (STS) care, also called kangaroo care, an intervention in which the unclothed, diapered infant is placed on the mother's bare chest, be used to promote thermoregulation instead of using separation and a warmer. STS care has been recognized as a way to facilitate maternal-infant attachment and promote thermoregulation. The literature review here provides an analysis of the available evidence and the author's conclusion that the research supports the use of STS care as an alternative to traditional rewarming. The evidence was graded and organized into an evidence-based practice guideline for the use of STS care in the treatment of mild hypothermia in the low-risk infant. Suggestions for further research and outcomes measurement are included.

Applying Cost Analyses to Drive Policy That Protects Children: Mercury as a Case Study

Exposure in prenatal life to methylmercury (MeHg) has become the topic of intense debate in the United States after the Environmental Protection Agency (EPA) announced a proposal in 2004 to reverse strict controls on emissions of mercury from coal-fired power plants that had been in effect for the preceding 15 years. This proposal failed to incorporate any consideration of the health impacts on children that would result from increased mercury emissions. We assessed the impact on children's health of industrial mercury emissions and found that between 316,588 and 637,233 babies are born with mercury-related losses of cognitive function ranging from 0.2 to 5.13 points. We calculated that decreased economic productivity resulting from diminished intelligence over a lifetime results in an aggregate economic cost in each annual birth cohort of $8.7 billion annually (range: $0.7-$13.9 billion, 2000 dollars). $1.3 billion (range: $51 million-$2.0 billion) of this cost is attributable to mercury emitted from American coal-fired power plants. Downward shifts in intellectual quotient (IQ) are also associated with 1566 (range: 115-2675) excess cases of mental retardation (MR defined as IQ < 70) annually. This number accounts for 3.2% (range: 0.2-5.4%) of MR cases in the United States. If the lifetime excess cost of a case of MR (excluding individual productivity losses) is $1,248,648 in 2000 dollars, then the cost of these excess cases of MR is $2.0 billion annually (range: $143 million-$3.3 billion). Preliminary data suggest that more stringent mercury policy options would prevent thousands of cases of MR and billions of dollars over the next 25 years.

Cutaneous poisoning syndromes in children: a review

PURPOSE OF REVIEW

The purpose of this article is to review cutaneous poisoning syndromes in the pediatric population and to describe the diagnostic and therapeutic challenges in the management of these conditions.

RECENT FINDINGS

In recent years, the American Academy of Pediatrics and the Center for Disease Control have been continuously monitoring the lowest blood levels of numerous elements and nutrients associated with the slightest degree of toxicity. This review will focus on the clinical presentation, recognition and management of poisoning with cutaneous manifestations such as carotenoderma, mercury, dioxin and arsenic poisoning.

SUMMARY

Despite numerous efforts of federal and local government agencies to decrease poisoning incidents among consumers, sporadic cases of cutaneous poisoning still arise. Pediatricians should be familiar with the clinical presentation of various toxic syndromes and, more importantly, be able to teach prevention during regular medical encounters.

Poisoning from aspiration of elemental mercury

BACKGROUND

Mercury and mercury compounds (inorganic and organic) can cause acute or chronic poisoning. Acute poisonings, especially with inorganic salts, are widely described, but only sparse data are available on intoxication from oral elemental mercury. We report a case of elemental mercury ingestion followed by pulmonary aspiration of the elemental mercury.

CASE REPORT

A 49-year-old woman intentionally ingested about 200 mL (2709 g) of elemental mercury and aspirated during gastric lavage. A chest radiograph demonstrated small radiodense droplets in the peripheral parts of both lung fields. Whole blood mercury concentrations were 330 microg/L on day 3, 457 microg/L on day 8, and 174 microg/L on day 17. The mercury concentration in a random urine sample was 231 microg/L on day 17. The patient was treated with oral d-penicillamine on the 25th-32nd day after ingestion. A hair sample taken from near the scalp on day 31 had a mercury concentration of 1.38 microg/g. The patient demonstrated impaired memory and disturbances in verbal-logical thinking. At 6 months, she had improved clinically; her whole blood mercury concentration was 16.4 microg/L and the mercury concentration in a random urine sample was 141 microg/L.

CONCLUSIONS

In this case, systemic absorption of elemental mercury, occured after the ingestion of a massive dose of elemental mercury complicated by pulmonary aspiration.

Hg(II) sequestration and protection by the MerR metal-binding domain (MBD)

MerR, the metalloregulator of the bacterial mercury resistance (mer) operon, binds Hg(II) with high affinity. To study the mechanism of metal-induced activation, a small protein was previously engineered embodying in a single polypeptide the metal-binding domain (MBD) ordinarily formed between two monomers of MerR. Here the physiological and biochemical properties of MBD expressed on the cell surface or in the cytosol were examined, to better understand the environments in which specific metal binding can occur with this small derivative. Over 20 000 surface copies of MBD were expressed per Escherichia coli cell, with metal stoichiometries of approximately 1.0 Hg(II) per MBD monomer. Cells expressing MBD on their surface in rich medium bound 6.1-fold more Hg(II) than those not expressing MBD. Although in nature cells use the entire mer operon to detoxify mercury, it was interesting to note that cells expressing only MBD survived Hg(II) challenge and recovered more quickly than cells without MBD. Cell-surface-expressed MBD bound Hg(II) preferentially even in the presence of a 22-fold molar excess of Zn(II) and when exposed to equimolar Cd(II) in addition. MBD expressed in the cystosol also afforded improved survival from Hg(II) exposure for E. coli and for the completely unrelated bacterium Deinococcus radiodurans.

Effects of prenatal exposure to mercury on cognitive and psychomotor function in one-year-old infants: epidemiologic cohort study in Poland

PURPOSE

The aim of the study is to assess the cognitive and psychomotor status of 1-year-old infants whose mothers were exposed to low, but varying, amounts of mercury during pregnancy.

METHODS

Mercury levels in cord and maternal blood at delivery were used to assess prenatal environmental exposure to mercury. Bayley Scales of Infant Development were used to assess neurobehavioral health outcomes. The cohort consisted of 233 infants who were born at 33 to 42 weeks of gestation between January 2001 and March 2003 to mothers attending ambulatory prenatal clinics in the first and second trimesters of pregnancy. Enrollment included only nonsmoking women with singleton pregnancies between the ages of 18 and 35 years who were free from chronic diseases.

RESULTS

The geometric mean (GM) for maternal blood mercury level for the group of infants with normal neurocognitive performance was lower (GM = 0.52 mug/L; 95% confidence interval [CI], 0.46-0.58) than that observed in the group with delayed performance (GM = 0.75 mug/L; 95% CI, 0.59-0.94), and this difference was significant (p = 0.010). The GM of cord blood mercury level in the normal group also was lower (GM = 0.85 mug/L; 95% CI, 0.78-0.93) than that observed in the group with delayed performance (GM = 1.05 mug/L; 95% CI, 0.87-1.27), and this difference was of borderline significance (p = 0.070). The relative risk (RR) for delayed performance increased more than threefold (RR = 3.58; 95% CI, 1.40-9.14) if cord blood mercury level was greater than 0.80 mug/L. Risk for delayed performance in the group of infants with greater maternal mercury levels (>0.50 mug/L) also was significantly greater (RR = 2.82; 95% CI, 1.17-6.79) compared with children whose mothers had mercury levels less than 0.50 mug/L.

CONCLUSIONS

The results may be of public health importance because delayed psychomotor or mental performance in infants is assumed to be an indicator of later neurocognitive development in children, which may persist into adult life.

Gestational mercury vapor exposure and diet contribute to mercury accumulation in neonatal rats

Exposure of pregnant Long-Evans rats to elemental mercury (Hg0) vapor resulted in a significant accumulation of Hg in tissues of neonates. Because elevated Hg in neonatal tissues may adversely affect growth and development, we were interested in how rapidly Hg was eliminated from neonatal tissues. Pregnant rats were exposed to 1, 2, or 4 mg Hg0 vapor/m3 or air (controls) for 2 hr/day from gestation day 6 (GD6) through GD15. Neonatal brain, liver, and kidney were analyzed for total Hg at various times between birth and postnatal day 90 (PND90). Milk was analyzed for Hg between birth and weaning (PND21). Before weaning, the Hg levels in neonatal tissues were proportional to maternal exposure concentrations and were highest in kidney followed by liver and then brain. There was no elimination of Hg between birth and weaning, indicating that neonates were exposed continuously to elevated levels of Hg during postpartum growth and development. Consumption of milk from exposed dams resulted in a slight increase in kidney Hg concentration during this period. Unexpectedly, neonatal Hg accumulation increased rapidly after weaning. Increased Hg was measured in both control and exposed neonates and was attributed to consumption of NIH-07 diet containing trace levels of Hg. By PND90, tissue Hg levels equilibrated at concentrations similar to those in unexposed adult Long-Evans rats fed the same diet. These data indicate that dietary exposure to trace amounts of Hg can result in a significantly greater accumulation of Hg in neonates than gestational exposure to high concentrations of Hg0 vapor.

Mental retardation and prenatal methylmercury toxicity

BACKGROUND

Methylmercury (MeHg) is a developmental neurotoxicant; exposure results principally from consumption of seafood contaminated by mercury (Hg). In this analysis, the burden of mental retardation (MR) associated with methylmercury exposure in the 2000 U.S. birth cohort is estimated, and the portion of this burden attributable to mercury (Hg) emissions from coal-fired power plants is identified.

METHODS

The aggregate loss in cognition associated with MeHg exposure in the 2000 U.S. birth cohort was estimated using two previously published dose-response models that relate increases in cord blood Hg concentrations with decrements in IQ. MeHg exposure was assumed not to be correlated with native cognitive ability. Previously published estimates were used to estimate economic costs of MR caused by MeHg.

RESULTS

Downward shifts in IQ resulting from prenatal exposure to MeHg of anthropogenic origin are associated with 1,566 excess cases of MR annually (range: 376-14,293). This represents 3.2% of MR cases in the US (range: 0.8%-29.2%). The MR costs associated with decreases in IQ in these children amount to $2.0 billion/year (range: $0.5-17.9 billion). Hg from American power plants accounts for 231 of the excess MR cases/year (range: 28-2,109), or 0.5% (range: 0.06%-4.3%) of all MR. These cases cost $289 million (range: $35 million-2.6 billion).

CONCLUSIONS

Toxic injury to the fetal brain caused by Hg emitted from coal-fired power plants exacts a significant human and economic toll on American children.

Biological monitoring of mercury exposure in individuals referred to a toxicological center in Venezuela

People in developing countries are often considered at greater risk of mercury (Hg) poisoning due to a variety of factors including a lack of awareness regarding their occupational risks. Individuals requiring urine mercury (U-Hg) analysis at the Center for Toxicological Investigations of the University of Carabobo (CITUC), between 1998 and 2002 were studied to identify demographic characteristics associated to U-Hg levels. The studied population included individuals with a history of exposure (or related exposures) to Hg processes, and was comprised of 1159 individuals (65 children, 1094 adults) ages 0.58-79 years old, mean 36.63+/-12.4. Children's geometric mean U-Hg levels were 2.73 microg/g Creatinine (Ct) and in adults 2.55 microg/g Ct. The highest frequency of adults' occupations were shipyard workers (35.47%), dentists (23.5%), lab technicians (11.43%), dental employees 10.42% and miners (10.2%). Chemical laboratory technicians had the highest mean U-Hg (4.46 microg/g Ct). Mean U-Hg levels in female adults (3.45 microg/g Ct) were statistically superior to levels in male adults (2.15 microg/g Ct). Two of the 172 women in reproductive age, had U-Hg levels higher than 78 microg/g Ct. Individuals from Falcon State were found to have the highest mean U-Hg (4.53 microg/g Ct). U-Hg levels higher than permissible limits were found in only 2 states (Carabobo and Bolivar) with a total of 24 cases. Although the results of this investigation were highly variable, the findings can be used to examine circumstances which influence mercury toxicity trends, and possibly used in future studies working to identify Hg exposures.

Ebselen protects glutamate uptake inhibition caused by methyl mercury but does not by Hg2+

Alterations of the neurotransmitter release systems in CNS have been reported in a variety of neuropathological processes associated with heavy metal toxicity. Neurotoxic effects of mercurials were investigated in vitro in cerebral cortex slices from young rats. The present study indicates that: (i) the environmental contaminants methylmercury (MeHg) and mercuric chloride (Hg2+) (50 microM) inhibited the glutamate net uptake from the cerebral cortex of 17-day-old rats; (ii) ebselen (10 microM) reverted the MeHg-induced inhibition of glutamate net uptake but did not protect the inhibition caused by Hg2+. At same time, we investigated another diorganochalcogenide, diphenyl diselenide (PhSe)2 and it was observed that this compound did not revert the action of MeHg or Hg2+; (iii) in addition, we observed that exposure of slices to 50 microM MeHg and Hg2+ for 30 min followed by Trypan blue exclusion assay resulted in 58.5 and 67.5% of staining cells, respectively, indicating a decrease in cell viability. Ebselen protected slices from the deleterious effects of MeHg, but not of Hg2+ on cell viability. Conversely, ebselen did not modify the reduction of MTT caused by MeHg and Hg2+; (iv) the protective effect of ebselen on MeHg-induced inhibition of glutamate net uptake seems to be related to its ability in maintaining cell viability.

Workgroup report: Biomonitoring study design, interpretation, and communication--lessons learned and path forward

Human biomonitoring investigations have provided data on a wide array of chemicals in blood and urine and in other tissues and fluids such as hair and human milk. These data have prompted questions such as a) What is the relationship between levels of environmental chemicals in humans and external exposures? b) What is the baseline or "background" level against which individual levels should be compared? and c) How can internal levels be used to draw conclusions about individual and/or population health? An interdisciplinary panel was convened for a 1-day workshop in November 2004 with the charge of focusing on three specific aspects of biomonitoring: characteristics of scientifically robust biomonitoring studies, interpretation of human biomonitoring data for potential risks to human health, and communication of results, uncertainties, and limitations of biomonitoring studies. In this report we describe the recommendations of the panel.

Mercury levels in urine and hair of children in an Andean gold-mining settlement

This field study investigated mercury (Hg) levels in urine and hair of Andean children of indigenous Saraguro and Metizo gold miners in the Nambija, Ecuador gold mining settlement. Spot samples of urine and hair samples were collected concurrently from 80 children each. Urine samples were used to determine the inorganic Hg burden, while hair samples were used as an index of methylmercury (MeHg) exposure from consumption of Hg contaminated fish. The mean level of Hg in urine (HgU) was 10.9 microg/L, and the mean level in hair (HgH) was 6.0 microg/g. Regression analysis showed a significant association (r = 0.404, p = 0.0007) between matched HgU and HgH samples. Mean HgU and HgU levels tended to be higher for children aged 6-14 years than for a younger group. The wide range of Hg levels in the urine and hair of Andean children of gold miners may place them at risk for neurodevelopmental and learning disorders.

The role of air pollution in asthma and other pediatric morbidities

A growing body of research supports the role of outdoor air pollutants in acutely aggravating chronic diseases in children, and suggests that the pollutants may have a role in the development of these diseases. This article reviews the biologic basis of children's unique vulnerability to highly prevalent outdoor air pollutants, with a special focus on ozone, respirable particulate matter (PM 2.5 [<2.5 microm in diameter] and PM 10 [<10 microm in diameter]), lead, sulfur dioxide, carbon monoxide, and nitrogen oxides. We also summarize understanding regarding health effects and molecular mechanisms of action. Practitioners can significantly reduce morbidity in children and other vulnerable populations by advising families to minimize pollutant exposures to children with asthma, or at a broader level by educating policymakers about the need to act to reduce pollutant emissions. Management of children with asthma must expand beyond preventing exposures to agents that directly cause allergic reactions (and therefore can be diagnosed by means of skin tests) and must focus more attention on agents that cause a broad spectrum of nonspecific, generalized inflammation, such as air pollution.

Public health and economic consequences of methyl mercury toxicity to the developing brain

Methyl mercury is a developmental neurotoxicant. Exposure results principally from consumption by pregnant women of seafood contaminated by mercury from anthropogenic (70%) and natural (30%) sources. Throughout the 1990s, the U.S. Environmental Protection Agency (EPA) made steady progress in reducing mercury emissions from anthropogenic sources, especially from power plants, which account for 41% of anthropogenic emissions. However, the U.S. EPA recently proposed to slow this progress, citing high costs of pollution abatement. To put into perspective the costs of controlling emissions from American power plants, we have estimated the economic costs of methyl mercury toxicity attributable to mercury from these plants. We used an environmentally attributable fraction model and limited our analysis to the neurodevelopmental impacts--specifically loss of intelligence. Using national blood mercury prevalence data from the Centers for Disease Control and Prevention, we found that between 316,588 and 637,233 children each year have cord blood mercury levels > 5.8 microg/L, a level associated with loss of IQ. The resulting loss of intelligence causes diminished economic productivity that persists over the entire lifetime of these children. This lost productivity is the major cost of methyl mercury toxicity, and it amounts to $8.7 billion annually (range, $2.2-43.8 billion; all costs are in 2000 US$). Of this total, $1.3 billion (range, $0.1-6.5 billion) each year is attributable to mercury emissions from American power plants. This significant toll threatens the economic health and security of the United States and should be considered in the debate on mercury pollution controls.

Ambient air pollution: health hazards to children

Ambient (outdoor) air pollution is now recognized as an important problem, both nationally and worldwide. Our scientific understanding of the spectrum of health effects of air pollution has increased, and numerous studies are finding important health effects from air pollution at levels once considered safe. Children and infants are among the most susceptible to many of the air pollutants. In addition to associations between air pollution and respiratory symptoms, asthma exacerbations, and asthma hospitalizations, recent studies have found links between air pollution and preterm birth, infant mortality, deficits in lung growth, and possibly, development of asthma. This policy statement summarizes the recent literature linking ambient air pollution to adverse health outcomes in children and includes a perspective on the current regulatory process. The statement provides advice to pediatricians on how to integrate issues regarding air quality and health into patient education and children's environmental health advocacy and concludes with recommendations to the government on promotion of effective air-pollution policies to ensure protection of children's health.

Subcutaneous injection of mercury: "warding off evil"

Deliberate injection of mercury, especially subcutaneous injection, is rare but is seen in psychiatric patients, individuals who attempt suicide, those who are accidentally injected, and boxers who wish to build muscle bulk. Metallic mercury plays a major role in ethnic folk medicine. Neurologic and renal complications can result from high systemic levels of mercury, and subcutaneous injection usually results in sterile abscesses. Urgent surgical evacuation and close monitoring for neurologic and renal functions as well as chelation (if toxicity is indicated) are key aspects of treatment. Education of the adverse effects and dangers of mercury is important, especially in pregnant women and children. As increased immigration changes demographic patterns, proper disposal of mercury and preventing its sale and use should become urgent societal priorities. Psychiatric consultation should be obtained whenever appropriate.

Mercury in the environment: sources, toxicities, and prevention of exposure

Acute and chronic exposure to mercury can significantly affect the health of a population, specifically the children. Methylmercury may pose the highest threat, as it is ubiquitous in the environment and it is a potent neurotoxicant. Methylmercury easily passes through the placenta to the developing fetus. Elemental mercury, or quicksilver, also poses a threat to children because it may be found readily in schools, hospitals, and medicine cabinets, and its intriguing liquid nature may be enticing to children. Pediatricians must be diligent in informing patients of possible exposure sources, and alerting them to new government advisories and recommendations. They should also be knowledgeable regarding classic clinical presentations of mercury toxicity. It is only in cases involving a knowledge of mercury that appropriate historical information is obtained and correct diagnoses are made. Preventing mercury exposure and consequent toxicity is of importance because therapies are controversial and long-term consequences may be significant.

Mercury exposure in children: a review

Exposure to toxic mercury (Hg) is a growing health hazard throughout the world today. Recent studies show that mercury exposure may occur in the environment, and increasingly in occupational and domestic settings. Children are particularly vulnerable to Hg intoxication, which may lead to impairment of the developing central nervous system, as well as pulmonary and nephrotic damage. Several sources of toxic Hg exposure in children have been reported in biomedical literature: (1) methylmercury, the most widespread source of Hg exposure, is most commonly the result of consumption of contaminated foods, primarily fish; (2) ethylmercury, which has been the subject of recent scientific inquiry in relation to the controversial pediatric vaccine preservative thimerosal; (3) elemental Hg vapor exposure through accidents and occupational and ritualistic practices; (4) inorganic Hg through the use of topical Hg-based skin creams and in infant teething powders; (5) metallic Hg in dental amalgams, which release Hg vapors, and Hg2+ in tissues. This review examines recent epidemiological studies of methylmercury exposure in children. Reports of elemental Hg vapor exposure in children through accidents and occupational practices, and the more recent observations of the increasing use of elemental Hg for magico-religious purposes in urban communities are also discussed. Studies of inorganic Hg exposure from the widespread use of topical beauty creams and teething powders, and fetal/neonatal Hg exposure from maternal dental amalgam fillings are reviewed. Considerable attention was given in this review to pediatric methylmercury exposure and neurodevelopment because it is the most thoroughly investigated Hg species. Each source of Hg exposure is reviewed in relation to specific pediatric health effects, particularly subtle neurodevelopmental disorders.

Dose–response study of thimerosal-induced murine systemic autoimmunity

The organic compound ethylmercurithiosalicylate (thimerosal), which is primarily present in the tissues as ethylmercury, has caused illness and several deaths due to erroneous handling when used as a disinfectant or as a preservative in medical preparations. Lately, possible health effects of thimerosal in childhood vaccines have been much discussed. Thimerosal is a well-known sensitizing agent, although usually of no clinical relevance. In rare cases, thimerosal has caused systemic immune reactions including acrodynia. We have studied if thimerosal might induce the systemic autoimmune condition observed in genetically susceptible mice after exposure to inorganic mercury. A.SW mice were exposed to 1.25-40 mg thimerosal/l drinking water for 70 days. Antinucleolar antibodies, targeting the 34-kDa protein fibrillarin, developed in a dose-related pattern and first appeared after 10 days in the two highest dose groups. The lowest observed adverse effect level (LOAEL) for antifibrillarin antibodies was 2.5 mg thimerosal/l, corresponding to an absorbed dose of 147 microg Hg/kg bw and a concentration of 21 and 1.9 microg Hg/g in the kidney and lymph nodes, respectively. The same LOAEL was found for tissue immune-complex deposits. The total serum concentration of IgE, IgG1, and IgG2a showed a significant dose-related increase in thimerosal-treated mice, with a LOAEL of 5 mg thimerosal/l for IgG1 and IgE, and 20 mg thimerosal/l for IgG2a. The polyclonal B-cell activation showed a significant dose-response relationship with a LOAEL of 10 mg thimerosal/l. Therefore, thimerosal induces in genetically susceptible mice a systemic autoimmune syndrome very similar to that seen after treatment with inorganic mercury, although a higher absorbed dose of Hg is needed using thimerosal. The autoimmune syndrome induced by thimerosal is different from the weaker and more restricted autoimmune reaction observed after treatment with an equipotent dose of methylmercury.

Total Mercury Levels in Human Autopsy Materials from a Nonexposed Polish Population

Mercury is considered to be one of the most harmful metals. Studies of the so-called normal mercury content in human internal organs, blood, and urine can be useful for assessment of the level of environmental exposure and also for legal and medical expert opinions. The examination encompassed 75 autopsies of inhabitants of southern Poland (50 male and 25 female) investigated at the Institute of Forensic Research in Kraków, Poland, between the end of 1998 and the beginning of 2001. Samples of internal organs were homogenized and digested with nitric and sulfuric acids. Determination of total mercury was performed by the use of cold vapor atomic absorption spectrometry. The following results (range and mean, in ng/g wet weight) were obtained: brain (n = 49) 0-14.2, 2.3 +/- 1.9; liver (n = 69) 2.6-55.0, 15.5 +/- 9.5; kidney (n = 63) 3.2-170, 35.9 +/- 31.7; heart (n = 4) 1.2-2.8, 2.2 +/- 0.75; spleen (n = 17) 2.4-9.6, 4.0 +/- 1.8; lung (n = 22) 1.8-9.1, 3.3 +/- 1.8; stomach (n = 48) 0-4.5, 2.0 +/- 1.0; small intestine (n = 32) 0-14.2, 2.8 +/- 2.7; large intestine (n = 13) 0 - 23.9, 5.2 +/- 7.2; blood (n = 35) 0 6.5, 1.6 +/- 1.2; urine (n = 14) 0 2.6, below detection limit. The above mentioned levels of mercury are similar to those reported by other Polish authors, but are lower than those determined in normal Korean and Japanese organs.