The Mt. Diwata study on the Philippines 1999--assessing mercury intoxication of the population by small scale gold mining

Reference Values on Children's Hair for 28 Elements (Heavy Metals and Essential Elements) Based on a Pilot Study in a Representative Non-Contaminated Local Area

Studies have been published, and laboratories offer services of measuring elements in hair as biomarkers of environmental exposure and/or control of essential elements (trace or macro). These reported values can have only sense if compared with adopted reference values. In this work, we propose provisional reference values based on a pilot child population. The concentrations of 28 elements were measured in children's hair samples. An observational, descriptive, cross-sectional study was conducted in a typical child population in the Mediterranean region void of excessive pollution problems to analyze 419 hair samples of children aged 3-12 years. Children were selected by a simple random method from eight primary education schools in different municipal districts, which included urban, rural and industrial areas. Samples of around 100 mg were washed and acid digested by an optimized procedure. All measures were performed using ICP-MS with Sc, Y and Re as internal standards. The statistical analysis was performed by two approaches: (a) considering all the data and (b) without outliers (second-order atypical data) to compare them with other published studies. The distribution curves in all the elements studied were asymmetric and did not fit the theoretical normality distributions. Therefore, the analysis based on percentiles was more appropriate. In most elements, only slight differences were observed with sex or age, which did not justify proposing separate reference ranges. From the results of this study, provisional reference values are proposed following two criteria: (a) simple application of the table of percentiles built by removing outlier values and (b) values after a detailed analysis case-by-case, considering other data as the distribution profile and other published data of each element. Although the pilot sample was from a limited area, it was carefully selected to be representative of a general non-contaminated population. With this limitation, the proposed reference values might be useful for researchers and physicians until a wider geographical study is available for a large number of elements.

Assessment of surface water quality and mercury levels from Artisanal and small-scale gold mining (ASGM) along Acupan River, Benguet, Philippines

Artisanal and small-scale mining activities are most evident among communities surrounding the Acupan River in Itogon Benguet. The mining activities include manual extraction of gold ores, use of improvised ball/rod mills and sluice boxes, and metallurgical processing such as cyanidation, carbon-in-pulp (CIP) and amalgamation. This study evaluates the influence of small-scale mining and the geology/mineralization of the Acupan Au-Ag-Te deposit to the water quality of the Acupan River and to the possible human exposures to Hg within the small-scale mining community. Different water quality parameters were monitored along selected sites along the Acupan River for a year and the results showed that the low average values of dissolve oxygen (DO) (2.54-4.53 mg L^-1) and the relatively high average values of pH (8.84-10.10), sulfate (300.00-1133.33 mg L^-1), nitrate (11.33-134.67 mg L^-1), arsenic (As) (0.227-0.574 mg L^-1) and mercury (Hg) (0.004-0.054 mg L^-1) have exceeded the acceptable criteria limit of the Department of Environment and Natural Resources for Class C waters. The exceeded values are noted to occur in areas where extensive small-scale mining activities are being done and have affected as well the downstream areas. To test possible human contamination in the use of Hg, hair samples from 56 volunteers were analyzed for total Hg (T-Hg) following standard protocols. The T-Hg concentrations in hair samples are mostly inorganic and are determined in various parameters such as sex, geographic location, occupation, age, fish consumption and localization in hair. Though not significantly different, higher Hg values are noted in males (1.280 ± 0.446 ng mg^-1) than among females (0.651 ± 0.163 ng mg^-1) as well as those with ages 41-50 years (3.130 ± 2.330 ng mg^-1) as compared to other age groups. The higher amounts of inorganic Hg in human hairs could be attributed to the discrete yet prevalent use of amalgamation. The findings of this study emphasize the need for better regulations of the small-scale mining activities and for stricter implementation of the total ban on the use of Hg in ore processing to ensure better water quality of Acupan River as well as the health and safety of the communities surrounding the river.

A Bibliometric Analysis of the Scientific Research on Artisanal and Small-Scale Mining

Mineral resource exploitation is one of the activities that contribute to economic growth and the development of society. Artisanal and small-scale mining (ASM) is one of these activities. Unfortunately, there is no clear consensus to define ASM. However, its importance is relevant in that it represents, in some cases, the only employment alternative for millions of people, although it also significantly impacts the environment. This work aims to investigate the scientific information related to ASM through a bibliometric analysis and, in addition, to define the new lines that are tending to this field. The study comprises three phases of work: (i) data collection, (ii) data processing and software selection, and (iii) data interpretation. The results reflect that the study on ASM developed intensively from 2010 to the present. In general terms, the research addressed focuses on four interrelated lines: (i) social conditioning factors of ASM, (ii) environmental impacts generated by ASM, (iii) mercury contamination and its implication on health and the environment, and (iv) ASM as a livelihood. The work also defines that geotourism in artisanal mining areas is a significant trend of the last decade, explicitly focusing on the conservation and use of the geological and mining heritage and, in addition, the promotion of sustainable development of ASM.

Transdisciplinary Communities of Practice to Resolve Health Problems in Southeast Asian Artisanal and Small-Scale Gold Mining Communities

Artisanal and small-scale gold mining (ASGM) has been a major part of people's livelihood in the rural areas of many developing countries, including those in Southeast Asia (SEA). Nevertheless, because of the use of mercury, ASGM activities have significant local and global adverse impacts on the environment and ASGM community health. Although there have been many monodisciplinary projects by academic researchers and governments to solve the environmental and health problems in SEA ASGM communities, they have not been sufficient to solve the complex socioeconomic problems. This review first outlines the nature of the SEA ASGM activities and the consequent environmental, community health, and socioeconomic problems and then introduces an approach using transdisciplinary communities of practice that involves both academic and nonacademic participants to relieve these wicked ASGM problems and to improve the environmental governance and community health in ASGM communities in SEA.

Efficacy of Hair Total Mercury Content as a Biomarker of Methylmercury Exposure to Communities in the Area of Artisanal and Small-Scale Gold Mining in Madre de Dios, Peru

Total mercury content (THg) in hair is an accepted biomarker for chronic dietary methylmercury (MeHg) exposure. In artisanal and small-scale gold mining (ASGM) communities, the validity of this biomarker is questioned because of the potential for contamination from inorganic mercury. As mining communities may have both inorganic and organic mercury exposures, the efficacy of the hair-THg biomarker needs to be evaluated, particularly as nations begin population exposure assessments under their commitments to the Minamata Convention. We sought to validate the efficacy of hair THg for public health monitoring of MeHg exposures for populations living in ASGM communities. We quantified both THg and MeHg contents in hair from a representative subset of participants (N = 287) in a large, population-level mercury exposure assessment in the ASGM region in Madre de Dios (MDD), Peru. We compared population MeHg-THg correlations and %MeHg values with demographic variables including community location, sex, occupation, and nativity. We observed that hair MeHg-THg correlations were high (r > 0.7) for all communities, regardless of location or nativity. Specifically, for individuals within ASGM communities, 81% (121 of 150 total) had hair THg predominantly in the form of MeHg (i.e., >66% of THg) and reflective of dietary exposure to mercury. Furthermore, for individuals with hair THg exceeding the U.S. EPA threshold (1.0 μg/g), 88 out of 106 (83%) had MeHg as the predominant form. As a result, had urine THg solely been used for mercury exposure monitoring, approximately 59% of the ASGM population would have been misclassified as having low mercury exposure. Our results support the use of hair THg for monitoring of MeHg exposure of populations in ASGM settings where alternative biomarkers of MeHg exposure are not feasible.

Transdisciplinary Online Health Assessment of an Artisanal and Small-Scale Gold Mining Community during the COVID-19 Pandemic in the Mandalay Region of Myanmar

Artisanal and small-scale gold mining (ASGM) has a known negative effect on the community's health; therefore, assessment to monitor community health is essential to detect any issues and enable early treatment. Because ASGM-related health issues are complex and cannot be addressed effectively with a traditional one-time health assessment alone, both long-term and regular health assessments using a transdisciplinary approach should be considered. In response to this need, we designed an online health assessment tool as a reference for a future long-term health assessment system. An online video interview was conducted with 54 respondents living in the ASGM area of Chaung Gyi Village, Thabeikkyin Township, Mandalay Region, Myanmar, via a social networking service application. The tool was used to evaluate community health during the coronavirus 2019 pandemic, including mercury intoxication symptoms, mining-related diseases, and other diseases. Results show that persons working in mining versus non-mining occupations had a greater prevalence of pulmonary diseases, such as pulmonary tuberculosis, silicosis, and bronchial asthma, in addition to malaria. Based on these findings, online health assessment using a transdisciplinary approach can be recommended as an effective tool for sustainable and long-term health assessment of ASGM-related disease and should be performed regularly following physical health surveys.

Fish, rice, and human hair mercury concentrations and health risks in typical Hg-contaminated areas and fish-rich areas, China

Human exposure to methylmercury (MeHg) from consuming contaminated fish has been a major concern for decades. Besides, human MeHg exposure through rice consumption has been recently found to be important in some Asian countries. China is the largest country on mercury (Hg) production, consumption, and anthropogenic emission. However, the health risks of human Hg exposure are not fully understood. A total of 624 fish, 299 rice, and 994 human hair samples were collected from typical Hg-contaminated areas and major fish-rich areas to assess the health risks from human Hg exposure in China. Fish and rice samples showed relatively low Hg levels, except the rice in the Wanshan Hg mining area (WMMA). Human hair total Hg (THg) and MeHg concentrations were significantly elevated in WMMA, Zhoushan (ZS), Xiamen (XM), Qingdao (QD), and zinc smelting area (ZSA), and 85% of hair samples in WMMA, 62% in ZS, 40% in XM, 26% in QD, and 17% in ZSA had THg concentrations exceeding the limit set by the USEPA (1 μg/g). Rice consumption was the main pathway (>85%) for human MeHg exposure in the studied Hg-contaminated areas. Meanwhile, fish was the primary human MeHg exposure source (>85%) in coastal cities. Therefore, soil remediation in typical Hg-contaminated areas and scientific guidance for fish consumption in coastal provinces are urgently needed to reduce the health risks from human Hg exposure in China.

Mercury poisoning of a 4-year-old child by indirect contact to a mercury-containing facial cream: A case report

We report the severe mercury poisoning of a 4-year-old child by a so far unknown route of exposure, namely, by skin-to-skin contact. The child was admitted to the hospital with episodic pain in his extremities, tachycardia, hypertension, increased sweating, behavioral changes and weight loss. Extensive examinations eventually revealed an acute mercury poisoning. The initial mercury levels were 19 µg/L in urine (reference level 0.4 µg/L) and 37 µg/L in blood (reference level 0.8 µg/L). A facial cream bought online, containing approximately 18% mercury, was identified as the primary source of intoxication. The symptoms improved after disposal of the cream and chelation therapy. Further analyses, home visits and interviews suggested that the child was accidently intoxicated by skin-to-skin contact with the mother, although other routes of exposure such as dust ingestion and surface-to-skin contact cannot be excluded. The mercury levels in urine and blood samples of the child and other family members as well as in domestic dust samples decreased considerably over time.

Dried blood spots to characterize mercury speciation and exposure in a Colombian artisanal and small-scale gold mining community

The artisanal and small-scale gold mining (ASGM) sector uses the most mercury (Hg) worldwide. Despite health concerns associated with high Hg exposures in these communities, ASGM sites are often situated in resource limited and remote regions which challenge traditional human biomonitoring approaches. To help overcome such challenges, here we report on the development of a high-quality method to characterize chemical speciation of Hg in dried blood spots (DBS), and then apply this method to assess Hg exposures in people sampled from an ASGM community (Pueblito Mejia) and a nearby town (Barranco de Loba) in Colombia. We collected DBS and urine samples from 35 individuals in 2018, and used these to assess occupational (DBS inorganic Hg (InHg) and urine total Hg (THg) measures) and environmental (DBS methylmercury (MeHg) measures) exposure of participants to different forms of Hg. The accuracy and precision of the DBS-based measures generally met assay performance guideline. In study participants, the mean concentrations of DBS MeHg, InHg, and THg, and urine THg were 1.9, 4.1, 6.0, and 3.1 μg/L, respectively. For 37% of the participants, DBS THg values exceeded the 5 μg/L 'alert level' proposed by the German HBM Commission. About 60% of the blood Hg was in the InHg form thus exemplifying a need to speciate Hg in blood sampled from ASGM sites to better understand the contributions of environmental and occupational exposure sources. This study demonstrates the feasibility of using DBS for Hg speciation exposure assessments in remote and resource-limited areas such as ASGM communities.

Health Impact Assessment of Artisanal and Small-Scale Gold Mining Area in Myanmar, Mandalay Region: Preliminary Research

Increasing artisanal and small-scale gold mining (ASGM) in developing countries has raised health concerns in mining communities. A preliminary health survey was conducted in Thabeikkyin Township, Mandalay Region, Myanmar, in February 2020 to assess the health conditions of an ASGM community. Respiratory function and other clinical assessments were evaluated in miners and non-miners, and participants’ hair was analyzed for heavy metals. Respiratory function of miners was similar to that of non-miners. However, miners’ respiratory function declined with longer mining activity duration. In total, 3 out of 18 miners showed neurological signs and symptoms of chronic mercury intoxication. The median concentration of the hair mercury was significantly higher in miners than non-miners (P = 0.01), and 9 out of 18 miners and 2 out of 11 non-miners showed the warning level of mercury. We found that, despite an association between declining respiratory function and length of time mining, only a minority of miners showed clinical features of chronic mercury intoxication. Further clinical surveys with a larger sample size are necessary to determine the broader health status of this community. In addition, clinical indicators such as pulmonary function tests are recommended as additional criteria for the diagnosis of mercury intoxication.

Health-related quality of life (EQ-5D + C) among people living in artisanal and small-scale gold mining areas in Zimbabwe: a cross-sectional study

Background

In Zimbabwe, an estimated 500,000 people work in the sector of artisanal and small-scale gold mining (ASGM). Two million Zimbabweans are dependent on this sector. Using mercury is common to extract gold from ore. Long term exposure to mercury can cause various adverse health conditions including chronic mercury intoxication. The influence of these adverse health effects on the health-related quality of life (HRQoL) is still unknown. The aim of this study is to assess the HRQoL of people who identify themselves as miners, and to analyze potential influencing factors, such as age, years of working with mercury and health conditions caused by mercury exposure.

Methods

This cross-sectional study assessed the HRQoL using the standardized EQ-5D + C (3 L) questionnaire and collected human specimens (blood, urine) of people living and possibly working in ASGM areas in Zimbabwe. Factors such as age, years of working with mercury and adverse health conditions possibly caused by mercury exposure were analyzed with regards to their influence on the HRQoL.

Results

The 207 participants (82% male, mean age 38 years) reported 40 different health states. Of the study participants 42.5% reported to be in complete good health while 57.5% reported being unwell in different ways. Nine participants (4.3%) were identified with chronic mercury intoxication, whereas 92 participants (33.3%) had mercury levels above the “Alert” threshold in at least one specimen. Having chronic mercury intoxication has a significant negative influence on the HRQoL, when taking into account age, gender and years of working with mercury. Cognitive problems were the most reported in the questionnaire, however, the association between this domain separately and the HRQoL was not verified.

Conclusion

This study shows that adverse health effects caused by chronic exposure to mercury, have a negative influence on the HRQoL among people living in ASGM areas.

Mercury Exposure and Health Problems of the Students Using Skin-Lightening Cosmetic Products in Makassar, South Sulawesi, Indonesia

Despite legal and safety issues, skin-lightening cosmetic products—including hazardous mercury-containing cosmetics—are in increasing demand in Indonesia. Perceptions of beauty may result in desires to have lighter skin tones, regardless of the safety of these cosmetics, which block the production of melanin and thus lighten skin tone. This study investigated Hg exposure of students using skin-lightening cosmetics and assessed the health issues. A total of 105 female students were given a questionnaire regarding their use of cosmetics; a further 43 students formed a non-cosmetic-user control group. Their scalp hair and cosmetic products were analyzed by particle-induced X-ray emission (PIXE) spectroscopy. The geometric-mean hair Hg concentration for the cosmetics-using students was 6.7 µg g−1—three times that of the control group (2.3 µg g−1). Of twenty-seven cosmetic samples were analyzed, twenty had Hg concentrations of 0.12–7834.4 µg g−1 (mean 554.6 µg g−1), and seven had no detectable Hg. The hair Hg concentrations exhibited a statistically significant correlation with cosmetic Hg concentration. The health assessments indicated only rigidity & ataxia and irregular eye movement were prevalent in the cosmetic-using students with less than 7% occurrences.

Infants and mothers levels of mercury in breast milk, urine and hair, data from an artisanal and small-scale gold mining area in Kadoma / Zimbabwe

In Kadoma (Zimbabwe) gold is extracted from ore based on a simple technology using mercury. Women are exposed whilst living in an exposed area, or even more working directly with mercury. Breast fed infants are exposed via mercury contaminated milk and the general environmental mercury exposure. The aim of the study was to measure infants and mothers levels of mercury in urine and hair, as well as in breast milk. In 2006, an environmental epidemiological field study with 120 mother - child pairs was conducted. A non exposed control group (n = 42) was compared with a medium exposed group (n = 51) and a high exposed group (occupational exposure, n = 27). Urine and hair samples from mother and infants plus breast milk samples were analyzed for total mercury. 120 breast milk samples were analyzed, median (maximum) concentrations [μg Hg/l] were (i) control group < 0.50 (1.55), (ii) medium exposed group 1.10 (10.48), (iii) high exposed group 1.20 (24.80) (p < 0,001). Urine and hair results were distributed similarly for infants and mothers, with higher levels according to the exposure subgroup. All specimen results correlated very well with another, indicating there is a pathway between breast milk and infant's level of mercury. The daily uptake of mercury via breast milk was calculated. The reference dose of 0.3°[μg Hg/kg BW/d] was used to compare the burden of the infants. No infant from the control group, but 17.6% of the medium and 18.5% of the high exposed group were above the reference dose. Mercury in breast milk is generally higher in artisanal and small scale gold mining areas. Breast fed infants were burdened with toxic mercury via breast milk and via the general environment, both are important public health issues.

Polymorphisms in potential mercury transporter ABCC2 and neurotoxic symptoms in populations exposed to mercury vapor from goldmining

BACKGROUND

Artisanal small-scale gold miners have high levels of mercury in human specimens often above recommended threshold values. There are differences reported in the manifestation of neurological symptoms of individuals with a comparable level of exposure to mercury, suggesting a genetic component influencing the susceptibility to mercury neurotoxicity.

OBJECTIVE

To investigate associations between polymorphisms (rs1885301, rs717620, rs2273697) in the potential Hg-transporter ABCC2 gene and neurological effects.

METHODS

968 participants from the Philippines, Indonesia, Tanzania and Zimbabwe were included in this study (age 12-59 years). For the statistical analysis the countries were categorized into Africa (Philippines, Indonesia) and Asia (Tanzania, Zimbabwe). Study participants were from three exposure groups: without mercury exposure from goldmining (n = 129); living in mercury-contaminated areas (n = 281) and mercury working exposure (n = 558). To identify chronic inorganic mercury intoxication we applied a modified neurological score sum including eight binary coded parameters (from anamnestic, clinical and neurophysiological examinations). Associations between genotype and neurological score sum, as well as between genotype and separate neurological tests (ataxia of gait, dysdiadochokinesia, ataxia heel to shin, pencil tapping test and matchbox test) were evaluated.

RESULTS

We found that ABCC2 genotype were associated with performance on certain neurological tests: for rs1885301, A-allele carriers in the African populations showed significantly worse performance than GG carriers on the pencil tapping test; whereas for rs2273697, A-allele carriers in the African and Asian populations showed a significantly better performance than GG carriers on this test. When including an interaction term between genotype and exposure subgroup, interaction effects were also seen for the pencil tapping test and matchbox tests for rs2273697 in Asia.

CONCLUSIONS

The results suggest that certain ABCC2 polymorphisms may influence the neurotoxic effects in mercury-burdened individuals. ABCC2 alleles associated with worse neurological performance in the present study. These alleles have previously been correlated with higher levels of urinary mercury concentrations in the same cohort. Taken together, these associations between ABCC2 genotype, mercury levels, and neurological effects support the hypothesis that some ABCC2 genotypes may have a higher neurotoxic potential, although further functional studies are needed to prove causation.

Concentration of mercury species in hair, blood and urine of individuals occupationally exposed to gaseous elemental mercury in Asturias (Spain) and its comparison with individuals from a control group formed by close relatives

Between November 19th, 2012 and December 3rd, 2012, 50 workers were intoxicated with gaseous Hg in San Juan de Nieva (Asturias, Spain) during the maintenance of a heat exchanger of a zinc manufacturer. We have quantified the concentration of methylmercury (MeHg), ethylmercury (EtHg) and Hg(II) in blood, hair and urine samples of those individuals taken three years after the accident. Blood, hair and urine of their closest relatives were also analyzed to assess whether the mercury burden present in the intoxicated individuals was due to the occupational exposure or to environmental or lifestyle-related factors. The determination of the mercury species in the samples was carried out applying multiple spiking Isotope Dilution GC-ICP-MS. This procedure corrects for possible interconversion reactions between the Hg species during the sample preparation procedure. Linear correlations were observed for both groups when plotting MeHg in blood vs MeHg in hair, and MeHg in hair vs Hg (II) in urine. The concentrations of Hg species in the intoxicated individuals were not significantly different from those obtained in the control group except for MeHg in blood. Significantly higher levels of MeHg in blood were obtained in some of the intoxicated individuals who had not consumed fish or seafood since the accident. A different correlation between MeHg in hair and MeHg in blood was obtained for these individuals compared to the control group who showed a hair-to-blood ratio consistent with the reported value for people exposed to Hg via fish consumption. Our results suggest that ingested MeHg followed the same pathway of deposition in hair in exposed and non-exposed individuals. However, the exposed individuals with high MeHg levels in blood showed a significantly different extent of MeHg deposition in hair compared to the control group.

An overview of worldwide and regional time trends in total mercury levels in human blood and breast milk from 1966 to 2015 and their associations with health effects

BACKGROUND

Mercury is a pollutant of global concern. To protect human health and environment from mercury pollution, the Minamata Convention on mercury entered into force in 2017.

OBJECTIVES

To support a future effectiveness evaluation of the convention, this study assesses worldwide and regional time trends of total mercury levels in human blood and breast milk across different population sub-groups in the last half-century prior to entry-into-force of the Minamata Convention. This study also provides an overview of the epidemiological literature showing evidence of associations between mercury exposure (in terms of total mercury levels in whole blood, cord blood, and breast milk) and human health.

METHODS

We searched electronic databases to identify articles published prior to June 14, 2017 and reported total mercury levels in any of three biological matrices (whole blood, cord blood, or breast milk) and/or associations with human health. Temporal trends of total mercury levels in the selected biological matrices across different population sub-groups were estimated using a linear fit of the log-transformed data. In parallel, statistical methods were employed to assess any possible effect of sources of inhomogeneity (i.e. study and population characteristics such as age, sex, ethnicity, source of exposure, sampling period, and geographical region) in the collected studies. Furthermore, a summary of significant and relevant associations between mercury exposure and human health conditions in children and adults was prepared.

FINDINGS

We found significant declines in total mercury levels in whole blood, cord blood, and breast milk between 1966 and 2015. A regional overview of total mercury levels in whole blood, cord blood, and breast milk suggests the highest levels in South America, followed by Africa or Asia whereas the population groups from Europe or North America displayed the lowest levels of total mercury in the selected biological matrices. We observed conclusive consistent associations of mercury exposure with selected health conditions, especially neurodevelopment and neurotoxicity in children and adults. For several other health conditions, reported findings in the collected studies do not support conclusive associations. We also found that several studies demonstrated significant associations between mercury exposure below the USEPA reference level and various health conditions.

CONCLUSIONS

This study provides a worldwide and regional overview of trends in total mercury levels in human blood and breast milk and associated health risks prior to entry-into-force of the Minamata Convention and calls for further epidemiological investigations from across the globe to fully understand the health implications of mercury exposure.

Assessment of Total Mercury in Hair, Urine and Fingernails of Small-Scale Gold Miners in the Amansie West District, Ghana

BACKGROUND

Mercury (Hg) is a heavy metal that can cause several adverse health effects based on its form (organic, inorganic or elemental), duration and pathway of exposure. Measurement of mercury present in human biological media is often used to assess human exposure to mercury at mining sites.

OBJECTIVES

The aim of the present study was to measure the concentrations of total mercury in urine, hair, and fingernails of miners and inhabitants of Amansie West District, Ghana.

METHODS

Concentrations of total mercury were measured in sixty-eight miners and twelve non-miners in the study area using cold vapor atomic absorption spectrophotometry with an automatic mercury analyzer (HG 5000).

RESULTS

Total mercury in nails and hair of smelter miners was 3.32 ± 0.36 and 6.59 ± 0.01 μg/g, respectively. Total mercury concentrations in hair samples obtained from smelter miners were above the 1 μg/g guideline set by the United States Environmental Protection Agency (USEPA). Moreover, the total mercury concentration in urine samples was 6.97 ± 0.06 μg/L, far below the >25 μg/L level considered to be a high level of mercury contamination. The total mercury accrued by the individuals was not dependent on age, but was positively associated with duration of stay.

CONCLUSIONS

Based on the total mercury (THg) levels analyzed in the biological media, artisanal gold mining activities in Amansie West District are on the increase with a potential risk of developing chronic effects. However, the majority of the population, particularly those engaged in artisanal small-scale gold mining, are unmindful of the hazards posed by the use of mercury in mining operations. The results showed that THg in urine, hair, and fingernails more efficiently distinguished mercury exposure in people close to mining and Hg pollution sources than in people living far from the mining sites. Further education on cleaner artisanal gold mining processes could help to minimize the impact of mercury use and exposure on human health and the environment.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

This study was approved by the Ghana Environmental Protection Agency and the Ministry of Local Government and Rural Development in Manso Nkwanta.

COMPETING INTERESTS

The authors declare no competing financial interests.

Urban coral reefs: Degradation and resilience of hard coral assemblages in coastal cities of East and Southeast Asia

Given predicted increases in urbanization in tropical and subtropical regions, understanding the processes shaping urban coral reefs may be essential for anticipating future conservation challenges. We used a case study approach to identify unifying patterns of urban coral reefs and clarify the effects of urbanization on hard coral assemblages. Data were compiled from 11 cities throughout East and Southeast Asia, with particular focus on Singapore, Jakarta, Hong Kong, and Naha (Okinawa). Our review highlights several key characteristics of urban coral reefs, including "reef compression" (a decline in bathymetric range with increasing turbidity and decreasing water clarity over time and relative to shore), dominance by domed coral growth forms and low reef complexity, variable city-specific inshore-offshore gradients, early declines in coral cover with recent fluctuating periods of acute impacts and rapid recovery, and colonization of urban infrastructure by hard corals. We present hypotheses for urban reef community dynamics and discuss potential of ecological engineering for corals in urban areas.

Removal of Hg0 from simulated flue gas over silver-loaded rice husk gasification char

Mercury released into the atmosphere from coal combustion is harmful to humans and the environment. Rice husk gasification char (RHGC) is an industrial waste of biomass gasification power generation, which is silver-loaded to develop a novel and efficient sorbent for mercury removal from simulated flue gas. The experiment was carried out in a fixed-bed experimental system. The Hg⁰ adsorption performance of RHGC was improved significantly after loading silver. Hg⁰ adsorption capacity and mercury inlet concentration were found to be nonlinear. The adsorption capacity of RHGC decreased with the increase of reaction temperature. SO₂ inhibited mercury removal, NO and HCl promoted mercury removal; the Hg⁰ adsorption capacity in the simulated flue gas was higher than that in pure N₂. The silver-loaded rice husk gasification char (SRHGC) could be recycled about five times without significantly losing its removal efficiency. The SRHGC will not only reduce the cost of mercury removal but also save energy and reduce environmental pollution. At the same time, it provides a new way for the resource utilization of RHGC.

Global Burden of Disease of Mercury Used in Artisanal Small-Scale Gold Mining

BACKGROUND

Artisanal small-scale gold mining (ASGM) is the world's largest anthropogenic source of mercury emission. Gold miners are highly exposed to metallic mercury and suffer occupational mercury intoxication. The global disease burden as a result of this exposure is largely unknown because the informal character of ASGM restricts the availability of reliable data.

OBJECTIVE

To estimate the prevalence of occupational mercury intoxication and the disability-adjusted life years (DALYs) attributable to chronic metallic mercury vapor intoxication (CMMVI) among ASGM gold miners globally and in selected countries.

METHODS

Estimates of the number of artisanal small-scale gold (ASG) miners were extracted from reviews supplemented by a literature search. Prevalence of moderate CMMVI among miners was determined by compiling a dataset of available studies that assessed frequency of intoxication in gold miners using a standardized diagnostic tool and biomonitoring data on mercury in urine. Severe cases of CMMVI were not included because it was assumed that these persons can no longer be employed as miners. Cases in workers' families and communities were not considered. Years lived with disability as a result of CMMVI among ASG miners were quantified by multiplying the number of prevalent cases of CMMVI by the appropriate disability weight. No deaths are expected to result from CMMVI and therefore years of life lost were not calculated. Disease burden was calculated by multiplying the prevalence rate with the number of miners for each country and the disability weight. Sensitivity analyses were performed using different assumptions on the number of miners and the intoxication prevalence rate.

FINDINGS

Globally, 14-19 million workers are employed as ASG miners. Based on human biomonitoring data, between 25% and 33% of these miners-3.3-6.5 million miners globally-suffer from moderate CMMVI. The resulting global burden of disease is estimated to range from 1.22 (uncertainty interval [UI] 0.87-1.61) to 2.39 (UI 1.69-3.14) million DALYs.

CONCLUSIONS

This study presents the first global and country-based estimates of disease burden caused by mercury intoxication in ASGM. Data availability and quality limit the results, and the total disease burden is likely undercounted. Despite these limitations, the data clearly indicate that mercury intoxication in ASG miners is a major, largely neglected global health problem.

Solid-phase partitioning of mercury in artisanal gold mine tailings from selected key areas in Mindanao, Philippines, and its implications for mercury detoxification

The solid-phase partitioning of mercury could provide necessary data in the identification of remediation techniques in contaminated artisanal gold mine tailings. This study was conducted to determine the total mercury content of mine wastes and identify its solid-phase partitioning through selective sequential extraction coupled with cold vapour atomic absorption spectroscopy. Samples from mine tailings and the carbon-in-pulp (CIP) process were obtained from selected key areas in Mindanao, Philippines. The results showed that mercury use is still prevalent among small-scale gold miners in the Philippines. Tailings after ball mill-gravity concentration (W-BM and Li-BM samples) from Mt Diwata and Libona contained high levels of mercury amounting to 25.024 and 6.5 mg kg^-1, respectively. The most prevalent form of mercury in the mine tailings was elemental/amalgamated mercury, followed by water soluble, exchangeable, organic and strongly bound phases, respectively. In contrast, mercury content of carbon-in-pulp residues were significantly lower at only 0.3 and 0.06 mg kg^-1 for P-CIP (Del Pilar) and W-CIP (Mt Diwata), respectively. The bulk of mercury in P-CIP samples was partitioned in residual fraction while in W-CIP samples, water soluble mercury predominated. Overall, this study has several important implications with regards to mercury detoxification of contaminated mine tailings from Mindanao, Philippines.

Efficacy of N,N'bis-(2-mercaptoethyl) isophthalamide on mercury intoxication: a randomized controlled trial

BACKGROUND

Chronic mercury intoxication is a severe health issue and occurs especially in gold mining communities. Common chelators used for improving mercury elimination are not everywhere available and challenged by poor cell wall penetration. This study is part of a feasibility trial and the aim was to gather first information about the efficacy of the newly developed chelator N,N'bis-(2-mercaptoethyl) isophthalamide (NBMI) on chronic mercury intoxication.

METHODS

In this three-armed, placebo-controlled randomized trial, 36 miners with mercury urine levels exceeding 15 μg/l were administered 100 mg NBMI, 300 mg NBMI or placebo for 14 days. Levels of mercury in urine [μg/l and μg/g creatinine] and plasma l were analyzed. Therapeutic effect was assessed using the medical intoxication score (MIS) and its single health outcomes (e.g. excessive salivation, sleeping problems), fatigue scores, a neuromotoric test battery (CATSYS) and a neurological outcome (Finger to nose test).

RESULTS

Physical fatigue was significantly decreased in the 300 mg NBMI group compared to the control. Mercury concentration in urine following 300 mg NBMI treatment was significantly lowered compared to control, however, this effect was less distinct with adjustment for creatinine.

CONCLUSION

NBMI showed an effect on physical fatigue and there were indications to positive effects on other symptoms as well. More comprehensive studies are mandatory to verify the effects of NBMI as a novel tool for treating mercury intoxications.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02486289 . Date of registration: June 24, 2015.

Water Quality: Mindanao Island of the Philippines

The Philippines is an archipelagic country dominated by water and inland water sources. Water quality has been the subject of attention for the country and specifically, Mindanao Island, because of the role this natural resource plays in agriculture. Water supply and usage for the island and the nation are identified and discussed in relation to the scarcity of potable water. Potential threats and pollution hotspots bring forth the various health and environmental impact attributed to the water system accessibility, distribution, and quality. Strategies addressing water resources problems are taken into consideration side-by-side the numerous national laws, policies, standards, and guidelines in addressing water quality control and management. Therefore, the legal framework for various agencies to carry out these policies on quality control, usage, and water management are pivotal to recommendations on revision of certain provisions that rely on embedding local community involvement to lessen the environmental impact that is causal to poor population health. The World Bank has been instrumental in prompting local activity with initiatives first established in relation to the United Nations Millennium Development Goals that are being carried forward today in the Sustainable Development Initiatives. This chapter extends the recent UN and World Bank initiatives to demonstrate how further community involvement can continue to improve quality of life for Philippine citizens through education and participation.

Dietary human exposure to mercury in two artisanal small-scale gold mining communities of northwestern Colombia

Artisanal and small-scale gold mining (ASGM) is the largest anthropogenic source of mercury pollution worldwide, posing a grave threat to human health. The present study identifies current levels of mercury in the human population from mining areas of the Chocó Department, Colombia, through total mercury (THg) and methylmercury (MeHg) measurements in human hair. Mercury exposure of the local population was assessed in two towns affected by ASGM and was related to different variables of interest. Concentrations of THg in human hair ranged from 0.06 to 17.54ppm and the mean value for the subjects under study was 2.48ppm. Men had significantly higher levels than women in both towns (3.29ppm vs. 0.77ppm). Fish consumption was related to a marked increase of THg in hair, with mean values close to five times higher in frequent fish consumers (5-7 times/week) than in non-fish consumers (4.80ppm vs. 0.90ppm). A multiple linear regression model was fitted successfully (R=0.671) and reveals that gender, fish consumption and location of residence were significant indicators of Hg levels in hair, while no significant relationship was found for age. Approximately 60% of subjects tested had THg levels that exceeded the U.S. Environmental Protection Agency reference dose of 1.0ppm, while 25% surpassed that of the World Health Organization (2.2ppm).

The Vernix Caseosa is the Main Site of Dioxin Excretion in the Human Foetus

Dioxins are highly toxic to foetuses and prenatal exposure leads to adverse health effects; however, the metabolic pathways involved in dioxin excretion are poorly understood. We determined the dynamics of maternal-to-foetal dioxin transfer during normal pregnancy and how foetuses eliminate polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, and non-ortho polychlorinated biphenyls. Dioxin levels in maternal blood, cord blood, placenta, vernix caseosa, meconium, and amniotic fluid were analysed by high-resolution gas chromatography/mass spectrometry. The average levels of total dioxins, expressed as picograms of toxic equivalency quantity per gram of lipid and in parentheses, dioxin fraction, with maternal blood levels arbitrarily set as 100%, were as follows: maternal blood, 15.8 (100%); placenta, 12.9 (81.5%); cord blood, 5.9 (37.2%); vernix caseosa, 8.4 (53.2%); meconium, 2.9 (18.2%); and amniotic fluid, 1.5 (9.2%). Similar proportions were observed for each dioxin congener. Thus, the highest content of foetal dioxins was observed in the vernix caseosa, indicating that this is the major site of dioxin excretion in human foetuses.

Contaminación por mercurio de leche materna de madres lactantes de municipios de Antioquia con explotación minera de oro

Introducción. La leche materna es esencial para el desarrollo del ser humano, pero puede contener sustancias tóxicas provenientes de la contaminación ambiental, especialmente en las áreas mineras.Objetivo. Determinar la prevalencia de la contaminación con mercurio de la leche materna de mujeres lactantes residentes en los municipios con explotación minera de oro.Materiales y métodos. Se hizo un estudio transversal de 150 madres lactantes de cuatro municipios mineros de Antioquia (El Bagre, Segovia, Remedios y Zaragoza), a quienes se les hizo una encuesta sobre factores sociodemográficos, ocupacionales y ambientales relacionados con el mercurio, y se les tomaron muestras de leche materna, de orina y de cabello. Se calculó el promedio de la concentración de mercurio y las prevalencias municipales de contaminación.Resultados. El promedio de la concentración de mercurio en la leche materna fue de 2,5 (± desviación estándar 9,2) μg/L. La prevalencia de muestras de leche materna con niveles altos de mercurio fue de 11,7 %.Conclusión. En este estudio se evidencia un grave problema en las regiones mineras auríferas de Antioquia por el efecto de la contaminación con mercurio en sectores de la población más vulnerable.

Current Mercury Exposure from Artisanal and Small-Scale Gold Mining in Bombana, Southeast Sulawesi, Indonesia-Future Significant Health Risks

The rapid expansion of the artisanal and small-scale gold mining (ASGM) industry in developing countries has marginalized the local communities in poverty, and resulted in occupational exposure to mercury via the gold extraction process. We investigated the mercury exposure of the mining workers lived inside and outside the mining area. Based on the occupations of the contributors, the hair samples were divided into three subgroups: directly exposed, indirectly exposed, and a control. A total of 81 hair samples were analyzed by particle-induced X-ray emission spectrometry. The median mercury concentration was highest in the hair from the directly exposed group (12.82 μg/g hair) (control group median: 4.8 μg/g hair, p < 0.05), and the concentrations in hair from 45 respondents exceeded the Human Biomonitoring I (HBM I) threshold limit. Mercury concentrations were also elevated in the hair from the indirectly exposed group (median 7.64 μg/g hair, p < 0.05), and concentrations in hair from 24 respondents exceeded the HBM I threshold limits. Exposure to mercury during ASGM presents health risks and is harmful for the miners; mercury is also at hazardous levels for people who live in the mining area but who are not engaged in mercury-based gold extraction.

Current progress on understanding the impact of mercury on human health

Mercury pollution and its impacts on human health is of global concern. The authors of this paper were members of the Plenary Panel on Human Health in the 12th International Conference on Mercury as a Global Pollutant held in Korea in June 2015. The Panel was asked by the conference organizers to address two questions: what is the current understanding of the impacts of mercury exposure on human health and what information is needed to evaluate the effectiveness of the Minamata Convention in lowering exposure and preventing adverse effects. The authors conducted a critical review of the literature published since January 2012 and discussed the current state-of-knowledge in the following areas: environmental exposure and/or risk assessment; kinetics and biomonitoring; effects on children development; effects on adult general populations; effects on artisanal and small-scale gold miners (ASGM); effects on dental workers; risk of ethylmercury in thimerosal-containing vaccines; interactions with nutrients; genetic determinants and; risk communication and management. Knowledge gaps in each area were identified and recommendations for future research were made. The Panel concluded that more knowledge synthesis efforts are needed to translate the research results into management tools for health professionals and policy makers.

Gold Mining in Ecuador: A Cross-Sectional Assessment of Mercury in Urine and Medical Symptoms in Miners from Portovelo/Zaruma

Mercury is a toxic metal and is used in small scale gold mining. In Portovelo, Ecuador, mercury has been an environmental and health problem for decades. The target of this study was to assess the mercury concentration in the urine of miners from Portovelo/Zaruma to establish a prevalence of high values. Eight hundred and sixty-five (865) urine samples were collected and analysed for their mercury content, using cold vapor atom absorption spectroscopy. The prevalence of high mercury values (>25 μg/L) was estimated. Forty-four (44) miners with mercury levels >15 μg/L filled in a questionnaire for characteristics and possible confounders, and were examined for intoxication symptoms to establish the ten points medical score sum. The median urine value was 1.8 μg/L; 78.3% of miners were below 7 μg/L and were not at risk of an intoxication, whereas 5.9% of miners exceeded the limit of 25 μg/L and were probable to experience intoxication symptoms. The medical score sum had a range of 2 to 8 points with a median of 6. The low prevalence of high mercury concentrations shows that the politics and techniques to eliminate the use of mercury are being successfully implemented. Further studies are needed to identify factors enabling this process.

Essential Indicators Identifying Chronic Inorganic Mercury Intoxication: Pooled Analysis across Multiple Cross-Sectional Studies

Background

The continuous exposure to inorganic mercury vapour in artisanal small-scale gold mining (ASGM) areas leads to chronic health problems. It is therefore essential to have a quick, but reliable risk assessing tool to diagnose chronic inorganic mercury intoxication. This study re-evaluates the state-of-the-art toolkit to diagnose chronic inorganic mercury intoxication by analysing data from multiple pooled cross-sectional studies. The primary research question aims to reduce the currently used set of indicators without affecting essentially the capability to diagnose chronic inorganic mercury intoxication. In addition, a sensitivity analysis is performed on established biomonitoring exposure limits for mercury in blood, hair, urine and urine adjusted by creatinine, where the biomonitoring exposure limits are compared to thresholds most associated with chronic inorganic mercury intoxication in artisanal small-scale gold mining.

Methods

Health data from miners and community members in Indonesia, Tanzania and Zimbabwe were obtained as part of the Global Mercury Project and pooled into one dataset together with their biomarkers mercury in urine, blood and hair. The individual prognostic impact of the indicators on the diagnosis of mercury intoxication is quantified using logistic regression models. The selection is performed by a stepwise forward/backward selection. Different models are compared based on the Bayesian information criterion (BIC) and Cohen`s kappa is used to evaluate the level of agreement between the diagnosis of mercury intoxication based on the currently used set of indicators and the result based on our reduced set of indicators. The sensitivity analysis of biomarker exposure limits of mercury is based on a sequence of chi square tests.

Results

The variable selection in logistic regression reduced the number of medical indicators from thirteen to ten in addition to the biomarkers. The estimated level of agreement using ten of thirteen medical indicators and all four biomarkers to diagnose chronic inorganic mercury intoxication yields a Cohen`s Kappa of 0.87. While in an additional stepwise selection the biomarker blood was not selected, the level of agreement based on ten medical indicators and only the three biomarkers urine, urine/creatinine and hair reduced Cohen`s Kappa to 0.46. The optimal cut-point for the biomarkers blood, hair, urine and urine/creatinine were estimated at 11. 6 μg/l, 3.84 μg/g, 24.4 μg/l and 4.26 μg/g, respectively.

Conclusion

The results show that a reduction down to only ten indicators still allows a reliable diagnosis of chronic inorganic mercury intoxication. This reduction of indicators will simplify health assessments in artisanal small-scale gold mining areas.

A preliminary study on health effects in villagers exposed to mercury in a small-scale artisanal gold mining area in Indonesia

Cisitu is a small-scale gold mining village in Indonesia. Mercury (Hg) is used to extract gold from ore, heavily polluting air, soil, fish and rice paddy fields with Hg. Rice in Cisitu is burdened with mercury. The main staple food of the inhabitants of Cisitu is this polluted rice. Villagers were concerned that the severe diseases they observed in the community might be related to their mining activities, including high mercury exposure. Case report of the medical examinations and the mercury levels in urine and hair of 18 people with neurological symptoms. Typical signs and symptoms of chronic mercury intoxication were found (excessive salivation, sleep disturbances, tremor, ataxia, dysdiadochokinesia, pathological coordination tests, gray to bluish discoloration of the oral cavity and proteinuria). Mercury levels in urine were increased in eight patients (>7µg Hg/L urine). All 18 people had increased hair levels (>1µg Hg/g hair). 15 patients exhibited several, and sometimes numerous, symptoms in addition to having moderately to highly elevated levels of mercury in their specimens. These patients were classified as intoxicated. The situation in Cisitu is special, with rice paddy fields being irrigated with mercury-contaminated water and villagers consuming only local food, especially mercury-contaminated rice. Severe neurological symptoms and increased levels of mercury in urine and hair support are possibly caused by exposure to inorganic mercury in air, and the consumption of mercury-contaminated fish and rice. The mercury exposure needs to be reduced and treatment provided. Further research is needed to test the hypothesis that mercury-contaminated rice from small-scale gold mining areas might cause mercury intoxication.

No effect of mercury exposure on kidney function during ongoing artisanal gold mining activities in Colombia

This cross-sectional study examined whether people who are exposed to mercury (Hg) vapours in ongoing artisanal gold mining activities have alteration in kidney function monitoring parameters. The study enrolled 164 miners and 127 participant controls. The Hg concentrations for miners and control participants were measured in blood (B-Hg; median 7.0 vs. 2.5 µg/L), urine (U-Hg; median 3.9 vs. 1.5 µg/g creatinine) and hair (H-Hg; median 0.8 vs. 0.4 µg/g hair). The biomarkers of renal function were creatinine, albumin and excretion of β-2 microglobulin. Glomerular filtration rate (eGFR) was calculated using the chronic kidney disease epidemiology collaboration equation. Significant statistical differences were found in Hg concentrations and eGFR levels between the two study groups ( p < 0.01) but not with the other biomarkers of renal function. A multiple regression model was applied to explore the relationship of eGFR levels and Hg concentrations. However, no association was found between the prevalence of reduced eGFR (<71.96 mL/min/1.73 m²) and the B-Hg or U-Hg levels after adjustment for covariates. Nevertheless, it was observed that having B-Hg levels above 10 µg Hg/L decreased the eGFR by 1.7 mL/min/1.73 m² (confidence interval 95% -5.1 to 1.7) compared to having levels below 2.0 µg Hg/L. Our results found no support for kidney damage associated with Hg vapour exposure in ongoing artisanal gold mining, whose population has a level of Hg exposure from low to moderate (B-Hg from 3.4 to 11.0 µg/L and U-Hg from 1.3 to 9.6 µg/g creatinine).

Assessing the Environmental and Socio-Economic Impacts of Artisanal Gold Mining on the Livelihoods of Communities in the Tarkwa Nsuaem Municipality in Ghana

Gold mining has played an important role in Ghana’s economy, however the negative environmental and socio-economic effects on the host communities associated with gold mining have overshadowed these economic gains. It is within this context that this paper assessed in an integrated manner the environmental and socio-economic impacts of artisanal gold mining in the Tarkwa Nsuaem Municipality from a natural and social science perspective. The natural science group collected 200 random samples on bi-weekly basis between January to October 2013 from water bodies in the study area for analysis in line with methods outlined by the American Water Works Association, while the social science team interviewed 250 residents randomly selected for interviews on socio-economic issues associated with mining. Data from the socio-economic survey was analyzed using logistic regression with SPSS version 17. The results of the natural science investigation revealed that the levels of heavy metals in water samples from the study area in most cases exceeded GS 175-1/WHO permissible guideline values, which are in tandem with the results of inhabitants’ perceptions of water quality survey (as 83% of the respondents are of the view that water bodies in the study area are polluted). This calls for cost-benefits analysis of mining before new mining leases are granted by the relevant authorities.

Disease profile and health-related quality of life (HRQoL) using the EuroQol (EQ-5D + C) questionnaire for chronic metallic mercury vapor intoxication

Background

Toxic mercury is still being used today for example by workers mining gold, resulting in diverse health symptoms in users and individuals in proximity. A considerable burden of disease (BoD) can be assumed, while previous analyses were limited by data scarcity. Besides limited epidemiological data, neither data about the health-related quality of life (HRQoL) nor about the disease severity (disability weight, DW) is available. The aim of the project was to develop disease profiles of chronic metallic mercury vapor intoxication (CMMVI) by including the HRQoL to improve the data basis for BoD analyses of gold miners exposed to mercury.

Methods

Disease profiles comprising the disease label [a], differentiation into disease stages [b], description of the cause of exposure [c], a list of common symptoms [d], and an assessment of the HRQoL [e] were developed using expert elicitation and literature search. The HRQoL was assessed by experts using the five EuroQol dimensions accompanied by the cognition add-on questionnaire (EQ-5D + C).

Results

The ten sources used for the analyses (interview transcript, presentation, and eight literature reviews) identified more than 250 terms describing 85 distinguishable health effects of CMMVI. The analysis revealed 29 common symptoms that were frequently mentioned. Moderate and severe CMMVI cases differ regarding their symptoms and/or symptom severity and HRQoL, resulting in the EQ-5D + C-3L codes 121222 and 233333, respectively.

Conclusions

The profiles should be used to facilitate the ascertainment of CMMVI cases, to compare the HRQoL with other diseases, to derive DWs for improving BoD estimates, and to foster discussions about how to reduce the associated burden.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-015-0388-0) contains supplementary material, which is available to authorized users.

Sources of Mercury Exposure to Children in Low- and Middle-Income Countries

BACKGROUND

Many children in low- and middle-income countries face enhanced risks of exposure to contaminants via the environment, parental occupation, and other routes. While mercury (Hg) is a global pollutant whose transport properties allow it to have an impact even in pristine areas, the presence of significant Hg sources in the developing world can cause localized effects that are more severe than those observed in other areas.

OBJECTIVES

This paper provides a narrative review of sources of Hg exposure to people in the developing world with a particular focus on children, and presents an overview of key aspects to this important issue.

METHODS

We searched Web of Knowledge and Google Scholar using keywords including combinations of "mercury" and one or more of the following: "children," "exposure," "breast milk," "artisanal mining," "prenatal," "religion," "medicine," "dental amalgam," "chlor-alkali," "VCM," "vaccine," "e-waste," "industry," "beauty," "cosmetics," "strategies," "child labor," "costs," and "developing countries" to find peer-reviewed articles pertaining to Hg exposure in the developing world.

RESULTS

Sources of Hg exposure include mining, consumption, industrial operations, religious practices, traditional medicines, beauty products, vaccines, dental amalgams, and waste scavenging and recycling.

CONCLUSION

Children in the developing world are often subject to higher levels of Hg exposure than those living in developed countries due to the higher prevalence of Hg-intensive industrial processes and consumer products, lack of environmental regulation, and limits in mobility and food choices, among other factors. This issue can be addressed through additional research to fill in data gaps on exposure sources, establish sound and enforceable policies, and increase education and participation in affected communities. Challenges to addressing this problem include limited resources for needed equipment, training, and manpower to implement solutions.

Mercury hair levels and factors that influence exposure for residents of Huancavelica, Peru

Between 1564 and 1810, nearly 17,000 metric tons of mercury (Hg) vapor was released to the environment during cinnabar refining in the small town of Huancavelica, Peru. The present study characterizes individual exposure to mercury using total and speciated Hg from residential samples, total Hg in hair, and self-reported questionnaire data regarding factors influencing exposure (e.g., frequency of fish consumption, occupation). Total Hg concentrations in hair from 118 participants ranged from 0.10 to 3.6 µg/g, similar to concentrations found in the USA and lower than concentrations in other Hg-exposed populations around the world. Pearson's correlation coefficients for data in this study suggest that there is a positive correlation between concentrations of total Hg in hair and concentrations of total Hg in adobe bricks, dirt floors, and surface dust; however, these correlations are not statistically significant. Results of a one-way analysis of variance (ANOVA) identified that total Hg concentrations in hair were significantly related to gender (p < 0.001), living in a neighborhood where smelters were previously located (p = 0.021), smoking status (p = 0.003), frequency of house cleaning (p = 0.019), and frequency of fish consumption (p = 0.046). These results highlight the need for further studies to better characterize Hg exposure in Huancavelica, particularly as related to residential contamination. A comprehensive analysis of residential Hg contamination and exposure in Huancavelica will guide the development and implementation of mitigation and remediation strategies in the community to reduce potential health risks from residential Hg exposure.

Integrated assessment of artisanal and small-scale gold mining in Ghana--part 1: human health review

This report is one of three synthesis documents produced via an integrated assessment (IA) that aims to increase understanding of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities surrounding ASGM, an IA framework was utilized to analyze economic, social, health, and environmental data, and co-develop evidence-based responses with pertinent stakeholders. The current analysis focuses on the health of ASGM miners and community members, and synthesizes extant data from the literature as well as co-authors' recent findings regarding the causes, status, trends, and consequences of ASGM in Ghana. The results provide evidence from across multiple Ghanaian ASGM sites that document relatively high exposures to mercury and other heavy metals, occupational injuries and noise exposure. The work also reviews limited data on psychosocial health, nutrition, cardiovascular and respiratory health, sexual health, and water and sanitation. Taken together, the findings provide a thorough overview of human health issues in Ghanaian ASGM communities. Though more research is needed to further elucidate the relationships between ASGM and health outcomes, the existing research on plausible health consequences of ASGM should guide policies and actions to better address the unique challenges of ASGM in Ghana and potentially elsewhere.

Neurotoxicity of metals

Metals are frequently used in industry and represent a major source of toxin exposure for workers. For this reason governmental agencies regulate the amount of metal exposure permissible for worker safety. While essential metals serve physiologic roles, metals pose significant health risks upon acute and chronic exposure to high levels. The central nervous system is particularly vulnerable to metals. The brain readily accumulates metals, which under physiologic conditions are incorporated into essential metalloproteins required for neuronal health and energy homeostasis. Severe consequences can arise from circumstances of excess essential metals or exposure to toxic nonessential metal. Herein, we discuss sources of occupational metal exposure, metal homeostasis in the human body, susceptibility of the nervous system to metals, detoxification, detection of metals in biologic samples, and chelation therapeutic strategies. The neurologic pathology and physiology following aluminum, arsenic, lead, manganese, mercury, and trimethyltin exposures are highlighted as classic examples of metal-induced neurotoxicity.

The burden of chronic mercury intoxication in artisanal small-scale gold mining in Zimbabwe: data availability and preliminary estimates

BACKGROUND

Artisanal small-scale gold mining (ASGM) is a poverty-driven activity practiced in over 70 countries worldwide. Zimbabwe is amongst the top ten countries using large quantities of mercury to extract gold from ore. This analysis was performed to check data availability and derive a preliminary estimate of disability-adjusted life years (DALYs) due to mercury use in ASGM in Zimbabwe.

METHODS

Cases of chronic mercury intoxication were identified following an algorithm using mercury-related health effects and mercury in human specimens. The sample prevalence amongst miners and controls (surveyed by the United Nations Industrial Development Organization in 2004 and the University of Munich in 2006) was determined and extrapolated to the entire population of Zimbabwe. Further epidemiological and demographic data were taken from the literature and missing data modeled with DisMod II to quantify DALYs using the methods from the Global Burden of Disease (GBD) 2004 update published by the World Health Organization (WHO). While there was no disability weight (DW) available indicating the relative disease severity of chronic mercury intoxication, the DW of a comparable disease was assigned by following the criteria 1) chronic condition, 2) triggered by a substance, and 3) causing similar health symptoms.

RESULTS

Miners showed a sample prevalence of 72% while controls showed no cases of chronic mercury intoxication. Data availability is very limited why it was necessary to model data and make assumptions about the number of exposed population, the definition of chronic mercury intoxication, DW, and epidemiology. If these assumptions hold, the extrapolation would result in around 95,400 DALYs in Zimbabwe's total population in 2004.

CONCLUSIONS

This analysis provides a preliminary quantification of the mercury-related health burden from ASGM based on the limited data available. If the determined assumptions hold, chronic mercury intoxication is likely to have been one of the top 20 hazards for population health in Zimbabwe in 2004 when comparing with more than 130 categories of diseases and injuries quantified in the WHO's GBD 2004 update. Improving data quality would allow more accurate estimates. However, the results highlight the need to reduce a burden which could be entirely avoided.

Impact of gold mining associated with mercury contamination in soil, biota sediments and tailings in Kenya

This work considered the environmental impact of artisanal mining gold activity in the Migori-Transmara area (Kenya). From artisanal gold mining, mercury is released to the environment, thus contributing to degradation of soil and water bodies. High mercury contents have been quantified in soil (140 μg kg(-1)), sediment (430 μg kg(-1)) and tailings (8,900 μg kg(-1)), as expected. The results reveal that the mechanism for transporting mercury to the terrestrial ecosystem is associated with wet and dry depositions. Lichens and mosses, used as bioindicators of pollution, are related to the proximity to mining areas. The further the distance from mining areas, the lower the mercury levels. This study also provides risk maps to evaluate potential negative repercussions. We conclude that the Migori-Transmara region can be considered a strongly polluted area with high mercury contents. The technology used to extract gold throughout amalgamation processes causes a high degree of mercury pollution around this gold mining area. Thus, alternative gold extraction methods should be considered to reduce mercury levels that can be released to the environment.

Mercury exposure and health impacts among individuals in the artisanal and small-scale gold mining community: a comprehensive review

BACKGROUND

Mercury (Hg) is used in gold mining to extract gold from ore by forming "amalgam"-a mixture composed of approximately equal parts mercury and gold. Approximately 15 million people, including approximately 3 million women and children, participate in artisanal small-scale gold mining (ASGM) in developing countries. Thirty-seven percent of global air emissions of Hg are produced by ASGM. The recently adopted Minamata Convention calls for nations to gather health data, train health-care workers, and raise awareness in regard to ASGM activity.

OBJECTIVE

The purpose of our review was to evaluate the current literature regarding the health effects of Hg among those working and/or living in or near ASGM communities.

METHODS

We searched PubMed, ScienceDirect, and Google Scholar for studies relating to health effects and biomarkers of Hg exposure in ASGM communities. Articles published from 1990 through December 2012 were evaluated for relevance.

DISCUSSION

Studies reporting health assessments, kidney dysfunction, neurological disorders and symptoms, and immunotoxicity/autoimmune dysfunction in individuals living in or near an ASGM community were identified. More than 60 studies that measured biomarkers of Hg exposure in individuals living in or near ASGM communities were also identified. These studies, conducted in 19 different countries in South America, Asia, and Africa, demonstrated that hair and urine concentrations are well above World Health Organization health guidance values in ASGM communities.

CONCLUSIONS

ASGM workers and their families are exposed to Hg vapor, and workers, workers' families, and residents of nearby and downstream communities are consuming fish heavily contaminated with methylmercury.

A review of mercury exposure among artisanal small-scale gold miners in developing countries

PURPOSE

Extraction of gold using mercury has been a way out of poverty for millions of people in developing countries. Artisanal small-scale gold mining (ASGM) has expanded during the last decades and is often carried out under primitive conditions. Thus, workers in this industry may be exposed to high levels of mercury and suffer from toxic effects from mercury exposure. The objective of this review was to provide an outline of the studies available on elemental mercury exposure among artisanal small-scale gold miners.

METHODS

Searching the PubMed and Embase databases, 26 studies with a total of 3,005 exposed subjects and 442 controls across 14 different developing countries were found. Urine mercury levels were used as biomarkers of exposure.

RESULTS

In general, the urine mercury levels were elevated and a considerable proportion of workers had urine mercury levels above existing guidelines. Exposed subjects were stratified into residents, miners, millers, smelters, and refiners, who by work task content were expected to be increasingly exposed to mercury. This group order did show a clear trend of increasing mercury levels. Mercury levels differed substantially between studies. Possible explanations include dissimilarities in gold extraction methods, use of protective devices, and selection of participants.

CONCLUSIONS

This review provides evidence that artisanal gold miners and residents of the mining sites are exposed to mercury vapour to an extent where acute and long-term toxic effects of mercury are likely. Interventions aimed at reducing exposure and emission of mercury from ASGM are needed.

Mercury exposure among artisanal gold miners in Madre de Dios, Peru: a cross-sectional study

INTRODUCTION

Exposure to mercury, a toxic metal, occurs primarily from inhaling mercury vapors or consuming methylmercury-contaminated fish. One third of all anthropogenic mercury emissions worldwide are from artisanal gold mining, which uses mercury to extract gold. Although recent reports suggest that the Madre de Dios region in Peru (with >30,000 artisanal miners) has extensive mercury contamination, residents had never been assessed for mercury exposure. Thus, our objective was to quantify mercury exposure among residents of an artisanal mining town in Madre de Dios and to assess risk factors for exposure.

METHODS

We conducted a cross-sectional assessment of 103 residents of an artisanal gold mining town in July 2010. Each participant provided a urine and blood sample and completed a questionnaire assessing potential exposures and health outcomes. We calculated geometric mean (GM) urine total mercury and blood methylmercury concentrations and compared log-transformed concentrations between subgroups using linear regression.

RESULTS

One third (34.0 %) of participants were gold miners. All participants had detectable urine total mercury (GM, 5.5 μg/g creatinine; range, 0.7-151 μg/g creatinine) and 91 % had detectable blood methylmercury (GM, 2.7 μg/L; range, 0.6-10 μg/L); 13 participants (13 %) reported having kidney dysfunction or a neurological disorder. Urine total mercury concentrations were higher among people who heated gold-mercury amalgams compared with people who never heated amalgams (p < 0.05); methylmercury concentrations were higher among fish consumers compared with nonfish consumers (p < 0.05).

CONCLUSION

Our findings suggest that mercury exposure may be widespread in Huaypetue.

Blood mercury concentration among residents of a historic mercury mine and possible effects on renal function: a cross-sectional study in southwestern China

This cross-sectional study aimed to investigate blood mercury (B-Hg) concentration of residents living in the vicinity of Chatian mercury mine (CMM) in southwestern China and to assess the possible effects on renal function. It evaluates the effects of gender and age (children, <18 years; adults, 18-60 years; elderly, >60 years) on the B-Hg and serum creatinine (SCR) and serum urea nitrogen (SUN) levels. In the CMM, elevated levels were found for B-Hg, SCR, and SUN with mean values at 6.09 μg/L, 74.21 μmol/L, and 13.26 mmol/L, which were significantly higher than those in the control area, respectively. Moreover, the coefficients between paired results for B-Hg and SCR and SUN levels were positive at statistical significance (B-Hg vs. SCR, r = 0.45, p < 0.01; B-Hg vs. SUN, r = 0.20, p < 0.05). The aforementioned results revealed that mercury exposure can cause human renal function impairment. B-Hg, SCR, and SUN can also be useful biomarkers to assess the extent of mercury exposure among residents in areas with extensive mining activities. Furthermore, data analysis revealed that there was a tendency for higher B-Hg, SCR, and SUN levels in females than in males, and the levels of B-Hg, SCR, and SUN increased among the older residents. We conclude that females and the elderly in the mining area were more susceptible to mercury exposure, and therefore, they deserve further research.

Polymorphisms in genes encoding potential mercury transporters and urine mercury concentrations in populations exposed to mercury vapor from gold mining

BACKGROUND

Elemental mercury (Hg0) is widely used in small-scale gold mining. Persons working or living in mining areas have high urinary concentrations of Hg (U-Hg). Differences in genes encoding potential Hg-transporters may affect uptake and elimination of Hg.

OBJECTIVE

We aimed to identify single nucleotide polymorphisms (SNPs) in Hg-transporter genes that modify U-Hg.

METHODS

Men and women (1,017) from Indonesia, the Philippines, Tanzania, and Zimbabwe were classified either as controls (no Hg exposure from gold mining) or as having low (living in a gold-mining area) or high exposure (working as gold miners). U-Hg was analyzed by cold-vapor atomic absorption spectrometry. Eighteen SNPs in eight Hg-transporter genes were analyzed.

RESULTS

U-Hg concentrations were higher among ABCC2/MRP2 rs1885301 A-allele carriers than among GG homozygotes in all populations, though differences were not statistically significant in most cases. MRP2 SNPs showed particularly strong associations with U-Hg in the subgroup with highest exposure (miners in Zimbabwe), whereas rs1885301 A-allele carriers had higher U-Hg than GG homozygotes [geometric mean (GM): 36.4 µg/g creatinine vs. 21.9; p = 0.027], rs2273697 GG homozygotes had higher U-Hg than A-allele carriers (GM: 37.4 vs. 16.7; p = 0.001), and rs717620 A-allele carriers had higher U-Hg than GG homozygotes (GM: 83 vs. 28; p = 0.084). The SLC7A5/LAT1 rs33916661 GG genotype was associated with higher U-Hg in all populations (statistically significant for all Tanzanians combined). SNPs in SLC22A6/OAT1 (rs4149170) and SLC22A8/OAT3 (rs4149182) were associated with U-Hg mainly in the Tanzanian study groups.

CONCLUSIONS

SNPs in putative Hg-transporter genes may influence U-Hg concentrations.

Mercury contamination in humans in Upper Maroni, French Guiana between 2004 and 2009

We measured hair mercury concentration in Amerindians between 2004 and 2009 in Upper Maroni, French Guiana. Hair samples were collected from 387 residents (males: 153, females: 234). Average hair mercury concentration was high (males: 9.4 ppm, females: 9.9 ppm). We examined fish consumption by 37 residents. There was a significant correlation between hair mercury concentration and fish consumption. We also measured mercury concentration in polluted fish in upper reaches of the Maroni River. Muscle mercury concentrations were high in the fish. These results indicate that current high hair mercury concentrations in Amerindians remain linked to fish consumption.

Role of methylmercury exposure (from fish consumption) on growth and neurodevelopment of children under 5 years of age living in a transitioning (tin-mining) area of the western Amazon, Brazil

Human occupation of the Amazon region has recently increased, bringing deforestation for agriculture and open-cast mining, activities that cause environmental degradation and pollution. Families of new settlers in mining areas might have a diet less dependent on abundant fish and their children might also be impacted by exposures to mining environments. Therefore, there is compounded interest in assessing young children's nutritional status and neurobehavioral development with regard to family fish consumption. Anthropometric (z-scores, WHO standards) and neurologic [Gesell developmental scores (GDS)] development in 688 preschool children (1-59 months of age) was studied. Overall, the prevalence of malnutrition [i.e., moderate stunting (≤2 H/A-Z), underweight (≤2 W/A-Z), and wasting (≤2 W/H-Z) were respectively 0.3% (n = 2), 1.6% (n = 11), and 2.5% (n = 17). Children's mean hair Hg (HHg) concentration was 2.56 μg/g (SD = 1.67); only 14% of children had HHg concentrations lower than 1 μg/g and 1.7% had ≥5 μg/g. The biomarker of fish consumption was weakly but positively correlated with GDS (Spearman r = 0.080; p = 0.035). In the bivariate model, attained W/H-Z scores were not significantly correlated with GDS. A moderate level of GDS deficits (70-84%) was seen in 20% of children. There was significant correlation between family fish consumption and children's hair Hg (HHg) (Spearman r = 0.1756; p < 0.0001) but no significant correlation between children's HHg and W/H-Z scores. However, the multivariate model showed that breastfeeding, a fish consumption biomarker (HHg), maternal education, and child's age were statistically significant associated with specific domains (language and personal-social) of the Gesell scale. In this mining environment, family fish-eating did not affect children's linear growth, but it showed a positive influence (along with maternal variables) on neurodevelopment. Health hazards attendant on a high prevalence of moderate neurodevelopment delays coexisting with exposure to multiple neurotoxic substances merits further investigation in poor environmental settings of tin-mining areas.

Mercury toxicity and treatment: a review of the literature

Mercury is a toxic heavy metal which is widely dispersed in nature. Most human exposure results from fish consumption or dental amalgam. Mercury occurs in several chemical forms, with complex pharmacokinetics. Mercury is capable of inducing a wide range of clinical presentations. Diagnosis of mercury toxicity can be challenging but can be obtained with reasonable reliability. Effective therapies for clinical toxicity have been described.