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Casey EMD, Mojarrabi M, Hannan-Jones MT, Bogard JR. Measuring dietary intake in low-and middle-income countries: a systematic review of the methods and tools for estimating fish and seafood intake. Nutr Rev 2024; 82:453-466. [PMID: 37335872 PMCID: PMC10925904 DOI: 10.1093/nutrit/nuad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
CONTEXT Fish and seafood consumption makes an important but often under-recognized contribution to dietary patterns and nutrition, particularly in low- and middle-income countries (LMICs). Therefore, valid, and reliable dietary assessment tools (DATs) and methods to measure seafood consumption in resource-poor settings are needed. OBJECTIVE To review the available DATs that have been used to measure fish and seafood consumption in LMICs and to assess their quality. DATA SOURCES A systematic search of the electronic databases Scopus, Embase, and Medline was conducted, identifying 1541 initial articles, of which 122 eligible full-text articles were reviewed. DATA EXTRACTION Data extraction focused on the purpose of dietary assessment, setting, target population group, DAT type, administration mode, type of fish and seafood assessed, specific measure of food intake, use of a portion-size-estimation aid, and details of validity, reliability, and pilot testing of the DATs. DATA ANALYSIS The most common DATs used were food frequency questionnaires (n = 80; 58%), of which 36 (25%) were semi-quantitative. The majority of tools (n = 107; 78%) included measurement of consumption frequency; only 41 studies (30%) measured frequency, quantity, and type of seafood consumed. Only 41 DATs (30%) solely focused on fish or seafood intake. Most DATs were interviewer administered (n = 80; 58%), 23 (16%) mentioned the use of a portion-size-estimation aid, and validity was tested for only 13% of DATs (n = 18). CONCLUSION This systematic review reveals a lack of sufficient detail in the use of standard DATs to fully capture the contribution of fish and seafood to diets in LMICs. Consequently, the need to develop or adapt existing DATs to capture frequency, quantity, and type of fish and seafood intake with consideration of cultural eating practices has been highlighted. This is essential for informing appropriate interventions to leverage the nutritional benefits of seafood consumption in LMICs. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42021253607.
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Affiliation(s)
- Elodie M D Casey
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Misa Mojarrabi
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Mary T Hannan-Jones
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Jessica R Bogard
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Agriculture and Food, Brisbane, Queensland, Australia
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Heng YY, Asad I, Coleman B, Menard L, Benki-Nugent S, Hussein Were F, Karr CJ, McHenry MS. Heavy metals and neurodevelopment of children in low and middle-income countries: A systematic review. PLoS One 2022; 17:e0265536. [PMID: 35358213 PMCID: PMC8970501 DOI: 10.1371/journal.pone.0265536] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 03/03/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The presence of harmful environmental exposures, which disproportionately affects low-and-middle income countries (LMICs), contributes to >25% of deaths and diseases worldwide and detrimentally affects child neurodevelopment. Few resources succinctly summarize the existing literature on this topic. Our objective is to systematically review and characterize the evidence regarding the relationship between heavy metals and neurodevelopment of children in LMICs. METHODS We conducted a medical librarian-curated search on multiple online databases to identify articles that included individuals <18 years living in a LMIC, quantitatively measured exposure to a heavy metal (either prenatal or postnatal), and used a standardized measurement of neurodevelopment (i.e. cognitive, language, motor, and behavior). Reviews, editorials, or case studies were excluded. Results were analyzed qualitatively, and quality was assessed. RESULTS Of the 18,043 screened articles, 298 full-text articles were reviewed, and 100 articles met inclusion criteria. The included studies represented data from 19 LMICs, only one of which was classified as a low-income country. Ninety-four percent of postnatal lead and all postnatal manganese studies showed a negative association with metal exposure and neurodevelopment, which were the strongest relationships among the metals studied. Postnatal exposure of mercury was associated with poor neurodevelopment in only half of studies. Limited data on postnatal arsenic and cadmium suggests an association with worse neurodevelopment. Findings were mixed for prenatal arsenic and lead, although some evidence supports that the neurotoxicity of lead was amplified in the presence of manganese. CONCLUSIONS AND POTENTIAL IMPACT We found that lead and manganese appear to consistently have a detrimental effect on the neurodevelopment of children, and more evidence is needed for mercury, arsenic, and cadmium. Better characterization of these effects can motivate and inform prioritization of much needed international policies and programs to reduce heavy metal exposures for young children within LMICs.
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Affiliation(s)
- Yi Yan Heng
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Iqra Asad
- School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Bailey Coleman
- School of Health and Human Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States of America
| | - Laura Menard
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Sarah Benki-Nugent
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Faridah Hussein Were
- Department of Chemistry, College of Biological and Physical Sciences of the University of Nairobi, Nairobi, Kenya
| | - Catherine J. Karr
- Department of Environmental and Occupational Health Sciences, Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
| | - Megan S McHenry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Kempton JW, Périssé ARS, Hofer CB, de Vasconcellos ACS, de Sousa Viana PV, de Oliveira Lima M, de Jesus IM, de Souza Hacon S, Basta PC. An Assessment of Health Outcomes and Methylmercury Exposure in Munduruku Indigenous Women of Childbearing Age and Their Children under 2 Years Old. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10091. [PMID: 34639393 PMCID: PMC8508331 DOI: 10.3390/ijerph181910091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/04/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
In line with the 1000-day initiative and the Sustainable Development Goals (SDG) 2 and 3, we present a cross-sectional analysis of maternal health, infant nutrition, and methylmercury exposure within hard-to-reach indigenous communities in the state of Pará, Brazilian Amazon. We collected data from all women of childbearing age (i.e., 12-49) and their infants under two years old in three Munduruku communities (Sawré Muybu, Sawré Aboy, and Poxo Muybu) along the Tapajos River. We explored health outcomes through interviews, vaccine coverage and clinical assessment, and determined baseline hair methylmercury (H-Hg) levels. Hemoglobin, infant growth (Anthropometric Z scores) and neurodevelopment tests results were collected. We found that 62% of women of childbearing age exceeded the reference limit of 6.0 μg/g H-Hg (median = 7.115, IQR = 4.678), with the worst affected community (Sawré Aboy) registering an average H-Hg concentration of 12.67 μg/g. Half of infants aged under 24 months presented with anemia. Three of 16 (18.8%) infants presented H-Hg levels above 6.0 µg/g (median: 3.88; IQR = 3.05). Four of the 16 infants were found to be stunted and 38% of women overweight, evidencing possible nutritional transition. No infant presented with appropriate vaccination coverage for their age. These communities presented with an estimated Infant Mortality Rate (IMR) of 86.7/1000 live births. The highest H-Hg level (19.6 µg/g) was recorded in an 11-month-old girl who was found to have gross motor delay and anemia. This already vulnerable indigenous Munduruku community presents with undernutrition and a high prevalence of chronic methylmercury exposure in women of childbearing age. This dual public health crisis in the context of wider health inequalities has the potential to compromise the development, health and survival of the developing fetus and infant in the first two critical years of life. We encourage culturally sensitive intervention and further research to focus efforts.
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Affiliation(s)
| | - André Reynaldo Santos Périssé
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Cristina Barroso Hofer
- Instituto de Pediatria e Puericultura Martagão Gesteira, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50, Cidade Universitária, Rio de Janeiro 21941-912, Brazil;
| | - Ana Claudia Santiago de Vasconcellos
- Laboratório de Educação Profissional em Vigilância em Saúde, Escola Politécnica de Saúde Joaquim Venân-cio, Fundação Oswaldo Cruz (EPSJV/Fiocruz), Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil;
| | - Paulo Victor de Sousa Viana
- Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (CRPHF/ENSP/Fiocruz), Estrada de Curicica, 2000, Curicica, Rio de Janeiro 22780-195, Brazil;
| | - Marcelo de Oliveira Lima
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7 s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Iracina Maura de Jesus
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7 s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Sandra de Souza Hacon
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Paulo Cesar Basta
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
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Mendes VA, Santos DADS, Farias EDS, Carvalho DPD, Bastos WR. Prevalence and factors associated with mercury exposure in riverside communities in the Brazilian Western Amazon. Rev Bras Enferm 2021; 73:e20200100. [PMID: 33206908 DOI: 10.1590/0034-7167-2020-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to verify mercury exposure prevalence and identify its possible associated factors in two riverside communities in the Madeira River basin of the Western Brazilian Amazon. METHOD a cross-sectional study comprising 95 children and adolescents. Age cycle, school attendance, Bolsa Família, number of siblings, meals, fish consumption, height by age were measured. Binary logistic regression was used to verify relationships between mercury exposure and its possible associated factors. RESULTS the general prevalence of mercury exposure was 46.3%; children, 35.4%; and adolescents, 57.4%. Associated factors were fish consumption (aOR=1.84; 95%CI 1.56-2.16), age cycle (aOR=2.50; 95%CI 1.09-5.7), parasites (aOR=1.22; 95%CI 1.02-2.71), and short stature (aOR=1.32; 95%CI 1.05-2.02). CONCLUSION mercury exposure prevalence in riverside children and adolescents was considered worrying, with association with fish consumption, adolescence, parasites, and short stature.
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Tournoud C, Capaldo L, Garnier R, Gnansia E, Jarreau PH, Moesch C, Nisse P, Quénel P, Yazbeck C, Labadie M. [Reprint of: Guidelines for pregnant women and their unborn children exposed to methylmercury. Recommendations of the French Society of Clinical Toxicology associated with the French Society of Analytical Toxicology, the French Society of Public Health, the French Society of Environnmental Health, the French Society of Pediatrics, the French Society of Neonatalogy, the National College of Obstetrician Gynecologists]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:225-238. [PMID: 33423946 DOI: 10.1016/j.gofs.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Christine Tournoud
- Centre antipoison Est, CHRU, 54000 Nancy, France; Société de toxicologie clinique, 75010 Paris, France.
| | - Lise Capaldo
- Société de toxicologie clinique, 75010 Paris, France; Urgences adultes, hôpital Pellegrin, CHU, 33000 Bordeaux, France
| | - Robert Garnier
- Société de toxicologie clinique, 75010 Paris, France; Centre antipoison, AP-HP, 75010 Paris, France
| | | | - Pierre-Henri Jarreau
- Service de médecine et réanimation néonatales de Port-Royal, hôpitaux universitaires Paris Centre, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Société française de pédiatrie et société française de néonatologie, France
| | - Christian Moesch
- Laboratoire de pharmacologie et de toxicologie, CHU, 87042 Limoges, France; Société française de toxicologie analytique, 92380 Garches, France
| | - Patrick Nisse
- Société de toxicologie clinique, 75010 Paris, France; Centre antipoison, CHU, 59037 Lille, France
| | - Philippe Quénel
- Inserm, EHESP, Institut de recherche en santé, environnement et travail (Irset), UMR_S 1085, Université de Rennes, 35000 Rennes, France; Société française de santé publique, 54520 Laxou, France
| | - Chadi Yazbeck
- Gynécologie-obstétrique et médecine de la reproduction, hôpital Foch, 92150 Suresnes, France; Gynécologie-obstétrique et médecine de la reproduction, CMC Pierre-Cherest, Hartmann, 92200 Neuilly-sur-Seine, France; Collège national des gynécologues obstétriciens français, 75002 Paris, France
| | - Magali Labadie
- Société de toxicologie clinique, 75010 Paris, France; Centre antipoison, CHU, 33076 Bordeaux, France
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6
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Santos-Sacramento L, Arrifano GP, Lopes-Araújo A, Augusto-Oliveira M, Albuquerque-Santos R, Takeda PY, Souza-Monteiro JR, Macchi BM, do Nascimento JLM, Lima RR, Crespo-Lopez ME. Human neurotoxicity of mercury in the Amazon: A scoping review with insights and critical considerations. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 208:111686. [PMID: 33396018 DOI: 10.1016/j.ecoenv.2020.111686] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/24/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
Human exposure to mercury is a major public health concern, causing neurological outcomes such as motor and visual impairment and learning disabilities. Currently, human exposure in the Amazon is among the highest in the world. A recent systematic review (doi:10.1016/j.jtemb.2018.12.001), however, highlighted the lack of high-quality studies on mercury-associated neurotoxicity. There is, therefore, a need to improve research and much to still learn about how exposure correlates with disease. In this review, we discuss studies evaluating the associations between neurological disturbances and mercury body burden in Amazonian populations, to generate recommendations for future studies. A systematic search was performed during July 2020, in Pubmed/Medline, SCOPUS and SCIELO databases with the terms (mercury*) and (Amazon*). Four inclusion criteria were used: original article (1), with Amazonian populations (2), quantifying exposure (mercury levels) (3), and evaluating neurological outcomes (4). The extracted data included characteristics (as year or origin of authorship) and details of the research (as locations and type of participants or mercury levels and neurological assessments). Thirty-four studies, most concentrated within three main river basins (Tapajós, Tocantins, and Madeira) and related to environmental exposure, were found. Mercury body burden was two to ten times higher than recommended and main neurological findings were cognitive, vision, motor, somatosensory and emotional deficits. Important insights are described that support novel approaches to researching mercury exposure and intoxication, as well as prevention and intervention strategies. As a signatory country to the Minamata Convention, Brazil has the opportunity to play a central role in improving human health and leading the research on mercury intoxication.
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Affiliation(s)
- Leticia Santos-Sacramento
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | - Gabriela P Arrifano
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | - Amanda Lopes-Araújo
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | - Marcus Augusto-Oliveira
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | - Raquel Albuquerque-Santos
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | - Priscila Y Takeda
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | | | - Barbarella M Macchi
- Laboratório de Neuroquímica Molecular e Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | - José Luiz M do Nascimento
- Laboratório de Neuroquímica Molecular e Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas, Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá (UNIFAP), 68903-419 Macapá, AP, Brazil.
| | - Rafael R Lima
- Laboratório de Biologia Estrutural e Funcional, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | - Maria Elena Crespo-Lopez
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
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7
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Crespo-Lopez ME, Augusto-Oliveira M, Lopes-Araújo A, Santos-Sacramento L, Yuki Takeda P, Macchi BDM, do Nascimento JLM, Maia CSF, Lima RR, Arrifano GP. Mercury: What can we learn from the Amazon? ENVIRONMENT INTERNATIONAL 2021; 146:106223. [PMID: 33120229 DOI: 10.1016/j.envint.2020.106223] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/07/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
Mercury is among the ten most dangerous chemicals for public health, and is a priority concern for the 128 signatory countries of the Minamata Convention. Mercury emissions to the atmosphere increased 20% between 2010 and 2015, with South America, Sub-Saharan Africa and Southeast Asia as the main contributors. Approximately 80% of the total mercury emissions in South America is from the Amazon, where the presence of the metal is ubiquitous and highly dynamic. The presence of this metal is likely increasing, with global consequences, due to events of the last two years including extensive biomass burning and deforestation, as well as mining activities and the construction of large-scale projects, such as dams. Here we present a concise profile of this mobilization, highlighting the human exposure to this metal in areas without mining history. Mercury reaches the food chain in its most toxic form, methylmercury, intoxicating human populations through the intake of contaminated fish. Amazonian populations present levels over 6 ppm of hair mercury and, according to the 175:250:5:1 ratio for methylmercury intake : mercury hair : mercury brain : mercury blood, consume 2-6 times the internationally recognized reference doses. This exposure is alarmingly higher than that of other populations worldwide. A possible biphasic behavior of the mercury-related phenomena, with consequences that may not be observed in populations with lower levels, is hypothesized, supporting the need of improving our knowledge of this type of chronic exposure. It is urgent that we address this serious public health problem in the Amazon, especially considering that human exposure may be increasing in the near future. All actions in this region carry the potential to have global repercussions.
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Affiliation(s)
- Maria Elena Crespo-Lopez
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | - Marcus Augusto-Oliveira
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | - Amanda Lopes-Araújo
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil
| | - Leticia Santos-Sacramento
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil
| | - Priscila Yuki Takeda
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil
| | - Barbarella de Matos Macchi
- Laboratório de Neuroquímica Molecular e Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil
| | - José Luiz Martins do Nascimento
- Laboratório de Neuroquímica Molecular e Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas, Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá (UNIFAP), 68903-419 Macapá, AP, Brazil.
| | - Cristiane S F Maia
- Laboratório de Farmacologia da Inflamação e do Comportamento, Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | - Rafael R Lima
- Laboratório de Biologia Estrutural e Funcional, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil.
| | - Gabriela P Arrifano
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA 66075-110, Brazil
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Bose-O'Reilly S, Lettmeier B, Shoko D, Roider G, Drasch G, Siebert U. 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. ENVIRONMENTAL RESEARCH 2020; 184:109266. [PMID: 32126374 DOI: 10.1016/j.envres.2020.109266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 02/10/2020] [Accepted: 02/16/2020] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Stephan Bose-O'Reilly
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, LMU Munich, Ziemssenstr. 1, D-80336, Munich, Germany; Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT (Private University for Health Sciences, Medical Informatics and Technology), Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria.
| | - Beate Lettmeier
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT (Private University for Health Sciences, Medical Informatics and Technology), Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria; Institute of Forensic Medicine, Ludwig-Maximilians-University (LMU), Nussbaumstraße 26, D-80336, Munich, Germany.
| | - Dennis Shoko
- Tailjet Consultancy Services, 4 Tor Road, Vainona, Borrowdale, Harare, Zimbabwe.
| | - Gabriele Roider
- Institute of Forensic Medicine, Ludwig-Maximilians-University (LMU), Nussbaumstraße 26, D-80336, Munich, Germany.
| | - Gustav Drasch
- Tailjet Consultancy Services, 4 Tor Road, Vainona, Borrowdale, Harare, Zimbabwe.
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT (Private University for Health Sciences, Medical Informatics and Technology), Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria; Cardiovascular Research Program, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.
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Baranowska B, Malinowska M, Stanaszek E, Sys D, Bączek G, Doroszewska A, Tataj-Puzyna U, Rabijewski M. Extended Breastfeeding in Poland: Knowledge of Health Care Providers and Attitudes on Breastfeeding Beyond Infancy. J Hum Lact 2019; 35:371-380. [PMID: 30571929 DOI: 10.1177/0890334418819448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Extended breastfeeding is rare in Poland, and lack of acceptance and understanding is often evident in public opinion. The ability to provide reliable information about breastfeeding beyond infancy depends on health professionals' levels of knowledge and attitudes. They are considered by most parents in Poland to be authorities in the field of child nutrition. RESEARCH AIMS To determine (1) the level of knowledge and the attitudes of Polish health professionals towards extended breastfeeding; (2) the relationship between personal breastfeeding experience and attitudes towards extended breastfeeding; and (3) the relationship between knowledge about breastfeeding beyond twelve months and attitudes towards breastfeeding beyond infancy. METHODS A one-group prospective, cross-sectional, self-report style survey was used. The convenience sample ( N = 495) comprised gynaecologists, neonatologists and midwives. Data were collected via an online questionnaire and the results were analyzed with the use of descriptive statistics, a chi-square independence test, Fisher's exact test, post-hoc testing, and two-part tables using SPSS. RESULTS Most of the respondents (76.7%; n = 384) had a low level of knowledge about the benefits of breastfeeding beyond twelve months and even emphasized that this nutritional choice could have negative impacts. There was a positive correlation ( F = 105.847; p = < .01) between levels of knowledge and respondents' attitudes towards breastfeeding beyond infancy. Attitudes were also influenced by the length of time respondents had breastfed. CONCLUSION Healthcare providers have an insufficient level of knowledge about extended breastfeeding and need further education in this area.
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Affiliation(s)
- Barbara Baranowska
- 1 Department of Obstetrics and Gynaecology Didactics, Medical University of Warsaw, Poland
| | - Marta Malinowska
- 2 Department of Obstetrics and Gynaecology, Wysokie Mazowieckie Hospital, Poland
| | - Ewelina Stanaszek
- 3 Department of Obstetrics and Gynaecology, St Sophia Specialist Hospital, Warsaw, Poland
| | - Dorota Sys
- 4 Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Grażyna Bączek
- 1 Department of Obstetrics and Gynaecology Didactics, Medical University of Warsaw, Poland
| | | | - Urszula Tataj-Puzyna
- 1 Department of Obstetrics and Gynaecology Didactics, Medical University of Warsaw, Poland
| | - Michał Rabijewski
- 4 Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
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10
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Tournoud C, Capaldo L, Garnier R, Gnansia E, Jarreau PH, Moesch C, Nisse P, Quénel P, Yazbeck C, Labadie M. Recommandations de bonne pratique sur la prise en charge des femmes enceintes exposées au mercure organique et leurs enfants à naître. Recommandations de la Société de toxicologie clinique, associée à la Société française de toxicologie analytique, à la Société française de santé publique, à la Société francophone de santé environnement, à la Société française de pédiatrie, à la Société française de néonatalogie, au Collège national des gynécologues obstétriciens. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2019. [DOI: 10.1016/j.toxac.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Dórea JG. Multiple low-level exposures: Hg interactions with co-occurring neurotoxic substances in early life. Biochim Biophys Acta Gen Subj 2018; 1863:129243. [PMID: 30385391 DOI: 10.1016/j.bbagen.2018.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/01/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022]
Abstract
All chemical forms of Hg can affect neurodevelopment; however, low levels of organic Hg (methylmercury-MeHg and ethylmercury-EtHg in Thimerosal-containing vaccines, hereafter 'TCV') exposures during early life (pregnancy and lactation) co-occur with other environmental neurotoxic substances. These neurotoxicants may act in parallel, synergistically, or antagonistically to Hg. Nevertheless, the risks of neurotoxicity associated with multiple neuro-toxicants depend on type, time, combinations of exposure, and environmental and/or genetic-associated factors. Neurological developmental disorders, delays in cognition and behavioral outcomes associated with multiple exposures (which include Hg) may show transient or lasting outcomes depending on constitutional and/or environmental factors that can interact to neutralize, aggravate or attenuate these effects; often these studies are challenging to interpret. During pregnancy and lactation, fish-MeHg exposure is frequently confounded with the opposing effects of neuroactive nutrients (in fish) that lead to positive, negative, or no effects on neurobehavioral tests. In infancy, exposures to acute binary mixtures (TCV- EtHg and Al-adjuvants in infant immunizations) are associated with increased risks of tics and other developmental disorders. Despite the certitude that promulgates single environmental neurotoxicants, empirical comparisons of combined exposures indicate that Hg-related outcome is uneven. Hg in combination with other neurotoxic mixtures may elevate risks of neurotoxicity, but these risks arise in circumstances that are not yet predictable. Therefore, to achieve the goals of the Minamata treaty and to safeguard the health of children, low levels of mercury exposure (in any chemical form) needs to be further reduced whether the source is environmental (air- and food-borne) or iatrogenic (pediatric TCVs).
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Affiliation(s)
- José G Dórea
- Universidade de Brasília, Brasília 70919-970, DF, Brazil..
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12
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Arrifano GPF, Martín-Doimeadios RCR, Jiménez-Moreno M, Fernández-Trujillo S, Augusto-Oliveira M, Souza-Monteiro JR, Macchi BM, Alvarez-Leite JI, do Nascimento JLM, Amador MT, Santos S, Ribeiro-Dos-Santos Â, Silva-Pereira LC, Oriá RB, Crespo-Lopez ME. Genetic Susceptibility to Neurodegeneration in Amazon: Apolipoprotein E Genotyping in Vulnerable Populations Exposed to Mercury. Front Genet 2018; 9:285. [PMID: 30100920 PMCID: PMC6073741 DOI: 10.3389/fgene.2018.00285] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/10/2018] [Indexed: 01/24/2023] Open
Abstract
Human exposure to mercury is a serious problem of public health in Amazon. As in other vulnerable populations throughout the world, Amazonian riverine populations are chronically exposed to this metal and some symptoms of mercury intoxication were already detected in these populations. However, studies on the genetic susceptibility to mercury toxicity in the Amazon are scarce, and they tested a limited number of individuals. In this context, apolipoprotein E gene (APOE) is a key element with a well-established association among their alleles and the neurodegenerative consequences of mercury intoxication. However, no studies have addressed APOE genotyping in Amazonian exposed populations. Additionally, epidemiological studies with APOE genotyping in Amazon have been restricted to indigenous populations. Therefore, this work analyzed for the first time the genotypic and allelic profiles of APOE in Amazonian riverine populations chronically exposed to mercury. Eight hundred and twenty three individuals were enrolled in our study donating blood (794) and/or hair (757). APOE genotyping was analyzed by real-time PCR. Total mercury and mercury species were quantified by ICP-MS and GC-pyro-AFS, respectively. Genomic ancestry markers were evaluated by multiplex-PCR reaction, separated by capillary electrophoresis on the ABI 3130 Genetic Analyzer instrument and analyzed on GeneMapper ID v3.2. The 𝜀3 and 𝜀3/𝜀3 were the most frequent allele and genotype, respectively, followed by 𝜀4 allele and 𝜀3/𝜀4 genotype. Only 𝜀2/𝜀2 genotype was not found, suggesting that the absence of this genotype is a generalized phenomenon in Amazon. Also, our data supported an association between the presence of APOE4 and the Amerindian origin in these populations. Fifty-nine individuals were identified at maximum risk with levels of mercury above 10 μg/g and the presence of APOE4. Interestingly, among individuals with high mercury content, APOE4-carriers had high mercury levels than APOE2-carriers, pointing to a different heavy metal accumulation according to the APOE allele. These data suggest that APOE4, in addition to a possible pharmacodynamic effect, may influence pharmacokinetically the mercury exposure causing its higher accumulation and leading to worse deleterious consequences. Our results may aid in the development of prevention strategies and health policy decision-making regarding these at-risk vulnerable populations.
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Affiliation(s)
- Gabriela P F Arrifano
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | - Rosa C R Martín-Doimeadios
- Department of Analytical Chemistry and Food Technology, Faculty of Environmental Sciences and Biochemistry, University of Castilla-La Mancha, Toledo, Spain
| | - María Jiménez-Moreno
- Department of Analytical Chemistry and Food Technology, Faculty of Environmental Sciences and Biochemistry, University of Castilla-La Mancha, Toledo, Spain
| | - Sergio Fernández-Trujillo
- Department of Analytical Chemistry and Food Technology, Faculty of Environmental Sciences and Biochemistry, University of Castilla-La Mancha, Toledo, Spain
| | - Marcus Augusto-Oliveira
- Laboratório de Investigações em Neurodegeneração e Infecção (Hospital Universitário João de Barros Barreto), Universidade Federal do Pará, Belém, Brazil
| | - José R Souza-Monteiro
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | - Barbarella M Macchi
- Laboratório de Neuroquímica Molecular e Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | | | - José L M do Nascimento
- Laboratório de Neuroquímica Molecular e Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil.,Neuroscience Research Group, CEUMA University, São Luís, Brazil
| | - Marcos T Amador
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | - Sidney Santos
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | - Ândrea Ribeiro-Dos-Santos
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
| | | | - Reinaldo B Oriá
- Laboratório da Biologia da Cicatrização, Ontogenia e Nutrição de Tecidos, Departamento de Morfologia e Instituto de Biomedicina, Escola de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Maria E Crespo-Lopez
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
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13
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Oliveira CS, Nogara PA, Ardisson-Araújo DMP, Aschner M, Rocha JBT, Dórea JG. Neurodevelopmental Effects of Mercury. ADVANCES IN NEUROTOXICOLOGY 2018; 2:27-86. [PMID: 32346667 PMCID: PMC7188190 DOI: 10.1016/bs.ant.2018.03.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The toxicology of mercury (Hg) is of concern since this metal is ubiquitously distributed in the environment, and living organisms are routinely exposed to Hg at low to high levels. The toxic effects of Hg are well studied and it is known that they may differ depending on the Hg chemical species. In this chapter, we emphasize the neurotoxic effects of Hg during brain development. The immature brain is more susceptible to Hg exposure, since all the Hg chemical forms, not only the organic ones, can harm it. The possible consequences of Hg exposure during the early stages of development, the additive effects with other co-occurring neurotoxicants, and the known mechanisms of action and targets will be addressed in this chapter.
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Affiliation(s)
- Cláudia S Oliveira
- Programa de Pós-graduação em Ciências Biológicas: Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Pablo A Nogara
- Programa de Pós-graduação em Ciências Biológicas: Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Daniel M P Ardisson-Araújo
- Programa de Pós-graduação em Ciências Biológicas: Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
- Laboratório de Virologia de Insetos, Departamento de Bioquímica e Biologia Molecular, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - João B T Rocha
- Departamento de Bioquímica e Biologia Molecular, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - José G Dórea
- Professor Emeritus, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brazil
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14
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Tatsuta N, Murata K, Iwai-Shimada M, Yaginuma-Sakurai K, Satoh H, Nakai K. Psychomotor Ability in Children Prenatally Exposed to Methylmercury: The 18-Month Follow-Up of Tohoku Study of Child Development. TOHOKU J EXP MED 2017; 242:1-8. [PMID: 28484113 DOI: 10.1620/tjem.242.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Fish contain nutrients essential to the developing fetal brain, but they are contaminated with methylmercury. The Tohoku Study of Child Development, now underway in the Sanriku coastal area of Miyagi prefecture, Japan, follows mother-child pairs to examine the risks and benefits of fish consumption during pregnancy, especially the effects of prenatal exposures to methylmercury, selenium, and docosahexaenoic acid (DHA) on child neurodevelopment. Children aged 18 months were administered the Bayley Scales of Infant Development second edition (BSID-II) and Kyoto Scale of Psychological Development (KSPD) in 2004-2008. Complete data of cord-blood total mercury (THg), cord-plasma selenium, maternal-plasma DHA, the above test scores, and confounders for 566 mother-child pairs were available. The median cord-blood THg level was 15.7 (range, 2.7-96.1) ng/g. Since the BSID-II and KSPD scores were significantly lower in the 285 boys than in the 281 girls, analyses were conducted separately. The Psychomotor Development Index (PDI) of BSID-II was significantly correlated with cord-blood THg only in the boys, and significance of the association remained unchanged after adjusting for possible confounders; i.e., a 10-fold increase in cord-blood THg was associated with a 8.3-point decrease in the score of the PDI. Other significant correlations of THg were not seen in the boys or girls. Selenium and DHA showed no significant correlations with the BSID-II or KSPD scores in either sex. In conclusion, intrauterine methylmercury exposure may affect psychomotor development, and boys appear to be more vulnerable to the exposure than girls.
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Affiliation(s)
- Nozomi Tatsuta
- Development and Environmental Medicine, Tohoku University Graduate School of Medicine.,Department of Environmental Health Sciences, Akita University Graduate School of Medicine
| | - Katsuyuki Murata
- Department of Environmental Health Sciences, Akita University Graduate School of Medicine
| | - Miyuki Iwai-Shimada
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies
| | - Kozue Yaginuma-Sakurai
- Department of Human Health and Nutrition, Shokei Gakuin University Faculty of Comprehensive Human Science
| | - Hiroshi Satoh
- Environmental Health Sciences, Tohoku University Graduate School of Medicine
| | - Kunihiko Nakai
- Development and Environmental Medicine, Tohoku University Graduate School of Medicine
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15
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Dórea JG. Abating Mercury Exposure in Young Children Should Include Thimerosal-Free Vaccines. Neurochem Res 2017; 42:2673-2685. [PMID: 28439753 DOI: 10.1007/s11064-017-2277-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 12/27/2022]
Abstract
Pediatric immunization is essential to prevent, control and eradicate children`s infectious diseases. Newborns and infants in less developed countries have a concentrated schedule of Thimerosal-containing vaccines (TCVs); pregnant mothers are also immunized with TCVs. Metabolic changes during early development are demonstrably an important risk factor for ethylmercury (EtHg) effects on neurodevelopment, while exposure to Thimerosal sensitizes susceptible individuals to life-long contact dermatitis. Concerns regarding toxicity of Hg have moved rich nations to withdraw it from medicines and, in particular, Thimerosal from pediatric vaccines; it has been more than 20 years since rich countries started using Thimerosal-free vaccines. TCVs and Thimerosal-free vaccines show dissimilar profiles of adverse effects. Thimerosal-free vaccines have shown a decrease in contact dermatitis, while TCVs showed a significant association with increased risk of tic disorders; in some circumstances, EtHg in combination with other neurotoxic substances negatively impacted neurobehavioral tests. In studies that explored vaccines and risk of tics, Thimerosal was a necessary factor. However, when the binary exposure to organic Hg forms (TCV-EtHg and fish-MeHg) was considered, effects on neurobehavioral tests were inconsistent. CONCLUSIONS (a) The indiscriminate use of pediatric-TCVs in less developed countries carries an unjustifiable and excessive EtHg exposure with an unnecessary risk of neurotoxicity to the developing brain; (b) measurable benefits (of Thimerosal-free) and measurable risks of tic disorders have been associated with the (Thimerosal-containing) type of vaccine;
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Affiliation(s)
- José G Dórea
- Professor Emeritus, Faculty of Health Sciences, Universidade de Brasília, 70919-970, Brasília, DF, Brazil.
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16
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Silva HP, Piperata BA, Dufour DL. Human Biology of the Amazon. Ann Hum Biol 2017; 43:289-92. [PMID: 27282032 DOI: 10.1080/03014460.2016.1197546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Hilton P Silva
- a Programa de Pós-Graduação em Antropologia & Programa de Pós-Graduação em Saúde, Ambiente e Sociedade na Amazônia, Laboratório de Estudos Bioantropológicos em Saúde e Meio Ambiente, Universidade Federal do Pará , Belém , PA , Brazil
| | - Barbara A Piperata
- b Department of Anthropology , The Ohio State University , Columbus , OH , USA
| | - Darna L Dufour
- c Department of Anthropology , University of Colorado at Boulder , Boulder , CO , USA
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17
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Dórea JG. Low-dose Thimerosal in pediatric vaccines: Adverse effects in perspective. ENVIRONMENTAL RESEARCH 2017; 152:280-293. [PMID: 27816865 DOI: 10.1016/j.envres.2016.10.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 06/06/2023]
Abstract
Vaccines are prophylactics used as the first line of intervention to prevent, control and eradicate infectious diseases. Young children (before the age of six months) are the demographic group most exposed to recommended/mandatory vaccines preserved with Thimerosal and its metabolite ethylmercury (EtHg). Particularly in the less-developed countries, newborns, neonates, and young children are exposed to EtHg because it is still in several of their pediatric vaccines and mothers are often immunized with Thimerosal-containing vaccines (TCVs) during pregnancy. While the immunogenic component of the product has undergone more rigorous testing, Thimerosal, known to have neurotoxic effects even at low doses, has not been scrutinized for the limit of tolerance alone or in combination with adjuvant-Al during immaturity or developmental periods (pregnant women, newborns, infants, and young children). Scientific evidence has shown the potential hazards of Thimerosal in experiments that modeled vaccine-EtHg concentrations. Observational population studies have revealed uncertainties related to neurological effects. However, consistently, they showed a link of EtHg with risk of certain neurodevelopment disorders, such as tic disorder, while clearly revealing the benefits of removing Thimerosal from children's vaccines (associated with immunological reactions) in developed countries. So far, only rich countries have benefited from withdrawing the risk of exposing young children to EtHg. Regarding Thimerosal administered to the very young, we have sufficient studies that characterize a state of uncertainty: the collective evidence strongly suggests that Thimerosal exposure is associated with adverse neurodevelopmental outcomes. It is claimed that the continued use of Thimerosal in the less-developed countries is due to the cost to change to another preservative, such as 2-phenoxyethanol. However, the estimated cost increase per child in the first year of life is lower than estimated lifetime cost of caring for a child with a neurodevelopmental disorder, such tic disorder. The evidence indicates that Thimerosal-free vaccine options should be made available in developing countries.
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Affiliation(s)
- José G Dórea
- Professor Emeritus, Faculty of Health Sciences, Universidade de Brasilia, 70919-970 Brasilia, DF, Brazil.
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