Research into Mercury Exposure and Health Education in Subsistence Fish-Eating Communities of the Amazon Basin: Potential Effects on Public Health Policy
The neurotoxic effects of fish-methylmercury (meHg) consumed regularly are considered hazardous to fetuses and newborn infants; as a result fish consumption advisories are an important asset to control meHg exposure in affluent societies. These concerns are now part of health promotion programs for Amazon subsistence villagers. While urban dwellers in affluent societies can choose an alternative nutritious diet, traditional and subsistence communities are caught up in controversial issues and lifestyle changes with unintended health consequences. Traditional fish-eating populations of industrialized and non-industrialized regions may be exposed to different neurotoxic substances: man-made pollutants and environmentally occurring meHg. Additionally, in non-industrialized countries, pregnant women and infants are still being immunized with thimerosal-containing vaccines (TCVs) which degrade to ethylmercury (etHg). Therefore, the complexity involving fish-meHg associated with wild-fish choices and Hg exposure derived from TCVs is difficult to disentangle and evaluate: are villagers able to distinguish exposure to differently hazardous chemical forms of Hg (inorganic, fish-meHg, and injected etHg)? Is it possible that instead of helping to prevent a plausible (unperceived) fish-meHg associated neurocognitive delay we may inadvertently arouse panic surrounding Hg exposure and disrupt subsistence fish-eating habits (necessary for survival) and life-saving vaccination programs (required by public health authorities)? These questions characterize the incompleteness of information related on the various chemical forms of Hg exposure and the need to convey messages that do not disrupt nutritional balance and disease prevention policies directed at Amazonian subsistence communities.
References
[1]
Scherer, AC; Tsuchiya, A; Younglove, LR; Burbacher, TM; Faustman, EM. A Comparative analysis of state fish consumption advisories targeting sensitive populations. Environ. Health Perspect？2008, 116, 1598–1606.
[2]
Roos, N; Wahab, MA; Chamnan, C; Thilsted, SH. The role of fish in food-based strategies to combat vitamin A and mineral deficiencies in developing countries. J. Nutr？2007, 137, 1106–1109.
[3]
Barbieri, FL; Cournil, A; Gardon, J. Mercury exposure in a high fish eating Bolivian Amazonian population with intense small-scale gold mining activities. Int. J. Environ. Health Res？2009, 19, 267–277.
[4]
Monrroy, SX; Lopez, RW; Roulet, M; Benefice, E. Lifestyle and mercury contamination of Amerindian populations along the Beni river (lowland Bolivia). J. Environ. Health？2008, 71, 44–50.
[5]
Benefice, E; Monrroy, SJL; Lopez Rodriguez, RW. A nutritional dilemma: Fish consumption, mercury exposure and growth of children in Amazonian Bolivia. Int. J. Env. Health Res？2008, 18, 415–427.
[6]
Dórea, JG. Fish are central in the diet of Amazonian riparians: Should we worry about their mercury concentrations? Environ. Res？2003, 92, 232–244.
[7]
Bonham, MP; Duffy, EM; Robson, PJ; Wallace, JM; Myers, GJ; Davidson, PW; Clarkson, TW; Shamlaye, CF; Strain, JJ; Livingstone, MB. Contribution of fish to intakes of micronutrients important for fetal development: A dietary survey of pregnant women in the Republic of Seychelles. Public Health Nutr？2009, 12, 1312–1320.
[8]
Greiner, A; Smith, KC; Guallar, E. Something fishy? News media presentation of complex health issues related to fish consumption guidelines. Public Health Nutr？2010. DOI: 10.1017/S1368980010000923.
[9]
Harper, BL; Harris, SG. A possible approach for setting a mercury risk-based action level based on tribal fish ingestion rates. Environ. Res？2008, 107, 60–68.
[10]
Peplow, D; Augustine, S. Community-directed risk assessment of mercury exposure from gold mining in Suriname. Rev. Panam. Salud Publica？2007, 22, 202–210.
[11]
Mertens, F; Saint-Charles, J; Lucotte, M; Mergler, D. Emergence and robustness of a community discussion network on mercury contamination and health in the Brazilian Amazon. Health Educ. Behav？2008, 35, 509–521.
[12]
Arnold, SM; Lynn, TV; Verbrugge, LA; Middaugh, JP. Human biomonitoring to optimize fish consumption advice: Reducing uncertainty when evaluating benefits and risks. Am. J. Public Health？2005, 95, 393–397.
[13]
Shimshack, JP; Ward, MB. Mercury advisories and household health trade-offs. J. Health Econ, Available online: http://mpra.ub.uni-muenchen.de/22584/ (accessed on 12 April 2010).
[14]
Mahaffey, KR; Clickner, RP; Jeffries, RA. Methylmercury and omega-3 fatty acids: Co-occurrence of dietary sources with emphasis on fish and shellfish. Environ. Res？2008, 107, 20–29.
[15]
Fillion, M; Passos, CJ; Lemire, M; Fournier, B; Mertens, F; Guimar？es, JR; Mergler, D. Quality of life and health perceptions among fish-eating communities of the Brazilian Amazon: An ecosystem approach to well-being. Ecohealth？2009, 6, 121–134.
[16]
Muniz, PT; Castro, TG; Araújo, TS; Nunes, NB; da Silva-Nunes, M; Hoffmann, EH; Ferreira, MU; Cardoso, MA. Child health and nutrition in the Western Brazilian Amazon: Population-based surveys in two counties in Acre State. Cad. Saúde Pública？2007, 23, 1283–1293.
[17]
Dórea, JG. Persistent, bioaccumulative and toxic substances in fish: Human health considerations. Sci. Total Environ？2008, 400, 93–114.
[18]
Brantsaeter, AL; Haugen, M; Thomassen, Y; Ellingsen, DG; Ydersbond, TA; Hagve, TA; Alexander, J; Meltzer, HM. Exploration of biomarkers for total fish intake in pregnant Norwegian women. Public Health Nutr？2010, 13, 54–62.
[19]
Turunen, AW; M？nnist？, S; Kiviranta, H; Marniemi, J; Jula, A; Tiittanen, P; Suominen-Taipale, L; Vartiainen, T; Verkasalo, PK. Dioxins, polychlorinated biphenyls, methyl mercury and omega-3 polyunsaturated fatty acids as biomarkers of fish consumption. Eur. J. Clin. Nutr？2010, 64, 313–23.
[20]
Plusquellec, P; Muckle, G; Dewailly, E; Ayotte, P; Bégin, G; Desrosiers, C; Després, C; Saint-Amour, D; Poitras, K. The relation of environmental contaminants exposure to behavioral indicators in Inuit preschoolers in Arctic Quebec. Neurotoxicology？2010, 31, 17–25.
[21]
Rabitto, ID; Bastos, WR; Almeida, R; Anjos, A; de Holanda, IB; Galv？o, RC; Neto, FF; de Menezes, ML; Dos Santos, CA; de Oliveira Ribeiro, CA. Mercury and DDT exposure risk to fish-eating human populations in Amazon. Environ Int？2010. DOI: 10.1016/j.envint.2010.07.001.
[22]
Gilbertson, M; Carpenter, DO. An ecosystem approach to the health effects of mercury in the Great Lakes basin ecosystem. Environ. Res？2004, 95, 240–246.
[23]
Malm, O; Dórea, JG; Barbosa, AC; Pinto, FN; Weihe, P. Sequential hair mercury in mothers and children from a traditional riverine population of the Rio Tapajós, Amazonia: Seasonal changes. Env. Res？2010, 110, 705–709.
[24]
Barbosa, F; Fillion, M; Lemire, M; Passos, CJ; Rodrigues, JL; Philibert, A; Guimar？es, JR; Mergler, D. Elevated blood lead levels in a riverside population in the Brazilian Amazon. Environ. Res？2009, 109, 594–549.
[25]
Barbieri, FL; Gardon, J. Hair mercury levels in Amazonian populations: Spatial distribution and trends. Int. J. Health Geogr？2009, 8, 71.
[26]
Lebel, J; Mergler, D; Branches, F; Lucotte, M; Amorim, M; Larribe, F; Dolbec, J. Neurotoxic effects of low-level methylmercury contamination in the Amazonian Basin. Environ. Res？1998, 79, 20–32.
[27]
Passos, CJ; Mergler, D. Human mercury exposure and adverse health effects in the Amazon: A review. Cad. Saúde Pública？2008, 24, s503–s520.
[28]
Tavares, LM; Camara, VM; Malm, O; Santos, EC. Performance on neurological development tests by riverine children with moderate mercury exposure in Amazonia, Brazil. Cad. Saúde Pública？2005, 21, 1160–1167.
[29]
Fonseca, MF; Dórea, JG; Bastos, WR; Marques, RC; Torres, JPM; Malm, O. Poor psychometric scores of children living in isolated riverine and agrarian communities and fish-methylmercury exposure. Neurotoxicology？2008, 29, 1008–1015.
[30]
Marques, RC; Dórea, JG; McManus, C; Le？o, RS; Brand？o, KG; Marques, RC; Vieira, IGI; Guimar？es, JRD; Malm, O. Hydroelectric-reservoir inundation (Rio Madeira Basin, Amazon) and changes in traditional lifestyle: Impact on growth and neuro-development of preschoolers. Pub Health Nut？2010.
[31]
Chevrier, C; Sullivan, K; White, RF; Comtois, C; Cordier, S; Grandjean, P. Qualitative assessment of visuospatial errors in mercury-exposed Amazonian children. Neurotoxicology？2009, 30, 37–46.
[32]
Dórea, JG. Comparing fish-mercury exposed Amazonian children: Should not we consider thimerosal-preserved vaccines? Neurotoxicology？2009, 30, 485–486.
[33]
Marques, RC; Dórea, JG; Bernardi, JV. Thimerosal exposure (from-tetanus-diphtheria vaccine) during pregnancy and neurodevelopment of breastfed infants at 6 months. Acta Paediatr？2010, 99, 934–939.
[34]
Marques, RC; Dórea, JG; Bernardi, JV; Bastos, WR; Malm, O. Prenatal and postnatal mercury exposure, breastfeeding and neurodevelopment during the first 5 years. Cogn. Behav. Neurol？2009, 22, 134–141.
[35]
Huang, LS; Myers, GJ; Davidson, PW; Cox, C; Xiao, F; Thurston, SW; Cernichiari, E; Shamlaye, CF; Sloane-Reeves, J; Georger, L; Clarkson, TW. Is susceptibility to prenatal methylmercury exposure from fish consumption non-homogeneous? Tree-structured analysis for the Seychelles Child Development Study. Neurotoxicology？2007, 28, 1237–1244.
[36]
Mendez, MA; Torrent, M; Julvez, J; Ribas-Fitó, N; Kogevinas, M; Sunyer, J. Maternal fish and other seafood intakes during pregnancy and child neurodevelopment at age 4 years. Public Health Nutr？2009, 12, 1702–1710.
[37]
Dórea, JG. Exposure to mercury during the first six months via human milk and vaccines: Modifying risk factors. Am. J. Perinatol？2007, 24, 387–400.
[38]
Marques, RC; Bernardi, JV; Dórea, JG; Bastos, WR; Malm, O. Principal component analysis and discrimination of variables associated with pre- and post-natal exposure to mercury. Int. J. Hyg. Environ. Health？2008, 211, 606–614.
[39]
Dórea, JG. Making sense of epidemiological studies of young children exposed to thimerosal in vaccines. Clin. Chim. Acta？2010, 411, 1580–1586.
[40]
Marques, RC; Dórea, JG; Fonseca, MF; Bastos, WR; Malm, O. Hair mercury in breast-fed infants exposed to thimerosal-preserved vaccines. Eur. J. Pediatr？2007, 166, 935–941.
[41]
Marques, RC; Dórea, JG; Bastos, WR; Malm, O. Changes in children hair-Hg concentrations during the first 5 years: Maternal, environmental and iatrogenic modifying factors. Regul. Toxicol. Pharmacol？2007, 49, 17–24.
[42]
Park, HJ; Kim, DS; Moon, JS; Yang, WH; Son, BS. Mercury level in hair of primary school children in Korea and China. Mol. Cel. Toxicol？2008, 4, 235–245.
[43]
Dórea, JG; Wimer, W; Marques, RC; Shade, C. Automated Speciation of Mercury in the Hair of Breastfed Infants Exposed to Ethylmercury from Thimerosal-Containing Vaccines. Biol Trace Elem Res？2010. doi: 10.1007/s12011-010-8695-0.
[44]
Dórea, JG. More on low-level non-occupational mercury exposure and health concerns. Sci. Total Environ？2010, 408, 2008–2009.
[45]
Marques, RC. As preocupa？？es públicas com a seguran？a das vacinas. Ciência Hoje？2008, 250, 26–31.
[46]
Dufour, DL. Diet and nutritional status of Ameridians: A review of the literature. Cad. Saúde Publica？1991, 7, 481–502.
[47]
Dórea, JG. Cassava cyanogens and fish mercury are high but safely consumed in the diet of native Amazonians. Ecotoxicol. Environ. Saf？2004, 57, 248–256.
[48]
Benefice, E; Barral, H. Differences in life style and nutritional status between settlers and Siona-Secoya Indians lrving in the same Amazonian milieu. Ecol. Food Nutr？1991, 25, 307–322.
[49]
Dórea, JG; de Souza, JR; Rodrigues, P; Ferrari, I; Barbosa, AC. Hair mercury (signature of fish consumption) and cardiovascular risk in Munduruku and Kayabi Indians of Amazonia. Environ. Res？2005, 97, 209–219.
[50]
Salonen, JT; Sepp？nen, K; Nyyss？nen, K; Korpela, H; Kauhanen, J; Kantola, M; Tuomilehto, J; Esterbauer, H; Tatzber, F; Salonen, R. Intake of mercury from fish, lipid peroxidation, and the risk of myocardial infarction and coronary, cardiovascular, and any death in eastern Finnish men. Circulation？1995, 91, 645–655.
[51]
Yoshizawa, K; Rimm, EB; Morris, JS; Spate, VL; Hsieh, CC; Spiegelman, D; Stampfer, MJ; Willett, WC. Mercury and the risk of coronary heart disease in men. N. Engl. J. Med？2002, 347, 1755–1760.
[52]
Guallar, E; Sanz-Gallardo, MI; van't Veer, P; Bode, P; Aro, A; Gómez-Aracena, J; Kark, JD; Riemersma, RA; Martín-Moreno, JM; Kok, FJ. Heavy metals and myocardial infarction study group. Mercury, fish oils, and the risk of myocardial infarction. N. Engl. J. Med？2002, 347, 1747–1754.
[53]
Cerdeira, R; Ruffino, M; Isaac, VJ. Fish catches among riverside communities around Lago Grande de Monte Alegre, Lower Amazon, Brazil. Fish Manag. Ecol？2000, 7, 355–374.
[54]
Passos, CJ; Da Silva, DS; Lemire, M; Fillion, M; Guimar？es, JR; Lucotte, M; Mergler, D. Daily mercury intake in fish-eating populations in the Brazilian Amazon. J. Expo. Sci. Environ. Epidemiol？2008, 18, 76–87.
[55]
Dórea, J; Barbosa, AC; Ferrari, I; de Souza, JR. Mercury in hair and in fish consumed by Riparian women of the Rio Negro, Amazon, Brazil. Int. J. Env. Health Res？2003, 13, 239–248.
