ORIGINAL PAPER
Signs and symptoms of mercury-exposed gold miners
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1
University Hospital Munich, Munich, Germany
(Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, WHO Collaborating Centre for Occupational Health)
2
The Health and Life Sciences University (UMIT), Hall in Tirol, Austria
(Institute of Public Health, Medical Decision Making and Health Technology Assessment,
Department of Public Health, Health Services Research and Health Technology Assessment)
3
United Nations Industrial Development Organization (UNIDO), Vienna, Austria
(Vienna International Centre)
4
The Health and Life Sciences University (UMIT), Hall in Tirol, Austria
(Institute of Public Health, Medical Decision Making and Health Technology Assessment
Department of Public Health, Health Services Research and Health Technology Assessment)
5
Harvard Medical School, Boston, USA
(Massachusetts General Hospital, Institute for Technology Assessment and Department of Radiology)
6
Harvard T.H. Chan School of Public Health, Boston, USA
(Center for Health Decision Science, Department of Health Policy and Management)
7
University of Munich, Munich, Germany
(Department of Forensic Toxicology, Institute of Forensic Medicine)
Online publication date: 2017-03-22
Corresponding author
Stephan Bose-O'Reilly
University Hospital Munich, Institute and Outpatient Clinic for Occupational, Social and Environmental
Medicine, WHO Collaborating Centre for Occupational Health, Ziemssenstr. 1, D-80336 Munich, Germany
Int J Occup Med Environ Health. 2017;30(2):249-69
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ABSTRACT
Objectives: Gold miners use mercury to extract gold from ore adding liquid mercury to the milled gold-containing ore. This
results in a mercury-gold compound, called amalgam. Miners smelt this amalgam to obtain gold, vaporizing it and finally
inhaling the toxic mercury fumes. The objective was to merge and analyze data from different projects, to identify typical
signs and symptoms of chronic inorganic mercury exposure. Material and Methods: Miners and community members from
various artisanal small-scale gold mining areas had been examined (Philippines, Mongolia, Tanzania, Zimbabwe, Indonesia).
Data of several health assessments were pooled. Urine, blood and hair samples were analyzed for mercury (N = 1252).
Questionnaires, standardized medical examinations and neuropsychological tests were used. Participants were grouped
into: Controls (N = 209), living in an exposed area (N = 408), working with mercury as panners (N = 181), working with
mercury as amalgam burners (N = 454). Chi2 test, linear trend test, Mann-Whitney test, Kruskal-Wallis test, correlation
coefficient, Spearman’s rho, and analysis of variance tests were used. An algorithm was used to define participants with
chronic mercury intoxication. Results: Mean mercury concentrations in all exposed subgroups were elevated and above
threshold limits, with amalgam burners showing highest levels. Typical symptoms of chronic metallic mercury intoxication
were tremor, ataxia, coordination problems, excessive salivation and metallic taste. Participants from the exposed
groups showed poorer results in different neuropsychological tests in comparison to the control group. Fifty-four percent
of the high-exposed group (amalgam burners) were diagnosed as being mercury-intoxicated, compared to 0% within
the control group (Chi2 p < 0.001). Conclusions: Chronic mercury intoxication, with tremor, ataxia and other neurological
symptoms together with a raised body burden of mercury was clinically diagnosed in exposed people in artisanal small-scale
mining areas. The mercury exposure needs to be urgently reduced. Health care systems need to be prepared for this emerging
problem of chronic mercury intoxication among exposed people. Int J Occup Med Environ Health 2017;30(2):249–269