MERCURY EXPOSURE IN LARUE COUNTY NOVEMBER 2004 ASHOKA

MERCURY EXPOSURE IN LARUE COUNTY - NOVEMBER 2004 ASHOKA INDUKURI Senior Epidemiologist Lincoln Trail District Health Department

NOVEMBER 10 TH 2004 n n n 15 yr old student brought a vial of mercury onto the school bus and into the Larue county high school. School officials notice around 15 students playing with Liquid Mercury in the Cafeteria. Mercury secured by school officials.

NOVEMBER 10 TH 2004 n n Cafeteria closed immediately. Basic cleaning procedures performed on Exposed students. Local Health Department, EPA and Emergency Management notified. EPA officials secure the school and school closed for next 2 days for cleaning and to limit exposure.

NOVEMBER 10 TH 2004 n n Education material about Mercury exposure, health effects and treatment sent Local health director Joyce Walsh. School officials notify the parents and advice them to seek medical attention if their child needs any testing for mercury exposure.

November 11 -15 th 2004 n n n US EPA, KDEP perform testing and cleaning of school, school buses and other facilities. District health department contacts state for advice regarding testing the exposed students and family members. Kentucky Regional Poison center informed about the spill.

NOVEMBER 11 -15 TH n n Initial investigation of the 15 yr old boy reveals that the Mercury has been stolen from a Dentist’s office on November 9 th. Blood and Urine samples has been ordered for all the family members living in a mobile home. Close contacts include Three adults and 6 children (14 yrs-5 yrs) Family members relocated to a motel in Elizabethtown to facilitate clean up of the mobile home.

Mercury Spill Investigation n n Further questioning of the boy reveals that he had mercury with him for more than an year( Taken from the Dentist’s office in August 2003 visit). Several children in the family experienced headaches, itchy rashes and mild tremors.

Mercury Spill Investigation n n One of the family members(13 yr old girl) has experienced several months of mysterious illness (unexplained tachycardia, hypertension , rashes, muscle pain, tremors, insomnia desquamatization of soles and palms) in Late 2003 and admitted to hospital in Louisville for 30 days. Mercury exposure was not on differential diagnosis at that time.

Mercury Spill Investigation n n Boy admits spilling some of the mercury in the family car of a close friend in October / November 2003 Investigation of the “Close friend’s” family confirms the incident. Four family members potentially exposed. All four contacts ordered testing for Blood and Urine samples. Additional 12 people who spent substantial amount of time in the mobile home interviewed and advised to contact their health care provider.

Mercury Spill Investigation - Lab Results The blood an urine samples reveal substantial mercury exposure in family members. n Blood mercury levels ranged from 32 – 72 micrograms/liter (normal: 010 ug/l) n 24 hr Urine mercury concentrations ranged from 28 -496 micrograms/liter (normal: 0 -19 ug/l) n

Mercury Spill Investigation - Lab Results n n n Lab tests reveal direct relation between Time spent in the mobile home and Mercury levels in blood and urine. The 15 yr old boy has highest Mercury concentrations in both blood(72 ug/l) and urine (496 ug/l). All other contacts tested negative.

Mercury Spill Investigation - EPA Investigation Results n n Family’s mobile home and possessions were destroyed(ambient mercury was >50, 000 ng/m 3 initially and 11, 550 ng/m 3 later) NORMAL--<3, 000 NG/m 3) Family van and vehicle cleaned and returned to family. Additional car (family of Boy’s friend) destroyed

Mercury Spill Investigation -Treatment n n n All children treated with chelation therapy with Succimer. Three adults in the family treated by multiple chelation sessions. All contacts are advised to take the advise of their healthcare provider if they develop any signs and symptoms.

Mercury Spill Investigation -Agencies involved n n n Larue county health department Larue county Emergency Management Lincoln Trail District Health Department Kentucky Department of Public Health Kentucky Regional Poison Center US EPA and KDEP

CONCLUSION n n Increase awareness of school and local public health officials (including ERRT members) about mercury exposure. Continue to increase coordination and communication between all agencies.

Useful links n This Article published in MMWR (Morbidity and Mortality Weekly Report) August 19, 2005 / Vol. 54 / No. 32 Link: http: //www. cdc. gov/mmwr/preview /mmwrhtml/mm 5432 a 2. htm Mercury information links: http: //www. epa. gov/mercury/ n