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Robin Lee,¹ Dan Middleton,¹ Kathleen Caldwell,² Steve Dearwent,¹ Steven Jones,¹ Brian Lewis,³ Carolyn Monteilh,⁴ Mary Ellen Mortensen,² Richard Nickle,¹ Kenneth Orloff,¹ Meghan Reger,¹ John Risher,¹ Helen Schurz Rogers,² and Michelle Watters¹

¹Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, USA; ²Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ³EDS, an HP Company, Plano, Texas, USA; ⁴TKC Integration Services, LLC, Anchorage, Alaska, USA

Abstract
Objective: Concern for children exposed to elemental mercury prompted the Agency for Toxic Substances and Disease Registry and the Centers for Disease Control and Prevention to review the sources of elemental mercury exposures in children, describe the location and proportion of children affected, and make recommendations on how to prevent these exposures. In this review, we excluded mercury exposures from coal-burning facilities, dental amalgams, fish consumption, medical waste incinerators, or thimerosal-containing vaccines.

Data sources: We reviewed federal, state, and regional programs with information on mercury releases along with published reports of children exposed to elemental mercury in the United States. We selected all mercury-related events that were documented to expose (or potentially expose) children. We then explored event characteristics (i.e., the exposure source, location) .

Data synthesis: Primary exposure locations were at home, at school, and at other locations such as industrial property not adequately remediated or medical facilities. Exposure to small spills from broken thermometers was the most common scenario ; however, reports of such exposures are declining.

Discussion and conclusions: Childhood exposures to elemental mercury often result from inappropriate handling or cleanup of spilled mercury. The information reviewed suggests that most releases do not lead to demonstrable harm if the exposure period is short and the mercury is properly cleaned up.

Recommendations: Primary prevention should include health education and policy initiatives. For larger spills, better coordination among existing surveillance systems would assist in understanding the risk factors and in developing effective prevention efforts.

Key words: children, elemental mercury, environmental health, exposure, United States. Environ Health Perspect 117:871–878 (2009) . doi:10.1289/ehp.0800337 available via http://dx.doi.org/ [Online 12 January 2009]

Address correspondence to R. Lee, Agency for Toxic Substances and Disease Registry, 4770 Buford Hwy NE, MS F-57, Atlanta, GA 30341 USA. Telephone: (770) 488-0705. Fax: (770) 488-1537. E-mail: RLee3@cdc.gov

We acknowledge the assistance of the American Association of Poison Control Centers, Association of Occupational and Environmental Clinics, and Agency for Toxic Substances and Disease Registry/Hazardous Substances Emergency Events Surveillance System for providing access to and information about the data they collect.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Disease Registry.

The authors declare they have no competing financial interests.

Received 29 October 2008 ; accepted 12 January 2009.