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Old 12-28-2007, 02:09 PM #1
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Arrow mercury in the medicines? and other toxic waste... not for humans

Cold medicines for infants pulled
OVERDOSE WORRIES FOR POPULAR BRANDS

By Barbara Feder Ostrov
Mercury News
Article Launched: 10/12/2007
01:34:04 AM PDT


Video
FDA studies link the drugs to accidental overdoses in toddlers and infants

Related Stories
Oct 12:
The 14 withdrawn medications - and alternative treatment
The decision by drugmakers to pull popular infant cold medicines has parents cleaning out their bathroom cabinets and scrambling for old-fashioned remedies as cold and flu season approaches.

Because of fears that the products may be misused and possibly lead to fatal overdoses, leading drugmakers Thursday to voluntarily remove 14 over-the-counter medications from the market. The medicines include top-selling products sold under the brand names Tylenol, Triaminic, Robitussin, Little Colds, Pediacare and Dimetapp.

The decision does not affect cold and cough medicines intended for children 2 years and older, or single-ingredient fever reducers or pain medications for infants.

Parents are advised not to use pulled medicines they may have at home for children younger than 2 years old. Whether refunds will be granted differs by manufacturer and drugstore.

Drugmakers say infant cold medications are safe when taken as directed, but concerns are mounting about overdoses and accidental ingestion of the drugs.

The withdrawal comes a week before a Food and Drug Administration meeting to review the safety and effectiveness of pediatric cold medications. At the meeting, the federal agency may strengthen warnings about the medications' risks for children and require new package labeling, as some health advocates have urged.

At least 1,500 children under age 2 required emergency-room care in 2004 and 2005 after taking non-prescription cough and



cold medicines, health officials reported. Another review conducted for the FDA documented 54 deaths involving decongestants and 69 involving antihistamines from 1969 to 2006.

"These medicines are - and always have been - safe at the recommended doses," said Linda Suydam, president of the Consumer Healthcare Products Association, which announced the withdrawal on behalf of drug manufacturers. "These voluntary actions are being taken out of an abundance of caution."

Many pediatricians already urge parents not to give cough and cold medications to their young children, saying they simply don't work that well.

"This should not be viewed as some tragic day for parents with sick kids, because these medications didn't do much to begin with," Dr. Peter Contini, a San Jose pediatrician, said Thursday.

In August, the federal government advised parents not to give any cold and cough medications to children under 2 unless specifically directed to do so by a doctor.

Yet the drugs remain popular, Contini said, because parents want to ease their children's misery.

Laura Ino is one San Jose parent who plans to keep using cold medications for her son, who turns 2 next week. As a manager of pharmaceutical clinical trials, Ino is confident the medicines are safe when used as directed, but she acknowledged that parents could overdose their children if they are not careful. She said she keeps close tabs on her child's weight to ensure the proper dose and calls the doctor with any questions.

"I totally believe in them," Ino said of the medications. "I don't believe your kids should suffer."

In contrast, Sarah Granger of Menlo Park spent Thursday clearing her 21-month-old daughter's cold medications out of the medicine cabinet. This week, she has been giving her daughter two of the withdrawn medications for a cold.

"Accidents happen, so I think it's smart they're recalling these medications until they can figure out how to dispense them more safely," said Granger, who writes for the Silicon Valley Moms Blog. Her daughter was feeling better Thursday, "but I'll be anxiously awaiting replacement options."

Those options, pediatricians say, include old-school remedies: infant or children's Tylenol or Motrin to reduce body aches and fever, a humidifier, rest and plenty of fluids, Contini said.

Using a nasal saline spray and a suction device for little noses also can relieve congestion, said Dr. Chris Halaburka, another San Jose pediatrician. Getting a flu shot, which is recommended for children from six months to 5 years old, also can reduce the severity of flu and other respiratory infections, she said.

Her challenge, she said, is helping parents understand what to do to make their children more comfortable - and how to cope with the fact that they might be miserable for a few days.

"It's normal for children up to age 4 to have up to 14 colds a year," Halaburka said. "That's how we build our immune system."



IF YOU'RE INTERESTED

For more information, visit the Food and Drug Administration's Web site at www.fda.gov.



Contact Barbara Feder Ostrov at bfeder@mercurynews.com or (408) 920-5064.



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Old 12-28-2007, 02:11 PM #2
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Question this article was archived - not available anymore?

This is an archive page. The links are no longer being updated.

TESTIMONY ON "MERCURY IN MEDICINES"
BY WILLIAM EGAN, Ph.D., ACTING OFFICE DIRECTOR,
OFFICE OF VACCINE RESEARCH AND REVIEW
CENTER FOR BIOLOGICS EVALUATION AND REVIEW
FOOD AND DRUG ADMINISTRATION
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES


BEFORE THE HOUSE COMMITTEE ON GOVERNMENT REFORM

JULY 18, 2000




INTRODUCTION

Mr. Chairman and Members of the Committee, I am William Egan, Ph.D., Acting Office Director, Office of Vaccine Research and Review (OVRR), Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA or Agency). We appreciate the opportunity to discuss the issue of additives in childhood vaccines, in particular thimerosal.

Vaccines, licensed for use in the United States (U.S.) by FDA, have been protecting our nation's children from deadly infectious diseases for over fifty years. In fact, immunizations represent one of the most significant public health achievements of the 20th century. Vaccines can be credited for saving more lives and preventing more illnesses than any medical treatment. Without question, continuing to ensure our children are vaccinated with licensed vaccines is critical to protect their health and to prevent disease outbreaks. Prior to licensure, each vaccine undergoes a rigorous review process to establish its safety and effectiveness. FDA considers all vaccines currently available to be safe and effective.

It is essential that children continue to receive all vaccines according to currently recommended schedules. The risk of the emergence of devastating childhood diseases like whooping cough, bacterial meningitis, tetanus, polio and diphtheria is real. The risk of these devastating childhood diseases from failure to vaccinate far outweighs the minimal, if any, risk of exposure to levels of thimerosal or mercury in vaccines.

Nevertheless, FDA has been actively addressing the issue of thimerosal as a preservative in vaccines. An FDA review of this issue one year ago found no evidence of harm from the use of thimerosal as a vaccine preservative but raised questions about the potential exposure of infants to mercury from thimerosal in vaccines. Based on this review, the Public Health Service (PHS) acted quickly, urging vaccine manufacturers to reduce or eliminate thimerosal in vaccines. Much progress has been made to date. The Agency has been working with other PHS agencies, the American Academy of Pediatrics and manufacturers, particularly those that manufacture childhood vaccines, to eliminate thimerosal from vaccines and to further evaluate the potential health effects of thimerosal.

PURPOSE OF VACCINE ADDITIVES

In addition to the actual immunogen, vaccines may contain preservatives (e.g., thimerosal), adjuvants (e.g., the aluminum salts), and stabilizers (e.g., gelatin). The vaccine may be a liquid preparation in a suspending fluid such as buffered saline. Adjuvants are materials that, when used in combination with vaccine immunogens, increase the strength and/or duration of the immune response. At present, the only adjuvants that are found in U.S. licensed vaccines are the aluminum salts.

Preservatives are added to vaccine preparations to help minimize the consequences of inadvertent microbial contamination; with certain exceptions, they are required by regulation for multi-dose formulations. There are four preservatives that are currently contained in U.S. licensed vaccines. These are: thimerosal, phenol, 2-phenoxyethanol, and benzethonium chloride.


THIMEROSAL AND MERCURY

Thimerosal is an effective preservative and has been used in some vaccines and other products since the 1930s. Thimerosal contains mercury in the form of ethyl mercury. Thimerosal is the most widely used preservative in vaccines. FDA estimates that it is used in more than 30 licensed vaccines and biologics currently marketed in the U.S. Thimerosal is used as a safeguard against microbial contamination. Disease outbreaks have occurred following contamination of multi-dose vaccine vials. While use of thimerosal as a preservative does not eliminate the possibility of bacterial contamination (multi-dose vials with thimerosal have become contaminated), the likelihood of contamination can be markedly reduced.

Mercury is a metal that is found in elemental form (such as the mercury used in thermometers), as inorganic salts, and as organomercurials (such as thimerosal). Humans may be exposed to organic mercury in the form of methyl mercury from eating contaminated fish. The magnitude of exposure to mercury (especially methyl mercury) and the degree of risk from fish consumption depend on the level of mercury in the fish consumed and the amount of fish an individual consumes. Very high levels of mercury are toxic. Because mercury is found naturally in the environment, it is not possible to prevent all exposure to mercury, however, the industrial uses and releases of mercury have been reduced very substantially in recent decades in the U.S. and most other industrialized countries.

Although mercury is found in the environment, in food and in household products, exposure to mercury is of concern and, when possible, should be avoided. For this reason, various Federal agencies have been addressing the health risks of mercury. One type of mercury, called methyl mercury, is found in fish and has received particular attention because high doses have been associated with adverse health effects. FDA, the Environmental Protection Agency (EPA) and the Agency for Toxic Substance and Disease Registry each have developed guidelines for intake of methyl mercury. As noted thimerosal contains a related mercury compound called ethyl mercury.

It is very important to remember that safety margins are incorporated into all acceptable mercury exposure limits. There are no convincing data or evidence of any harm caused by the low levels of thimerosal that some children may have encountered in following the existing immunization schedule.

Nearly all recommended pediatric vaccines available today in the U.S. are thimerosal-free. In 1999, FDA conducted a review of vaccines being used at that time. The review suggested that some infants, depending on which vaccines they receive and the timing of vaccination, may have been exposed to levels of ethyl mercury that could build up to exceed one of the Federal guidelines established for the intake of methyl mercury. There are no guidelines established for ethyl mercury, but experts agree that methyl mercury guidelines are appropriate to use in this situation. It is important to remember that there are safety margins incorporated into all Federal guidelines on methyl mercury exposure. Again, any mercury exposure from these vaccines is within the safety margin incorporated into the guidelines. No children or infants were receiving toxic levels of mercury from vaccines, but FDA still believed it appropriate to pursue alternatives to using thimerosal as a preservative in vaccines.

It should be noted that other than the occurrence of local hypersensitivity reactions, no harmful effects have been reported from thimerosal at doses found in vaccines. Some individuals experience local skin reactions such as redness and swelling that may suggest a delayed type of hypersensitivity reaction following injection with products containing thimerosal. While one study found that most patients do not develop reactions to thimerosal given as a component of vaccines, even when they tested positive for thimerosal hypersensitivity, a prior history of hypersensitivity to thimerosal, or any component in a vaccine, is considered a contraindication to further vaccination with thimerosal-containing vaccines.

PROGRESS AND CONTINUING ACTIONS ON REMOVAL OF THIMEROSAL

Under section 413(a) of the Food and Drug Administration Modernization Act (FDAMA) of 1997 (Pub. L. 105-115), entitled "Food and Drug Administration Study of Mercury Compounds in Drugs and Food," FDA was required to: (1) Compile a list of drugs and foods that contain intentionally introduced mercury compounds, and (2) provide a quantitative and qualitative analysis of the mercury compounds in this list. The statute did not differentiate between mercury as an active or an inactive ingredient. The provision also required the study of the "adverse effects on health of children and other sensitive populations from exposure to . . . mercury."

CBER conducted a review of the use of thimerosal in childhood vaccines as well as other biologics. As part of this review, U.S. vaccine manufacturers responded to a December 1998 and April 1999 FDA Federal Register request to provide more detailed information about the thimerosal content of their products which included thimerosal as a preservative. It should be noted that the approved labeling of all biologicals including vaccines requires the listing of preservatives and the concentration on the label.

(21 CFR 610.61)

While the review found no evidence of adverse effects caused by thimerosal in vaccines, except for minor local hypersensitivity reactions (as explained above), the assessment determined that the use of thimerosal as a preservative in vaccines might result in the intake of mercury during the first six months of life that exceeded recommended guidelines from EPA. The amounts, however, do not exceed the recommended guidelines set by FDA, the Agency for Toxic Substances and Disease Registry, and the World Health Organization. Of note, such guidelines contain safety factors and are meant as starting points for evaluation of mercury exposure, not absolute levels above which toxicity can be expected to occur.

Even though no major safety concerns resulting from use of thimerosal in vaccines were found, FDA concluded that reducing or eliminating exposure to thimerosal in vaccines was merited. Given the goal of reducing human exposure to mercury from all sources and the feasibility of single dose vials in the U.S., for which preservatives are not mandated, this action was justified. This review recognized the limitations of available data and recommended further studies to provide a more precise characterization of the potential risk from thimerosal in vaccines. These conclusions led FDA and others within PHS to announce the July 1999 recommendation that, as a precautionary measure, thimerosal be reduced or eliminated from childhood vaccines to make already safe vaccines even safer.

On July 1, 1999, CBER notified all vaccine manufacturers by letter that the use of thimerosal in biologic products would continue to be evaluated. As part of the evaluation, CBER requested that all manufacturers of thimerosal-containing vaccines provide information to CBER regarding their plans for thimerosal as a preservative in U.S. licensed vaccines.

The letter requested that if the manufacturer intended to remove thimerosal from their product(s), the following information needed to be discussed:

proposed studies to assess the effect of removing thimerosal on sterility, potency, stability, and immunogenicity of the product;
feasibility of eliminating or reducing the amount of thimerosal, using alternative preservatives, or reformulating the product solely for single dose containers;
anticipated manufacturing changes as a result of removing thimerosal, if any; and,
approximate time-line necessary to evaluate and implement removal.
If the manufacturer intended to continue using thimerosal in their product(s), an explanation was requested as to why that decision was made. (The letter can be found at www.fda.gov/cber/ltr/thim070199.htm.)

In August 1999, the available scientific information on thimerosal in vaccines was reviewed at a public workshop sponsored by the National Vaccine Advisory Committee (NVAC). The NVAC workshop was convened to examine the evidence for risks associated with possible exposures, however, there was no current evidence of a significant public health problem from thimerosal in vaccines. The meeting participants did urge that thimerosal be removed from vaccines as a prudent measure and that further research continue.

FDA�s OVRR has been encouraging manufacturers to develop new vaccines without thimerosal as a preservative and to remove or reduce the thimerosal content of existing, licensed vaccines. Substantial progress has been made in the removal of thimerosal from vaccines. In August 1999, FDA approved a license supplement from Merck for a thimerosal-free hepatitis B vaccine. In March 2000, FDA approved a license supplement from SmithKline Beecham Biologicals for a thimerosal reduced hepatitis B vaccine (with more than 96 percent of the thimerosal removed from the vaccine, from a level of 25 micrograms of thimerosal per dose to less than one microgram per dose). Additionally, Wyeth-Lederle Vaccines and Pediatrics is now marketing only a single-dose, thimerosal-free formulation of their Haemophilus influenzae type b (Hib) vaccine (they are no longer marketing the thimerosal containing multi-dose formulation). The other U.S.-licensed Hib vaccines are thimerosal-free. Thus, all pediatric hepatitis B and Hib vaccines currently being marketed are thimerosal-free or greatly reduced. Vaccines for polio, chicken pox, and mumps-measles-rubella already were thimerosal-free. Based on the progress in the past year, the maximum amount of ethyl mercury that an infant may be exposed to from the routine immunization schedule has been reduced by sixty percent (60%).

At present, there are four U.S.-licensed DTaP vaccines. The DTaP manufactured by SmithKline Beecham Biologicals (SBB) does not contain thimerosal as a preservative, while the DTaP vaccines from Wyeth-Lederle Vaccines and Pediatrics, Aventis Pasteur, and North American Vaccine do contain thimerosal.

Recently both Wyeth-Lederle Vaccines and Aventis Pasteur announced plans to submit supplements to their respective DTaP licenses in either July or August of this year for thimerosal-reduced DTaP vaccine formulations. FDA is committed to the expedited review of these supplements.

To further encourage the development of thimerosal-free vaccines, CBER sent another letter to vaccine manufacturers on May 31, 2000. CBER requested an update on progress toward the goal of thimerosal-free vaccines, particularly for vaccines administered to infants and children. For each manufacturer's product noted in the reply to CBER, the following information was requested:

actions taken to date to develop thimerosal-free or thimerosal-reduced vaccine;
time lines for implementing proposed changes to reduce or eliminate thimerosal from the product(s); and,
identification of which products, if any, the manufacturer intended to continue using thimerosal and an explanation of why reduction or removal of thimerosal is not feasible.
Responses were requested from manufacturers within 45 days. (The letter can be found at www.fda.gov/cber/ltr/thim053100.htm.)

In June 2000, the National Immunization Program (NIP) of the Centers for Disease Control and Prevention (CDC) convened another meeting intended to further address the potential for health problems associated with exposure to thimerosal in vaccines. CDC had recently conducted an initial study to screen for any possible association between a variety of neurologic, developmental, and renal outcomes and the amount of thimerosal in vaccines. The consensus of the group reviewing the data was that the findings were insufficient to support any causal relations between exposure to thimerosal-containing vaccines and selected neurological development disorders, but did urge that additional research be continued.



FDAMA REPORT

As discussed above, under section 413(a) of FDAMA, FDA was required to: (1) compile a list of drugs and foods that contain intentionally introduced mercury compounds, and (2) provide a quantitative and qualitative analysis of the mercury compounds in this list. FDA published requests for data and information on mercury compounds in drugs and food. The Agency asked all manufacturers of any food, including dietary supplements, and human and veterinary drug products (prescription or over-the-counter (OTC)) containing any intentionally introduced mercury compounds, whether used as an active or inactive ingredient, to provide information about the products to the Agency.

The Agency received 41 responses to the request-for-data notices; 38 from manufacturers of products, one from an association of homeopathic pharmacists, and two from consumers. Of the 38 responses from manufacturers, 15 were from manufacturers of homeopathic drug products, and 23 were from manufacturers of drug and/or biologic products (13 drug manufacturers, eight biologic manufacturers, and two manufacturers of both types of products). Five of the drug manufacturers informed the Agency that they had no products containing any mercury compounds. One drug manufacturer was an animal health corporation providing information on a veterinary drug product, and two manufacturers of homeopathic products included information on five veterinary drug products as well as human drug products.

In November 1999, FDA made available the document prepared in response to the FDAMA section entitled "Mercury Compounds in Drugs and Foods." The document discusses drugs (including biologics) and foods that contain intentionally introduce mercury compounds. The document provides a quantitative and qualitative analysis of the mercury compounds in the products. (The document can be found at www.fda.gov/cder/fdama/mercuryreport.htm.)

CONCLUSION

On April 17, 2000, Secretary Donna E. Shalala, Department of Health and Human Services (DHHS), kicked off National Infant Immunization Week by releasing a new public awareness campaign urging all parents to immunize their children. The key message is that childhood vaccines have been a success story in American public health initiatives. Childhood immunization rates have reached all time highs with more than 90% of America's children receiving the most critical doses of vaccines for children by age two. Reported rates of diseases, for which childhood vaccines were developed, were at or near record lows in 1998. Without vaccinations, children would be at a very high risk for contracting many of these preventable childhood diseases.

While FDA and other components of DHHS work to remove thimerosal from childhood vaccines, parents should continue to have their children vaccinated. The risks of not vaccinating children far outweigh the unknown and much smaller risk, if any, of exposure to thimerosal in vaccines.

Thank you for the opportunity to testify.
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Old 12-28-2007, 02:22 PM #3
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Letter to Vaccine Manufacturers
Regarding Plans for Continued use of Thimerosal as a Vaccine Preservative

Department of Health and Human Services
Public Health Service
Food and Drug Administration
1401 Rockville Pike
Rockville, MD 20852-1448


July 1, 1999

Dear Vaccine Manufacturer:

The Center for Biologics Evaluation and Research (CBER) is evaluating the continued use of thimerosal in biologic products under the Food and Drug Administration Modernization Act (FDAMA) of 1997, Section 413, "FDA Study of Mercury Compounds in Drugs and Food."

As part of this evaluation, we are now requesting that all manufacturers of thimerosal-containing vaccines provide information to CBER regarding their plans for thimerosal as a preservative in U.S. licensed vaccines, addressing each product separately.


If you intend to remove thimerosal from your product(s), please discuss the following:

proposed studies to assess the effect of removing thimerosal on sterility, potency, stability, and immunogenicity of the product;

feasibility of eliminating or reducing the amount of thimerosal, using alternative preservatives, or reformulating the product solely for single dose containers;

anticipated manufacturing changes as a result of removing thimerosal, if any;

approximate time-line necessary to evaluate and implement removal.

If you intend to continue using thimerosal in your product (s), please provide an explanation as to why you have made this decision.
Please note that FDA regulations do not require use of preservatives in biological products formulated for single-dose containers. CBER encourages discussions with manufacturers as to what additional data, if any, would be required to effect such a change.

We request that you submit the information requested above within 45 days to the attention of Ms. Valerie Vashio, HFM-475. Please contact Norman W. Baylor, Ph. D. at 301-827-0655 if you have questions or would like to schedule a meeting with CBER regarding the above request.

Sincerely yours,

--- signature ---

William Egan, Ph.D.
Acting Director,
Office of Vaccines
Research and Review
Center for Biologics
Evaluation and Research




Updated May 20, 2002
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Old 12-28-2007, 02:33 PM #4
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Mercury Poisoning Overview
This article discusses poisoning from mercury.

Reference from A.D.A.M.
Back to TopPoisonous Ingredient
There are three different forms of mercury that cause health problems.

Elemental mercury, also known as liquid mercury or quick silver
Inorganic mercury salts
Organic mercury
Back to TopWhere Found
Elemental mercury can be found in:

Glass thermometers
Electrical switches
Fluorescent light bulbs
Older dental fillings
Some medical equipment
Inorganic mercury can found in:

Chemistry labs
Some disinfectants
Folk culture medicines
Red cinnabar mineral
Organic mercury can be found in:

Older antiseptics, such as red mercurochrome (merbromin) -- this substance is now banned by the FDA
Thimerosal
Fumes from burning coal converted into organic mercury by certain organisms
Fish that have eaten a form of organic mercury called methylmercury -- see article on methylmercury
Note: This list may not be all inclusive.
Back to TopSymptoms
ELEMENTAL MERCURY

Elemental mercury is usually quite harmless if touched or swallowed. It is so thick and slippery that it usually falls off your skin or out of your stomach without being absorbed.

Considerable damage can occur, however, if mercury is made airborne into small, little droplets and breathed into the lungs. This can often occur by mistake when people try to vacuum up mercury that has spilled onto the ground.

Breathing in elemental mercury will cause symptoms right away (acute) if enough mercury is breathed in. Symptoms will also occur over time (chronic) if little amounts are inhaled every day. If this occurs, symptoms may include:

Metallic taste
Vomiting
Difficulty breathing
Bad cough
Swollen, bleeding gums
Depending on how much mercury is inhaled, permanent lung damage and death may occur. You may also have some long-term brain damage from inhaled elemental mercury.

INORGANIC MERCURY

Unlike elemental mercury, inorganic mercury is usually poisonous when swallowed. Depending on the how much is swallowed, symptoms may include:

Burning in the stomach and throat
Bloody diarrhea and vomiting
If inorganic mercury enters your blood stream, it can attack the kidneys and brain. Permanent kidney damage and failure may occur. A large overdose may cause massive blood and fluid loss from diarrhea, kidney failure, and death.

ORGANIC MERCURY

Organic mercury can cause sickness if breathed in, eaten, or placed on the skin for long periods of time. Usually organic mercury causes problems over years or decades, not immediately. In other words, being exposed to small amounts of organic mercury every day for years will likely cause symptoms to appear later. Regardless, a single large exposure can also cause problems.

Long-term exposure will likely cause neurological symptoms, including:

Numbness or pain in certain parts of your skin
Uncontrollable shake or tremor
Inability to walk well
Blindness and double vision
Memory problems
Seizures and death (with large exposures)
Medical evidence suggests that being exposed to large amounts of the organic mercury called methylmercury while pregnant can permanently damage the baby’s developing brain. Most doctors will recommend eating less fish, especially swordfish, while pregnant. These recommendations are made to be extremely cautious. Small exposures are unlikely to cause any problems. Women should talk to their doctor about what should and should not be eaten while pregnant.
Back to TopBefore Calling Emergency
Determine the following:

The patient's age, weight, and condition
The name of the product (ingredients and strengths if known)
The time it was swallowed, inhaled, or touched
The amount swallowed, inhaled, or touched
Back to TopPoison Control, or a Local Emergency Number
The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the U.S. use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

See National Poison Control center.
Back to TopWhat to Expect at the Emergency Room
The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure.

ELEMENTAL MERCURY

Inhaled elemental mercury poisoning may be difficult to treat. The patient may receive:

Humidified oxygen or air
Breathing tube into the lungs
Suctioning of mercury out of the lungs
Medication to remove mercury and heavy metals from the body
INORGANIC MERCURY

For inorganic mercury poisoning, treatment usually begins with supportive care. The patient may receive:

Fluids by IV (into a vein)
Medicines to treat symptoms
Activated charcoal, a medicine that soaks up many substances from the stomach
Medicines called chelators to remove mercury from the blood
ORGANIC MERCURY

Treatment of organic mercury usually consists of medicines called chelators to remove mercury from the blood and away from the brain and kidneys. Often, these medications will have to be used for weeks to months.
Back to TopExpectations (prognosis)
Breathing in a small amount of elemental mercury will cause very few, if any, long-term side effects. However, larger amounts will lead to a long hospital stay. Permanent lung damage is likely. There may be some brain damage. Very large exposures will likely cause death.

A large overdose of inorganic mercury may cause massive blood and fluid loss, kidney failure, and likely death.

Chronic brain damage from organic mercury is difficult to treat. Although some people never recover, some success has been described in patients treated with chelation.
Back to TopReferences
Sue YJ. Mercury. In: Goldfrank LR, Flomenbaum NE, Lewin NA, et al. Goldfrank's Toxicologic Emergencies. 7th ed. McGraw-Hill; 2002:1239-1247.

Ford MD. Clinical Toxicology. 1st ed. Philadelphia, Pa: WB Saunders; 2001: 732-742.

Foulke JE. Mercury in Fish: A Cause for Concern. FDA Consumer Magazine. September 1994.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.
__________________
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by
.
, on Flickr
pd documentary - part 2 and 3

.


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Resolve to be tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant with the weak and the wrong. Sometime in your life you will have been all of these.
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Old 12-28-2007, 02:36 PM #5
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November 27, 2002
Justice Dept. Seeks to Seal Vaccine Papers
By SHERYL GAY STOLBERG
The Bush administration asked a federal claims court today to seal documents relating to hundreds of claims that a mercury-based preservative in vaccines, thimerosal, has caused autism and other neurological disorders in children.

Lawyers for the Justice Department asked for the protective order on behalf of Tommy G. Thompson, the secretary of health and human services, whose department administers a government fund to compensate people injured by vaccines.

A department spokesman said that the law creating the fund gives the secretary control over what information is released and that the government was merely trying to preserve that right.

About 1,000 families have filed claims under the program, asserting that their children suffered mercury poisoning from the vaccines, which until recently included the preservative. The claims are being heard by a special master, George Hastings, in a so-called vaccine court that was created in 1986, when Congress passed the measure setting up the government fund.

Lawyers for the families said they were outraged by today's move. They said the government was trying to prevent families from obtaining damaging information about the preservative, which could later be used against drug companies in civil courts.

''We're dealing with real injury to real children in a program that is funded by taxpayer dollars,'' said Michael R. Hugo, a Boston lawyer. ''It is unbelievable to me that the president of the United States, in the name of trying to help the drug industry, would put the interests of the drug industry over the interests of neurologically impaired sick children and their parents.''

Today's move comes on the heels of another controversy involving thimerosal.

Congressional Republicans inserted a provision into the domestic security bill, signed into law on Monday by President Bush, that is intended to protect Eli Lilly, thimerosal's manufacturer, from lawsuits over the preservative. The provision would force families to seek compensation through the vaccine court instead of civil courts.

Michael Bender, a spokesman for the Mercury Policy Project, a nonprofit advocacy group that is helping the families, said today's move ''amounts to insult on injury'' for children whose parents have filed claims.

''Suppressing these documents,'' Mr. Bender said, ''flies in the face of an open and transparent court system.''

Correction: November 28, 2002, Thursday An article yesterday about a Bush administration request to seal documents relating to claims that thimerosal, a mercury-based preservative in vaccines, has caused neurological disorders referred incorrectly to the measles-mumps-rubella vaccine in some copies. It does not contain the preservative.






Copyright 2007 The New York Times
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Resolve to be tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant with the weak and the wrong. Sometime in your life you will have been all of these.
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Old 12-28-2007, 02:38 PM #6
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November 25, 2002
Whose Hands Are Dirty?
By BOB HERBERT
Thimerosal is a preservative that contains mercury and was used for many years as an additive in some routinely administered children's vaccines.

Fears developed a few years ago that the additive might have been causing dangerously elevated levels of mercury in infants, resulting in neurological impairment and, in some cases, autism.

Studies thus far have neither shown nor ruled out a link between the vaccines and neurological damage in children. But in the summer of 1999 the American Academy of Pediatrics and the Public Health Service urged vaccine manufacturers to stop using thimerosal as quickly as possible.

Thus, thimerosal, which was developed by Eli Lilly & Company in the 1920's and was in widespread use by the 1990's, is no longer added to vaccines commonly given to children. But a serious controversy continues. Lawsuits have been filed by parents across the country who are convinced that their children suffered severe neurological damage from the mercury in the vaccines. Talking to them can be heartbreaking.

Lyn Redwood, a nurse practitioner and the wife of a physician in suburban Atlanta, spoke to me last week about her 8-year-old son, Will. ''I have a little boy who was completely normal at birth -- walking, talking, smiling, meeting all of his developmental landmarks,'' she said. ''Then, shortly after he turned 1 year old, he lost his ability to speak, to make eye contact. He started regressing and ultimately was diagnosed with pervasive developmental disorder, which falls into a spectrum of autism disorders.''

Ms. Redwood contends that three infant vaccines administered to her son when he was 2 months old exposed him to levels of mercury that far exceeded all safety guidelines.

At this point we must interrupt our narrative and turn our attention to the federal government's effort to fight terrorism in the United States.

Last week the Senate approved legislation to establish a Department of Homeland Security and it will soon be signed into law by the president. Buried in this massive bill, snuck into it in the dark of night by persons unknown (actually, it's fair to say by Republican persons unknown), was a provision that -- incredibly -- will protect Eli Lilly and a few other big pharmaceutical outfits from lawsuits by parents who believe their children were harmed by thimerosal.

Now this has nothing to do with homeland security. Nothing. This is not a provision that will in any way protect us from the ferocious evil of Osama bin Laden and Al Qaeda. So why is it there? Perhaps it has something to do with the fact that the major drug companies have become a gigantic collective cash machine for politicians, and that the vast majority of that cash goes to Republicans.

Or maybe it's related to the fact that Mitch Daniels, the White House budget director, is a former Eli Lilly big shot. Or the very convenient fact that just last June President Bush appointed Eli Lilly's chairman, president and C.E.O., Sidney Taurel, to a coveted seat on the president's Homeland Security Advisory Council.

There's a real bad smell here. Eli Lilly will benefit greatly as both class-action and individual lawsuits are derailed. But there are no fingerprints in sight. No one will own up to a legislative deed that is both cynical and shameful.

An official spokesman for Eli Lilly, Edward Sagebiel, insists the company knew nothing about it, nothing at all.

While the vote for the Homeland Security Department was overwhelming, even some Republicans were upset by the provision to benefit Lilly and the other drug companies.

Senator John McCain of Arizona characterized the provision as ''among the most inappropriate'' in the homeland security legislation. He said: ''This language will primarily benefit large brand-name pharmaceutical companies which produce additives to children's vaccines -- with substantial benefit to one company in particular. It has no bearing whatsoever on domestic security.''

The politicians with their hands out and the fat cats with plenty of green to spread around have carried the day. Nothing is too serious to exploit, not even the defense of the homeland during a time of terror.

Lyn Redwood put together an advocacy group, called Safe Minds, for parents struggling with the thimerosal issue. They're at a slight disadvantage, wielding a popgun against the nuclear-powered influence of an Eli Lilly.

E-mail: bobherb@nytimes.com

Copyright 2007 The New York Times
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Resolve to be tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant with the weak and the wrong. Sometime in your life you will have been all of these.
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Old 12-28-2007, 04:14 PM #7
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Default small pox shots cause alarm

Vaccines Ruined by Poor Refrigeration

From: AP Online Date: December 5, 2007
Author: MELANIE S. WELTE More results for:

small pox shots cause alarm
Every year, thousands of American children go through the tearful, teeth-gritting ordeal of getting their vaccinations, only to be forced to do it all over again. The vaccines were duds, ruined by poor refrigeration.

It is more than a source of distress for parent and child. It is a public health threat, because youngsters given understrength vaccines are unprotected against dangerous diseases. And it accounts for a big part of the $20 million in waste incurred by the federal Vaccines for Children program.

"This is a substantial problem that needs to be addressed through prevention, and when problems are discovered, often times through revaccinations," said Dr. Lance Rodewald, director of immunization services at the Centers for Disease Control and Prevention in Atlanta.

By CDC estimates, hundreds of thousands of doses of vaccines against such diseases as flu, diphtheria, tetanus, whooping cough, polio, mumps, measles, chicken pox and the cervical cancer virus are thrown out each year because of poor refrigeration at clinics, hospitals and doctors' offices.

In one recent case in Sioux City, Iowa, more than 1,000 families were notified by letter and telephone that they needed to get their children revaccinated. State officials found that the refrigerator at the clinic that administered the shots repeatedly dropped below freezing over a 17-month period in 2005 and 2006, potentially ruining the vaccines stored there.

"We just didn't notice it," said Dr. Ray Sturdevant, president of the Prairie Pediatrics and Adolescent Clinic.

Poor refrigeration has been blamed for similar problems elsewhere around the country over the past 2 1/2 years:

_ In St. Cloud, Minn., a clinic had to revaccinate 8,600 patients, most of them children.

_ In Lane County, Ore., 500 children and adults had to get another shot.

_ In western Florida, it happened to about 250 kids.

In Sioux City and other cases, the spoilage resulted from a combination of factors: The refrigerator malfunctioned or was not set or maintained at the proper temperature _ a problem that can be caused simply by leaving the door open for a while _ and the workers responsible for regularly logging the temperature did not seem to recognize when the readings were off.

"We do everything we can to advise and to make people aware that this is very expensive vaccines they're dealing with and we really want to handle it properly and store it properly to prevent these things from happening _ but they do," said Charles Alexander, chief of immunization with the Florida Health Department.

Inadequate refrigeration can cause vaccines to lose their potency, although experts say spoiled childhood vaccines are not dangerous in themselves if given to a youngster.

And there are no known cases of children contracting a disease because they had been given a vaccine rendered ineffective by poor refrigeration. But it could happen, and "that's why we're concerned about it," Rodewald said.

Since 2000 the CDC has pushed state health departments to visit clinics and check their refrigerators. Most states require clinics to use refrigerators with reliable thermometers that can be monitored, and staff members must know what to do when temperatures are above or below the proper range, Rodewald said.

Waste costs the $2 billion-a-year federal Vaccines for Children Program about $20 million a year, and the biggest single problem is improper refrigeration, Rodewald said. Other causes: The vaccines expire or were damaged in shipment.

Rodewald had no breakdown of how much in waste is attributable to poor refrigeration. But he emphasized that the losses amount to an extremely small percentage of the childhood vaccine program.

"The childhood program saves $10 billion each year in direct health care costs by preventing disease among children," he said. "Although preventing vaccine wastage is a priority, the amount wasted should be placed in the context of the overall program economic benefits."

Altogether in 2006, there were 32 instances in Iowa in which vaccines were not refrigerated correctly, said Dr. Patricia Quinlisk, state epidemiologist. Quinlisk would not say how many patients were affected, but estimated $750,000 worth of vaccine in the Vaccine for Children Program was wasted.

"We will get months and months and months of vaccine refrigerator logs where the refrigerator is out of the temperature and nobody has done anything except every day mark down it's out of temperature," she said.

In the Minnesota case, the refrigerator was not kept at the proper temperature and there were gaps in documentation, said Jill Marette of the Minnesota Department of Health.

"It's stressful to vaccinate your children in the first place _ just the idea of giving them all those shots. Then you have to think about getting revaccinated," Marette said.

Of greatest concern is the chickenpox vaccine. It must be kept frozen at an average temperature of 5 degrees or lower and should be kept in the dark. Children who receive an ineffective vaccine could easily become infected because the disease is fairly common in the U.S.

Dr. Joseph Bocchini, chairman of the Committee on Infectious Diseases with the American Academy of Pediatrics, said his group and others have issued clear recommendations about storing vaccines, and refrigerators can be equipped with alarms that sound when the temperature goes out of range.

Copyright 2007 The Associated Press
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Resolve to be tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant with the weak and the wrong. Sometime in your life you will have been all of these.
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