Selection of biological matrix(ces) UN Environment National Research Council of Italy - Institute of Atmospheric Pollution Research World Health Organization (WHO) Workshop “Elements to consider when designing a Global Monitoring Plan for Mercury” 13 – 14 February 2018, Rome, Italy Selection of biological matrix(ces) Kyrgyz Republic Prepared by Prof. Ainash Sharshenova (M.D., Ph.D.) Head, Centre for Environmental medicine and human ecology Scientific and Production Centre for Preventive Medicine (SPCPM), MoH KR

Criteria for selection of biological matrices Scientific value For HBM surveys, non-invasive matrices are preferred. Selected biomarkers collected at birth or soon after the birth indicate exposure throughout the pregnancy. The selection of biological matrix for assessing human exposure depends: on mercury compounds (organic vs. inorganic), exposure pattern (chronic or acute), on time of sampling after the exposure (UNEP and WHO, 2008). Conclusion When choosing the type of biomatrix, the main thing is to determine What will be investigated? Which population group?

Criteria for selection of matrices Feasibility of collection The difficulties in selecting hair samples were in some countries because of cultural traditions (superstition): Ghana – braided hair (with hairpieces); India – due to cultural issue, collection of hair sample from pregnant was difficult; Mongolia - pregnant women think that use metal scissors for hair it will be adversely affected to their fetus. As a result: due to the team effort and understanding of the participants, the samples were selected.

Feasibility, applicability of matrices Samples/ country HAIR (HM) CORD BLOOD (CB) URINE (UM) Cultural differences Russia good Kyrgyz Republic Mongolia difficult * India Ghana All three bio-matrices (CB, HM, UM) are applicable.

overfilling of freezer cameras Inadequate space in laboratories Other criteria Biomatrix WHO SOPs STORAGE In hospital in laboratory Maternal scalp hair (HM) 3 cm of scalp hair taken close to the scalp, registration form (RF) in envelopes, zip-lock bags Room t Under normal conditions Cord Blood (CB) Collection: ex-utero and in-utero Tubes: B1 polypropylene 50mL with 0.5mL EDTA CB -10ml; B2 polypropylene metal-free tube 10ml CB - 2ml and (RF) t= + 4° C up to 2 hours t ≤ - 20° C until analysis Maternal urine (UM) First morning UM sample or 5 hours since last urination. Place: maternity ward prior to child birth or up to 14 days after birth (RF). UM aliquote: minimum – 50 m; Tube U2 (Hg) – 5-10ml no pipetting Tube U4 (creatinine) -5-10ml. up to 2 hours; t≤ -20° C Challenges Participants noted a problem in the lack of space for storing cord blood and urine samples overfilling of freezer cameras (1per month) Inadequate space in laboratories

Transportation and safety measures MATRIX SAFETY measures IN-LAND transportation Maternal scalp hair (HM) should be 2 samples ID code do not require any special transport conditions Cord Blood (CB) samples should be at least 2 aliquots before freezing for Hg analysis in the national & the reference laboratories ID code Refrigerated bags, refrigerants, correct packing and shipment of samples, special transport Maternal urine (UM) samples should be at least 3 aliquots before freezing for Hg and creatinine analysis in the national & the reference laboratories. ID code. special transport. Challenges: 1) Limited finance; additional costs for transportation from the field to the laboratory. 2) Logistics from local small hospitals to Central (Russia). 3) Long distance (>900 km), hard-to-reach region, highlands (Kyrgyz Republic). OUT-LAND transportation Compliance the international transport regulations – IATA, WHO Guidance for the transport of Infectious substances 2017-2018 (Biological Substances, Category B, UN codes, packed according instruction 650, etc.). All samples should the correct packing and shipment.

Sampling quality control Training: the team and medical staff of the hospitals Control of field work quality: regular visits NC/LA, good collaboration with doctors and nurses; compliance with requirements of WHO SOPs; ID codes, sampling check, filling the forms, protocols, check-lists. Usefulness of WHO SOPs - Useful. Challenges: WHO SOPs were too complicated for Understanding by local staff; need to be simplified; to make additions for the international shipments (IATA). In the questionnaire, it is necessary to rank education in detail; review questions on sources for heating, cooking and nutrition.

THANK YOU VERY MUCH for WHO/UNEP project and Summary Choose criteria Hair Blood Urine General population +++ - Occupational exposure and some hot spots (industrial) + Easiness to collect ++ Storage (t -regime, space, conditions) Transportation Cultural complications THANK YOU VERY MUCH for WHO/UNEP project and all teams!