The nervous system effects of occupational exposure to manganese--measured as respirable dust--in a South African manganese smelter.

OBJECTIVES

A major recent review of occupational exposure limits for manganese (Mn) has proposed a respirable dust level of 0.1 mg/m3. There is, however, no theoretical basis for using this exposure metric to estimate the systemic effects of Mn, and little in the way of empirical data relating respirable Mn to neurobehavioural and other non-pulmonary effects. Cross-sectional data from a study showing few and unconvincing neurobehavioural effects of inhalable dust in Mn smelter workers published just prior to this review were reanalyzed here using respirable Mn. The hypotheses tested were that respirable Mn exposure is a more appropriate predictor of neurobehavioural effects than inhalable Mn where such effects exist, and that there should be no observed effects at respirable dust levels below 0.1 mg/m3.

METHODS

Five hundred and nine production workers and 67 external referents were studied. Exposure measures from personal sampling included the Mn content of respirable dust as a concentration-time integrated cumulative exposure index (CEI) and as average intensity (INT) over a working lifetime. Neurobehavioural endpoints included items from the Swedish nervous system questionnaire (Q16), World Health Organisation neurobehavioural core test battery (WHO NCTB), Swedish performance evaluation system (SPES), Luria-Nebraska (LN), and Danish Product Development (DPD) test batteries, and a brief clinical examination.

RESULTS

The median respirable Mn exposure was 0.058 mg/m3 (range=0-0.51; IQR=0.02-0.16) amongst the exposed, with 30% having average intensities above the proposed 0.1 mg/m3 and 44% above the proposed supplemental limit of 0.5 mg/m3 inhalable dust. As in the study of inhalable Mn effects, there were few respirable Mn effects showing clear continuity of response with increasing exposure.

CONCLUSION

These data did not provide empirical support for a respirable, as opposed to an inhalable, dust metric being more sensitive in the identification of Mn effects. Neither metric showed convincing effects within the exposure range studied. Further study is needed to determine a threshold for respirable Mn effects, if such exist, and to verify our findings.