Document LgMw580OMDmDa43oBR2pVd10d

Preventing Lead Poisoning in Young Children A STATEMENT BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION - OCTOBER 1991 William L. Roper, M.D., M.P.H, Director National Center for Environmental Health and Injury Control Vernon N. Houk, M.D., Director Division of Environmental Hazards and Health Effects Henry Falk, M.D., Director Lead Poisoning Prevention Branch Sue Binder, M.D., Chief U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention NOTE: Use of trade names is for identification purposes only and does not constitute endorsement by the public health service or by the department of health and human services. Table of Contents: Preface Advisory Committee On Childhood Lead Poisoning Prevention Conversion To Systeme International (SI) Units Chapter 1. Introduction Summary References Chapter 2. Background Summary Effects of lead on children and fetuses Absorption of lead Blood lead levels in the united states References Chapter 3. Sources And Pathways Of Lead Exposure Introduction Lead-based paint Soil and dust Drinking water Occupations and hobbies Airborne lead Food Other sources Sources of lead outside the united states References Chapter 4. The Role Of The Pediatric Health-Care Provider Anticipatory guidance Screening for childhood lead poisoning Doing appropriate diagnostic blood lead testing Interpretation of blood lead levels Educating parents about reducing blood lead levels Coordinating with public sector officials Appropriate follow-up Chapter 5. The Role Of State And Local Public Agencies Public health agencies Housing Agencies Environmental Agencies Chapter 6. Screening Summary Suggested priorities for screening Screening method Anticipatory guidance and assessing risk Screening schedule Classification on the basis of screening test results Measurement of blood lead levels Erythrocyte protoporphyrin (ep) References Chapter 7. Diagnostic Evaluation And Medical Management Of Children With Blood Lead Level 20 g/dL Summary Symptoms of lead poisoning Evaluation of the child with a blood lead level > or = 20 g/dl Pharmacology of chelating agents Bal CaNa2EDTA Treatment guidelines for children with blood lead levels > or = 20 g/dl Post-chelation follow-up Research areas and future trends in the management of childhood lead poisoning References Chapter 8. Management Of Lead Hazards In The Environment Of The Individual Child Summary Environmental case management Testing for and abating lead-based paint References Chapter 9. Management Of Lead Hazards In The Community Surveillance Risk assessment and integrated prevention planning Outreach and education Infrastructure development Hazard abatement Appendix I. Capillary Sampling Protocol A. Needed materials B. Preparing for blood collection C. Preparing the finger for puncture D. Puncturing of the finger and forming drops of blood E. Filling the collection container References Appendix II. Summary For The Pediatric Health-Care Provider Chapters 1 and 2. Introduction and background Chapter 3. Sources and pathways of lead exposure Chapter 4. The role of the pediatric health-care provider Chapter 5. The role of state and local public agencies Chapter 6. Screening Chapter 7. Diagnostic evaluation and medical management of children with blood lead levels > or = 20 g/dl BAL CaNa2EDTA Chapter 8. Management of lead hazards in the environment of the individual child Chapter 9. Management of lead hazards in the community Point Of Contact For This Document Tables Table 1.1 - Interpretation Table 3.1 - Industries Table 6.1 - Priority Table 6.2 - Assessing Table 6.3 - Class Table 6.4 - Suggested Table 7.1 - Pharmacology Figures Fig. 2.1 - Lowest Fig. 2.2 - Blood Fig. 2.3 - Blood Fig. 2.4 - Cumulative Fig. 2.5 - Change Fig. 2.6 - Relationship Back to top Preface This is the fourth revision of the statement on Preventing Lead Poisoning in Young Children by the Centers for Disease Control (CDC). The recommendations continued herein are based mainly on the scientific data showing adverse effects of lead in young children at increasingly lower blood lead levels. They are tempered, however, by practical considerations, for example, of the numbers of children echo would require follow up and the resources required to prevent this disease. It is possible that further scientific data and development of infrastructure and technology will result in a lowering of the blood lead level at which interventions are recommended at a future time. This statement is a departure from previous ones in several ways. Perhaps most important is the emphasis on primary prevention and the need for coordination between pediatric health-care providers and public agencies. This statement reflects the vision expressed in the Department of Health and Human Services' Strategic Plan for the Elimination of Childhood Lead Poisoning, which calls for a concerted, coordinated society wide effort to eliminate this disease. In writing this statement, we identified several areas where better data are needed in order to provide scientifically sound guidance. These range from evaluating the efficacy of chelation therapy at lower blood lead levels in terms of preventing the adverse effects of lead to developing science-based criteria for determining when an abated unit is cleaned up enough for rehabilitation. We hope that the appropriate research to answer such questions will be conducted in a timely manner, and we will continue to update the statement to reflect current understanding. We are aware of concerns about the impact the changes in the statement will have on childhood lead poisoning prevention programs, laboratories, and pediatric health-care providers. In this new statement, we recognize the need for a transition period until we are able to implement fully the new recommendations; it will take time and a concerted effort to implement this new guidance. CDC is conducting several activities which bear directly on the implementation of the statement. First, as noted above, the Strategic Plan for the Elimination of Childhood Lead Poisoning was released by Dr. Louis W. Sullivan, Secretary of the Department of Health and Human Services, on February 21, 1991. In addition to laying out the actions needed to eliminate childhood lead poisoning, this plan describes the need for infrastructure and technology development, including for the evaluation of blood and environmental lead levels. Second, CDC is aggressively pursuing research and development efforts in collaboration with several instrument manufacturers to develop a field-rugged, relatively inexpensive, and simple-to-operate blood lead instrument, which would markedly enhance blood lead screening efforts. Initial results are encouraging, but the effort is still in the developmental stage. If all goes well, new instrumentation could be ready in 2 to 3 years. Third, we are continuing our efforts to help laboratories improve the quality of their blood lead measurements through our proficiency testing program and through our Blood Lead Laboratory Reference System. Finally, CDC also has a grant program in childhood lead poisoning prevention, through which state and local health agencies receive Federal money to screen children for lead poisoning, ensure environmental and medical follow up for poisoned children, and provide education about lead poisoning. By the end of FY 1991, we will be funding 13 state and 2 city childhood lead poisoning prevention programs, and the President's budget for 1992 includes almost a doubling of the FY 1991 budget. We continue to encourage CDC-funded programs to address infrastructure issues. Other Federal agencies, like the Environmental Protection Agency and the Department of Housing and Urban Development, have also released plans that deal with aspects of the childhood lead poisoning problem. These agencies are also working to build the needed infrastructure for and expand the scientific knowledge on reducing exposure to lead in the environment. I wish to thank the members of the Committee and consultants, as well as the numerous other people who assisted in the development and revision of this document. I believe this document will be a major landmark in the effort to eliminate childhood lead poisoning from the United States. Vernon N. Houk, M.D. Director National Center for Environmental Health and Injury Control Back to top ADVISORY COMMITTEE ON CHILDHOOD LEAD POISONING PREVENTION MEMBERS AND CONSULTANTS Chair John F. Rosen, M.D., Attending Pediatrician, Montefiore Hospital and Medical Center, 111 East 20th Street, Bronx, New York 10467 Executive Secretary Henry Falk, M..D., Director Division of Environmental Hazards and Health Effects, National Center for Environmental Health and Injury Control, Centers for Disease Control, Atlanta, Georgia 30333 Members Evelyn S. Bouden, M.D. ,Director ,Division of Maternal and Child Health, Pennsylvania Department of Health, 725 H & W Building, Harrisburg, Pennsylvania 17108 Beverly Coleman-Miller, M.D., Special Assistant for Medical Affairs, Commission of Public Health, 1660 L Street, N.W., Suite 1204, Washington, D.C. 20036 Ronald L. Fletcher, M.D., Co-Director, Oncology Department, Greene Memorial Hospital, 1141 N. Monroe Drive, Xenia, Ohio 44385 Lynn R. Goldman, M.D., Chief, Environmental Epidemiology and Toxicology Section Department of Health Services, 5900 Hollis Street, Suite E Emeryville, California 94608 Dwala S. Griffin, Administrator, Division of Preventive Medicine, Louisville-Jefferson County Board of Health, 400 East Gray Street, Louisville, Kentucky 40202 Richard J. Jackson, M.D., Chief, Office of Environmental Health Hazards Assessment, California Department of Health Services, 2151 Berkeley Way, Room 619, Berkeley, California 4704-1071 Rudolph E. Jackson, M.D., Professor and Acting Chairman, Department of Pediatrics, Morehouse School of Medicine, 720 Westview Drive, S.W., Atlanta, Georgia 30310 James C. Keck, President, Leadtec Services, Inc., 522 Beck Avenue, Baltimore, Maryland 21221 Herbert L. Needleman, M.D., Professor of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Iroquois Building, Suite 305, 3600 Forbes Avenue, Pittsburgh, Pennsylvania 15213-2593 Sergio Piomelli, M.D., Director, Babies Hospital, 3959 Broadway, New York, New York 10032 Stephanie L. Pollack, J.D., Attorney, Conservation Law Foundation of New England, 3 Joy Street, Boston, Massachusetts 02108-1497 Knut Ringen, Dr.P.H., Director, Laborers' National Health and Safety Fund, 905 16th Street, NW, Washington, D.C. 20006 Noel V. Stanton, Lead Chemist, Toxicology Section, State Laboratory of Hygiene, 465 Henry Mall, Madison, Wisconsin 53706 Consultants David Bellinger, Ph.D., Neuroepidemiology Unit Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115 James J. Chisolm, Jr., M.D., Associate Professor, Francis Scott Key Medical Center, Building G. Room 224, 4940 Eastern Avenue, Baltimore, Maryland 21224 Charles G. Copley, Deputy Health Commissioner, City of Saint Louis, Department of Health and Hospitals, Office of the Commissioner, 634 N. Grand, P. O. Box 147202, Saint Louis, Missouri 63178 Anita S. Curran, M.D., Assistant Dean for Clinical Affairs, Robert Wood Johnson Medical Center, University of Medicine and Dentistry of New Jersey, One Robert Wood Johnson Place, New Brunswick, New Jersey 08903 John W. Graef, M.D., Director, Lead/Toxicology Clinic, The Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115 Phillip J. Landrigan, M.D., Director Division of Environmental and Occupational Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, New York 10029 John R. Reigart, M.D., Project Pediatrician, S. C. Childhood Lead Poisoning Project, Department of Pediatrics, Children's Hospital, 171 Ashley Avenue, 6th Floor, Charleston, South Carolina 29425 Back to top CONVERSION TO SYSTEME INTERNATIONAL (SI) UNITS Blood Lead 1.0 g/dL = 0.04826 umol/L 1.0 g/dL = 20.72 g/dL 0 g/dL = 0. umol/L 5 g/dL = 0.241 umol/L 10 g/dL = 0.483 umol/L 15 g/dL = 0.724 umol/L 20 g/dL = 0.965 umol/L 25 g/dL = 1.206 umol/L 30 g/dL = 1.448 umol/L 35 g/dL = 1.689 umol/L 40 g/dL = 1.930 umol/L 45 g/dL = 2.172 umol/L 50 g/dL = 2.413 umol/L 55 g/dL = 2.654 umol/L 60 g/dL = 2.896 umol/L 65 g/dL = 3.137 umol/L 70 g/dL = 3.378 umol/L Erythrocyte Protoporphyrin 1.0 g/dL = 0.01778 umol/L 1.0 umol/L = 56.25 g/dL 28 g/dL = 0.498 umol/L 35 g/dL = 0.622 umol/L 70 g/dL = 1.245 umol/L Lead Home | About Lead | Lead Publications | Lead Events NCEH Home| Programs | Publications | Contact Us | Privacy | About NCEH CDC Home | CDC Search | Health Topics A-Z