Surveillance of Elevated Blood Lead Levels Among Adults --
United States, 1992
As of May 1, 1992, health departments of 18 states required
reporting of elevated blood lead levels (BLLs) in adults (Table 1).
State-based lead surveillance activities have the following common
features: 1) a regulation specifying a reportable level, 2)
designation of reporting sources (e.g., laboratories and
health-care providers), 3) a means for gathering further essential
information about reported cases, and 4) a mechanism for linking
case reports with follow-up activities (e.g., educational efforts
and epidemiologic field investigations). In response to the recent
changes in CDC's guidelines for preventing lead poisoning in
children (1) and to recommendations of CDC's National Institute for
Occupational Safety and Health (NIOSH) to reduce occupational lead
exposures (2), many states are revising downward their reportable
BLLs.
During 1991, 13 states provided 18,879 reports of elevated
BLLs in adults to NIOSH (Table 2). However, lead monitoring
programs may perform multiple BLL tests for individual workers:
during 1991, the 10,117 reports from Illinois, New Jersey, and New
York * represented 4406 persons (i.e., an average of 2.3 reports
per person).
The reports in this issue of MMWR highlight the role of the
field investigation in the control of occupational lead poisoning
and address unique aspects of the control of lead in the workplace
and in the environment. During 1992, NIOSH will begin reporting
blood lead data for adults (as prevalence and incidence) on a
quarterly basis in MMWR.
Reported by: B Harrell, MPA, Div of Epidemiology; CH Woernle, MD,
State Epidemiologist, Alabama Dept of Public Health. N Maizlish,
PhD, A Osorio, MD, Occupational Health Surveillance and Evaluation
Program, California Dept of Health Svcs. N Tolentino, MPH,
Connecticut State Dept of Health Svcs. J Keller, PhD, M Lehnherr,
Occupational Disease Registry; H Howe, PhD, Div of Epi Studies,
Illinois Dept of Public Health. R Currier, DVM, State
Epidemiologist, Iowa Dept of Public Health. E Coe, MPH, Health
Registries Div, Maryland Dept of the Environment. R Rabin, MSPH,
Div of Occupational Hygiene, Massachusetts Dept of Labor and
Industries. B Gerwel, MD, Occupational Disease Prevention Program,
New Jersey State Dept of Health. R Stone, PhD, New York State Dept
of Health. T O'Connor, JE Gordon, PhD, Environmental
Epidemiologist, State Health Div, Oregon Dept of Human Resources.
J Logue, DrPH, Div of Environmental Health, Pennsylvania Dept of
Health. J Pichette, DM Perrotta, PhD, Environmental Epidemiologist,
Texas Dept of Health. D Beaudoin, MD, D Thurman, MD, Bur of
Epidemiology, Utah Dept of Health. L Hanrahan, MS, Wisconsin Dept
of Health and Social Svcs. Div of Surveillance, Hazard Evaluations,
and Field Studies, National Institute for Occupational Safety and
Health, CDC.
Editorial Note
Editorial Note: NIOSH assists states in establishing lead
surveillance and has begun to collect data from states and to
routinely disseminate national data on elevated BLLs in adults.
Surveillance activities 1) document the magnitude of the lead
exposure problem in the workplace, 2) assist public health agencies
in focusing on industries where control of lead exposure remains a
problem, 3) identify new sources of industrial lead poisoning, 4)
guide engineers in the design of technologies to
control lead in the workplace, and 5) focus public attention and
education efforts on excessive lead exposure as an ongoing
occupational health problem. Efforts have been initiated to use
surveillance data to monitor trends in the incidence of
workplace-associated lead poisoning and to provide evaluation of
prevention programs to reduce lead exposure.
Lead-induced health effects are known to occur in children and
adults across a wide range of exposures. Laboratory-based
surveillance is the preferred approach because symptoms of lead
poisoning are not particularly sensitive or specific for lead
exposure. The lowest observed health effects for children and
adults have been compiled (see box, next page).
One of the national health objectives for the year 2000 is to
eliminate occupational lead exposures that result in workers having
blood lead concentrations greater than 25 ug/dL (objective 10.8)
(2). Both the Council of State and Territorial Epidemiologists and
the American Medical Association have endorsed positions
encouraging health departments to make elevated BLLs in children
and adults a notifiable condition nationwide.
References
CDC. Preventing lead poisoning in young children: a statement by
the Centers for Disease Control--October 1991. Atlanta: US
Department of Health and Human Services, Public Health Service,
CDC, 1991.
Public Health Service. Healthy people 2000: national health
promotion and disease prevention objectives -- full report, with
commentary. Washington, DC: US Department of Health and Human
Services, Public Health Service, 1991; DHHS publication no.
(PHS)91-50212.
CDC. Strategic plan for the elimination of childhood lead
poisoning. Atlanta: US Department of Health and Human Services,
Public Health Service, 1991.
Agency for Toxic Substances and Disease Registry. Toxicological
profile for lead. Atlanta: US Department of Health and Human
Services, Public Health Service, Agency for Toxic Substances and
Disease Registry, 1990; DHHS publication no. ATSDR/TP-88/17.
Goldman RH, Baker EL, Hannan M, Kamerow DB. Lead poisoning in
automobile radiator mechanics. N Engl J Med 1987;317:214-8.
The only states for which this information is available.
Disclaimer
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