Guidelines for the Identification and Management of Lead Exposure

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MEMBERS OF THE WORK GROUP ON LEAD AND PREGNANCYChairpersonJessica Leighton, PhD, MPHDeputy Commissioner, New York City Department of Health & Mental HygieneMembersDavid Bellinger, PhD, MScProfessor of NeurologyChildren’s Hospital of Boston, Harvard Medical SchoolCarla Campbell, MD, MSPhiladelphia Department of Public Health and Children’s Hospital of PhiladelphiaCrystal Cash, MDAssociate Chair for Graduate Education, Department of Family MedicineAssociate Professor of Clinical MedicineStritch School of Medicine, Loyola University ChicagoLiaison to the American Academy of Family MedicineValerie Charlton, MD, MPHChief, Childhood Lead Poisoning Prevention BranchCalifornia Department of Public HealthJoel Forman, MDAssociate Professor of Pediatrics and Community and Preventive MedicineVice Chair for Education and Residency Program Director, Department of PediatricsMount Sinai School of MedicineNathan Graber, MDNew York City Department of Health and Mental HygieneBarbara Hackley, MS, CNMYale University of School of NursingLiaison to the American College of Nurse MidwivesHoward Hu, MD, MPH, ScDChair and Professor of Environmental Health SciencesUniversity of Michigan School of Public HealthEzatollah Keyvan-Larijani, MD, DrPHMaryland Department of EnvironmentLiaison to the Council of State and Territorial EpidemiologistsKathryn Mahaffey, PhD (deceased)U.S. Environmental Protection AgencyMorri Markowitz, MD Montefiore Medical Center Ellen O’Flaherty, PhD University of Cincinnati Medical School (Emeritus Professor) vii
Michael Shannon, MD, MPH (deceased)Children’s Hospital of BostonLiaison to the American Academy of PediatricsKevin U. Stephens, Sr., MD, JDDirector, New Orleans Department of HealthJuan Vargas, MDSan Francisco General HospitalLiaison to the American College of Obstetricians and GynecologistsRichard P. Wedeen, MDUniversity of Medicine and Dentistry of New JerseyDepartment of Veterans Affairs Health Care System, New JerseyLiaison to the Association of Occupational and Environmental ClinicsCDC Staff MembersMary Jean Brown, ScD, RNChief, Healthy Homes and Lead Poisoning and Prevention Branch (HHLPPB)National Center for Environmental HealthAdrienne S. Ettinger, ScD, MPHOak Ridge Institute for Science and Education Fellow, HHLPPBResearch Scientist, Harvard School of Public HealthJohn Osterloh, MD, MSDivision of Laboratory SciencesNational Center for Environmental HealthElizabeth A. Whelan, PhDChief, Industrywide Studies BranchNational Institute for Occupational Safety and HealthACKNOWLEDGMENTSAdrienne S. Ettinger, ScD, MPH was supported by the Centers for Disease Control and Prevention (CDC) ResearchParticipation Program with the Oak Ridge Institute for Science and Education (ORISE) through aninteragency agreement with the U.S. Department of Energy (DOE). ORISE is managed by Oak Ridge AssociatedUniversities under DOE contract number DE-AC05-00OR22750.Anne M. Wengrovitz, MPH provided editorial and writing services under contract to CDC.Kendrin Sonneville, MS, RD provided input on public health nutrition.viii
Page 1 and 2: GUIDELINES FOR THE IDENTIFICATION A
Page 3 and 4: This document is dedicated to the m
Page 5 and 6: XIV Template for Letter to Construc
Page 8 and 9: EXECUTIVE SUMMARYDespite improvemen
Page 10 and 11: pregnant women with BLL
Page 14 and 15: MEMBERS OF THE ADVISORY COMMITTEE O
Page 16 and 17: Sally OdlePresident and Owner, Safe
Page 18 and 19: GLOSSARYabatement: any set of measu
Page 20 and 21: cumulative: increasing by successiv
Page 22 and 23: lead-safe work practices: low-techn
Page 24: enovation: construction and/or home
Page 27 and 28: Finally, there is evidence that a s
Page 30 and 31: CHAPTER 2.ADVERSE HEALTH EFFECTS OF
Page 32 and 33: lead exposure (Tabacova et al. 1994
Page 34 and 35: The strongest evidence to date is a
Page 36 and 37: Epidemiologic Evidence for Neurodev
Page 38 and 39: Table 2-1. Summary of Studies Estim
Page 40 and 41: EstimateStudy Study of Prenatal Lea
Page 52 and 53: CHAPTER 3.BIOKINETICS AND B
Page 54 and 55: this biomarker may be a useful rese
Page 56 and 57: Recent studies have documented that
Page 58: Figure 3-1. Major Lead Exposure Pat
Page 61 and 62: Additionally, recent evidence has s
Page 63 and 64:
in the study population was 12%
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Mobilization of Endogenous Bone Lea
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Most of the published literature re
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On occasion, imported foods and foo
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Case Study 4-3. A Case of Lead Pois
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Table 4-1. Risk Factors for Lea
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CHAPTER 5.BLOOD LEAD TESTING
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Blood Lead Testing in the General P
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absorption spectrophotometry (GFAAS
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ally, the measured BLL of pregnant
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Table 5-2. Schedule for Follow-up B
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Figure 5-1. New York City Departmen
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CHAPTER 6.MANAGEMENT OF PRE
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y providing information to health d
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upon eliciting accurate information
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tivity that disturbs paint can incr
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Case management of pregnant women w
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Interpretation and follow-up of blo
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Table 6-2. Suggested Factors to Ass
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Decades of laboratory and clinical
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tion of skeletal mineral. Observati
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of follow up, suggesting decreased
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Supplemental Nutrition Program for
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Inadequate vitamin D status is comm
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CHAPTER 8.CHELATION OF PREGNANT
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CLINICAL EVIDENCE IN PREGNANCY AND
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Table 8-1. Chelating Agents Used
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Table 8-3. Published Experience wit
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CHAPTER 9.BREASTFEEDINGKey Consid
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maternal blood exceeds 40 µg/dL (L
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guidance for breastfeeding by women
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Table 9-1. Frequency of Maternal Bl
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Table 9-3. Estimated a Increase in
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CHAPTER 10.RESEARCH, POLICY, AND HE
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Identification and development of n
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Mandatory Reporting of All Adult Bl
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CHAPTER 11. RESOURCES AND REFERRAL
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Offce of Pollution Prevention and T
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Marino PE, Landrigan PJ, Graef J, N
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Dietrich KN, Ris MD, Succop PA, Ber
Page 146 and 147:
McMichael AJ, Vimpani GV, Robertson
Page 148 and 149:
Vigeh M, Yokoyama K, Mazaheri M, Be
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Gulson BL, Jameson CW, Mahaffey KR,
Page 152 and 153:
Satin KP, Neutra RR, Guirguis G, Fl
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Centers for Disease Control and Pre
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Lee MG, Chun OK, Song WO. 2005. Det
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Simpson E, Mull JD, Longley E, East
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Rothenberg SJ, Khan F, Manalo M, Ji
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Piazza C, Fisher W, Hanley G, LeBla
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Godwin HA. 2001. The biological che
Page 166 and 167:
Looker AC, Loyevsky M, Gordeuk VR.
Page 168 and 169:
Willoughby RA, Thirapatsakun T, McS
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Bachrach VR, Schwarz E, Bachrach LR
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U.S. Food and Drug Administration.
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Appendices 149
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Appendix IExisting State Legislatio
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Guidelines for the Identification &
Page 180 and 181:
Appendix IICharge Questions to the
Page 182 and 183:
Page 184 and 185:
Appendix IIICommonly Ingested Subst
Page 186 and 187:
Page 188 and 189:
Appendix IVList of Occupations and
Page 190 and 191:
Page 192 and 193:
Appendix VAlternative Cosmetics, Fo
Page 194 and 195:
Page 196 and 197:
Appendix VIRecommendations for Medi
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Research | Mini-Monograph Recommend
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Recommendations for medical manag
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Recommendations for medical manag
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Recommendations for medical managem
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Recommendations for medical managem
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Appendix VIIMedical Management Guid
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Medical Management Guidelines for L
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Because lead interferes with bioche
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The clinician, with the patient’s
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i.e., at least monthly. In general,
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If elevated maternal blood lead is
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TABLE 2Non-occupational and Environ
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TABLE 4TABLE 4Health Based Health M
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Gulson BL, Mizon KJ, Korsch MJ, Pal
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Appendix VIIIPregnancy Risk Assessm
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EDC:_________________ID:___________
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ID:___________________________B. HO
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ID:___________________________10. I
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ID:___________________________14a.
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ID:___________________________G. NO
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ID:___________________________I. PA
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SUMMARYInstructions: Check all thos
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ID:___________________________APPEN
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Appendix IXAssessment Interview For
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RISK ASSESSMENT INTERVIEW FORMDate:
Page 248 and 249:
Appendix XLead Based Paint Risk Ass
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Lead-Based Paint Risk Assessment Re
Page 252 and 253:
(Use one of the following sentences
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Appendix ATesting Locations229
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Appendix CDust Wipe and Soil Sample
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Appendix XIPrimary Prevention Infor
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LI #:NEW YORK CITY DEPARTMENT OF HE
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LI #:8a. If yes >> Please tell me h
Page 264 and 265:
Appendix XIIChild Risk Assessment F
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CHILD ID: Page 1 of 12PNEW YORK CIT
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CHILD ID: Page 3 of 126. Does [chil
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CHILD ID: Page 5 of 1217a. If yes >
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CHILD ID: Page 7 of 1224. [Imported
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CHILD ID: Page 9 of 12Home renovati
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CHILD ID: Page 11 of 12Provide the
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Appendix XIIINutritional Reference
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Nutrition Reference InformationRECO
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Blood hemoglobin levels are routine
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Beef, chuck, blade roast, lean, coo
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Sunflower oil, 1 TbspCottonseed oil
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Appendix XIVTemplate for Letter to
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Template for Letter to Construction
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Appendix XVWorkplace Hazard Alert f
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WORKPLACE HAZARD ALERTNew Health Da
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What should I tell my doctor?Your d
Page 298 and 299:
Make sure you don’t accidentally
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Worksite Evaluation FormWhat your e
Page 302:
CS2016857
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