Guidelines for the Identification and Management of Lead Exposure

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MEMBERS OF THE ADVISORY COMMITTEE ON CHILDHOOD LEADPOISONING PREVENTIONChairGeorge G. Rhoads, MD, MPHAssociate Dean, School of Public HealthUniversity of Medicine and Dentistry of New JerseyPiscataway, NJTerm: 07/19/04-05/31/12Carla Campbell, MD, MSThe Children’s Hospital of PhiladelphiaPhiladelphia, PennsylvaniaTerm: 5/31/02–5/31/07Designated Federal OffcialMary Jean Brown, ScD, RNChief, Healthy Homes and Lead Poisoning Prevention BranchNational Center for Environmental HealthCenters for Disease Control and PreventionAtlanta, GAMembersMagaly C. Angeloni, MBAProgram Manager, Childhood Lead Poisoning Prevention ProgramRhode Island Department of HealthProvidence, Rhode IslandTerm: 06/01/05-05/31/09William Banner, Jr. MD, PhDThe Children’s Hospital at St. FrancisTulsa, OklahomaTerm: 10/1/02 – 5/31/05Helen J. Binns, MDChildren’s Memorial HospitalChicago, IllinoisTerm: 9/30/02-5/31/05Valerie Charlton, MD, MPHChief, Childhood Lead Poisoning Prevention BranchCalifornia Department of Public HealthRichmond, CaliforniaTerm: 06/01/05-05/31/09Deborah A. Cory-Slechta, PhDProfessor of Environmental MedicineUniversity of Rochester School of Medicine & DentistryRochester, New YorkTerm: 06/01/06-05/31/10ix
Sher Lynn Gardner, MD, FAAPAssistant Professor of Pediatrics, Emory UniversityAtlanta, GeorgiaTerm: 06/01/06-05/31/10Walter S. Handy, Jr., PhDCincinnati Health DepartmentCincinnati, OhioTerm: 9/30/03–5/31/07Kimberly Hansen, MDPediatric Medical DirectorPeoples Community Health ClinicWaterloo, IowaTerm: 07/02/08–05/31/12Ing Kang Ho, PhDUniversity of Mississippi Medical CenterJackson, MississippiTerm: 9/28/03–5/31/07Richard E. Hoffman, MDState EpidemiologistDenver, Colorado 80231Term: 5/19/97–5/31/2004Valarie JohnsonFounder, Urban Parent to ParentRochester, New YorkTerm: 06/01/04-05/31/08Linda KiteCoordinator, Healthy Homes CollaborativeLos Angeles, CaliforniaTerm: 03/16/05-05/31/10Michael J. Kosnett, MD, MPHAssociate Clinical Professor, University of Colorado Health Sciences CenterDenver, COTerm: 12/12/06-5/31/11Jessica Leighton, PhD, MPHDeputy Commissioner, New York City Department of Health and Mental HygieneNew York, New YorkTerm: 10/1/03–12/15/09Tracey Lynn, DVM, MPHAlaska Department of Health and Social ServicesAnchorage, AlaskaTerm: 5/31/02–5/31/2006x
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 12 and 13: MEMBERS OF THE WORK GROUP ON LEAD A
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%
Page 65 and 66:
Mobilization of Endogenous Bone Lea
Page 67 and 68:
Most of the published literature re
Page 69 and 70:
On occasion, imported foods and foo
Page 71 and 72:
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
Page 78 and 79:
Blood Lead Testing in the General P
Page 80 and 81:
absorption spectrophotometry (GFAAS
Page 82 and 83:
ally, the measured BLL of pregnant
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Table 5-2. Schedule for Follow-up B
Page 86 and 87:
Figure 5-1. New York City Departmen
Page 88 and 89:
CHAPTER 6.MANAGEMENT OF PRE
Page 90 and 91:
y providing information to health d
Page 92 and 93:
upon eliciting accurate information
Page 94 and 95:
tivity that disturbs paint can incr
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Case management of pregnant women w
Page 98 and 99:
Interpretation and follow-up of blo
Page 100:
Table 6-2. Suggested Factors to Ass
Page 103 and 104:
Decades of laboratory and clinical
Page 105 and 106:
tion of skeletal mineral. Observati
Page 107 and 108:
of follow up, suggesting decreased
Page 109 and 110:
Supplemental Nutrition Program for
Page 111 and 112:
Inadequate vitamin D status is comm
Page 114 and 115:
CHAPTER 8.CHELATION OF PREGNANT
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CLINICAL EVIDENCE IN PREGNANCY AND
Page 118 and 119:
Table 8-1. Chelating Agents Used
Page 120 and 121:
Table 8-3. Published Experience wit
Page 122 and 123:
CHAPTER 9.BREASTFEEDINGKey Consid
Page 124 and 125:
maternal blood exceeds 40 µg/dL (L
Page 126 and 127:
guidance for breastfeeding by women
Page 128 and 129:
Table 9-1. Frequency of Maternal Bl
Page 130 and 131:
Table 9-3. Estimated a Increase in
Page 132 and 133:
CHAPTER 10.RESEARCH, POLICY, AND HE
Page 134 and 135:
Identification and development of n
Page 136 and 137:
Mandatory Reporting of All Adult Bl
Page 138 and 139:
CHAPTER 11. RESOURCES AND REFERRAL
Page 140 and 141:
Offce of Pollution Prevention and T
Page 142 and 143:
Marino PE, Landrigan PJ, Graef J, N
Page 144 and 145:
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
Page 150 and 151:
Gulson BL, Jameson CW, Mahaffey KR,
Page 152 and 153:
Satin KP, Neutra RR, Guirguis G, Fl
Page 154 and 155:
Centers for Disease Control and Pre
Page 156 and 157:
Lee MG, Chun OK, Song WO. 2005. Det
Page 158 and 159:
Simpson E, Mull JD, Longley E, East
Page 160 and 161:
Rothenberg SJ, Khan F, Manalo M, Ji
Page 162 and 163:
Piazza C, Fisher W, Hanley G, LeBla
Page 164 and 165:
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
Page 170 and 171:
Bachrach VR, Schwarz E, Bachrach LR
Page 172 and 173:
U.S. Food and Drug Administration.
Page 174 and 175:
Appendices 149
Page 176 and 177:
Appendix IExisting State Legislatio
Page 178 and 179:
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
Page 198 and 199:
Research | Mini-Monograph Recommend
Page 200 and 201:
Recommendations for medical manag
Page 202 and 203:
Recommendations for medical manag
Page 204 and 205:
Recommendations for medical managem
Page 206 and 207:
Recommendations for medical managem
Page 208 and 209:
Appendix VIIMedical Management Guid
Page 210 and 211:
Medical Management Guidelines for L
Page 212 and 213:
Because lead interferes with bioche
Page 214 and 215:
The clinician, with the patient’s
Page 216 and 217:
i.e., at least monthly. In general,
Page 218 and 219:
If elevated maternal blood lead is
Page 220 and 221:
TABLE 2Non-occupational and Environ
Page 222 and 223:
TABLE 4TABLE 4Health Based Health M
Page 224 and 225:
Gulson BL, Mizon KJ, Korsch MJ, Pal
Page 226 and 227:
Appendix VIIIPregnancy Risk Assessm
Page 228 and 229:
EDC:_________________ID:___________
Page 230 and 231:
ID:___________________________B. HO
Page 232 and 233:
ID:___________________________10. I
Page 234 and 235:
ID:___________________________14a.
Page 236 and 237:
ID:___________________________G. NO
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ID:___________________________I. PA
Page 240 and 241:
SUMMARYInstructions: Check all thos
Page 242 and 243:
ID:___________________________APPEN
Page 244 and 245:
Appendix IXAssessment Interview For
Page 246 and 247:
RISK ASSESSMENT INTERVIEW FORMDate:
Page 248 and 249:
Appendix XLead Based Paint Risk Ass
Page 250 and 251:
Lead-Based Paint Risk Assessment Re
Page 252 and 253:
(Use one of the following sentences
Page 254 and 255:
Appendix ATesting Locations229
Page 256 and 257:
Appendix CDust Wipe and Soil Sample
Page 258 and 259:
Appendix XIPrimary Prevention Infor
Page 260 and 261:
LI #:NEW YORK CITY DEPARTMENT OF HE
Page 262 and 263:
LI #:8a. If yes >> Please tell me h
Page 264 and 265:
Appendix XIIChild Risk Assessment F
Page 266 and 267:
CHILD ID: Page 1 of 12PNEW YORK CIT
Page 268 and 269:
CHILD ID: Page 3 of 126. Does [chil
Page 270 and 271:
CHILD ID: Page 5 of 1217a. If yes >
Page 272 and 273:
CHILD ID: Page 7 of 1224. [Imported
Page 274 and 275:
CHILD ID: Page 9 of 12Home renovati
Page 276 and 277:
CHILD ID: Page 11 of 12Provide the
Page 278 and 279:
Appendix XIIINutritional Reference
Page 280 and 281:
Nutrition Reference InformationRECO
Page 282 and 283:
Blood hemoglobin levels are routine
Page 284 and 285:
Beef, chuck, blade roast, lean, coo
Page 286 and 287:
Sunflower oil, 1 TbspCottonseed oil
Page 288 and 289:
Appendix XIVTemplate for Letter to
Page 290 and 291:
Template for Letter to Construction
Page 292 and 293:
Appendix XVWorkplace Hazard Alert f
Page 294 and 295:
WORKPLACE HAZARD ALERTNew Health Da
Page 296 and 297:
What should I tell my doctor?Your d
Page 298 and 299:
Make sure you don’t accidentally
Page 300 and 301:
Worksite Evaluation FormWhat your e
Page 302:
CS2016857
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Guidelines for the Identification and Management of Lead Exposure

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