Guidelines for the Identification and Management of Lead Exposure

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GLOSSARYabatement: any set of measures designed to permanently eliminate lead-based paint or lead-based paint hazards. ABLES: Adult Blood Lead Epidemiology and Surveillance program, a CDC-funded state-based program to track laboratory-reported BLLs in adults. ACCLPP: CDC Advisory Committee on Childhood Lead Poisoning Prevention. ACOG: American College of Obstetrics and Gynecology. acute: having or experiencing a rapid onset and short duration. AI (adequate intake): a recommended average daily nutrient intake level, based on estimations of average nutrient intakes by groups healthy people. alternative medicines: for these guidelines, alternative medicines are defined as nonstandard therapies not sanctioned in modern Western medicine; typically from other countries; and usually unregulated in the United States, including folk, traditional, botanic, herbal, alternative, and complementary therapies, medicines, agents, and remedies (also “traditional medicines”). anemia: a condition in which there is a reduction of the number or volume of red blood cells or of the total amount of hemoglobin in the bloodstream antenatal: occurring or existing before birth (also “prenatal”). antepartum: pertaining to the period before delivery or birth. anticipatory guidance: practical information given to individuals to promote health before a certain milestone, such as pregnancy, is reached. antioxidant: any substance that reduces damage due to oxygen in the body. AOEC: Association of Occupational and Environmental Clinics. apoptosis: a form of cell death in which a programmed sequence of events leads to the elimination of cells without releasing harmful substances into the surrounding area. asymptomatic: without observable signs or reportable symptoms of illness. at-risk populations: populations with characteristics, behaviors, or lifestyles (including home, work, and hobbies) that put them at increased risk for lead exposure. ayurveda: one of India’s traditional systems of medicine, involving a holistic system of healing and natural (herbal) medicines, that has been practiced for over 5,000 years. bioavailable: readily absorbed and used by the body. biokinetics: the study of movements of or within organisms. biomarker (biological marker): a measure of exposure to lead, or other substance, that is measured in human tissue and corresponds to absorbed dose. BLL (blood lead level): the concentration of lead in a sample of blood expressed in micrograms per deciliter (µg/dL) or micromoles per liter (µmol/L) (1 µg/dL = 0.048 µmol/L). xiii
east milk lead: levels of lead in breast milk; the concentration of lead in a sample of maternal breast milk isusually expressed in micrograms per liter (µg/L).bone lead: long-lived stores of lead from past exposure that is accumulated in the body’s skeletal system;measured in micrograms (µg) of lead/gram bone mineral.bone mobilization or bone turnover: the process by which the body dissolves part of the bone in the skeletonin order to maintain or raise the levels of circulating calcium in the blood or for pathological reasons, suchas immobilization, age-related osteoporosis, or hyperthyroidism.bone resorption: the break down and wearing away of bone tissue that results in the release of bone mineralsinto circulation.care coordination: the formal coordination of the care of a mother or infant with a BLL that exceeds a specificvalue and making available existing services as needed to the mother-infant pair.case management: the follow-up care of a pregnant/lactating woman with a blood lead level ≥5 µg/dL, andher newborn infant, if necessary. Case management includes a) client identification and outreach, b) individualassessment and diagnosis, c) service planning and resource identification, d) linkage of clients to neededservices, e) service implementation and coordination, f) monitoring of service delivery, g) advocacy, and h)evaluation.casein: the main protein found in milk and other dairy products.CDC (Centers for Disease Control and Prevention): part of the U.S. Department of Health andHuman Services.chelation therapy: the use of a chelating agent (chemical compounds that bind to metals) to remove toxicmetals, such as lead, from the body.chronic: being long-lasting and recurrent.CI (confidence interval): an interval estimate that defines and upper and lower limit with an associated probability.clearance standards: maximum allowable lead dust levels (established by the U.S. Department of Housingand Urban Development and the U.S. Environmental Protection Agency) on floors and interior window sillsafter a residence has undergone lead hazard control work.CLPPP (Childhood Lead Poisoning Prevention Program): CDC-funded state or local program to preventchildhood lead poisoning.conception: union of the sperm and the egg which marks the onset of pregnancy (also “fertilization”).confirmatory test: a venous blood lead test performed after a previous capillary, filter paper, or venous bloodlead test to verify the results before interventions occur.congenital anomaly: a structural or functional abnormality of the human body that develops before birth butis usually identified in the period just after birth or in early life.contraindication: a condition that makes a particular treatment or medical procedure inadvisable.creatinine: a chemical waste product generated from muscle processes that create and use energy in the humanbody; measured to determine if kidneys are functioning properly.xiv
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 14 and 15: MEMBERS OF THE ADVISORY COMMITTEE O
Page 16 and 17: Sally OdlePresident and Owner, Safe
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
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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
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McMichael AJ, Vimpani GV, Robertson
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Vigeh M, Yokoyama K, Mazaheri M, Be
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Gulson BL, Jameson CW, Mahaffey KR,
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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
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Looker AC, Loyevsky M, Gordeuk VR.
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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 &
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Appendix IICharge Questions to the
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Appendix IIICommonly Ingested Subst
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Appendix IVList of Occupations and
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Appendix VAlternative Cosmetics, Fo
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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:
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Appendix XLead Based Paint Risk Ass
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Lead-Based Paint Risk Assessment Re
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(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
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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
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Make sure you don’t accidentally
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Worksite Evaluation FormWhat your e
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CS2016857
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Guidelines for the Identification and Management of Lead Exposure

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