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Low level lead exposure harms children; a renewed call for primary prevention
  • Published Date:
    January 4, 2012
Filetype[PDF-922.12 KB]

  • Description:
    Abbreviations -- ACCLPP and Blood Lead Level Work Group Rosters -- Executive summary -- Introduction -- I. Scientific rationale for eliminating the CDC's 10 ug/dL blood lead level of concern -- II. Putting primary prevention first -- III. Health management for primary prevention of lead exposure -- IV. Achieving leadsafe housing -- V. Environmental interventions -- VI. Research needs -- VII. References

    "Based on a growing body of studies concluding that blood lead levels (BLLs) <10 μg/dL harm children, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) recommends elimination of the use of the term 'blood lead level of concern'. This recommendation is based on the weight of evidence that includes studies with a large number and diverse group of children with low BLLs and associated IQ deficits. Effects at BLLs < 10 μg/dL are also reported for other behavioral domains, particularly attention-related behaviors and academic achievement. New findings suggest that the adverse health effects of BLLs less than 10 μg/dL in children extend beyond cognitive function to include cardiovascular, immunological, and endocrine effects. Additionally, such effects do not appear to be confined to lower socioeconomic status populations. Therefore, the absence of an identified BLL without deleterious effects combined with the evidence that these effects, in the absence of other interventions, appear to be irreversible, underscores the critical importance of primary prevention. Primary prevention is a strategy that emphasizes the prevention of lead exposure, rather than a response to exposure after it has taken place. Primary prevention is necessary because the effects of lead appear to be irreversible. In the U.S., this strategy will largely require that children not live in older housing with lead-based paint hazards. Screening children for elevated BLLs and dealing with their housing only when their BLL is already elevated should no longer be acceptable practice. The purpose of this report is to recommend to the CDC how to shift priorities to implement primary prevention strategies and how to best provide guidance to respond to children with BLLs <10 μg/dL. This report also makes recommendations to other local, state and federal agencies, and the ACCLPP recommends that CDC work cooperatively with these other stakeholders to provide advice and guidance on the suggested actions. This report recommends that a reference value based on the 97.5th percentile of the NHANES-generated BLL distribution in children 1-5 years old (currently 5 μg/dL) be used to identify children with elevated BLL. There are approximately 450,000 U.S. children with BLLs above this cut-off value that should trigger lead education, environmental investigations, and additional medical monitoring. In the pediatric primary care office, primary prevention must start with counseling-even prenatally when possible. This includes recommending environmental assessments for children PRIOR to screening BLLs in children at risk for lead exposure. After confirmatory testing, children at or above the reference value of 5 μg/dL must undergo ongoing monitoring of BLLs. These children should also be assessed for iron deficiency and general nutrition (e.g. calcium and vitamin C levels), consistent with American Academy of Pediatrics (AAP) guidelines. Iron-deficient children should be provided with iron supplements. All BLL test results should be communicated to families in a timely and appropriate manner. Children with elevated BLLs will need to be followed over time until the environmental investigations and subsequent responses are complete. Despite significant progress in reducing geometric mean BLLs in recent decades, racial and income disparities persist. These observed differences can be traced to differences in housing quality, environmental conditions, nutrition, and other factors. The goal of primary prevention is to ensure that all homes become lead-safe and do not contribute to childhood lead exposure. Prevention requires that we reduce environmental exposures from soil, dust, paint and water, before children are exposed to these hazards. Efforts to increase awareness of lead hazards and ameliorative nutritional interventions are also key components of a successful prevention policy."--p. ix-x

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