Fluorometric assay of erythrocyte protoporphyrin: simple screening test for lead poisoning and iron deficiency.

Erythrocyte protoporphyrin levels are high in lead poisoning, iron deficiency and erythropoietic porphyria. On-site fluorometric assay was used to screen for raised blood levels in three groups of children in one city: 166 who were severely mentally retarded and lived in an institution, 88 who were moderately to severely mentally retarded and attending special schools but lived at home, and 128 who were of normal intelligence and attended a regular school. High erythrocyte protoporphyrin levels (40 micrograms/dl [0.7 mumol/l] or greater) were found in 14 of the children, each of whom was tested for further evidence of lead poisoning and iron deficiency. The two children found to have high blood lead levels (above 30 micrograms/dl [1.5 mumol/l]) were both living in the institution, were ambulatory and had pica. Of the other 12 children 8 had evidence of iron deficiency, though in 4 the probability of a true deficiency was low. The fluorometric assay of erythrocyte protoporphyrin may prove to be a simple method of screening for lead poisoning and iron deficiency.     

Urban Lead Exposures of Children in Cincinnati,Ohio

Abstract

Environmental dust lead and other lead measures were highly intercorrelated for the wide range of housing in the Cincinnati prospective study. The causal pathway revealed by the data (soil and paint lead to surface dust lead to hand lead to blood lead) has been used to develop intervention strategies to reduce blood lead and hand lead levels which are currently being implemented in the Cincinnati Soil Lead Abatement Demonstration Project. These interventions, soil lead abatement, exterior dust abatement, and interior dust abatement, are being applied in various combinations in an examination of data for children residing in a single type of housing from birth, blood lead levels were compared according to three paint lead categories (low: < 2 mg cm^?2; medium: 2.1 to 6.0 mg cm^?2, and high: > 6.0mg cm^?2). Geometric mean blood lead values were 14.1 and 12.1 μg dL^?1, respectively, for the low and medium paint lead categories and much greater for children living in housing in the highest paint lead category, 24.8 μg dL^?1. These data suggest that for situations similar to those in Cincinnati, priority for lead-based paint abatement should be considered for the housing with paint lead above 6 mg cm^?2. A Ln—Ln relationship between environmental lead and blood lead for children in the Cincinnati study was found to represent the data much more closely than did a linear relationship such as that used in the current US EPA Lead Uptake/Biokinetic Model.     

Comparison of blood lead levels in three groups of Sardinian children.

This paper reports blood lead levels in children from three Sardinian municipalities: Portoscuso, Iglesias, and Sestu. Portoscuso, chosen as the control area, is located about 2 km from one of the most important industrial complexes of the island. Iglesias was once an important zinc-lead mining centre. Sestu is a semi-urban centre located about 10 km from Cagliari (the islands's capital), and may be considered unexposed to lead pollution. Blood lead concentration was evaluated in heparinized venous blood samples by graphite furnace atomic absorption spectrophotometry. Children living in Portoscuso show a higher mean of blood lead levels (8.43 micrograms/dl) as compared to that of children of the same age living in Iglesias (6.92 micrograms/dl) and Sestu (5.71 micrograms/dl). By the Bonferroni t-tests procedure these mean differences appear to be statistically significant. The mean of PbB levels obtained in this investigation for children from Portoscuso showed a decrease of 33.62% with respect to that reported in a previous investigation carried out in 1987 (12.7 micrograms/dl).     

Lead poisoning in zoo-dwelling primates

Lead intoxication was diagnosed in 42 primates at the National Zoological Park. Diagnoses were made clinically by the observation of signs of encephalopathy and the finding of 200 μg lead or more/100 ml blood, or postmortem by the presence of renal acid-fast intranuclear inclusion bodies and excess lead in liver specimens. Twenty-five of the primates had signs or lesions of lead encephalopathy. Lead poisoning was most common in the Cercopithecidae, and in the summer months. Lead encephalopathy was most frequent in juveniles. Leaded paint on the monkey cages was determined to be the source of poisoning. Blood studies revealed slight hypochromic anemia and immature and stippled erythrocytes. Postmortem lesions included acid-fast intranuclear inclusions in renal tubular and other epithelial cells; metaphyseal bone changes (lead lines); necrosis of striated muscle fibers; and other lesions. Treatment of one monkey for encephalopathy was attempted and proved successful.     

Lead poisoning in wild populations of Marsh Harriers Circus aeruginosus in the Camargue and Charente-Maritime, France

Lead poisoning of waterfowl, through the ingestion of spent gunshot, has been recognized as a mortality factor for over a century. However, in Europe relatively little attention has been paid to raptors that may ingest shot embedded in the flesh of prey. The present study examines the incidence of lead poisoning in wild Marsh Harriers Circus aeruginosus trapped at two sites in France, the Camargue and Charente-Maritime.
Eight captive Marsh Harriers (controls) had blood lead (PbB) concentrations of 5.3–10.8 μg per dl. Of 94 wild birds trapped during the winters of 1990/1991 and 1991/1992 either in baited clap traps or in mist nets at night roosts, 29 (31%) had elevated (>30 μg/dl) PbB concentrations and 13 (14%) had concentrations indicative of clinical poisoning (> 60 μg/dl). Similar percentages of birds caught using the two trapping methods had elevated (>30 μg/dl) PbB concentrations. However, clap netting appeared to select for more heavily contaminated birds and for juvenile birds, although the two are not necessarily correlated. In the Camargue, significantly more females than males trapped in clap nets had elevated PbB concentrations.
The incidence of shot in regurgitated Marsh Harrier pellets increased significantly between October and December, indicating increased exposure to lead as the hunting season progressed. There appeared to be a parallel increase in PbB concentrations throughout the hunting season, although this could not be clearly demonstrated as sex ratios were different during different sampling periods.
Elevated PbB concentrations of harriers in the Camargue are likely to result primarily from the ingestion of shot in the flesh of crippled or unretrieved waterfowl and in Charente-Maritime, from eating crippled or dead mammals.
Other raptors at risk from lead poisoning and solutions to this problem are discussed.     

Effects of lead on luteal function in rhesus monkeys

Exposure to lead in the workplace or home environment has been implicated as a cause of decreased fertility in women. In a previous study, as part of our effort to determine effects of lead in primates, female rhesus monkeys were exposed to lead acetate in drinking water (n = 10) or provided water with no added lead (n = 7) for 33 mo. Lead was administered at levels between 2 and 8 mg/kg/day, with doses adjusted to keep blood lead values near a target of 70 micrograms/dl (observed mean +/- SEM = 68.9 +/- 6.54 micrograms/dl). Blood lead concentrations in control animals were less than 10 micrograms/dl. No significant differences were detected between control and experimental animals in body weight, hematocrit, or general health. Female monkeys receiving lead exhibited longer and more variable menstrual cycles and shorter menstrual flow. In the present study, circulating amounts of progesterone (P4) were determined to evaluate luteal function during the final 7 mo of treatment with lead. Several characteristics were altered as a result of lead treatment: circulating amounts of P4 were reduced as indicated by relative units of area under the concentration-time curve, maximal amounts of P4 were reduced, and P4 levels were greater than 1 ng/ml on fewer days. There were no significant differences between groups in mean percent of anovulatory cycles. Therefore, although chronic treatment with the levels of lead used in this study did not prevent ovulation, luteal function was suppressed. These results extend previous observations of adverse effects of lead on ovarian activity and fertility in monkeys.     

Environmental Lead Exposure Among Children in Chengdu, China, 2007–2009

Lead poisoning is one of the most significant environmental health threats which children face. The aim of the study was to evaluate the relationship between the blood lead level (BLL) of children and environmental pollution, as well as the effect of BLL on children's heath, in the biggest city in south-west China. A questionnaire survey was administered to 3,624 children's (6 months-7 years old) guardian in urban Chengdu from 2007 to 2009, collecting data on inhabited environment, living habits, and health status. All blood samples were collected for BLL test when the children came to the hospital. The analysis was conducted in West China Second University Hospital, Chengdu, China in December, 2009. A total of 3,624 children were included. The mean BLL was 62.31 μg/L. Three hundred thirty-three (9.2%) of 3,624 children's BLL were above 100 μg/L. Taking Chinese medicinal herbs usually, puffed foods, and substitutes of breast milk were risk factors (P < 0.05).The study shows that Chinese children's lead poisoning prevention and treatment lags far behind developed countries. The findings have implications for environmental health policy.     

Global approach to reducing lead exposure and poisoning

Lead poisoning is an important environmental disease that can have life-long adverse health effects. Most susceptible are children, and most commonly exposed are those who are poor and live in developing countries. Studies of children's blood-lead levels (BLLs) are showing cognitive impairment at increasingly lower BLLs. Lead is dangerous at all levels in children. The sources of lead exposure vary among and within countries depending on past and current uses. Sources of lead may be from historic contamination, recycling old lead products, or from manufacturing new products. In all countries that have banned leaded gasoline, average population BLLs have declined rapidly. In many developing countries where leaded gasoline is no longer used, many children and workers are exposed to fugitive emissions and mining wastes. Unexpected lead threats, such as improper disposal of electronics and children's toys contaminated with lead, continue to emerge. The only medical treatment available is chelation, which can save lives of persons with very high BLLs. However, chelating drugs are not always available in developing countries and have limited value in reducing the sequelae of chronic low dose lead exposure. Therefore, the best approach is to prevent exposure to lead. Because a key strategy for preventing lead poisoning is to identify and control or eliminate lead sources, this article highlights several major sources of lead poisoning worldwide. In addition, we recommend three primary prevention strategies for lead poisoning: identify sources, eliminate or control sources, and monitor environmental exposures and hazards.     

Comparative Study of Blood Lead Levels in Uruguayan Children (1994–2004)

Lead does not fulfill any physiological function in the human body. It is generally accepted that the blood lead level (BLL) is the best exposure index, as there is an excellent correlation between the actual exposure of the individual and the concentration of lead in blood. In Uruguay, lead contamination becomes a matter of public concern in 2001, giving rise to a sensitization in the population, which in many cases brought about a change in hygienic and dietary habits of the children. In 2004, after the leaded gasoline phasing out process in Uruguay was completed, we studied non-exposed children to correlate BLL with variables such as age, sex, area of residence, and available environmental lead data and compared these results with those from our similar screening studies 10years ago. The main result of this comparison is that BLL from children in our country had a significant decrease between 1994 and 2004.     

Identification of the origin of infantile saturnism based on lead isotopic and elemental ratios

BackgroundIn France, the prevalence of childhood lead poisoning is becoming rare since the avoidance of lead in paints in 1949 and the gradual replacement of water pipes. Chronic lead toxicity is well known and is well correlated to blood lead concentration.AimHere we report a case of severe lead poisoning occurring in a young female child with a pica behavior.MethodsA blood sample and four environmental samples were analyzed using inductively coupled plasma- mass spectrometry (ICP-MS). Lead concentration, lead isotopes and elemental ratios were compared.ResultsThe determination of ²⁰⁸Pb/²⁰⁶Pb, ²⁰⁶Pb/²⁰⁷Pb and Cd/Pb has allowed us to identify the origin of lead poisoning.Discussion-conclusionThe source of contamination was eliminated and the child benefited from a psychological and medical follow up. Her outcome was positive. This case illustrated the potential interest of the use of elemental and isotopic ratios for clinical practice as the ICP-MS measurement has allowed a quick response and a rapid eviction of the contamination’s source.     

Blood lead levels in children from Sardinian villages at high risk of environmental crisis

This study reports blood lead levels measured in 1998 in children from three Sardinian villages: Portoscuso, Sant'Antioco, and Sestu. Portoscuso is located about 2 km from one of the most important industrial complexes in Sardinia. Sant'Antioco, together with the villages of Carbonia, Gonnesa, Portoscuso and San Giovanni Suergiu, is in the Sulcis-Iglesiente zone, defined as an “area of high risk of environmental crisis” on the basis of the Decree of the Italian Council of Ministers dated November 30, 1990. Sestu, a semi-urban centre about 10 km from Cagliari (the island's capital), can be considered not exposed to lead pollution. Blood lead concentration was determined in heparinized venous blood samples by graphite furnace atomic absorption spectrophotometry. Comparing the mean blood lead levels for the boys of Portoscuso measured in 1993 (9.27 μg/dl) and 1998 (11.30 μg/dl), we found an increase of 21.90%, whereas the mean values for the girls are practically identical in 1993 (7.35 μg/dl) and 1998 (7.39 μg/dl). In contrast, in the boys and girls of Sestu, the mean blood lead levels decrease from 1993 to 1998 by 55.62% and 29.09% respectively (from 6.71 μg/dl to 4.09 μg/dl in the boys; from 4.71 μg/dl to 3.34 μg/dl in the girls). In the Sant'Antioco children, we found a 52.65% decrease from 1987 (8.30 μg/dl reported for a sample not subdivided by sex)) to 1998 (3.93 μg/dl for males and females combined). Our results confirm the findings of previous investigations of blood lead levels in children from Sardinian villages with different environmental risks of lead pollution: the children of Portoscuso present higher blood lead levels than other groups of Sardinian children.     

Identifying and managing adverse environmental health effects: 3. Lead exposure

LEAD LEVELS IN NORTH AMERICAN CHILDREN AND ADULTS have declined in the past 3 decades, but lead persists in the environment in lead paint, old plumbing and contaminated soil. There are also a number of occupations and hobbies that carry a high risk of lead exposure. There is no evidence for a threshold below which lead has no adverse health effects. Blood lead levels previously considered safe are now known to cause subtle, chronic health effects. The health effects of lead exposure include developmental neurotoxicity, reproductive dysfunction and toxicity to the kidneys, blood and endocrine systems. Most lead exposures are preventable, and diagnosing lead poisoning is relatively simple compared with diagnosing health effects of exposures to other environmental toxins. Accurate assessment of lead poisoning requires specific knowledge of the sources, high-risk groups and relevant laboratory tests. In this article we review the multiple, systemic toxic effects of lead and provide current information on groups at risk, prevention, diagnosis and clinical treatment. We illustrate how the CH²OPD² mnemonic (Community, Home, Hobbies, Occupation, Personal habits, Diet and Drugs) and specific screening questions are useful tools for physicians to quickly obtain an environmental exposure history and identify patients at high risk of lead exposure. By applying effective primary prevention, case-finding and treatment interventions for lead exposure, both the individual patient and the larger community reap the benefits of better health.CaseA previously healthy 2-year-old girl and her mother visit their family physician because of the daughter''s 2-month history of intermittent complaints of a mild “tummy ache.” There is no associated vomiting, weight loss, or change in appetite, bowels or diet. There are no abnormal findings on physical examination. When asked about symptom onset the mother reports that it began shortly after the family started to renovate their kitchen. They live in an old farmhouse on the outskirts of town and drink water from a drilled well on the property. The physician decides to take an environmental exposure history using the CH²OPD² mnemonic (Community, Home, Hobbies, Occupation, Personal habits, Diet and Drugs; for children, the occupation question refers to workplace contaminants brought into the child''s environment).¹ The child''s exposure history (Open in a separate windowQuestions surrounding this case: Is the family at risk of health effects from lead exposure? Who else might be at risk? Are other laboratory tests indicated? Where can the physician get advice on the significance of the family''s blood lead levels? How should this case of lead exposure be treated?To some extent lead is one of the small success stories of environmental health. The association of lead poisoning with cognitive impairment is well established² and has resulted in the removal of lead from gasoline, paint and food cans. Despite these preventive measures, however, silent, low-level lead exposure continues to present a problem for many communities and populations. In 1997, data from the US National Health and Nutrition Examination Surveys showed that 4.4% of children in the United States had elevated blood lead levels.³ Black children living in older housing, children living in metropolitan areas with populations of 1 million or more and poor children living in older housing were at highest risk of exposure.³In Canada children living near a point-source smelter in the South Riverdale area of Toronto were tested in 1973 and found to have an unusually high mean lead level (1.34 μmol/L).⁴ Canada''s Federal–Provincial Committee on Environmental and Occupational Health suggested in 1994 that 5%–10% of Canadian children living in urban areas have blood lead levels exceeding 0.48 μmol/L, even though they are not exposed to point sources.⁵ The Ontario government estimated in 1994 that 4% of children in the province still had blood lead levels above 0.48 μmol/L;⁶ a 1992 study found that the mean level in Ontario children had fallen from 0.91 μmol/L in 1972 to 0.29 μmol/L in 1988.⁷ A study of Vancouver children using blood lead levels collected in 1989 found that 8% had elevated levels (mean 0.29 μmol/L).⁸ A later study of the children living in Trail, BC, the site of a lead and zinc smelter, demonstrated that 50% had an elevated blood lead level.⁹     

Determination of lead in whole blood: comparison of the LeadCare blood lead testing system with Zeeman longitudinal electrothermal atomic absorption spectrometry.

This study compares the efficiency of blood lead level analysis by graphite furnace atomic absorption spectrometry (GFAAS) and the portable LeadCare Blood Lead Testing System (LCS). Recoveries of two added lead concentrations of 22 and 42 micrograms/dL ranged from 102.4 to 105.5% for LCS and from 96.3 to 97.2% for GFAAS. Measurement of a certified sample (Certified Danish Whole Blood) at a blood lead concentration of 26.2 micrograms/dL gave within- and between-run coefficients of variation which were both approximately 8% by LCS and 2% by GFAAS. Comparison of the tested method (LCS) versus GFAAS from analysis of 76 samples of blood lead collected from workers in different industrial sectors showed imperfect overall correlation (r = 0.95). The LCS is quite suitable for screening purposes, but requires the use of non-frozen blood collected less than 24 h before. Conservative threshold values should be applied when using the LCS for initial screening in the field.     

Paint chip poisoning of Laysan albatross at Midway Atoll

Epizootic mortality occurred in Laysan albatross (Diomedea immutabilis) fledgings at Midway Atoll in 1983. Heavy metal toxicity from ingestion of weathered paint chips was one of the causes. Sick albatrosses were unable to retract their wings, causing a "droop-wing" appearance. Five normal and 12 droop-winged fledglings were captured, killed, and examined. Paint chips found in the proventriculus of the affected fledglings contained up to 144,000 ppm lead. Blood, liver, and kidney concentrations of lead in affected birds were higher than in normal fledglings, and acid-fast intranuclear inclusion bodies were present in the kidneys. Degenerative lesions were present in the myelin of some brachial nerves. Weathered paint samples collected from 12 buildings contained up to 247,250 ppm lead and 101 ppm mercury. Lead poisoning was diagnosed in 10 of the droop-winged albatrosses and was one of the causes of morbidity. Mercury toxicosis and plastic impaction were other possible causes.     

Is lead in tap water still a public health problem? An observational study in Glasgow.

OBJECTIVE: To assess the relation between tap water lead and maternal blood lead concentrations and assess the exposure of infants to lead in tap water in a water supply area subjected to maximal water treatment to reduce plumbosolvency. DESIGN: Postal questionnaire survey and collection of kettle water from a representative sample of mothers; blood and further water samples were collected in a random sample of households and households with raised water lead concentrations. SETTING: Loch Katrine water supply area, Glasgow. SUBJECTS: 1812 mothers with a live infant born between October 1991 and September 1992. Blood lead concentrations were measured in 342 mothers. MAIN OUTCOME MEASURES: Mean geometric blood lead concentrations and the prevalence of raised tap water lead concentration. RESULTS: 17% of households had water lead concentration of 10 micrograms/l (48.3 nmol/l) or more in 1993 compared with 49% of households in 1981. Tap water lead remained the main correlate or raised maternal blood lead concentrations and accounted for 62% and 76% of cases of maternal blood lead concentrations above 5 and 10 micrograms/dl (0.24 and 0.48 mumol/l) respectively. The geometric mean maternal blood lead concentration was 3.65 micrograms/dl (0.18 mumol/l) in a random sample of mothers and 3.16 micrograms/dl (0.15 mumol/l) in mothers whose tap water lead concentrations were consistently below 2 micrograms/l (9.7 nmol/l). No mother in the study had a blood lead concentration above 25 micrograms/dl (1.21 mumol/l). An estimated 13% of infants were exposed via bottle feeds to tap water lead concentrations exceeding the World Health Organisation''s guideline of 10 micrograms/l (48.3 nmol/l). CONCLUSIONS: Tap water lead and maternal blood led concentrations in the Loch Katrine water supply area have fallen substantially since the early 1980s. Maternal blood lead concentrations are well within limits currently considered safe for human health. Tap water lead is still a public health problem in relation to the lead exposure of bottle fed infants.     

Lifetime exposure to environmental lead and children's intelligence at 11-13 years: the Port Pirie cohort study.

OBJECTIVE--To examine the association between environmental exposure to lead and children''s intelligence at age 11-13 years, and to assess the implications of exposure in the first seven years of life for later childhood development. DESIGN--Prospective cohort study. SUBJECTS--375 children born in or around the lead smelting town of Port Pirie, Australia, between 1979 and 1982. MAIN OUTCOME MEASURE--Children''s intelligence quotient (IQ) measured at 11-13 years of age. RESULTS--IQ was inversely associated with both antenatal and postnatal blood lead concentrations. Verbal, performance, and full scale IQ were inversely related to blood lead concentration with no apparent threshold. Multivariate analyses indicated that after adjustment for a wide range of confounders, the postnatal blood lead concentrations (particularly within the age range 15 months to 7 years) exhibited inverse associations with IQ. Strong associations with IQ were observed for lifetime average blood lead concentrations at various ages. The expected mean full scale IQ declined by 3.0 points (95% confidence interval 0.07 to 5.93) for an increase in lifetime average blood lead concentration from 0.48 to 0.96 mumol/l (10 to 20 micrograms/dl). CONCLUSION--Exposure to environmental lead during the first seven years of life is associated with cognitive deficits that seem to persist into later childhood.     

Negative relationships between erythrocyte Ca-pump activity and lead levels in mothers and newborns

Lead poisoning induces hematological, gastrointestinal and neurological dysfunctions. One of the potential mechanisms is the inhibition of calcium-pump (Ca-pump), a transport protein. We investigated the effects of an environmental low lead exposure on Ca-pump activity in 247 mothers and their newborns. Maternal and cord blood, and newborn and mother hair, were sampled at delivery. Geometric means for mother and cord blood lead (Pb-B), and for mother and newborn hair lead (Pb-H), were 6.3 and 4.8 microg/dl, and 1.7 and 1.1 microg/g. Means for mother and cord basal Ca-pump activities were 2,442 and 2,675 nM/mg/hr. Mother enzymatic activity was negatively related to her Pb-B and Pb-H and to the cord Pb-B and newborn Pb-H levels. Newborn enzymatic activity was negatively related to his Pb-H level only. Adjustment for gestational age, child's sex, mother's age at delivery, alcohol, coffee and tea consumption, and smoking habits during pregnancy did not modify these relationships. Our findings support the hypothesis that lead toxicity could be in part mediated by a reduction of Ca-pump activity. This effect could be observed at low environmental exposure, in mothers and newborns.     

Management and Conservation Article

Abstract Despite increased knowledge about environmental toxins and changes in lead use (i.e., the mandated use of nonlead paint, gasoline, and shotgun pellets used for hunting waterfowl on federal lands), lead poisoning continues to occur in terrestrial birds. The degree of exposure and its demographic effect, however, continue to be described, emphasizing the growing concern over lead exposure. We examined 302 blood samples from common ravens (Corvus corax) scavenging on hunter-killed large ungulates and their offal piles to determine if lead rifle-bullet residuum was a point source for lead ingestion in ravens. We took blood samples during a 15-month period spanning 2 hunting seasons. Of the ravens tested during the hunting season, 47% exhibited elevated blood lead levels (≥ 10 μg/dL) whereas 2% tested during the nonhunting season exhibited elevated levels. Females had significantly higher blood lead levels than did males. Our results confirm that ravens are ingesting lead during the hunting season and are likely exposed to lead from rifle-shot big-game offal piles.     

Low level lead inhibits the human brain cation pump.

The impact of low level lead exposure on human central nervous system function is a major public health concern. This study addresses the inhibition of the cation pump enzyme Na, K-ATPase by low level lead. Human brain tissue was obtained at autopsy and frozen until use. Brain homogenates were preincubated with PbCl2 for 20 min at 0 degrees C. Inhibition of K-paranitrophenylphosphatase (pNPPase), a measure of the dephosphorylation step of Na,K-ATPase, reached steady state within 10 min. K-pNPPase activity, expressed (mean +/- SEM) as a percentage of control (45.2 +/- 2.7 nmol/mg/min), fell to 96.3 +/- 0.9% at 0.25 uM [PbCl2] to 82.0 +/- 1.6% at 2.5 uM [PbCl2] in homogenates prepared from normal brain. Similar results were obtained with homogenates prepared from brains of patients with a history of alcohol abuse and of those with other miscellaneous conditions. Since the mean blood level of lead in the United States has ranged recently from 9.2 to 16.0 ug/dl (0.44 to 0.77 uM), these results indicate that current in vivo levels of lead exposure may impair important human brain function.     

Low level environmental lead exposure--a continuing challenge

The current threshold for lead toxicity, defined as a blood lead level of 10 mug/dL, was adopted by the United States (US) Centers for Disease Control and Prevention (CDC) in 1991 and the World Health Organization in 1995. Since that time, adverse health outcomes at blood lead levels below this threshold have been well demonstrated. Most concern probably relates to children of pre-school age; an international pooled analysis has demonstrated lead-associated intellectual deficits at blood lead levels well below 10 mug/dL. In the case of adults, several convincing population studies have shown a positive association between blood lead and risk of death. The largest such study compared mortality information from participants with blood lead levels in the highest third of the blood lead distribution (3.6 mug/dL or greater) with those in the lowest third (less than 1.9 mug/dL). After adjustment for potential confounders, estimates of the excess risk were 25% for all cause mortality and 55% for cardiovascular mortality. The adverse consequences of lead exposure have no discernible blood lead threshold, implying there is no safety margin at existing exposure levels. Despite marked declines in population mean blood lead levels since 1980, low level environmental lead exposure remains a significant public health concern.