Interpreting and Managing Blood Lead Levels 10 ΜgdL in Children and Reducing Childhood Exposures to...

7/23/2019 Interpreting and Managing Blood Lead Levels 10 gdL in Children and Reducing Childhood Exposures to Lead

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Interpreting and Managing Blood Lead Levels $ C"C defined the !lood lead level ;LL< that shold promptp!lic health actions as >5g/dL+ Concrrently$ C"C also recogni?ed that a LL of >5g/dL did not define athreshold for the harmfl effects of lead ;633> has strengthened the evidencethat children@s physical and mental development can !e affected at LLs >5g/dL ;1,7


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"ring 440041$ a %or'grop of C"C@s Advisory Committee on Childhood Lead Poisoning Prevention;ACCLPP< revie%ed the scientific literatre regarding adverse health effects associated %ith LLs>5g/dL$ inclding 45 p!lished reports that analy?ed >6 separate poplations %ith =ntelligence Botient;=B< or general cognitive index otcomes and >4 p!lications related to other health otcomes+ =n its 47report$ the %or'grop conclded that an inverse association exists !et%een LLs and cognitive fnction$ %ithno evidence of a %ea'er association in poplations %ith lo%er LLs ; 15g/dL shold not !e classified as Flead poisoned+F The report notedthat no safe level for !lood lead in children has !een identified ;1 5g/dL on developmentalotcomes ;9,:


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clinically asymptomatic+ ecase no safe LL has !een defined ;15g/dL$ a la!oratory might operate %ithin an error range of25g/dL and still meet federal proficiency standards+ &or example$ an actal vale of !lood lead at . 5g/dLcold !e reported as !eing any vale ranging from 55g/dL to >>5g/dL and still remain %ithin the allo%a!leerror limit+ A stdy of dplicate testing of identical !lood samples ;all %ith a mean !lood lead vale>5g/dL< at eight la!oratories reported all reslts as > 5g/dL and %ithin 55g/dL of the overall mean forthat specimen vale ;195g/dL %ithot difficlty ;1:75g/dL ;122075g/dL+

Children!s BLL $atterns

LLs increase Gic'ly after an acte exposre$ then gradally ;over %ee's< reach eGili!rim %ith !odystores of lead+ Lead is distri!ted nevenly %ithin the hman !ody) in children$ approximately .J is storedin the !one compartment ;062209


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remain >5g/dL+ Ho%ever$ in clinical practice$ even shold additional research data !ecome availa!le$la!oratory ncertainty might interfere %ith a clinician@s a!ility to detect patterns for individal children+

nce a high LL has !een esta!lished in a child$ the time reGired for the LL to decline to > 5g/dL canrange from months to years$ depending on the dration and dose of exposre+ &or example$ for a grop ofchildren starting at a LL of >00>15g/dL and receiving case management services$ the mean time reGired

for 7J to achieve a LL >5g/dL %as 3 months ;7:5g/dL todecline in response to interventions is n'no%n+

(ltiple stdies have confirmed that !lood lead measrements vary seasonally+ &or example$ a stdycondcted in oston reported that LLs %ere highest in late ,ne and lo%est in (arch ; 7


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All children !enefit from parental nrtring$ regardless of their LL+ &or example$ a child@s langage s'illsare enhanced !y the amont of langage addressed to the child ;more is !etter3100>373 and 2J of those !ilt dring >3600>3..) estimates are higher forhomes in the Northeast and (id%est and for homes in %hich yong children reside ;1753 million for this prpose$ administered throgh seven differentgrant types+ ther federal programs provide fnding to eliminate lead0!ased paint ha?ards in federally assistedhosing+ Typically$ the focs of these programs is on hosing reha!ilitation and activities that remediate leadha?ards after children are identified %ith elevated LLs$ !t H:"0fnded local programs also no% incldeprimary prevention interventions that control or eliminate lead !efore children are exposed+

C"C is %or'ing %ith H:"$ the :+S+ Environmental Protection Agency ;EPA


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promote primary prevention strategies to redce exposre to lead ;1,87,84


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property o%ners %ho %ish to perform dst %ipe sampling may conslt their local health or hosingdepartments for advice regarding sampling procedres$ interpretation of reslts$ and frther actions !ased onreslts+

&or a lead0safe environment to !e esta!lished in older !ildings$ repair of lead ha?ards and carefl attention tomaintenance is necessary+ Ho%ever$ local ordinances typically do not reGire action ntil a child@s LL is

elevated$ and property o%ners might !e na%are of lead ha?ards or ignore them+ Primary prevention ispossi!le only if the focs on safety in older hosing is increased and lead ha?ards are repaired proactively!efore a child is exposed+ =n all pre0>3.2 properties$ o%ners shold se lead0safe %or' techniGes %henimplementing rotine maintenance to decrease the li'elihood of lead ha?ards developing in a home+

Home renovation or repair is 'no%n to !e a ris' factor for increasing or elevated LLs$ principally throghexposres to the dst reside generated dring the %or' ; 76,962299< relocating families %hen the %or' %arrants$ 4< minimi?ing the amont of dst created$ 55g/dL+

ecome informed a!ot lead exposre prevention strategies of local or state health departments and

partner %ith p!lic health agencies$ commnity grops$ and parents to %or' to%ard esta!lishing

lead0safe environments in homes and schools for all children and the redction of exposre to leadfrom all sorces+ Advocate for the expansion of services that foster lead poisoning primaryprevention+

or 2overnment "gencies

=ncrease efforts to resolve lead0!ased paint ha?ards safely !efore children are exposed+

Expand services that promote lead poisoning primary prevention and develop systems that ena!le

clinicians and parents to learn a!ot sch services+

"evelop and implement strategies to encorage the safe elimination of lead ha?ards in properties

sing trained %or'ers and lead0safe %or' practices$ in compliance %ith federal$ state$ and localreglations+

Esta!lish Drisdictional policies that mandate ensring lead safety in hosing and enforce these

mandates+

"evelop and apply systematic approaches to prevent exposres to even small amonts of lead in

food or consmer prodcts$ particlarly %hen safer alternatives are availa!le+

Promote implementation of state and local primary prevention plans that target areas$ poplations$

and activities of highest ris') foster political %ill) expand resorces for hosing remediation) identify


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and correct lead ha?ards) and esta!lish a reglatory infrastrctre to create and maintain lead0safehosing and spport the se of lead0safe constrction %or' practices+

Expand the availa!ility of and promote the se of early enrichment programs for all children from

economically and socially lo%0resorce families living in areas %here exposre to lead is li'ely+

Promote and fnd research that %ill frther evalate the effects of lead in !lood at levels >5g/dL

and evalate strategies to identify and redce exposre or the potential for exposre to lead$inclding strategies applied in medical offices and in homes+

"c.no*ledgment

Helpfl sggestions %ere provided !y Patric' ,+ Parsons$ Ph"$ Lead Poisoning/Trace Elements La!oratory$Oads%orth Center$ Ne% or' State "epartment of Health$ Al!any$ Ne% or'+

References

>+ C"C+ Preventing lead poisoning in yong children+ Atlanta$ A- :S "epartment of Health andHman Services$ C"C) 47+

4+ C"C+ (anaging elevated LLs among yong children- recommendations from the AdvisoryCommittee on Childhood Lead Poisoning Prevention+ Atlanta$ A- :S "epartment of Health andHman Services$ C"C) 44+ Availa!leat http-//%%%+cdc+gov/nceh/lead/Case(anagement/case(anageQmain+htm+

5+ American Academy of Pediatrics Committee on Environmental Health+ Lead exposre in children-prevention$ detection$ and management+ Pediatrics 47)>>6->560016+

1+ ellinger "C+ Lead+ Pediatrics 41)>>5->>60044+

7+ C"C+ Preventing lead poisoning in yong children+ Atlanta$ A- :S "epartment of Health andHman Services$ C"C) >33>+

6+ Canfield #L$ Henderson C# ,r$ Cory0Slechta "A$ Cox C$ ,s'o TA$ Lanphear P+ =ntellectal

impairment in children %ith !lood lead concentrations !elo% > 5g per deciliter+ N Engl , (ed45)512- >7>.0046+

.+ Lanphear P$ Hornng #$ hory ,$ et al+ Lo%0level environmental lead exposre and children@sintellectal fnction- an international pooled analysis+ Environ Health Perspect 47)>>5-2310033+

2+ TRlle?0#oDo (($ ellinger "C$ Arroyo0Biro? C$ et al+ Longitdinal associations !et%een !loodlead concentrations lo%er than >5g/dL and nero!ehavioral development in environmentallyexposed children in (exico City+ Pediatrics 46)>>2-e545005+ Availa!leat http-//pediatrics+aapp!lications+org/content/vol>>2/isse4/index+shtml+

3+ Annest ,L$ Pir'le ,L$ (a'c "$ Neese ,O$ ayse ""$ ovar (+ Chronological trend in !lood leadlevels !et%een >3.6 and >32+ N Engl , (ed >325)52->5.500.+

>+ Pir'le ,L$ rody ",$ nter EO$ et al+ The decline in !lood lead levels in the :nited States- TheNational Health and Ntrition Examination Srveys ;NHANES331)4.4-421003>+

>>+ C"C+ lood lead levels000:nited States$ >33>00>331+ ((O# >33.)16->1>006+

>4+ C"C+ lood lead levels000:nited States$ >3330044+ ((O# 47)71-7>5006+

>5+ ,aco!s "E$ Clic'ner #P$ ho ,$ et al+ The prevalence of lead0!ased paint ha?ards in :S hosing+Env Health Perspect 44)>>-A7330066+
http://www.cdc.gov/nceh/lead/CaseManagement/caseManage_main.htmhttp://www.cdc.gov/nceh/lead/CaseManagement/caseManage_main.htmhttp://pediatrics.aappublications.org/content/vol118/issue2/index.shtmlhttp://pediatrics.aappublications.org/content/vol118/issue2/index.shtmlhttp://www.cdc.gov/nceh/lead/CaseManagement/caseManage_main.htmhttp://pediatrics.aappublications.org/content/vol118/issue2/index.shtml


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>1+ ellinger "C+ Ohat is an adverse effect A possi!le resoltion of clinical and epidemiologicalperspectives on nero!ehavioral toxicity+ Environ #esearch 41)37-5310017+

>7+ Sargent ,"$ ,ohnson L$ #oda S+ "isparities in clinical la!oratory performance for !lood leadanalysis+ Arch Pediatr Adolesc (ed >336)>7-6300>1+

>6+ #oda S($ reenland #"$ ornschein #L$ Hammond P+ Anodic stripping voltammetry procedre

modified for improved accracy of !lood lead analysis+ Clin Chem >322)51-76500.+

>.+ ,ohanptra N$ ,ones #$ c'ler $ et al+ Accracy and reprodci!ility of !lood lead testing incommercial la!oratories+ Arch Pediatr Adolesc (ed >332)>74-7120075+

>2+ Parsons P,$ eraghty C$ Ueroste' (&+ An assessment of contemporary atomic spectroscopictechniGes for the determination of lead in !lood and rine matrices+ Spectrochim Acta 4>)76->7350061+

>3+ Schlen'er TL$ &rit? C,$ (ar' "$ et al+ Screening for pediatric lead poisoning+ Compara!ility ofsimltaneosly dra%n capillary and venos !lood samples+ ,A(A >331)4.>->516002+

4+ Parsons P,$ #eilly AA$ Esernio0,enssen "+ Screening children exposed to lead- an assessment of thecapillary !lood lead fingerstic' test+ Clin Chem >33.)15-5400>>+

4>+ Sargent ,"$ "alton (A+ #ethin'ing the threshold for an a!normal capillary !lood lead screeningtest+ Arch Pediatr Adolesc (ed >336)>7->21002+

44+ Holtrop T$ ee H$ Simpson P($ affman #E+ A commnity otreach lead screening programsing capillary !lood collected on filter paper+ Arch Pediatr Adolesc (ed >332)>74-177002+

45+ Schoenfeld ",$ Cllen (#$ #ainey P($ et al+ Screening for lead poisoning in an r!an pediatricclinic sing samples o!tained !y fingerstic'+ Pediatrics >331)31->.1003+

41+ C"C+ Capillary !lood sampling protocol+ Atlanta$ A- :S "epartment of Health and HmanServices$ C"C) >33.+ Availa!le athttp-//%%%+cdc+gov/nceh/lead/gide/>33./pdf/c4+pdf+

47+ arry PS$ (ossman "+ Lead concentrations in hman tisses+ r , =nd (ed >3.)4.-553007>+

46+ Schroeder HA$ Tipton =H+ The hman !ody !rden of lead+ Arch Environ Health >362)>.-36700.2+

4.+ Leggett #O+ An age0specific 'inetic model of lead meta!olism in hmans+ Environ Health Perspect>335)>>-732006>6+

42+ H H$ #a!ino%it? ($ Smith "+ one lead as a !iological mar'er in epidemiologic stdies of chronictoxicity- conceptal paradigms+ Environ Health Perspect >332)>6->002+

43+ (anton O=$ Angle C#$ Stane' L$ #eese #$ ehnemann T,+ AcGisition and retention of lead !yyong children+ Environ #esearch 4)24-6002+

5+ Schell L($ "enham ($ Star' A"$ et al+ (aternal !lood lead concentration$ diet dring pregnancy$and anthropometry predict neonatal !lood lead in a socioeconomically disadvantaged poplation+Environ Health Perspect 45)>>>->37004+

5>+ "ietrich N$ #is ("$ Sccop PA$ erger $ ornschein #L+ Early exposre to lead and DveniledelinGency+ Nerotoxicol Teratol 4>)45-7>>002+

54+ "ietrich $ erger $ Sccop P+ Lead exposre and the motor developmental stats of r!an six0year0old children in the Cincinnati Prospective Stdy+ Pediatrics >335)3>-5>00.+
http://www.cdc.gov/nceh/lead/guide/1997/pdf/c2.pdfhttp://www.cdc.gov/nceh/lead/guide/1997/pdf/c2.pdfhttp://www.cdc.gov/nceh/lead/guide/1997/pdf/c2.pdfhttp://www.cdc.gov/nceh/lead/guide/1997/pdf/c2.pdf


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55+ aghrst PA$ #o!ertson E&$ (c(ichael A,$ Uimpani U$ Oi!! N#$ #o!erts ##+ The Port PirieCohort Stdy- Lead effects on pregnancy otcome and early childhood development+Nerotoxicology >32.)2-5370014+

51+ #a!ino%it? ($ Leviton A$ Needleman H+ Uaria!ility of !lood lead concentrations dring infancy+Arch Environ Health >321)53-.100.+

57+ #a!ino%it? ($ Leviton A$ Needleman H$ ellinger "$ Oaternax C+ Environmental correlates ofinfant !lood lead levels in oston+ Environ #esearch >327)52-3600>.+

56+ ellinger "$ Sloman ,$ Leviton A$ #a!ino%it? ($ Needleman HL$ Oaternax C+ Lo%0level leadexposre and children@s cognitive fnction in the preschool years+ Pediatrics >33>)2.-4>3004.+

5.+ Lanphear P$ Hornng #$ Ho ($ Ho%ard C#$ E!erly S$ naf + Environmental lead exposredring early childhood+ , Pediatr 44)>1-100.+

52+ #o!erts ,#$ #eigart ,#$ E!eling ($ Hlsey TC+ Time reGired for !lood lead levels to decline innonchelated children+ , Toxicol Clin Toxicol 4>)53->75006+

53+ :S Environmental Protection Agency+ Seasonal rhythms of !lood0lead levels- oston$ >3.300>325+Oashington$ "C- :S Environmental Protection Agency) >337+ P!lication no+ EPA .1.0#031005+

1+ :S Environmental Protection Agency+ Seasonal trends in !lood lead levels in (il%a'ee- statisticalmethodology+ Oashington$ "C- :S Environmental Protection Agency) >336+ P!lication no+ EPA.1.0#0370>+

1>+ iin L($ #hoads $ Lioy P,+ Seasonal inflences on childhood lead exposre+ Environ HealthPerspect 4)>2->..0024+

14+ Laidla% (AS$ (iel'e HO$ &ilippelli ($ ,ohnson "L$ on?ales C#+ Seasonality and children@s!lood lead levels- developing a predictive model sing climatic varia!les and !lood lead data from=ndianapolis$ =ndiana$ Syrasse$ Ne% or'$ and Ne% rleans$ Loisiana ;:SA>5-.35002+

15+ Oasserman A$ Li $ Popovac "$ et al+ The goslavia Prospective Lead Stdy- contri!tions ofprenatal and postnatal lead exposre to early intelligence+ Nerotoxicol Teratol 4)44-2>>002+

11+ Pococ' S$ Smith ($ aghrst P+ Environmental lead and children@s intelligence- a systematic revie%of the epidemiological evidence+ (, >331)53->>23003.+

17+ aghrst PA$ (c(ichael A,$ Oigg N#$ et al+ Environmental exposre to lead and children@sintelligence at the age of seven years+ The Port Pirie Cohort Stdy+ N Engl , (ed >334)54.->4.30021+

16+ ellinger "$ Stiles $ Needleman H+ Lo%0level lead exposre$ intelligence$ and academicachievement- a long0term follo%0p stdy+ Pediatrics >334)3-277003>+

1.+ Lanphear P$ "ietrich $ Ainger P$ Cox C+ Cognitive deficits associated %ith !lood lead

concentrations >5g/dL in :S children and adolescents+ P!lic Health #ep 4)>>7-74>003+

12+ Chen A$ "ietrich N$ Oare ,H$ #adcliffe ,$ #ogan O,+ =B and !lood lead from 4 to . years of age-Are the effects in older children the residal of high !lood lead concentrations in 40year0oldsEnviron Health Perspect 47)>>5-73.006>+

13+ oller $ ro%n #$ Sprgeon A$ Levy L+ #ecent developments in lo%0level lead exposre andintellectal impairment in children+ Environ Health Perspect 41)>>1-32.0031+

7+ Needleman H$ atsonis C+ Lo%0level lead exposre and the =B of children+ ,A(A >33)465-6.5002+


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7>+ Hart $ #isley T#+ American parenting of langage0learning children- persisting differences infamily0child interactions o!served in natral home environments+ "ev Psychol >334)42->3600>7+

74+ Oal'er "+ Prediction of school otcomes !ased on early langage prodction and socioeconomicfactors+ Child "ev >331)67-66004>+

75+ Schneider ,S$ Lee (H$ Anderson "O$ c' L$ Lids'y T=+ Enriched environment dring

development is protective against lead0indced nerotoxicity+ rain #esearch 4>)236-120077+

71+ ilarte T#$ Toscano C"$ (clothan ,L$ Oeaver SA+ Environmental enrichment reverses cognitiveand moleclar deficits indced !y developmental lead exposre+ Ann Nerology 45)75-7006+

77+ #amey CT$ #amey SL+ Prevention of intellectal disa!ilities- early interventions to improvecognitive development+ Prev (ed >332)4.-4410054+

76+ lascoe &P+ Early detection of developmental and !ehavioral pro!lems+ Pediatr #ev 4)4>-4.4002

7.+ Anderson L($ Shinn C$ &llilove (T$ et al+ The effectiveness of early childhood developmentprograms- a systematic revie%+ Am , Prev (ed 45)41;5 Sppl4 epidemiologic stdies+ Env#esearch >332).3-7>0062+

6+ C"C+ lood lead levels in residents of homes %ith elevated lead in tap %ater000"istrict of Colm!ia$41+ ((O# 41-75)46200.+

6>+ (anton OE$ Angle C#$ rogstrand LS+ rigin of lead in the :nited States diet+ Environ SciTechnol 47)53-2337003+

64+ National Center for Healthy Hosing+ Another lin' in the chain- state policies and practices for casemanagement and environmental investigation for lead0poisoned children$ pdate+ Colm!ia$ ("-National Center for Healthy Hosing) 4>+ Availa!leat http-//%%%+afhh+org/res/resQp!s/Lin'QinQChainQ:pdate+pdf+

65+ C"C+ Preventing lead exposre in yong children- a hosing0!ased approach to primary preventionof lead poisoning+ Atlanta$ A- :S "epartment of Health and Hman Services$ C"C) 41+Availa!le athttp-//%%%+cdc+gov/nceh/lead/P!lications/PrimaryJ4PreventionJ4"ocment+pdf+

61+ C"C+ ilding !loc's for primary prevention- protecting children from lead0!ased paint ha?ards+Atlanta$ A- :S "epartment of Health and Hman Services$ C"C) 47+ Availa!leathttp-//%%%+cdc+gov/nceh/lead/ildingJ4loc'sJ4,neJ447+pdf+

67+ ro%n (,$ ardner ,$ Sargent ,"$ S%art? $ H H$ Timperi #+ The effectiveness of hosing policies

in redcing children@s lead exposre+ Am , P!lic Health 4>)3>-64>001+

66+ :S "epartment of Hosing and :r!an "evelopment+ LeadSafeHomes+info+ Oashington$ "C- :S"epartment of Hosing and :r!an "evelopment) 44+ Availa!le athttp-//%%%+leadsafehomes+info+

6.+ Lead- reGirements for disclosre of 'no%n lead !ased paint and/or lead !ased paint ha?ards inhosing$ 14 :+S+C+ Sect+ 1274d ;>334. ;47


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63+ National Center for Healthy Hosing and :niversity of Cincinnati "epartment of EnvironmentalHealth+ Evalation of the H:" Lead0ased Paint Ha?ard Control rant Program- final report+Cincinnati$ H- National Center for Healthy Hosing and :niversity of Cincinnati "epartment ofEnvironmental Health) 41+ Availa!leathttp-//%%%+hd+gov/offices/lead/Evalation&inal#eport+pdf+

.+ Clar' S$ (enrath O$ Chen ($ Sccop P$ ornschein #$ al'e O$ Oilson ,+ The inflence of exterior

dst and soil lead on interior dst lead levels in hosing that had ndergone lead0!ased paint ha?ardcontrol+ , ccp Environ Hyg 41)>-4.50024+

.>+ "ixon SL$ Oilson ,O$ Clar' CS$ al'e OA$ Sccop PA$ Chen (+ The inflence of common arealead loadings and lead ha?ard control on dst lead loadings in mltinit !ildings+ , ccp EnvironHyg 47)4-6730066+

.4+ inns H,$ ray A$ Chen T$ et al+ Evalation of landscape coverings to redce soil lead ha?ards inr!an residential yards- The Safer ards ProDect+ Environ #esearch 41)36->4.0052+

.5+ iin L($ #hoads $ #ich "B$ et al+ Comparison of techniGes to redce residential lead dst oncarpet and pholstery- The Ne% ,ersey Assessment of Cleaning TechniGes Trial+ Environ HealthPerspect 44)>>->45500.+

.1+ ro%n (,$ (cLaine P$ "ixon S$ Simon P+ A randomi?ed$ commnity0!ased trial of home visiting toredce !lood lead levels in children+ Pediatrics 46)>>.)>1.0075+

.7+ C"C+ Children %ith elevated !lood lead levels attri!ted to home renovation and remodelingactivities000Ne% or'$ >33500>331+ ((O# >33.)17->>4005+

.6+ #eissman "$ (atte T"$ rnit? L$ afmann #$ Leighton ,+ =s home renovation or repair a ris'factor for exposre to lead among children residing in Ne% or' City , :r!an Health 44).3-7400>>+

..+ :S Environmental Protection Agency+ Lead exposre associated %ith renovation and remodelingactivities- phase ===+ Oisconsin Childhood lood0Lead Stdy+ Oashington$ "C- :S EnvironmentalProtection Agency) >333+ P!lication no+ EPA .1.0#033004+

.2+ :S Environmental Protection Agency+ EPA model renovation training corse minimi?ing lead0!asedpaint ha?ards dring renovation$ remodeling$ and painting+ Oashington$ "C- :S EnvironmentalProtection Agency) 4+ P!lication no+ EPA .1.0007/6+

.3+ :S "epartment of Hosing and :r!an "evelopment+ Lead paint safety- a field gide for painting$home maintenance$ and renovation %or'+ Oashington$ "C- :S "epartment of Hosing and :r!an"evelopment) 4>+ Availa!le at http-//%%%+hd+gov/offices/lead/training/LPgide+pdf+

2+ :S Environmental Protection Agency+ Lead in yor home- a parent@s reference gide+ Oashington$"C- :S Environmental Protection Agency) >332+ P!lication No+ EPA .1.003204+ Availa!leat http-//%%%+epa+gov/lead/p!s/leadrev+pdf+

2>+ &ederal #egister 4>+ Part ===+ Environmental Protection Agency+ Lead) identification of dangeros

levels of lead- final rle)66->461+

24+ Aschengra A$ eiser A$ ellinger "$ Copenhafer "$ Oeit?man "+ #esidential lead0!ased0paintha?ard remediation and soil lead a!atement- their impact among children %ith mildly elevated !loodlead levels+ Am , P!lic Health >33.)2.->63200.4+

25+ Lanphear P$ Oeit?man ($ Ointer NL$ et al+ Lead0contaminated hose dst and r!an children@s!lood lead levels+ Am , P!lic Health >336)26->1>6004>+
http://www.hud.gov/offices/lead/EvaluationFinalReport.pdfhttp://www.hud.gov/offices/lead/training/LBPguide.pdfhttp://www.hud.gov/offices/lead/training/LBPguide.pdfhttp://www.epa.gov/lead/pubs/leadrev.pdfhttp://www.hud.gov/offices/lead/EvaluationFinalReport.pdfhttp://www.hud.gov/offices/lead/training/LBPguide.pdfhttp://www.epa.gov/lead/pubs/leadrev.pdf


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21+ al'e O$ Clar' S$ (cLaine P$ et al+ National evalation of the :S "epartment of Hosing and :r!an"evelopment Lead0ased Paint Ha?ard Control rant Program- stdy methods+ Environ #esearch47)32-5>70042+

27+ al'e O$ Clar' S$ Oilson ,$ et al+ Evalation of the H:" Lead Ha?ard Control rant Program- earlyoverall findings+ Environ #esearch 4>)26->130076+

26+ "ixon SL$ Oilson ,O$ Sccop PA$ et al+ #esidential dst lead loading immediately after interventionin the H:" Lead Ha?ard Control rant Program+ , ccp Environ Hyg 41)>-.>60041+

2.+ Clar' S$ rote ,A$ Oilson ,$ et al+ ccrrence and determinants of increases in !lood lead levels inchildren shortly after lead ha?ard control activities+ Environ #esearch 41)36->360047+

22+ ersten H$ (oghan $ (oran (($ Spector N"$ Smals LE$ "eLago CO+ A videotape to improveparental 'no%ledge of lead poisoning+ Am!l Pediatr 41)1-51100.+

23+ :S Environmental Protection Agency+ asis for edcational recommendations on redcingchildhood lead exposre+ Oashington$ "C- :S Environmental Protection Agency) 4+ P!licationno+ EPA .1.0#00>+ Availa!le athttp-//%%%+epa+gov/opptintr/lead/p!s/redcQp!+pdf+

3+ Haynes E$ Lanphear P$ Tohn E$ &arr N$ #hoads + The effect of interior lead ha?ard controls onchildren@s !lood lead concentrations- a systematic evalation+ Environ Health Perspect44)>>->500.+

3>+ Sandel ($ Phelan $ Oright #$ Hynes HP$ Lanphear P+ The effects of hosing interventions onchild health+ Pediatr Ann 41)55-1.1002+

34+ ,ordan "($ se L$ #o!inson LL$ Hannan P$ "einard AS+ A randomi?ed trial of edcation toprevent lead !rden in children at high ris' for lead exposre- efficacy as measred !y !lood leadmonitoring+ Environ Health Perspect 45)>>>->31.007>+

35+ Lanphear P$ Ho%ard C$ E!erly S$ et al+ Primary prevention of childhood lead exposre- arandomi?ed trial of dst control+ Pediatrics >333)>5-..400.+

31+ Lanphear P$ E!erly S$ Ho%ard C#+ Long0term effect of dst control on !lood lead concentrations+Pediatrics 4)>6-e12+ Availa!leathttp-//pediatrics+aappp!lications+org/content/vol>6/isse1/index+shtml+

37+ Lanphear P$ Ointer NL$ Apet? L$ E!erly S$ Oeit?man (+ A randomi?ed trial of the effect of dstcontrol on children@s !lood lead levels+ Pediatrics >336)32-57001+

36+ #hoads $ Ettinger AS$ Oeisel CP$ et al+ The effect of dst control on !lood lead in toddlers- arandomi?ed trial+ Pediatrics >333)>5-77>007+

3.+ Aschengra A$ Hardy S$ (ac'ey P$ Pltinas "+ The impact of lo% technology lead ha?ard redctionactivities among children %ith mildly elevated !lood lead levels+ Environ #es >332).3-1>007+

32+ Liin L($ Lioy P,$ #hoads + =mpact of home carpets on childhood lead intervention stdy+

Environ #esearch 45)34->6>007+

33+ Ettinger AS$ ornschein #L$ &arfel ($ et al+ Assessment of cleaning to control lead dst in homes ofchildren %ith moderate lead poisoning- Treatment of Lead0Exposed Children Trial+ Environ HealthPerspect 44)>>-A..5003+

>+Camp!ell C$ Sch%ar? "&$ #ich "$ "oc'ery "+ Effect of a follo%0p professional home cleaning onserial dst and !lood lead levels in r!an children+ Arch Environ Health 45)72-..>002+
http://www.epa.gov/opptintr/lead/pubs/reduc_pb.pdfhttp://www.epa.gov/opptintr/lead/pubs/reduc_pb.pdfhttp://www.epa.gov/opptintr/lead/pubs/reduc_pb.pdfhttp://pediatrics.aapppublications.org/content/vol106/issue4/index.shtmlhttp://pediatrics.aapppublications.org/content/vol106/issue4/index.shtmlhttp://www.epa.gov/opptintr/lead/pubs/reduc_pb.pdfhttp://pediatrics.aapppublications.org/content/vol106/issue4/index.shtml


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>>+Tohn E#$ "ixon SL$ Oilson ,O$ al'e OA$ Clar' CS+ An evalation of one0time professionalcleaning in homes %ith lead0!ased paint ha?ards+ Appl ccp Environ Hyg 45)>2->520015+

>4+C"C+ Screening yong children for lead poisoning- gidance for state and local p!lic healthofficials+ Atlanta$ A- :S "epartment of Health and Hman Services$ C"C) >33.+

>5+C"C Advisory Committee on Childhood Lead Poisoning Prevention+ #ecommendations for !lood

lead screening of yong children enrolled in (edicaid- targeting a grop at high ris'+ ((O#4)13;No+ ##0>11+:S eneral Acconting ffice+ Lead poisoning- federal health care programs are not effectivelyreaching at0ris' children+ Oashington$ "C- :S eneral Acconting ffice) >333+ A/HEHS0330>2+

>7+emper A#$ Cohn L($ &ant E$ "om!'o%s'i ,+ lood lead testing among (edicaid0enrolledchildren in (ichigan+ Arch Pediatr Adolesc (ed 47)>73-616007+

>6+Steinsapir C$ Leighton ,$ Nagin "$ Ehrlich ,+ Childhood lead poisoning prevention and management+Ne% or' City Health =nformation 41)45-45002+

>.+Philadelphia "epartment of P!lic Health$ Childhood Lead Poisoning Prevention Program-recommendations for the screening and management of yong children potentially exposed to lead+Philadelphia$ PA- "epartment of P!lic Health) >33.+

>2+Chicago "epartment of P!lic Health+ lood lead testing gidelines for Chicago+ Chicago$ =L-"epartment of P!lic Health) >333+ Availa!leathttp-//%%%+ci+chi+il+s/%e!portal/CCOe!Portal/CCQE"=T#=AL/ChicagoLLTestingidelines+pdf+

>3+#o!in L&$ eller ($ (iddagh ,P+ State%ide assessment of lead poisoning and exposre ris' amongchildren receiving (edicaid services in Alas'a+ Pediatrics >33.)33-e3+ Availa!leathttp-//pediatrics+org/cgi/content/fll/33/1/e3+

>>+C"C+ lood lead levels among children in a managed0care organi?ation000California$ cto!er >33400

(arch >335+ ((O# >337)11- 64.0057+

>>>+ inns H,$ Leailly SA$ Poncher ,$ insella T#$ Sanders SE$ Pediatric Practice #esearch rop+ =sthere lead in the s!r!s #is' assessment in Chicago s!r!an pediatric practices+ Pediatrics>331)35->6100.>+

>>4+a?al LA ,r+ The failre of C"C screening Gestionnaire to efficiently detect elevated lead levels ina rral poplation of children+ , &am Practice >33.)17-7>7002+

>>5+(ni? (A$ "ndas #$ (ahoney (C+ Evalation of a childhood lead Gestionnaire in predictingelevated !lood lead levels in a rral commnity+ , #ral Health 45)>3->7003+

>>1+&rance E$ itterman A$ (elin'ovich P$ Oright #A+ The accracy of a lead Gestionnaire inpredicting elevated pediatric !lood lead levels+ Arch Pediatr Adolesc (ed >336)>7-3720065+

>>7+inns H,$ Leailly SA$ &ingar A#$ Sanders S+ Evalation of ris' assessment Gestions sed totarget !lood lead screening in =llinois+ Pediatrics >333)>5->006+

>>6+#ooney L$ Hayes E$ Allen $ Strtt P,+ "evelopment of a screening tool for prediction ofchildren at ris' for lead exposre in a mid%estern clinical setting+ Pediatrics >331)35->2500.+

>>.+Striph + Prevalence of lead poisoning in a s!r!an practice+ , &am Pract >337)1>-6700.>+
http://www.ci.chi.il.us/webportal/COCWebPortal/COC_EDITORIAL/ChicagoBLLTestingGuidelines.pdfhttp://www.ci.chi.il.us/webportal/COCWebPortal/COC_EDITORIAL/ChicagoBLLTestingGuidelines.pdfhttp://www.ci.chi.il.us/webportal/COCWebPortal/COC_EDITORIAL/ChicagoBLLTestingGuidelines.pdfhttp://pediatrics.org/cgi/content/full/99/4/e9http://pediatrics.org/cgi/content/full/99/4/e9http://www.ci.chi.il.us/webportal/COCWebPortal/COC_EDITORIAL/ChicagoBLLTestingGuidelines.pdfhttp://www.ci.chi.il.us/webportal/COCWebPortal/COC_EDITORIAL/ChicagoBLLTestingGuidelines.pdfhttp://pediatrics.org/cgi/content/full/99/4/e9


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>>2+TeDeda "(+ Oyatt ""+ #oste' #+ Solomon O+ "o Gestions a!ot lead exposre predict elevatedlead levels Pediatrics >331)35->34001+

>>3+Snyder "C$ (ohle0oetani ,C$ Palla $ &enstershei! (+ "evelopment of a poplation0specific ris'assessment to predict elevated !lood lead levels in Santa Clara Conty$ California+ Pediatrics>337)36- 615002+

>4+Schaffer S,$ incaid (S$ Endres N$ Oeit?man (+ Lead poisoning ris' determination in a rralsetting+ Pediatrics >336)3.-21003+

>4>+Palo??i L,$ Shapp ,$ "ra%!agh #E$ Carney ,+ Prevalence of lead poisoning among t%o0year0oldchildren in Uermont+ Pediatrics >337)36-.2002>+

>44+#olnic' S,+ Nordin ,$ Cherney L(+ A comparison of costs of niversal verss targeted leadscreening for yong children+ Environ #esearch >333)2-21003>+

>45+"alton (A$ Sargent ,"$ St'el TA+ :tility of a ris' assessment Gestionnaire in identifying children%ith lead exposre+ Arch Pediatr Adolesc (ed >336)>7->3.0044+

>41+Casey #$ Oiley C$ #tstein #$ Pinto0(artin ,+ Prevalence of lead poisoning in an r!an cohort ofinfants %ith high socioeconomic stats+ Clin Pediatr >331)55-12001+

>47+Schaffer S,$ S?ilagyi P$ Oeit?man (+ Lead poisoning ris' determination in an r!an poplationthrogh the se of a standardi?ed Gestionnaire+ Pediatrics >331)35->730065+

>46+ronson (A$ Tilden #L$ #enier C(+ Commnity0!ased screening for childhood lead poisoning+=dentification of ris' factors and sscepti!le poplations in "lth+ (inn (ed >333)24-47003+

>4.+Haan (N$ erson ($ ish'a A+ =dentification of children at ris' for lead poisoning- an evalationof rotine pediatric !lood lead screening in an H(0insred poplation+ Pediatrics >336)3.-.30025+

>42+Schonfeld ",$ #ainey P($ Cllen (#$ Sho%alter "#$ Cicchetti "U+ Screening for lead poisoning !yfingerstic' in s!r!an pediatric practices+ Arch Pediatr Adolesc (ed >337)>13-11.007+

* A list of mem!ers of this committee appears on page >6 of this isse+

KA complimentary video or "U" entitled$ FC"C idelines for Collecting and Handling lood LeadSamples00041$F may !e o!tained from the National Center for Environmental Health$ "ivision ofLa!oratory Sciences$ Lead and (ltielement Proficiency Program at e0mail ncehdls8cdc+gov+

"dvisor# Committee on Childhood Lead $oisoning $revention

Mem3ership List4 +cto3er 5006,,e3ruar# 5007

Chairperson% Carla Camp!ell$ ("$ Children@s Hospital of Philadelphia$ Philadelphia$ Pennsylvania+

Executive )ecretar#%(ary ,ean ro%n$ Sc"$ "ivision of Environmental and Emergency HealthServices/Agency for Toxic S!stances and "isease #egistry$ National Center for Environmental Health$C"C$ Atlanta$ eorgia+

Mem3ers%(agaly C+ Angeloni$ (A$ #hode =sland "epartment of P!lic Health$ Providence$ #hode=sland) Ualerie Charlton$ ("$ California "epartment of Health$ #ichmond$ California) Oalter S+ Handy$ ,r+$Ph"$ Cincinnati Health "epartment$ Cincinnati$ hio) =ng ang Ho$ Ph"$ :niversity of (ississippi (edicalCenter$ ,ac'son$ (ississippi) Ualarie ,ohnson$ :r!an Parent to Parent$ #ochester$ Ne% or') Linda ite$(A$ Healthy Homes Colla!orative$ Los Angeles$ California) ,essica Leighton$ Ph"$ Ne% or' City"epartment of Health and (ental Hygiene$ Ne% or' City$ Ne% or') Sally dle$ SafeHomes$ =nc+$


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Oater!ry$ Connectict) eorge + #hoads$ ("$ :niversity of (edicine and "entistry of Ne% ,ersey$Piscata%ay$ Ne% ,ersey) Catherine (+ Slota0Uarma$ ("$ (edical College of Oisconsin$ (il%a'ee$Oisconsin) Oayne #+ Snodgrass$ ("$ Ph"$ :niversity of Texas (edical ranch$ alveston$ Texas) evin :+Stephens$ Sr+$ ("$ ,"$ Ne% rleans "epartment of Health$ Ne% rleans$ Loisiana) Helen ,+ inns$* ("$&ein!erg School of (edicine$ North%estern :niversity$ Chicago$ =llinois) im!erly (+ Thompson$ KSc"$Harvard :niversity$ oston$ (assachsetts+

onvoting ederal Mem3ers%Phyllis St!!s0Oynn$ ("$ (aternal and Child Health rea$ Health#esorces and Services Administration$ Oashington$ "C) (ichael olger$ Ph"$ :+S+ &ood and "rgAdministration) Oashington$ "C) ,ohn orra??o$ Ph"$ :+S+ Agency for =nternational "evelopment$Oashington$ "C) "avid ,aco!s$VPh"$ :+S+ "epartment of Hosing and :r!an "evelopment$ Oashington$"C) Oarren &riedman$ Ph"$ :+S+ "epartment of Hosing and :r!an "evelopment$ Oashington$ "C),acGeline E+ (os!y$ (PH$ :+S+ Environmental Protection Agency$ Oashington$ "C) Oalter #ogan$ ("$National =nstitte of Environmental Health Sciences$ Oashington$ "C) #o!ert ,+ #oscoe$ (S$ National=nstitte for ccpational Safety and Health$ C"C$ Cincinnati$ hio) Lori E+ Salt?man$ (S$ :+S+ ConsmerProdct Safety Commission$ Oashington$ "C) ,erry elinger$ ("$ Center for (edicare and (edicaid andServices$ Oashington$ "C+

onvoting Liaison Representatives%Steve ($ Hays$ American =ndstrial Hygiene Association$ Nashville$

Tennessee) E?atollah eyvan0LariDani$ ("$ "rPH$ Concil of State and Territorial Epidemiologists$altimore$ (aryland) Pat (cLaine$W(PH$ National Center for Healthy Hosing$ Colm!ia$ (aryland),onathan Oilson$ (PP$ National Center for Healthy Hosing$ Colm!ia$ (aryland) enDamin itterman$("$ American P!lic Health Association$ Oashington$ "C) #ott #eigart ==$** ("$ American Academy ofPediatrics$ Charleston$ Soth Carolina) eorge C+ #odgers$ ,r+$ ("$ Ph"$ American Association of PoisonControl Centers$ eorgeto%n$ =ndiana) ,an To%ers$ Ph"$ American Academy of Nrse Practitioners$ettys!rg$ Pennsylvania) Anne ( thrie$ (PH$ Alliance for Healthy Homes$ Oashington$ "C) Calvin +,ohnson$ ("$ American State and Territorial Health fficials$ Harris!rg$ Pennsylvania+

* (em!er 440041+ +

K(em!er 440047+

V

(em!er >3360041+

W#epresentative >3320047+

** #epresentative >33.0041+

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:se of trade names and commercial sorces is for identification only and does not imply endorsement !y the:+S+ "epartment of Health and Hman Services+

#eferences to non0C"C sites on the =nternet are provided as a service to;;


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Interpreting and Managing Blood Lead Levels 10 ΜgdL in Children and Reducing Childhood Exposures to...

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