Lead poisoning primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
There are no established measures for the primary prevention of [disease name].
OR
There are no available vaccines against [disease name].
OR
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
OR
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
Regulation
US Rules and Regulations
See United States Environmental Protection Agency: Rules and Regulations for its jurisdiction and regulations.
"In 1998, the US Government instituted regulations which limit the amount of lead in toys and other consumer products which are expected to be used by infants to 0.06% (or 600 ppm)."[1]
Ten µg/dL (micrograms /deciliter) was adopted by CDC in 1991 as an action level for children, an advisory level for environmental and educational intervention. There are requirements that children receiving Medicaid be screened. Most states ask or require primary care physicians and persons in charge of screening programs to report both presumptive and confirmed cases of lead toxicity to the appropriate health agency. This is to ensure abatement of the lead source, education of the patient, and remediation steps are undertaken. In some states, the clinical laboratories performing blood lead testing are required to report cases of lead toxicity.
In early 2008, the watchdog Food and Drug Administration ordered several US retail stores and malls to remove bindi and sindoor from their shelves due to concerns over high lead and other harmful chemical contents.[2]
Workplace Air
The OSHA Lead Standard specifies the permissible exposure limit (PEL) of lead in the workplace, the frequency and extent of medical monitoring, and other responsibilities of the employer. OSHA has set a PEL (enforceable) of lead in workplace air at 50 µg/m3 averaged over an 8-hour workday for workers in general industry. NIOSH at CDC has set a Recommended Exposure Limit (REL) of 50 µg/m3 to be maintained so that worker blood lead remains < 60 µg/dL of whole blood.[2] The ACGIH has set a threshold limit value for a time-weighted average (TLV/TWA) of 50 µg/m3 for lead in workplace air (except for lead arsenate).[3]
The NIOSH Adult Blood Lead Epidemiology and Surveillance (ABLES) program,[4] a state-based surveillance program of laboratory-reported adult blood lead levels works to reduce the rate of adults (age 16 or older) who have blood lead levels of 25 micrograms per deciliter (mcg/dL) or greater.[5]
Lead contaminated soil can pose a risk through direct ingestion, uptake in vegetable gardens, or tracking into homes. Uncontaminated soil contains lead concentrations less than 50 ppm but soil lead levels in many urban areas exceed 200 ppm. (AAP 1993) The EPA’s standard for lead in bare soil in play areas is 400 ppm by weight and 1200 ppm for non-play areas. This regulation applies to cleanup projects using federal funds. The soil screening level (SSL) for lead represents a conservative estimate for a level that would be protective of public health in residential soils based on an analysis of the direct ingestion pathway for children.
EPA has set drinking water standards with two levels of protection. The maximum contaminant level goal (MCLG) is zero. This is the level determined to be safe by toxicological and biomedical considerations, independent of feasibility. EPA’s final rule establishes an action level is set at 15 µg/L. The use of lead solder and other lead-containing materials in connecting household plumbing to public water supplies was banned by EPA as of June 1988.
FDA has set a number of action levels (enforceable) and levels of concern for lead in various food items. These levels are based on FDA calculations of the amount of lead a person can consume without ill affect. FDA has set an action level of 0.5 µg/mL for lead in products intended for use by infants and children and has banned the use of lead-soldered food cans.[6]
House paint contained up to 50% lead before 1955. Federal law lowered the amount of lead allowable in paint to 1% in 1971. The CPSC has limited since 1977 the lead in most paints to 0.06% (600 ppm by dry weight). Paint for bridges and marine use may contain greater amounts of lead.[7]
Both the federal government and the state of Massachusetts are considering (as of September 2007) action against lead in children’s jewelry. "But Mr. Durbin said he was disappointed with Ms. Nord and the safety commission, which he said did not appear to be attacking the problem aggressively enough, including moving too slowly to institute and enforce a ban on lead in children’s jewelry. He also mocked a new agreement with Chinese officials to block lead in toys, saying that the Chinese government told his office the policy had long been in place."[8]
Less regulated countries
Dermatologists have concluded that the internal effects of lead are dangerous, as it has effects on the central nervous system, kidney and heart. Nevertheless, the emergence of synthetic dye industry has led to a variety of chemical dyes and salts being produced at a cheaper price in India.
Primary Prevention
- There are no established measures for the primary prevention of [disease name].
- There are no available vaccines against [disease name].
OR
- Effective measures for the primary prevention of [disease name] include:
- [Measure1]
- [Measure2]
- [Measure3]
OR
- [Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include:
- [Strategy 1]
- [Strategy 2]
- [Strategy 3]
References
- ↑ "Detecting Lead in Paint on Toys With Handheld Scanner From Oxford Instruments". azom.com. August 28, 2007. Retrieved 2007-09-09.
- ↑ "NIOSH Pocket Guide to Chemical Hazards". United States National Institute for Occupational Safety and Health. Retrieved 2007-09-09.
- ↑ "home page". American Conference of Governmental Industrial Hygienists. Retrieved 2007-09-09.
- ↑ NIOSH Topic: Adult Blood Lead Epidemiology and Surveillance (ABLES) | CDC NIOSH
- ↑ "NIOSH ABLES". United States National Institute for Occupational Safety and Health. Retrieved 2007-10-04.
- ↑ FDA 1994 and FDA 1995 as cited in ATSDR 1999.
- ↑ "Lead Toxicity: What Are U.S. Standards for Lead Levels?". United States Center for Disease Control. 2002. Retrieved 2007-09-09.
- ↑ Eric Lipton (September 13, 2007). "Senators Urge More Stringent Rules for Toy Safety". The New York Times. Retrieved 2007-09-13.