Geometric Mean Blood Lead Levels Research Articles

Blood Lead Levels in U.S. Women of Childbearing Age, 1976-2016.

Background:Lead can adversely affect maternal and child health across a wide range of exposures; developing fetuses and breastfeeding infants may be particularly vulnerable. We describe the distribution of blood lead levels (BLLs) in U.S. women of childbearing age and associations with sociodemographic, reproductive, smoking, and housing characteristics over a 40-y period.Methods:Data from the National Health and Nutrition Examination Survey (NHANES) II, NHANES III Phase I and Phase II, and 1999–2016 continuous NHANES were used to describe the distribution of BLLs (given in micrograms per deciliter; ) in U.S. women 15–49 years of age between 1976 and 2016. For all women with valid BLLs (), geometric mean (GM) BLLs and estimated prevalence of BLLs were calculated overall and by selected demographic characteristics. For NHANES II, estimated prevalence of BLLs and were also calculated.Results:The most recent GM BLLs (2007–2010 and 2011–2016, respectively) were [95% confidence interval (CI): 0.79, 0.84] and (95% CI: 0.59, 0.64). In comparison, GM BLLs in earlier periods (1976–1980, 1988–1991, and 1991–1994) were (95% CI: 9.95, 10.79), (95% CI: 1.75, 1.94), and (95% CI: 1.45, 1.60), respectively. In 2011–2016, 0.7% of women of childbearing age had BLLs , and higher BLLs were associated with older age, other race/ethnicity, birthplace outside the United States, four or more live births, exposure to secondhand tobacco smoke, and ever pregnant or not currently pregnant.Discussion:Lead exposure in U.S. women of childbearing age is generally low and has substantially decreased over this 40-y period. However, based on these estimates, there are still at least 500,000 U.S. women being exposed to lead at levels that may harm developing fetuses or breastfeeding infants. Identifying high-risk women who are or intend to become pregnant remains an important public health issue. https://doi.org/10.1289/EHP5925

Evaluation of the Effectiveness of Hygenall<sup>©</sup> Leadoff<sup>TM</sup> Foaming Soap in Reducing Lead on Workers’ Hands and the Uptake of Lead on Bridge Painting Projects

Although considerable research has been conducted regarding airborne lead exposures during lead paint removal, little data has been collected measuring the lead concentration on workers’ hands in the construction industry. As a result, there are gaps in our understanding of the effectiveness of a standard work practice control (handwashing) in the prevention and control of elevated blood lead levels (BLLs) in the workplace. The primary objective of this study was to assess if a National Institute for Occupational Safety and Health (NIOSH) formulation intended to remove lead from skin (Hygenall© LeadoffTM Foaming Soap) is more effective than a commonly used soap in the industrial painting industry (Zep Cherry Bomb Soap) in reducing the concentration of lead on workers’ hands after exposure. A secondary aim was to assess if using LeadoffTM Foaming Soap during handwashing reduces worker uptake of lead on bridge painting projects. We evaluated hand wipe, air sample and blood lead level data collected by two industrial bridge painting contractors. Airborne exposures ranged from 350 μg/m3 to 19,700 μg/m3. The geometric mean lead concentration remaining on workers’ hands after using Zep Cherry Bomb Soap was 77 μg per hand wipe compared with 61 μg per hand wipe after use of LeadoffTM Foaming Soap for all work classifications. The geometric lead concentration on workers’ hands decreased by 16 μg/hand wipe for all work classifications combined after using LeadoffTM Foaming Soap—a decrease of 21%. The use of Hygenall LeadoffTM Foaming Soap reduced the maximum lead concentration on workers’ hands by 85%. The geometric mean BLL for all work classifications was 12.1 μg/dl before the use of LeadoffTM. After two months of airborne exposure and use of LeadoffTM Foaming Soap at breaks and at the end of the workday, the geometric mean BLL for all work classifications increased to 18.1 μg/dl. Worker BLLs increased despite the reduction in the concentration of lead measured on workers’ hands—most likely a result of ineffective inhalation exposure controls. We found that the LeadoffTM Foaming Soap was more effective in removing lead from workers’ hands than Zep Cherry Bomb.

Blood lead levels among Chinese children: The shifting influence of industry, traffic, and e-waste over three decades

In China, data relating to the historic prevalence of childhood lead poisoning suggest its pervasiveness. This review analysed published epidemiological data on blood lead levels (BLLs) of 735,271 Chinese children aged 0–6 between 1987 and 2017. Among these children, the geometric mean (GM) BLL was 95.1 μg/L (geometric SD = 1.62), and 24.1% suffered lead poisoning (BLL ≥ 100 μg/L). Importantly, there was a temporal decrease in the GM BLL value, from 182.9 μg/L in 1987–1991 to 42.4 μg/L in 2012–2017. However, a rebound was seen in the most recent two years (2016 and 2017). Moreover, the GM BLL among Chinese children has not fallen as low as U.S. children. This indicates that either (1) leaded petrol or lead based-paint exposure sources have not been adequately controlled in China, or (2) other pollution sources, such as industry, traffic, and e-waste, are impacting Chinese children. Drivers behind spatio-temporal variations were explored to provide scientific evidence regarding the prevention of childhood lead poisoning. We found that BLLs among children in the central and eastern areas of China have dropped lower than those in the western area, and that the GM BLL of children living in rural areas now exceeds children in urban areas. These reversals may be associated with the industrial decentralization policy of the late 1980s, when many heavily polluting industries and manufacturers moved away from cities on the east coast. It was discovered that the BLLs of children living in areas associated with mining have remained high (GM BLL = 155.0 μg/L for 2007–2017), and that the lead poisoning rate (LPR) has become exceptionally high in areas associated with e–waste. Finally, the review offers a data comparison with other countries, an overview of potentially influencing factors and sources, as well as some suggested prevention strategies to reduce childhood lead exposure.

Pre-school child blood lead levels in a population-derived Australian birth cohort: the Barwon Infant Study.

ObjectivesTo investigate blood lead levels in an Australian birth cohort of children; to identify factors associated with higher lead levels.Design, settingCross‐sectional study within the Barwon Infant Study, a population birth cohort study in the Barwon region of Victoria (1074 infants, recruited June 2010 – June 2013). Data were adjusted for non‐participation and attrition by propensity weighting.ParticipantsBlood lead was measured in 523 of 708 children appraised in the Barwon Infant Study pre‐school review (mean age, 4.2 years; SD, 0.3 years).Main outcome measureBlood lead concentration in whole blood (μg/dL).ResultsThe median blood lead level was 0.8 μg/dL (range, 0.2–3.7 μg/dL); the geometric mean blood lead level after propensity weighting was 0.97 μg/dL (95% CI, 0.92–1.02 μg/dL). Children in houses 50 or more years old had higher blood lead levels (adjusted mean difference [AMD], 0.13 natural log units; 95% CI, 0.02–0.24 natural log units; P = 0.020), as did children of families with lower household income (per $10 000, AMD, –0.035 natural log units; 95% CI, –0.056 to –0.013 natural log units; P = 0.002) and those living closer to Point Henry (inverse square distance relationship; P = 0.002). Associations between hygiene factors and lead levels were evident only for children living in older homes.ConclusionBlood lead levels in our pre‐school children were lower than in previous Australian surveys and recent surveys in areas at risk of higher exposure, and no children had levels above 5 μg/dL. Our findings support advice to manage risks related to exposure to historical lead, especially in older houses.

Contemporary blood lead levels of children aged 0–84 months in China: A national cross-sectional study

Despite the global abundance of studies on children’s lead (Pb) exposure, the magnitude of Pb exposure among children across China remains unclear, especially for rural areas. In 2000, Pb was removed from petrol, marking a change in the sources of Pb exposure in China. To better understand children’s Pb exposure and inform potential approaches to exposure reduction, we conducted a national blood Pb survey of 31,373 children (0–84 months old) from May 2013 to March 2015, using a multi-stage and multi-strata sampling method. Blood lead levels (BLLs) were tested using graphite furnace atomic absorption spectrometry with a detection limit of 1 µg/L. The results show that Chinese children had a contemporary geometric mean (GM) BLL of 26.7 μg/L, with 8.6% of BLLs exceeding 50 µg/L. Boys had higher BLLs (GM 27.2 μg/L) compared to girls (GM: 25.9 μg/L) (p < 0.001). Children at the age of 0–36 months had a lower PbB (GM 25.7 μg/L) level compared with those aged 36–84 months (GM 27.9 μg/L) (p < 0.001). When taking into account sociodemographic factors, a multivariate logistic regression analysis shows that the odds ratios (OR) of having a BLL of 27 µg/dL (i.e., median BLL of this study) or higher were 1.88 (95% CI: 1.76, 2.02) and 1.35 (95% CI: 1.22, 1.49) for homes using coal and biomass fuels, respectively, compared to those using gas or electricity. Meanwhile, children in homes close to roads were more likely to have BLLs exceeding 27 µg/dL (OR: 1.11, 95% CI: 1.03, 1.20). In China, rural children had higher BLLs compared to urban children. As a result of pediatric exposure to Pb, there were approximately 144 million and 36 million IQ points lost for rural children and urban children, respectively, revealing a disparity of Pb exposure between rural and urban areas in China. Cleaner domestic fuels and improved cooking/heating equipment will reduce contemporary Pb exposure in rural areas. In addition, the association between contemporary BLLs and distance away from roads further suggests that resuspension of legacy soil/dust Pb should not be neglected in future remediation programs and household interventions. As a large scale survey, this study provides evidence for revising the reference value of BLL, improving the guideline for clinical and public health management, and implementing interventions to prevent adverse health outcomes associated with low-level Pb exposure in children.

Declining blood lead levels among small-scale miners participating in a safer mining pilot programme in Nigeria

ObjectivesOur objective was to monitor blood lead levels (BLLs) of miners and ore processors participating in a pilot programme to reduce lead poisoning and take-home exposures from artisanal small-scale gold...

Changes of Atmospheric and Blood Concentrations of Lead and Cadmium in the General Population of South Korea from 2008 to 2017.

We measured changes in atmospheric and blood levels of lead and cadmium in the South Korean general population during the past decade. Blood data of 16,873 adults were taken from the Korean National Health and Nutrition Examination Survey (KNHANES, 2008–2017). Atmospheric data were taken from 66 air quality monitoring sites in 16 different regions in South Korea. From 2008 to 2017, the geometric mean (GM) blood lead level decreased from 2.37 to 1.46 μg/dL (38.4% decrease), and the atmospheric lead concentration decreased by 61.0% in the overall population. During this time, the GM blood cadmium level decreased from 0.88 to 0.72 μg/L (18.2% decrease), and the atmospheric cadmium concentration decreased by 63.6%. Multiple linear regression analysis indicated that a half reduction in air lead was associated with a 0.09 μg/dL decrease in blood lead (95% CI: 0.03 to 0.15) in a subgroup of the metropolitan city population. However, a half reduction in air cadmium had no significant effect on blood cadmium. Multiple linear regression analyses indicated that the decrease in blood lead level over 10 years in Korea was related to the decrease in atmospheric lead concentration. However, the decrease in blood cadmium level during this time was not significantly associated with the decrease in atmospheric cadmium concentration. Our findings suggest that inhalation is a major source of lead exposure, but not of cadmium exposure. Ingestion of dietary cadmium presumably has a stronger impact on blood cadmium levels.

Prevalence of Blood Lead among Children Living in Battery Recycling Communities in Greater Jakarta, Indonesia.

This study aimed to assess the prevalence of blood lead levels (BLLs) among children 1 to 5 years old who reside near and distant to informally used lead-acid battery (ULAB) recycling locations and examine risk factors for elevated BLLs. A cross-sectional study was conducted in three greater Jakarta neighborhoods where informal ULAB recycling occurs. Venous BLLs among 279 children were analyzed using portable blood lead testing machines. Demographic, child activities, and sources of lead exposure inside and outside homes were assessed. Multivariate analysis was performed to evaluate factors associated with the prevalence of BLLs. Forty-seven percent of children had BLLs ≥ 5 µg/dL and 9% had BLLs ≥ 10 µg/dL. No differences in geometric mean BLLs were observed between children who lived near and distant to ULAB locations. Older child age groups [Prevalence Ratio (PR) 2.14, 95% Confidence Interval (CI) 1.16, 4.18) and low household income (PR 1.58, 95% CI 1.03, 2.40) were associated with BLLs 5–9 µg/dL. Low educational attainment of the child’s father (PR 3.17, 95% CI 1.23, 8.16) and frequent outdoor child activity (PR 4.93, 95% CI 1.09, 22.21) were predictors of BLLs ≥ 10 µg/dL. This study shows the association between lead exposure among children and environmental sources. Public health officials can consider expanded surveillance, health care provider education, and development of strategies to reduce lead exposure.

Analysis of blood lead levels of young children in Flint, Michigan before and during the 18-month switch to Flint River water

Background: The toxicity of lead, like any xenobiotic, is directly linked to the duration of exposure and toxin concentration in the body. The elevation in blood lead levels (BLLs) in young Flint, Michigan children noted in time-periods before, and during the 18-month exposure to Flint River water (FRW) from 25 April 2014 to 15 October 2015 is well-known internationally. The length of time BLLs were elevated is unknown, yet key in understanding the potential health impact of the event. The objective of this study was to evaluate whether BLLs in Flint children were increased during the entire 18-month FRW exposure compared to similar earlier time periods.Methods: We conducted a retrospective study analyzing BLLs from Flint children aged 5 years and under. The geometric mean (GM) BLLs and percentages of BLLs ≥5.0 μg/dL in Period I: 25 April 2006 to 15 October 2007 (earliest timeframe available for study) and Period II: 25 April 2012 to 15 October 2013 (timeframe immediately before the water switch), were compared to Period III, 25 April 2014 to 15 October 2015 (FRW exposure).Results: There were 5663 BLLs available for study. GM ± SE BLLs decreased from 2.19 ± 0.03 μg/dL in Period I to 1.47 ± 0.02 μg/dL in Period II [95% CI, 0.64, 0.79]; p<.001 and decreased further to 1.32 ± 0.02 µg/dL during the FRW Period III [95% CI, 0.79, 0.95]; p<.001. The percentage of BLLs ≥5.0 μg/dL decreased from Period I (10.6%) to Period II (3.3%) [95% CI, 5.7, 8.8]; p<.001 and from Period I to Period III (3.9%) [95% CI, 5.0, 8.2]; p=.002. The 0.6% increase from Period II to Period III was not statistically significant [95% CI, −1.9, 0.57]; p=.30.Conclusion: Analyses of GM and percentages ≥5.0 μg/dL of BLLs do not support the occurrence of a global increase in BLLs in young children of Flint during the entire 18-month period of FRW exposure.

Assessment of Child Lead Exposure in a Philadelphia Community, 2014.

Several urban neighborhoods in Philadelphia, Pennsylvania, have a history of soil, household lead paint, and potential lead-emitting industry contamination. To (1) describe blood lead levels (BLLs) in target neighborhoods, (2) identify risk factors and sources of lead exposure, (3) describe household environmental lead levels, and (4) compare results with existing data. A simple, random, cross-sectional sampling strategy was used to enroll children 8 years or younger living in selected Philadelphia neighborhoods with a history of lead-emitting industry during July 2014. Geometric mean of child BLLs and prevalence of BLLs of 5 μg/dL or more were calculated. Linear and logistic regression analyses were used to ascertain risk factors for elevated BLLs. Among 104 children tested for blood lead, 13 (12.4%; 95% confidence interval [CI], 7.5-20.2) had BLLs of 5 μg/dL or more. The geometric mean BLL was 2.0 μg/dL (95% CI, 1.7-2.3 μg/dL). Higher geometric mean BLLs were significantly associated with front door entryway dust lead content, residence built prior to 1900, and a child currently or ever receiving Medicaid. Seventy-one percent of households exceeded the screening level for soil, 25% had an elevated front door floor dust lead level, 28% had an elevated child play area floor dust lead level, and 14% had an elevated interior window dust lead level. Children in households with 2 to 3 elevated environmental lead samples were more likely to have BLLs of 5 μg/dL or more. A spatial relationship between household proximity to historic lead-emitting facilities and child BLL was not identified. Entryway floor dust lead levels were strongly associated with blood lead levels in participants. Results underscore the importance to make housing lead safe by addressing all lead hazards in and around the home. Reduction of child lead exposure is crucial, and continued blood lead surveillance, testing, and inspection of homes of children with BLLs of 5 μg/dL or more to identify and control lead sources are recommended. Pediatric health care providers can be especially vigilant screening Medicaid-eligible/enrolled children and children living in very old housing.

Control of Lead Sources in the United States, 1970-2017: Public Health Progress and Current Challenges to Eliminating Lead Exposure.

During the past 45 years, exposure to lead has declined dramatically in the United States. This sustained decline is measured by blood and environmental lead levels and achieved through control of lead sources, emission reductions, federal regulations, and applied public health efforts. Explore regulatory factors that contributed to the decrease in exposure to lead among the US population since 1970. We present historical information about the control of lead sources and the reduction of emissions through regulatory and selected applied public health efforts, which have contributed to decreases in lead exposure in the United States. Sources of lead exposure, exposure pathways, blood lead measurements, and special populations at risk are described. From 1976-1980 to 2015-2016, the geometric mean blood lead level (BLL) of the US population aged 1 to 74 years dropped from 12.8 to 0.82 μg/dL, a decline of 93.6%. Yet, an estimated 500 000 children aged 1 to 5 years have BLLs at or above the blood lead reference value of 5 μg/dL established by the Centers for Disease Control and Prevention. Low levels of exposure can lead to adverse health effects. There is no safe level of lead exposure, and child BLLs less than 10 μg/dL are known to adversely affect IQ and behavior. When the exposure source is known, approximately 95% of BLLs of 25 μg/dL or higher are work-related among US adults. Despite much progress in reducing exposure to lead in the United States, there are challenges to eliminating exposure. There are future challenges, particularly from the inequitable distribution of lead hazards among some communities. Maintaining federal, state, and local capacity to identify and respond to populations at high risk can help eliminate lead exposure as a public health problem. The results of this review show that the use of strong evidence-based programs and practices, as well as regulatory authority, can help control or eliminate lead hazards before children and adults are exposed.

Blood Lead Levels in Children Aged 0 to 6 Years in China: A National Survey

Background : Lead exposure is a major environment-related disease that severely endangers childhealth. However, the magnitude of lead exposure among children in China remains unclear at thenational level. We conducted a national survey of blood lead levels in children aged 0 &amp;#8211; 6 years.Methods :From May 2013 to March 2015, we used a multi-stage clustered random samplingapproach to select 90 districts/counties in 15 provinces across the country. Parents were interviewed,and the blood lead levels in children were tested using graphite furnace atomic absorptionspectrometry.Findings: A total of 31,373 children with valid samples were included. The median and geometricmean blood lead levels were 26.4 and 26.7&amp;#956;g/L, respectively. The geometric mean blood lead levelof children in Shanghai was the lowest (18.8&amp;#956;g/L), and that in Guangdong was the highest(33.7&amp;#956;g/L). The blood lead level of the children in the central region was the lowest (25.5&amp;#956;g/L)compared with the eastern region (26.6&amp;#956;g/L) and the western region (27.3&amp;#956;g/L). The geometric meanblood lead level of the children in large cities (24.2&amp;#956;g /L) was lower than that of the children insmaller cities (27.4&amp;#956;g /L) and rural areas (27.5&amp;#956;g/L). Boys had a higher lead level than girls (27.2 vs.25.9&amp;#956;g/L, p&amp;lt;0.0001). Children aged 36-84 months had a slightly higher lead level than children aged0-36 months (25.7 vs. 27.9&amp;#956;g/L, p&amp;lt;0.0001).Interpretation: The blood lead levels in children aged 0-6 years in China showeda dramatic decline compared with the past few decades. The blood lead levels of children were thelowest in the central region and among urban children in big cities. The blood lead levels of boyswere higher than those of girls, and the lead levels were much higher in 36- to 84-month-old childrenthan in 0- to 36-month-olds.

Estimates of potential childhood lead exposure from contaminated soil using the USEPA IEUBK model in Melbourne, Australia.

Soils in inner city areas internationally and in Australia have been contaminated with lead (Pb) primarily from past emissions of Pb in petrol, deteriorating exterior Pb-based paints and from industry. Children can be exposed to Pb in soil dust through ingestion and inhalation leading to elevated blood lead levels (BLLs). Currently, the contribution of soil Pb to the spatial distribution of children's BLLs is unknown in the Melbourne metropolitan area. In this study, children's potential BLLs were estimated from surface soil (0-2cm) samples collected at 250 locations across the Melbourne metropolitan area using the United States Environmental Protection Agency (USEPA) Integrated Exposure Uptake Biokinetic (IEUBK) model. A dataset of 250 surface soil Pb concentrations indicate that soil Pb concentrations are highly variable but are generally elevated in the central and western portions of the Melbourne metropolitan area. The mean, median and geometric soil Pb concentrations were 193, 110 and 108mg/kg, respectively. Approximately 20 and 4% of the soil samples exceeded the Australian HIL-A residential and HIL-C recreational soil Pb guidelines of 300 and 600 mg/kg, respectively. The IEUBK model predicted a geometric mean BLL of 2.5 ± 2.1µg/dL (range: 1.3-22.5µg/dL) in a hypothetical 24-month-old child with BLLs exceeding 5 and 10µg/dL at 11.6 and 0.8% of the sampling locations, respectively. This study suggests children's exposure to Pb contaminated surface soil could potentially be associated with low-level BLLs in some locations in the Melbourne metropolitan area.

Environmental justice analyses may hide inequalities in Indigenous people’s exposure to lead in Mount Isa, Queensland

Distributive environmental justice studies frequently identify how ethnic minorities and communities of low socio-economic status (SES) are disproportionately likely to live in areas with an elevated risk of exposure to pollution. Few distributive justice studies have been conducted in Australia to explore whether this relationship is relevant to rural mining communities. In the remote mining city of Mount Isa, studies have found higher geometric mean blood lead levels (BLLs) among Indigenous children compared to non-Indigenous children. However, there is a lack of recent BLL data to determine conclusively if Indigenous children in Mount Isa are disproportionately exposed to lead pollution. We employed a common distributive environmental justice analysis approach to determine if Indigenous residents are disproportionately likely to live in areas with elevated soil lead concentrations. We analysed soil samples from 49 of 51 census areas at the Statistical Area 1 (SA1) level and measured the statistical correlation between soil lead concentration and the percentage of residents living in each SA1 who were of Indigenous status using Kendall’s tau and linear regression. We found little evidence of an association between soil lead concentration and either Indigenous status or SES, indicating that Indigenous and low-SES residents are not disproportionately likely to live in areas with elevated concentrations of soil lead. The results of this study, along with prior research on mining emissions and housing quality in Mount Isa, indicate that elevated BLLs among Indigenous children may be due to low-SES increasing the risk of exposure as a result of lower quality housing. Actions by governing and mining bodies to address children’s elevated BLLs in Mount Isa should give greater attention to risk factors related to SES. Furthermore, distributive environmental justice research must account for disparities in exposure which are not the result of disproportionate proximity to polluting sources.

Environmental Assessment and Blood Lead Levels of Children in Owino Uhuru and Bangladesh Settlements in Kenya.

Background.Lead exposure is linked to intellectual disability and anemia in children. The United States Centers for Disease Control and Prevention (CDC) recommends biomonitoring of blood lead levels (BLLs) in children with BLL ≥5 μg/dL and chelation therapy for those with BLL ≥45 μg/dL.Objectives.This study aimed to determine blood and environmental lead levels and risk factors associated with elevated BLL among children from Owino Uhuru and Bangladesh settlements in Mombasa County, Kenya.Methods.The present study is a population-based, cross-sectional study of children aged 12–59 months randomly selected from households in two neighboring settlements, Owino Uhuru, which has a lead smelter, and Bangladesh settlement (no smelter). Structured questionnaires were administered to parents and 1–3 ml venous blood drawn from each child was tested for lead using a LeadCare ® II portable analyzer. Environmental samples collected from half of the sampled households were tested for lead using graphite furnace atomic absorption spectroscopy.Results:We enrolled 130 children, 65 from each settlement. Fifty-nine (45%) were males and the median age was 39 months (interquartile range (IQR): 30–52 months). BLLs ranged from 1 μg/dL to 31 μg/dL, with 45 (69%) children from Owino Uhuru and 18 (28%) children from Bangladesh settlement with BLLs >5 μg/dL. For Owino Uhuru, the geometric mean BLL in children was 7.4 μg/dL (geometric standard deviation (GSD); 1.9) compared to 3.7 μg/dL (GSD: 1.9) in Bangladesh settlement (p<0.05). The geometric mean lead concentration of soil samples from Owino Uhuru was 146.5 mg/Kg (GSD: 5.2) and 11.5 mg/Kg (GSD: 3.9) (p<0.001) in Bangladesh settlement. Children who resided <200 m from the lead smelter were more likely to have a BLL ≥5 μg/dL than children residing ≥200 m from the lead smelter (adjusted odds ratio (aOR): 33.6 (95% confidence interval (CI): 7.4–153.3). Males were also more likely than females to have a BLL ≥5 μg/dL (39, 62%) compared to a BLL<5 μg/dL [aOR: 2.4 (95% CI: 1.0–5.5)].Conclusions.Children in Owino Uhuru had significantly higher BLLs compared with children in Bangladesh settlement. Interventions to diminish continued exposure to lead in the settlement should be undertaken. Continued monitoring of levels in children with detectable levels can evaluate whether interventions to reduce exposure are effective.Participant Consent.ObtainedEthics Approval.Scientific approval for the study was obtained from the Ministry of Health, lead poisoning technical working group. Since this investigation was considered a public health response of immediate concern, expedited ethical approval was obtained from the Kenya Medical Research Institute and further approval from the Mombasa County Department of Health Services. The investigation was considered a non-research public health response activity by the CDC.Competing Interests.The authors declare no competing financial interests.

Blood Lead Levels of Children in Flint, Michigan: 2006-2016

We evaluated the increases in blood lead levels (BLLs) observed in young children in Flint, Michigan, during their exposure to corrosive Flint River water during the years 2014 and 2015 and compared their BLLs to those of Flint children measured during the years 2006-2013 and 2016. This was a retrospective study design using BLLs extracted from databases from 2006 to 2016. We analyzed a population sample of 15 817 BLLs from children aged ≤5 years with potential exposure to contaminated Flint River water. Percentages of BLLs ≥5.0 µg/dL and geometric mean (GM) BLLs were analyzed over time. A significant decline in the percentages of BLLs ≥5.0 µg/dL from 11.8% in 2006 to 3.2% in 2016 was observed (P < .001). GM ± SE BLLs decreased from 2.33 ± 0.04 µg/dL in 2006 to 1.15 ± 0.02 µg/dL in 2016 (P < .001). GM BLLs increased twice: from 1.75 ± 0.03 µg/dL to 1.87 ± 0.03 µg/dL (2010-2011) and from 1.19 ± 0.02 µg/dL to 1.30 ± 0.02 µg/dL (2014-2015). Overall, from 2006 to 2016, there was a 72.9% decrease in the percentage of children with BLLs ≥5.0 µg/dL and a 50.6% decrease in GM BLLs. These findings suggest that the 11 year trend of annual decreases in BLLs in children in Flint, Michigan, reversed to a degree consistent with random variation from 2010 to 2011, and again during the exposure to Flint River water in 2014-2015. Historically, public health efforts to reduce BLLs of young children in Flint have been effective over the 11-year period studied.

Cost Effectiveness of Environmental Lead Risk Mitigation in Low- and Middle-Income Countries.

Environmental remediation efforts in low‐ and middle‐income countries have yet to be evaluated for their cost effectiveness. To address this gap we calculate a cost per Disability Adjusted Life Year (DALY) averted following the environmental remediation of the former lead smelter and adjoining residential areas in Paraiso de Dios, Haina, the Dominican Republic, executed from 2009 to 2010. The remediation had the effect of lowering surface soil lead concentrations to below 100 mg/kg and measured geometric mean blood lead levels (BLLs) from 20.6 μg/dL to 5.34 ug/dL. Because BLLs for the entire impacted population were not available, we use environmental data to calculate the resulting disease burden. We find that before the intervention 176 people were exposed to elevated environmental lead levels at Paraiso de Dios resulting in mean BLLs of 24.97 (95% CI: 24.45–25.5) in children (0–7 years old) and 13.98 μg/dL (95% CI: 13.03–15) in adults. We calculate that without the intervention these exposures would have resulted in 133 to 1,096 DALYs and that all of these were averted at a cost of USD 392 to 3,238, depending on assumptions made. We use a societal perspective, meaning that we include all costs regardless of by whom they were incurred and estimate costs in 2009 USD. Lead remediation in low‐ and middle‐income countries is cost effective according to World Health Organization thresholds. Further research is required to compare the approach detailed here with other public health interventions.

Sources, symptoms and characteristics of childhood lead poisoning: experience from a lead specialty clinic in China

Objectives: This study explored the sources of lead exposure, identified patients’ geographic distribution and evaluated the symptoms of children with elevated blood lead levels (BLLs) referred to a pediatric lead specialty clinic in China.Material and methods: Data were collected from 515 consecutive outpatients attending the Pediatric Lead Poisoning Clinic in Xinhua Hospital, Shanghai, China, between 2011 and 2016, referred for BLLs ≥5 μg/dL. Atomic absorption spectrometry was used to measure venous BLLs.Results: The mean ± standard deviation age of the patients was 4.1 ± 3.2 years. Their BLLs ranged from 5 to 126 μg/dL. The geometric mean and median BLLs were 24 and 26 μg/dL, respectively. Two hundred and twenty-two children (43.1%) were exposed to industrial lead pollution—mainly from Zhejiang, Jiangsu, Hunan, Henan and Anhui provinces; whereas, 41.4% (213 cases) were induced by folk medicines used widely throughout China. Other nonindustrial sources of lead exposure included lead-containing tinfoil and tin pots. Household lead paint was a rare source. Most patients exhibited nonspecific symptoms, such as hyperactivity, attention difficulty, aggressiveness, constipation and anorexia.Conclusions: Industrial pollution and folk medicines are important sources of lead exposure in China. Childhood lead poisoning may be difficult to diagnose clinically as symptoms are nonspecific. Thus, blood lead screening may be necessary to identify children at high risk of exposure. Education to raise the awareness of potential sources of exposure resulting in their elimination would be expected to decrease the incidence of children with elevated BLLs.

Application of the IEUBK model for linking Children's blood lead with environmental exposure in a mining site, south China

This study consisted of a site- and age-specific investigation linking children's blood lead level (BLL) to environmental exposures in a historic mining site in south China. A total of 151 children, aged 3–7 years, were included in this study. The geometric mean (GM) BLL was 8.22 μg/dl, indicating an elevated BLL. The Integrated Exposure Uptake Bio-Kinetic (IEUBK) model has proven useful at many sites for study of routes of exposure. Application of the IEUBK model to these children indicated that the GM difference between observed and predicted BLL levels was only 1.07 μg/dl. It was found that the key environmental exposure pathway was soil/dust intake, which contributed 86.3% to the total risk. Younger children had higher BLL than did older children. Therefore, of the various low risk-high benefit solutions, interventions for the children living near the site should be focused on the dust removal and soil remediation. Implementation of the China Eco-village Construction Plan and China New Rural Reconstruction Movement of the government may be a better solution.

Blood Lead Levels among Children in Yaoundé Cameroon.

Blood lead levels (BLLs) are a useful indication of a population exposure to lead from environmental sources. No previous published study had reported BLLs in Cameroon. Our objective is to characterize exposure levels in children to inform policymakers of potential lead exposure sources. We tested the BLLs of 147 children aged 12 months to 6 years residing in Yaoundé, Cameroon, and conducted an extensive questionnaire with their parents or guardians to characterize potential exposure sources. The geometric mean BLL among this population was 8.0 μg/dl and arithmetic mean level was 8.7 μg/dl. These levels are more than sixfold higher than the geometric mean BLL reported in the U.S. and more than fivefold higher than those reported in France. In addition, 88% of the children tested had lead levels greater than 5 μg/dl. One limitation of the study is that the selection of the children sampled was not a random survey. The analysis of the responses to the questionnaire failed to uncover any specific exposure patterns. A statistically significant association was noted between the age of the child’s home and the duration of exclusive breastfeeding with BLLs. The study points to a need for greater efforts to control sources of lead exposure in Cameroon.