USA Case Definition of Adult (including Occupational) & Child Elevated Blood Lead Levels (EBLL) This Information was provided
by the National Institute for Occupational Safety and Health (NIOSH) ABLES current case definition for an elevated blood lead level (BLL) is a blood lead concentration ≥ 10 µg/dL. The description below provides more details on the use of this updated case definition and the slide presents it in perspective with other reference blood lead levels. In 2007 the AOEC published its Medical Management Guidelines for Lead-Exposed Adults (http://www.aoec.org/documents/positions/MMG_FINAL.pdf). In its medical surveillance section, it states that “New employees and those newly assigned to lead work should have a preplacement lead medical examination and BLL test, followed by periodic BLL testing, blood pressure measurement, and health status review. Monthly BLL testing is recommended for the first three months of employment for an initial assessment of the adequacy of exposure control measures. Subsequently, testing frequency can be reduced to every six months as long as BLLs remain below 10 μg/dL (0.48 μmol/L).”In the Pregnancy and Breast Feeding Concerns section “the panel’s recommendation is that the mother’s BLL should be kept below 5 μg/dL (0.24 μmol/L) from the time of conception through pregnancy.” And in the conclusions section “Clinicians are encouraged to advise patients of the risks associated with any elevation of lead level and to advocate strongly for environmental controls that would maintain BLLs below 10 μg/dL (0.48 μmol/L) wherever feasible.” NIOSH case definition for an elevated blood lead level was updated in 2009: “ADULT BLOOD LEAD EPIDEMIOLOGY & SURVEILLANCE (ABLES) Program Description: ABLES is a state-based surveillance program of laboratory-reported adult blood lead levels. In 2009, the ABLES program updated its case definition for an Elevated Blood Lead Level for surveillance purposes as a blood lead concentration ≥ 10 µg/dl.” http://www.cdc.gov/niosh/topics/ABLES/description.html Also in 2009, CSTE issued a position statement on lead: CSTE List of Nationally Notifiable Conditions. June 2009. CSTE 2009 Position Statement. Public Health Reporting and National Notification for Elevated Blood Lead Levels http://www.cste.org/ps2009/09-OH-02.pdf http://www.cste.org/dnn/LinkClick.aspx?fileticket=7CCxM20JUGg%3d&tabid=36&mid=1496 In 2010 CDC included, for the first time, elevated blood lead levels as a Nationally Notifiable Non-Infectious Conditions, using the same BLL (≥ 10 µg/dL) in the case definition. Nationally Notifiable Non-Infectious Conditions. United States 2010. Elevated Blood Lead Levels: http://www.cdc.gov/osels/ph_surveillance/nndss/phs/non_infdis2010.htm http://www.cdc.gov/osels/ph_surveillance/nndss/casedef/lead_current.htm Also in 2010, DHHS adopted the HP2020 objective OSH-7 “Reduce the proportion of persons who have elevated blood lead concentrations from work exposures Reduce the proportion of persons who have elevated blood lead concentrations from work exposures” (http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=30) and the operational definition for HP2020 is presented in http://www.healthindicators.gov/Indicators/Elevated-blood-lead-rates-in-adults_1300/National_0/Profile To get to this page I suggest the following: 1- In the webpage http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=30 click on OSH-7 2- When this objective expands, click on the link below 3- Which will take you to the HHS Health Indicators Warehouse (http://www.healthindicators.gov/Indicators/Elevatedbloodleadratesinadults_1300/Profile/Data). In this page click on the “Overview” tab that will take you to the operational definition: http://www.healthindicators.gov/Indicators/Elevated-blood-lead-rates-in-adults_1300/National_0/Profile “Starting in 2009, the ABLES case definition for elevated blood lead levels was changed from 25 µg to 10 µg/dL which is consistent with guidance from the Association of Occupational and Environmental Clinics and the Council of State and Territorial Epidemiologists. CDC has also included in 2010, for the first time, elevated blood lead levels (defined as BLL =>10 µg/dL) in the list of national notifiable conditions. Therefore, this measure uses the updated case definition of 10 µg/dL or greater” This slide presents the ABLES case definition for an elevated blood level in perspective with other reference levels: Thank you, Walter A. Alarcon, MD MSc Adult Blood Lead Epidemiology and Surveillance (ABLES) Program Project Officer Surveillance Branch / Division of Surveillance, Hazard Evaluations and Field Studies National Institute for Occupational Safety and Health Centers for Disease Control and Prevention 4676 Columbia Parkway, R-17 Cincinnati, OH, 45226 Phone: 513-841-4451 Fax: 513-841-4489 NIOSH is a Federal agency responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries: http://www.cdc.gov/niosh/about.html NIOSH Safety and Health Topic: Adult Blood Lead Epidemiology and Surveillance (ABLES) http://www.cdc.gov/niosh/topics/ABLES/ables.html Additional Links California. Workplace hazard alert. New Health Dangers from Lead. http://www.cdph.ca.gov/programs/olppp/Documents/LeadHazAlert.pdf Health Effects of Low-level Lead Evaluation NTP Monograph on Health Effects of Low-level Lead (June 2012)http://ntp.niehs.nih.gov/?objectid=4F04B8EA-B187-9EF2-9F9413C68E76458E
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