gh risk populations within the state and to develop and provide educational and
informational materials for parents, health care providers and other interested
individuals about childhood blood lead poisoning.
During 1996, the CBLES project received reports of blood lead levels on
approximately 0.79% (1839) of children <5 years old living in Utah. About 65% of
those reports were on children 1 and 2 years of age. The geometric mean blood lead level
was 3.0 µg/dL, slightly higher than the national average of 2.7 µg/dL. Blood lead levels
ranged from <0.1 (less than the analytical limits of detection) to 35.0 µg/dL.
Eighty-nine children were reported with EBLL >10 µg/dL. Elevated blood lead
levels were categorized as confirmed if the test was performed on a venous blood sample or
if the child had a follow-up EBLL. Unconfirmed EBLL cases are those cases where only one
blood lead test was performed for that child using a capillary blood sample. Of the 89
children, 35 were confirmed cases, 15 were found to be <10 µg/dL by a confirmation
test, and 39 cases were unconfirmed. The prevalence of elevated blood lead levels was
between 1.9% (confirmed) and 4.0% (confirmed and unconfirmed). That prevalence range would
indicate that as many as 9,200 children living in Utah may have blood lead levels >10
µg/dL. This prevalence range is slightly lower than the national average of 4.4% for
children 1-5 years of age.
CDC RELEASES DRAFT GUIDELINES FOR CHILD BLOOD LEAD TESTING
In February 1997, CDC released a draft of screening guidelines: Screening
Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials.
That document suggests two approaches for childhood lead poisoning screening and the
criteria to select the most appropriate approach for screening children. Those approaches
are universal screening and targeted screening. Universal screening is the testing of all
children ages 1 and 2 and all children 3-6 years old who have not been previously
screened. With targeted screening, only children in certain high risk populations are
tested for elevated blood lead levels. Two specific criteria are given that determine if
targeted rather than universal screening is appropriate. One criterion is the percentage
of housing stock built before 1950. The CDC draft guidelines recommend that targeted
screening may be appropriate if the area under consideration has less than 27% of its
housing stock built before 1950. Figure 1 is a map of the percentage of housing stock
built before 1950 in each county in Utah (based on 1990 census data). The other selection
criterion is the percentage of children with elevated blood lead levels in the state or
geographic region. The CDC draft guidelines recommend that targeted screening may be
appropriate in areas where a significant amount of universal screening has occurred and
the prevalence of children with elevated blood lead levels is found to be <12% and the
housing criterion is also met.
Figure 1. Percent of Utah
Housing Stock Built before 1950 by County.
Copies of the new guidelines can be obtained by calling 1-888-232-6789,
or down loaded from the Internet at http://www.cdc.gov/nceh/programs/lead /lead.htm.
CHANGES IN THE INJURY REPORTING RULE
Utah Administrative Code R386-703 (Injury Reporting Rule)
establishes an injury surveillance and reporting system for major injuries occurring in
Utah. Lead poisoning was added to the list of reportable injuries in 1990. Initially,
under the rule, lead poisoning injuries were defined to include lead poisoning of all
persons with whole blood lead concentration >30 µg/dL. In December 1991, the
reportable level was lowered to >15 µg/dL, and effective January 1, 1997, the
reportable level was lowered to >10 µg/dL.
Generally, the Bureau of Epidemiology (BOE) obtains blood lead test
results from the laboratory performing the tests. However, the rule also specifies that
hospitals, physicians, nurses, other health care practitioners and medical examiners are
also required to report. Reports should include the injured persons name, date of birth or
age if date of birth is unknown, gender, address of residence, date of sampling, date of
testing, physician or clinic requesting the test and their phone number. Each case of
injury can be reported to the BOE or to the local health department responsible for the
geographic area where the injury occurred. The local health officer can then forward all
reports of blood lead levels to the BOE.
SURVEILLANCE OF ADULT BLOOD LEAD LEVELS, UTAH 1996
The primary source for adult exposure to lead occurs in the work place.
Since 1990, the Bureau of Epidemiology has maintained the Utah Blood Lead Registry (UBLR).
In 1992, the bureau established the Adult Blood Lead Epidemiology and Surveillance (ABLES)
Project, to study the epidemiology of occupational lead poisoning in Utah adults, and to
develop and disseminate information about adult blood lead poisoning to employees and
employers working in the lead industries.
Elevated blood lead levels >15 µg/dL on 129 Utah adults (18
years of age or older) were reported to the UBLR during 1996. Ninety-seven of those adults
were reported for the first time. The range of EBLL was 15.0 to 54.0 µg/dL with a GM of
23.3 µg/dL. Those values are lower than in 1995 (range of 15.0 to 65.8 µg/dL, GM of 24.3
µg/dL). The range and GM BLL of reports received in the registry for each year that the
registry has been in existence are presented in Figure 2. The prevalence of EBLL in adults
in Utah has also decreased since 1995. Figure 3. shows a history of prevalence rates since
Figure 2. Highest Blood Lead Level Reported and Geometric Mean of All Elevated Blood
Lead Levels in Utah Adults (ages 18 and older) Reported to the Utah Blood Lead Registry by
Figure 3. Prevalence of Elevated Blood Lead Levels Among Utah Adults
(ages 18 and older) Employed in Non-Agricultural Jobs per 100,000 Population
Follow-up phone surveys were conducted on 28 individuals who were new
1996 cases with EBLL >25 µg/dL. Those surveys asked about significant personal
risk factors. The most significant personal risk factor identified was the use of house
and auto paint and participating in target practice. Those risk factors are consistent
with what has been found in previous years. The potential of secondary exposure to
occupational lead by children is also of interest. In 1996, 29% of the cases surveyed had
children in the high-risk age group (0-6 years old) living at home. The individuals
surveyed were also asked questions about occupational protective measures and occupational
risk behavior they practiced. Case reported employer control measures include providing
showers at the work site and lead risk training. The number of cases responding
affirmatively to questions about control measures were significantly lower in 1996 than in
1995 (41% in 1996 versus 64% in 1995 reported showers available at the work site and 43%
in 1996 versus 73% in 1995 reported that they had received lead risk training).
Occupational risk questions on the survey included questions about protective measures
such as changing clothing and taking a shower before leaving the worksite and negative
risks such as use of tobacco and eating snacks in the work area. Figure 4. presents a
comparison of the percents of cases responding affirmatively to questions about protective
measures and occupational risks for 1994 through 1996.
Figure 4. Trend of Affirmative Responses to Occupational Risk Factors Among Utah
Adults (18 and older) Employed in Non-Agricultural Jobs With Elevated Blood Lead Levels (>
40 µg/dL) for 1994-1996.
Showers Available refers to the availability of showers at the work site.
Takes Shower refers to those employees who have showers at the work site and take
showers prior to going home.
Training Received refers to training regarding the health effects of lead, protective
clothing, or the lead standard.
Changes Clothing refers to the employee changing into clean clothes before leaving the
Uses Tobacco refers to those employees who smoke or use smokeless tobacco in their
Snack refers to those employees who eat or have snacks including chewing gum at their
Ten of 24 cases (42%) surveyed (with blood lead levels >25
µg/dL) reported experiencing one or more symptoms of EBLL. Five cases had blood lead
levels >40 µg/dL. Of those cases, only 1 (20%) reported experiencing one or
more symptoms. The only case to report experiencing all symptoms queried about in the
survey was the case of an accidental gun shot wound (blood lead level 30.4 µg/dL). The
most commonly identified symptoms were muscle pain and headaches.
The only case of accidental lead poisoning that resulted in
hospitalization involved the accidental gun shot wound where a bullet lodged in the body
and had to be surgically removed. That case was hospitalized for lead poisoning as well as
other conditions associated with the wound. No cases with elevated blood lead levels from
occupational exposure were reported to have been hospitalized in 1996.