Adult Blood Lead Levels

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• Public health importance of elevated blood lead levels in adults.
• Purpose and operation of the surveillance system.
• System components.
• Lead resources developed by the SHARP program.
• Links to other lead information.

Public health importance of elevated blood lead levels in adults

Ninety-four percent of adults with elevated blood lead levels (BLLs) are exposed to lead in the workplace. In 2004, 9170 adults were reported by 37 states to have blood lead levels (BLLs) greater than or equal to 25 micrograms per deciliter (mcg/dL).

An Occupational Lead Exposure Registry (Registry) has operated in Washington State since May 1993. Through December of 2006, the Registry received 90,631 BLL reports from 76,004 individuals. Approximately two percent of the cases, representing 1444 individuals, had BLLs greater than or equal to 25 mcg/dL.

Adults exposed to lead can experience anemia, nervous system dysfunction, kidney problems, hypertension, decreased fertility, and increased level of miscarriages.

Workers can bring lead home from their workplace and expose their families. Approximately two to three percent of children with blood lead levels of 10 mcg/dL or greater were exposed by lead brought home from work. Children exposed to low levels of lead may exhibit symptoms of neurologic damage, including learning disabilities and short attention spans.

For more information about elevated blood lead levels as a reportable condition in Washington State, visit SHARP's Reporting Adult Blood Lead Levels page.

Purpose and operation of the surveillance system

Purpose

The purpose of the Registry is to identify patterns and trends in elevated blood lead levels in adult workers. This information is used to target high-risk workplaces, industries, and occupations for prevention activities focused on reducing lead exposures.

Objectives

• Describe the incidence and prevalence of elevated blood lead levels in the workplace.
• Identify high risk occupations and industries.
• Identify useful prevention strategies.
• Generate hypotheses about causative agents and factors.

Planned uses

• Identifying outbreaks of occupational lead poisoning.
• Analyzing risks by occupation and industry.
• Tracking trends in the incidence and prevalence associated with occupational lead poisoning; sharing information with the public, health care providers, public health professionals, and labor and industry stakeholders.
• Evaluating efforts to reduce lead as an occupational risk.
• Measuring progress in achieving Healthy People 2010 Objective 20-7, reducing the number of persons who have elevated blood lead concentrations from work exposures.

Case definition

A case of occupational lead overexposure is defined as an adult (15 years of age or older) with a BLL greater than or equal to 25 mcg/dL. All workers employed in Washington State that undergo blood lead testing are included in the Registry, except self-employed individuals and those who fall under Federal OSHA's jurisdiction (for example, longshoremen, Federal workers, and contractors at Federal facilities).

Legal authority

On July 12, 2000 the Washington State Board of Health adopted revisions to the Washington Administrative Code Chapter 246 Section 101 (WAC 246‑101) making elevated blood lead levels a reportable condition (www.doh.wa.gov). The Department of Labor and Industries was given authority to maintain a surveillance system that can include direct reporting from laboratories, health care providers and health care facilities; develop routine dissemination mechanisms; and provide consultation and technical assistance to health departments, business and labor organizations.

Organizational location

The Registry is located within the Safety and Health Assessment and Research for Prevention (SHARP) Program of the Washington State Department of Labor and Industries.

System components

Population under surveillance

Workers aged 15 years of age or older who are exposed at Washington State workplaces, except self-employed individuals and those who fall under Federal OSHA's jurisdiction (for example, longshoremen, Federal workers, and contractors at Federal facilities).

Time period of data collection

May 1993 to the present.

Collection and reporting sources

Data format and case reporting requirements are specified in WAC 246‑101. Laboratories or health care facilities send blood lead level reports to the Washington State Department of Health, where case reports for individuals 15 years of age or older are forwarded to SHARP. A telephone or mail interview is conducted with cases to obtain details about the workplace exposure and other demographic information. Health care providers are encouraged to have their patient compete a blood lead testing form at the time of the blood draw, which is designed to collect additional demographic information.

Data management

The Registry is maintained in a secure Microsoft Access database. This relational database management system has the tools needed to perform automated edit checks during data entry; eliminate duplicate records; add, delete and update records; and perform the queries needed to maintain the database and create a variety of outputs.

Data analysis and dissemination

Dissemination of educational information is a routine part of case follow-up. The type of follow-up is dependent upon the patient's elevated blood lead level:

• Between 25 and 39 mcg/dL - the individual is mailed informational material and a brief interview form. If the individual consents, informational material is also sent to the employer.
• Between 40 and 59 mcg/dL - the individual is mailed informational material and interviewed via telephone. If the individual consents, SHARP contacts the employer and mails informational material. The employer is provided with three suggestions for technical help: free-of-charge assistance from SHARP or DOSH Consultation services, or enlist the services of a private industrial hygiene company.
• 60 mcg/dL or greater - the individual is mailed informational material, interviewed via telephone, and physician from SHARP provides an occupational medicine consult. If the individual consents, SHARP contacts the employer and mails informational material. The employer is offered same three options described above, but SHARP reserves the right to report the employer to DOSH Compliance services if the employer takes no action.
• If the circumstances surrounding the lead exposure are critical, (e.g., a temporary worksite, many exposures), there is an immediate referral to DOSH Compliance services for regulatory action.

An annual report is submitted to the Adult Blood Lead Epidemiology and Surveillance Program at the National Institute for Occupational Safety along with an Access file of new case reports. Analysis of registry data has identified seven industries with the highest risks for occupational lead exposure. The prevention index calculated from registry data for these industries has been used to prioritize the use of intervention resources. Alerts for workers, employers, and health care providers have been published for case follow-up and use in other preventive strategies. These publications are available from SHARP's Publications page.

Patient privacy, data confidentiality, and system security

All records containing or accompanied by patient identifying information are confidential. These records are used solely for surveillance and prevention purposes. All hard copies of case information data are kept in secure file cabinets. Access to the registry is controlled with its own password protection. Passwords are issued only to authorized personnel within SHARP. Physical access to the building and access to individual computers are controlled as part of the security systems of the Department of Labor and Industries.

Lead resources developed by the SHARP program

Publications

Surveillance reports and prevention reports are available from SHARP's Publications page.

Surveillance tools

The following case follow-up materials are available as Microsoft Word for Windows files and Adobe® Acrobat® PDF files.

These materials may be downloaded to your system and modified for your use. Please reference the source.

Letters mailed to patients

• Blood lead levels between 25 and 39 mcg/dL (5 KB MS Word).
• Blood lead levels between 25 and 39 mcg/dL (13 KB PDF).
• Blood lead levels of 40 mcg/dL and greater (5 KB MS Word).
• Blood lead levels of 40 mcg/dL and greater (14 KB PDF).

Patient interview forms

• Mail interview for patients with blood lead levels between 25 and 39 mcg/dL (10 KB MS Word).
• Mail interview for patients with blood lead levels between 25 and 39 mcg/dL (23 KB PDF).
• Telephone interview for patients with blood lead levels of 40 mcg/dL or greater (83 KB MS Word).
• Telephone interview for patients with blood lead levels of 40 mcg/dL or greater (59 KB PDF).

Follow-up letters to employers

• Blood lead levels between 25 and 39 mcg/dL (5 KB MS Word).
• Blood lead levels between 25 and 39 mcg/dL (12 KB PDF).
• Blood lead levels between 40 and 59 mcg/dL (5 KB MS Word).
• Blood lead levels between 40 and 59 mcg/dL (13 KB PDF).
• Blood lead levels of 60 mcg/dL or greater (7 KB MS Word).
• Blood lead levels of 60 mcg/dL or greater (13 KB PDF).

Links to other lead information

External hyperlinks are provided as a public service by the SHARP Program. Neither L&I nor SHARP are responsible for the reliability or accuracy of the information found on other web sites (Privacy and Security Policy).

Washington State materials

• The Department of Ecology's Lead Chemical Action Plan web site (www.ecy.wa.gov) describes Washington State's efforts to address lead contamination of the environment, the public and workers. A presentation by the Washington State ABLES program (321 KB PDF / 2 min) (www.ecy.wa.gov) describes blood lead level tracking in workers and the challenges faced by adult blood lead registries.
• Washington State Department of Health - The Health of Washington State, 2002 - Occupational Lead Poisoning (www.doh.wa.gov).
• The Division of Occupational Safety & Health's (DOSH) health hazards of lead page provides links to regulations, policies and other Washington State resources.

National lead surveillance

• NIOSH's ABLES (www.cdc.gov) web site provides background information about national occupational lead exposure surveillance, including contact information and links to many of the ABLES states, national occupational lead surveillance data and conference presentations.
• Several ABLES states provide extensive resources on their web sites, including:
  • California's Occupational Lead Poisoning Prevention Program
    (www.dhs.ca.gov).
  • Massachusetts' Division of Occupational Safety
    (www.mass.gov).
  • New Jersey's Department of Health and Senior Services
    (www.state.nj.us).
  • Oregon's Department of Human Services
    (oregon.gov).
  • Michigan State University's Occupational and Environmental Medicine site
    (ww.oem.msu.edu).

Medical management guidelines

• The Association of Occupational and Environmental Clinics' (AOEC) Medical Management Guidelines for Lead-Exposed Adults (240 KB PDF / 1 min) (www.aoec.org).
• Kosnett MJ et al. Recommendations for Medical Management of Adult Lead Exposure (www.ehponline.org). Environmental Health Perspectives. March 2007, Volume 115, Issue 3, pages 463-471.

Workplace lead standards

• OSHA's Lead Standards (www.osha.gov).
• The Council for State and Territorial Epidemiologist's (CSTE) Position Statement: Improved Protection for Lead-Exposed Workers: Updating the OSHA Lead Standards for General Industry and Construction (19 KB PDF) (www.cste.org).

Other

• CDC's Healthy People 2010 (www.healthypeople.gov) document includes Objective 20-7: Reduce the number of persons who have elevated blood lead concentrations from work exposures.