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The article “How Low Is Low? Blood-lead Levels and Lead Poisoning in Emerging Economies” in the April 2015 edition of The Synergist mischaracterizes the guidance on blood-lead levels provided by the Centers for Disease Control and Prevention (CDC) through the Advisory Committee on Childhood Lead Poisoning Prevention. As co-chairs of the subcommittee that authored these recommendations, we would like to clarify the guidance and suggest how it can be useful in low- and middle-income countries. First, the current reference value of 5 µg/dL for blood-lead levels in children in the U.S. is in fact a public health goal or action level that triggers specific responses including education, environmental assessments, and follow-up blood-lead monitoring. Although this guidance is limited to U.S. children based on the ACCLPP Committee’s mandate, it is something that is applicable to assessing and responding to lead exposures in developing countries where there is often no official guidance or policy. The level of 5 µg/dL should be used in countries without more restrictive guidelines to set environmental remediation goals as a public health benchmark until WHO or another recognized health agency sets a lower action level. We do not believe, as the authors suggest, that human health action levels for lead in blood should be “adjusted to local situations and economies.” However, as the ACCLPP report acknowledges, “action or inaction at an individual or community level will be primarily dependent upon the availability of effective remediation approaches and financial means to accomplish them and, to some degree, related analytical considerations.” Unfortunately, resource limitations for addressing lead poisoning prevention are present both in the U.S. and abroad. Despite these constraints, we want to encourage all public health and environmental agencies to set appropriate public health targets to begin to address the noted disparities between blood-lead levels in the U.S. and those in developing regions. Perry Gottesfeld, MPH Executive Director Occupational Knowledge International Deborah A. Cory-Slechta, PhD Professor of Environmental Medicine, Pediatrics and Public Health Sciences Department of Environmental Medicine University of Rochester School of Medicine The authors respond: We appreciate the feedback of Mr. Gottesfeld and Dr. Cory-Slechta regarding our article. We completely agree that the blood-lead level of 5 µg/dL or even lower should be considered as an action level, internationally. In the article, we stated, “as a start, we recommend establishing a blood-lead level target of 5 µg/dL with the possibility of gradually decreasing this level as countries progress in their lead poisoning prevention systems.” Our statement that “the target level may have to be adjusted to local situations and economies” is in line with the WHO suggestion that a lower level, perhaps 2 µg/dL, should require follow-up and an assessment by health professionals. We also realize that in some countries (like Russia or Kazakhstan), even reaching a 10 µg/dL target would require comprehensive and long-term measures, including substitution and limitations on use, improved engineering controls surrounding emissions and exposures, environmental remediation, and public health interventions. We join Mr. Gottesfeld and Dr. Cory-Slechta in their call for reducing disparities between blood-lead levels in developed and developing countries. Andrey Korchevskiy, PhD, CIH Director of Research and Development Chemistry & Industrial Hygiene, Inc. James Rasmuson, PhD, CIH, DABT Senior Scientist and CEO Chemistry & Industrial Hygiene, Inc. Eric Rasmuson, CIH President Chemistry & Industrial Hygiene, Inc.
Blood-lead Levels in Emerging Economies