Blood-lead Levels and Lead Poisoning in Emerging Economies
Other sources of lead exposure have contributed to elevated levels of lead in the blood of Kazakhstan children. Lead paint is widespread and, according to some new data, its use is growing. In addition, we discovered a significant presence of lead in toys and tableware. Lead in gasoline apparently has been banned in Kazakhstan and other countries of the region, although some leaded gasoline may have been used there illegally.
WHAT TO DO, AND WHAT NOT TO DO
Developing countries need increased international attention on the subject of occupational and environmental lead contamination. International expertise in this area is abundant, and the increasing awareness on “green” topics presents new opportunities to discuss the issues surrounding lead exposures and associated risks.
Many international foundations are interested in resolving environmental and public health issues in developing countries. Considering Russia’s strained relationships with its neighbors, helping countries clean up the affected zones could be a way to build bridges between societies.
The extent of the lead problem in countries of the former Soviet Union suggests that it would be beneficial for public health policymakers, and perhaps occupational and environmental health organizations such as AIHA, to determine a meaningful action level value with respect to children’s blood-lead levels. The CDC’s reference value is probably out of reach for many developing regions, unless it is interpreted as a recommended, eventual reduction of 10 µg/dL to 5 µg/dL. The target level may have to be adjusted to local situations and economies. Without a target action-level for blood lead in children, it is difficult or even impossible to establish goals related to environmental remediation, biological monitoring, and education or relocation of affected populations. 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.
AIHA’s reference document addresses the issues of lead poisoning prevention and treatment. Medical treatment associated with lead poisoning is extremely important for children in post-Soviet countries. However, treatment approaches remain controversial, because, as far as we know, chelation therapy is not permitted there for children with any level of blood lead, even when suffering severe encephalopathy. Medical professionals should be educated in the use of chelation therapy to treat acute cases of lead poisoning, especially when, as the CDC recently emphasized, there is a tendency to use this term fraudulently in Internet advertisements. Currently, CDC recommends chelation therapy for levels of lead in blood higher than 45 µg/dL, with consideration of such treatment at lower levels, based on the results of medical testing, down to 25 µg/dL. New methods of treatment for children with lower levels of lead in blood would be helpful, but their development will require intensive scientific studies, rigorous testing, and regulatory approval. In any event, removal of lead-poisoned children from the source of the lead always remains the most important goal. ?
The international community should consider all necessary steps to reduce lead contamination in the environment. Given the apparent growth of lead-based paint utilization in the former Soviet Union and other countries, a ban on lead in paint (above an appropriate lead concentration standard) should be a worldwide priority.
The problems associated with childhood lead poisoning in developing countries are of special interest for industrial hygienists in the U.S. Because of social responsibility standards, those issues should be assessed and known for employees of international companies. Companies working in areas where children may have elevated baseline blood-lead levels should work to reduce lead emissions, should educate their staff in methods to prevent further environmental contamination, and as responsible corporate citizens, should offer help and community education to reduce risks. New research on lead exposure in adults may require reduction of workplace air and worker blood-lead standards. In the occupational environment, measures to further diminish lead exposure represent best practices and will also result in reduction in related household exposures.
ANDREY KORCHEVSKIY, PhD, CIH, is director of research and development with Chemistry & Industrial Hygiene, Inc., in Wheat Ridge, Colo. He can be reached at firstname.lastname@example.org.
JAMES RASMUSON, PhD, CIH, DABT, is senior scientist and CEO at Chemistry & Industrial Hygiene, Inc. He can be reached at email@example.com.
ERIC RASMUSON, CIH, is president at Chemistry & Industrial Hygiene, Inc. He can be reached at firstname.lastname@example.org.