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Prevention Measures

A PERSPECTIVE ON LEAD POISONING: PREVENTION AND INTERVENTION STRATEGIES

Dr. Babasaheb R. Sonawane

Lead Poisoning is currently thought to be one of the most serious diseases of environmental and occupational origin because of its high prevalence of toxicity in affected population around the world, especially in the most sensitive sub-population i.e. infants, children and pregnant women. Exposure of various sensitive populations to lead induces a wide variety of adverse health effects in children and fetuses, as seen in various growth indices in children and in the cardiovascular homeostasis and function. Reproductive and developmental effects from the high dose lead exposure are well established. It is an entirely preventable disease through identification and control of exposure to lead. Lead poisoning is caused by acute or chronic environmental exposure through contamination of air, drinking water, foods, paints, soils, dusts, ceramic potteries, and lead soldered pipes, cans, etc. For occupational exposure to workers, lead smelters, small-scale metal cottage industries, mining and construction operations serve as major sources of lead. Certain traditional practices using lead containing cosmetics and folk medicines also expose significant populations to high levels of lead.

Control, reduction, prevention and intervention strategies to address environmental lead exposure sources are more complex than those for confined occupational sources, because the former is varied and heterogeneous in nature. Women and children continue to be exposed to lead across the world. Sources and pathways of exposure differ across and within countries and remain a daunting task. A successful control, prevention and intervention strategies require the involvement and commitment of public and organizations at all levels of society sharing the task from the government down to the grassroots.

Concerning strategies to eliminate lead poisoning, effort must be based on six principles of action, namely, prevention, interdisciplinary approach, coordination at all levels, public awareness and community involvement, priority based research, and life cycle management. Lead poisoning prevention requires the implementation of a comprehensive program that can be implemented in stages oriented toward source control such as phasing out leaded gasoline, collecting and analyzing existing and new data on population blood lead levels, enforcing occupational health safety standards, and industrial permission. Setting priorities for action to ensure the multiple sources of exposure, they should be controlled most efficiently, effectively, and economically they must be part of the action plan. Raising public awareness about the dangers of lead from occupational and environmental sources not only helps prevent lead poisoning, but builds a constituency of support for developing and sustaining the prevention programs. Implementation of the strategy requires a well-coordinated effort by the full range of stakeholders making them to be part of the solution.

Prevention is a proactive rather than a reactive approach that focuses on controlling, reducing or eliminating sources of lead exposure in the environment. Medical intervention occurs too late after poisoning when the damage has been done. There are several obstacles in the way of prevention programs that include a lack of awareness of the severity and magnitude of lead poisoning problem, lack of enforcement, short-sighted economic and political objectives and poor local availability of expertise and technologies in support of prevention and control activities.

Childhood lead poisoning is one of the most common pediatric environmental health problems in the world today and presents a singular and direct challenge to public health authorities, clinicians, regulatory agencies, and society. As a basis for prevention, in 1991 the Centers for Disease Control and Prevention (CDC) defined a blood lead concentration in excess of 10 ug/dL as a cause for concern. Community prevention activities should be triggered by blood lead levels >10 ug/dL. Medical evaluation and environmental investigation and remediation should be done for all children with blood lead levels >20 ug/dL. All children with blood levels >15 ug/dL should require individual follow-up, including nutritional and educational interventions as a part of routine pediatric care. Children with blood lead levels 45 ug/dL and above or with symptoms of lead poisoning should receive medical treatment immediately. Because iron deficiency can enhance lead absorption and toxicity and often coexists with it, all children with blood lead levels> 20 ug/dL should be tested for iron deficiency. Several drugs are used in the treatment of lead poisoning, These drugs are capable of binding or chelating lead, depleting the skeletal lead and thus reducing it's acute toxicity. They also have potential side effects and must be used with utmost caution and only under experienced physician's care. The commonly used chelating agents include Ca Na² EDTA, 2,3- dimercapto-1 propanol (BAL), D-penicillamine and DMSA. Disodium editate (Na² EDTA) should never be used for treating children with lead poisoning because it will induce tatany and possibly fatal hypocalcemia.

Eradicating child lead poisoning requires a long-term active program of primary prevention, including abatement of hazard at all sources. For the child who is lead poisoned, efficient and effective interventions are needed as quickly as possible.

Views expressed are that of the author and the use of trade names do not constitute endorsement of the products or represent the U.S. EPA policy. This publication has not been formally reviewed by the U.S. EPA, therefore, should not be construed to represent Agency Policy.

References

Howson, C.P., Hernandez-Avila, M. and Rail, D. Editors, (1996) Lead in the Americas-A call for action. The U.S. National Academy of science. Washington, D.C, and National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico.

Alliance to End Childhood Lead Poisoning and EDF (Environmental Defense Fund). (1994), The Global Dimensions of Lead Poisoning: An Initial Analysis. Washington, D.C.: Alliance to End Childhood lead Poisoning.

CDC (U.S. Centers for Disease Control and Prevention). (1991) Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control. Atlanta, GA: CDC, U.S. department of Health and Human Services.

EPA (U.S. Environmental Protection Agency). (1986). Air Quality Criteria for Lead, EPA-600/8-8-33/028aF, vols 1-4. Research Triangle Park, N.C.: Environmental Protection Agency, Environmental Criteria and Assessment Office.

NRC (National Research Council). (1993), Measuring Lead Exposure in Infants, Children and other Sensitive Populations. Washington D.C.: National Academy Press.

NRDC (Natural Resources Defense Council) N.d. Global Phase-out of Leaded Gasoline by Year 2000, Washington, D.C.

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