Summary of Notifiable Noninfectious Conditions and Disease Outbreaks: Elevated Blood Lead Levels Among Employed Adults — United States, 1994–2012

Overexposure to inorganic lead continues to be an important problem worldwide.The reduction of lead in the U.S. environment, largely accomplished through effective EPA regulatory efforts, has resulted in lowering the overall geometric mean whole blood lead level (BLL) for the general population in the United States from approximately 13 µg/dL (0.63 µmol/L) in the 1970s to less than 2 µg/dL (0.10 µmol/L) (CDC 2005;NCHS 1984).Lead exposure remains a significant public health and medical concern for thousands of children and adults exposed primarily through remaining lead-based paint in older housing stock as well as to workplace exposures, although other sources occur.For children and adults, the role of environmental investigation, identification and reduction or elimination of sources of exposure remains of primary importance.While the clinical care of lead-exposed children has been well established in the pediatric and public health communities, similar clinical recommendations for adults have not been widely available.The purpose of this document is to provide useful advice to clinicians caring for adult patients who have been exposed to lead, whether at work, at home, through hobbies, in the community, through consumer products, retained bullets, or other sources.This document is derived, in part, from the input of an expert panel convened by the Association of Occupational and Environmental Clinics (AOEC).However, three clinical scholars then considered the medical evidence submitted by the expert panel and incorporated many of the conclusions reached by this panel.This paper, therefore, reflects a general consensus of the clinical views of AOEC members, not necessarily the expert panel, particularly in areas where the expert panel had been unable to come to consensus.The following points are emphasized:1) Medical care serves as an adjunct to public health and industrial hygiene exposure control.Clinicians who evaluate patients with potential lead exposure should have appropriate referral mechanisms in place for prevention of further exposure to lead.Although one goal of health care is to remove the patient from exposure, the social consequences of potential disruption of housing or of income may be important and must be considered by the clinician.2) Current occupational standards are not sufficiently protective and should be strengthened.Although the federal Occupational Safety and Health Administration's (OSHA) lead standards have provided guidance that has been beneficial for lead-exposed workers, these regulations have not been substantially changed since the late 1970s and thus are primarily based on health effects studies that are well over three decades old.There is an urgent need to revise them.3) The clinical guidelines presented here are appropriate for adults, recognizing that younger adults, particularly those in workplace settings, may share developmental risks that place them