Primary Prevention Primary Prevention of Lead Poisoning:of Lead Poisoning:

Shifting the ParadigmShifting the ParadigmA Community-Based A Community-Based

InitiativeInitiativeMichael A. Noll, M.D.Michael A. Noll, M.D.

Walden University Walden University School of Health SciencesSchool of Health Sciences

November 12, 2009November 12, 2009

Welcome!Welcome!Prenatal Services: You

are literally on the Front Lines of Medicine

You can Affect Meaningful Positive Changes

Preventive Measures are Key to Healthy Families and Children

Our Focus Today:Our Focus Today:Preventing Exposure to Preventing Exposure to

Lead in ChildrenLead in Children What We KnowWhat We Know

Toxic Effects of Lead ExposureToxic Effects of Lead Exposure Special Focus of Neurodevelopmental Special Focus of Neurodevelopmental

Issues Issues Sources of ExposureSources of Exposure Current Preventive MeasuresCurrent Preventive Measures Changing the Status QuoChanging the Status Quo

Lead Poisoning in ChildrenLead Poisoning in Children 250,000 U.S. children under age 5 have blood lead 250,000 U.S. children under age 5 have blood lead

levels greater than 10 micrograms of lead per levels greater than 10 micrograms of lead per deciliter (mcg/dl).deciliter (mcg/dl). 10 mcg/dl of lead is the level at which CDC 10 mcg/dl of lead is the level at which CDC

recommends public health actions be initiated (CDC, recommends public health actions be initiated (CDC, 2009).2009).

Lead interferes with a variety of body processes Lead interferes with a variety of body processes (CDC, 2009) including, most notably in children:(CDC, 2009) including, most notably in children: The Nervous System The Nervous System

Reference:Center for Disease Control (2009). Lead. Retrieved October 10, 2009,

from: http://www.cdc.gov/lead/Credit:Image of Neuron used with permission from Quasar Jarosz (2009).Retrieved October 25, 2009, from: http://en.wikipedia.org/wiki/File:Neuron

The Neuron

Neurotoxic Effects Neurotoxic Effects High levels of exposure can lead to:High levels of exposure can lead to:

Seizures, coma and deathSeizures, coma and death (Cecil, 2008). (Cecil, 2008). Exposure has been linked to:Exposure has been linked to:

Learning DisabilitiesLearning Disabilities (Meyer & McGeehim, (Meyer & McGeehim, 2003)2003)

Aggression and DelinquencyAggression and Delinquency (Needleman, (Needleman, 2004)2004)

ADHD & antisocial behaviorADHD & antisocial behavior (Bellinger, 2008). (Bellinger, 2008). References Bellinger, C (2008). Very low lead exposures and children's neurodevelopment. Current Opinions in

Pediatrics, 20 (2): 172–177Cecil, M, et al. (2008). Decreased brain volume in adults with childhood lead exposure.

PLoS Medicine, 5 (5): 112.Meyer PA; Mcgeehin F (2003). A global approach to childhood lead poisoning prevention.

International Journal of Hygiene and Environmental Health, 206 (4-5): 363–9Needleman, H. (2004). Lead poisoning. Annual Review of Medicine, 55; 209–222.

Cerebrums of adults that were exposed to lead as children show decreased volume, especially in the

prefrontal cortex. Areas of volume loss are shown as red/orange/ yellow over a

normal brain.

Persistent Persistent Neurological EffectsNeurological Effects

Reference and Image SourceCecil M, et al. (2008). Decreased brain volume in adults with childhood lead exposure. PLoS Medicine, 5 (5): 112.

Exposure to LeadExposure to Lead Lead-based paintLead-based paint and lead-contaminated and lead-contaminated

dust dust in older homes are the most common in older homes are the most common sources of lead poisoning in children (CDC, sources of lead poisoning in children (CDC, 2009)2009)

Although lead was banned for use in paints in Although lead was banned for use in paints in 1978, 1978, 98% of homes built before 1940 still 98% of homes built before 1940 still contain lead contain lead (HUD, 2009)(HUD, 2009)

More than 30 million homes, More than 30 million homes, roughly 1/3 of roughly 1/3 of the homes in the US are at least 50 years the homes in the US are at least 50 years oldold (Solomon, 2009). (Solomon, 2009).

References:Center for Disease Control (2009). Lead. Retrieved October 12, 2009, from www..cdc.gov/nceh/leadSolomon C (2009). This old (dangerous?) house. Microsoft Network Real Estate. Retrieved October 25, 2009, from http://realestate.msn.com/article.aspx?cp-documentid=21917660US Dept. of Housing and Urban Development (HUD) (2009). Retrieved October 20, 2009 from: www.hud.gov/offices/lead/enforcement/lshr.cfm

Lead PaintLead Paint

Image Source: US EPA. Retrieved October 19, 2009, from: http://www.epa.gov/opp00001/factsheets/child-ten-tips.htm

Paint Paint FlakesFlakes

Image Source: County of Marin, California (2009).Retrieved October 20, 2009, from: www.co.marin.ca.us/depts/hh/main/hs/clinicalsvcs/

Primary Prevention:Primary Prevention:The Status Quo.The Status Quo.

Current Recommendations: Current Recommendations: ““Screen 12-month-old infants for lead poisoning if they Screen 12-month-old infants for lead poisoning if they

live in communities in which the prevalence of lead live in communities in which the prevalence of lead levels requiring intervention is high or undefined” (AAP, levels requiring intervention is high or undefined” (AAP, 2005)2005)

Reference:Reference: American Academy of Pediatrics (2005). Lead American Academy of Pediatrics (2005). Lead exposure in children: prevention, detection, and management. exposure in children: prevention, detection, and management. PediatricsPediatrics 2005; 116:1036-46. 2005; 116:1036-46.

““All children should receive a screening blood lead test All children should receive a screening blood lead test at 12 months and 24 months of age; children between at 12 months and 24 months of age; children between the ages of 36 months and 72 months of age must the ages of 36 months and 72 months of age must receive a screening blood lead test if they have not been receive a screening blood lead test if they have not been previously screened for lead poisoning” (CDC, 2005)previously screened for lead poisoning” (CDC, 2005)

Reference:Reference: Centers for Disease Control and Prevention. Blood Centers for Disease Control and Prevention. Blood Lead Levels - United States, 1999-2002. Lead Levels - United States, 1999-2002. MMWRMMWR 2005;54(20):513-6. 2005;54(20):513-6.

Image Source: www.ushersyndrome.nih.gov/join/blood.html

The Clinical Intervention Model

True PreventionTrue Prevention

Screen Homes for

Lead Prior

to Bringing a Newborn

HomeImage Source: http://spokanepublishing.files.wordpress.com

Community and Clinic-Based Intervention

Let us Truly Prevent the Problem

Image Source: www.ksre.ksu

MethodsMethods

FREE lead FREE lead dust kitdust kit available to available to NJ residentsNJ residents

The Lead Kit

Image Source: State of NJ (2009). Lead Safe NJ Program. Retrieved October 15, 2009, from: http://www.state.nj.us/dca/dcr/leadsafe/

If Lead is Detected in the If Lead is Detected in the HomeHome

Hire a Certified Hire a Certified Lead Abatement Lead Abatement Contractor Contractor

NJ Lead Abatement NJ Lead Abatement Hot-line at (609) Hot-line at (609) 633-6224. 633-6224.

Financial Financial assistance is assistance is available. available. Reference: State of NJ (2009). Lead Safe NJ Program. Retrieved October 15, 2009, from: http://www.state.nj.us/dca/dcr/leadsafe/

Image source: http://rwss.ap.nic.in/pred/images/contractor.gif

Image courtesy of: http://burningourmoney.blogspot.com

For Further InformationFor Further Information EPA Website: EPA Website: www.epa.gov/leadwww.epa.gov/lead EPA (New Jersey regional) info: EPA (New Jersey regional) info: (732) 321-(732) 321-

66716671 CDC Childhood Lead Poisoning Prevention CDC Childhood Lead Poisoning Prevention

Program: Program: www.cdc.gov/nceh/lead/about/programwww.cdc.gov/nceh/lead/about/program

National Lead Info Center: National Lead Info Center: 800-424-LEAD800-424-LEAD Lead Safe NJ Program Lead Safe NJ Program (To Obtain the Free (To Obtain the Free

Lead Detection Kit): 856-665-6000 ext Lead Detection Kit): 856-665-6000 ext 327327

References:References: American Academy of Pediatrics (2005). Lead exposure in children: American Academy of Pediatrics (2005). Lead exposure in children:

prevention, detection, and management. prevention, detection, and management. PediatricsPediatrics, 116:, 116: 1036-46. 1036-46. Bellinger, C (2008). Very low lead exposures and children's Bellinger, C (2008). Very low lead exposures and children's neurodevelopment. neurodevelopment. Current Opinions in Pediatrics,Current Opinions in Pediatrics, 20 (2): 20 (2): 172–177172–177 Cecil, M, et al. (2008). Decreased brain volume in adults with Cecil, M, et al. (2008). Decreased brain volume in adults with

childhood lead exposure. childhood lead exposure. PLoS Medicine,PLoS Medicine, 5 (5): 112. 5 (5): 112. Centers for Disease Control and Prevention. Blood Lead Levels - Centers for Disease Control and Prevention. Blood Lead Levels -

United States, United States, 1999-2002. MMWR; 54(20):513-6. 1999-2002. MMWR; 54(20):513-6.

Center for Disease Control (2009). Lead. Retrieved October 10, Center for Disease Control (2009). Lead. Retrieved October 10, 2009,2009,

from: www.cdc.gov/lead/from: www.cdc.gov/lead/ Environmental Protection Agency (EPA) 2009. Lead. Retrieved Environmental Protection Agency (EPA) 2009. Lead. Retrieved

October 12, October 12, 2009, from: 2009, from: http://www.epa.gov/lead/pubs/rrpamph.pdfhttp://www.epa.gov/lead/pubs/rrpamph.pdf

Meyer PA; Mcgeehin F (2003). A global approach to childhood lead Meyer PA; Mcgeehin F (2003). A global approach to childhood lead poisoning poisoning prevention. prevention. International Journal of Hygiene and Environmental International Journal of Hygiene and Environmental HealthHealth, 206 (4-5): , 206 (4-5): 363–9.363–9.

References (continued)References (continued) Moeller, DW (2005). Environmental Health (3rd ed.). Moeller, DW (2005). Environmental Health (3rd ed.).

Boston: Harvard Boston: Harvard University Press. University Press. Needleman, H. (2004). Lead poisoning. Needleman, H. (2004). Lead poisoning. Annual Review of Annual Review of

Medicine, 55Medicine, 55; 209–222.; 209–222. Solomon C (2009). This old (dangerous?) house. Microsoft Solomon C (2009). This old (dangerous?) house. Microsoft

Network Real Network Real Estate. Retrieved October 26, 2009, from: Estate. Retrieved October 26, 2009, from:

http://realestate.msn.com/article.aspx?cp-documentidhttp://realestate.msn.com/article.aspx?cp-documentid=21917660=21917660

State of NJ (2009). Lead Safe NJ Program. Retrieved State of NJ (2009). Lead Safe NJ Program. Retrieved October 15, 2009, October 15, 2009, from: from: http://www.state.nj.us/dca/dcr/leadsafe/http://www.state.nj.us/dca/dcr/leadsafe/

US Dept. of Housing and Urban Development (HUD) US Dept. of Housing and Urban Development (HUD) (2009). Retrieved (2009). Retrieved October 20, 2009 from: October 20, 2009 from: www.hud.gov/offices/lead/enforcement/lshr.cfm www.hud.gov/offices/lead/enforcement/lshr.cfm