1. Lead Toxicity Human Health Effects Board Council of Governments April 14, 2004 Washington, DC Georges C. Benjamin, MD, FACP Executive Director American Public Health Association

2. Where It Comes From? Naturally occurring element in the environment Naturally occurring element in the environment 40% of US Homes have lead based paint 40% of US Homes have lead based paint –In these homes 25% are kids under age 6 –Dust, dirt & paint chips Water (20%)* – Usually lead pipes or solder Water (20%)* – Usually lead pipes or solder Imported Lead glazed dishes, food cans Imported Lead glazed dishes, food cans Some imported candy; some folk remedies Some imported candy; some folk remedies * 60% of exposure if heavy mixed formula used

3. 1977 Public Health Success Story! Unleaded Gas Unleaded Gas Solders & pipe Solders & pipe House paint House paint

4. Where It Goes? Gets into the body by ingestion or inhalation Gets into the body by ingestion or inhalation Lead is confused by the body as iron, calcium etc Lead is confused by the body as iron, calcium etc Calcium is an essential nutrient used for cellular function & strong bones Calcium is an essential nutrient used for cellular function & strong bones Absorbed lead goes to bones (years) where it is stored and into many types of cells where it disrupts cell function Absorbed lead goes to bones (years) where it is stored and into many types of cells where it disrupts cell function Absorption increased during pregnancy Absorption increased during pregnancy It can come back out of growing bones into the blood often during pregnancy, growth spurts, menopause It can come back out of growing bones into the blood often during pregnancy, growth spurts, menopause

5. What It Does? Anemia Anemia Developmental delay Developmental delay Mental / cognitive disorders Mental / cognitive disorders Kidney dysfunction causing hypertension Kidney dysfunction causing hypertension Muscle aches Muscle aches Miscarriages Miscarriages Coma & death in doses Coma & death in doses No useful physiologic purpose

6. Who Is At Risk? No proven safe level Infants & those <6y/o –Growing –Increased absorption –Everything goes to mouth Pregnant women & fetus Brest feeding women can pass to child if they have increased lead Adults – especially some workers (battery, smelters, painters)

7. How Do We Stop It? Prevention Prevention – Flush pipes; filters –Lead abatement –Avoidance of high risk –Environmental testing & remediation – Water Action 15 ppb This is a preventable condition!!!!

8. What Can We Do About It? Detection Detection –Universal vs. targeted; blood vs. risk questionnaires –Childhood blood screening (Vena puncture vs. finger stick) –Ages: 12 & 24 months –Symptoms –Reportable to public health authorities

9. Treatment Changing: better therapies/knowledge Changing: better therapies/knowledge –<10 ug/dL blood level –>10 ug/dL - 25ug/dL blood level (2% in US) –35 ug/dL – 50 ug/dL blood level (Symptoms) –> 70 ug/dL Medical emergency Evaluate exposure Evaluate exposure Environmental remediation Environmental remediation Remove from exposure Remove from exposure Medication - Chelation therapy Medication - Chelation therapy –Older ones have side effects –Newer ones can often be given as outpatient

10. Georges C. Benjamin, MD, FACP Georges C. Benjamin, MD, FACP Executive Director Executive Director American Public Health Association American Public Health Association WWW.APHA.ORG WWW.APHA.ORG “Public Health: Prevent, Protect, Promote”