A Grand Rounds Presentation for Primary Care Providers Lead ead an - PowerPoint PPT Presentation

A Grand Rounds Presentation for Primary Care Providers Lead ead an and A Arsen enic E Exposure e Near ear the F e Former er C Colorad ado Smel elter er in n Pueb eblo, C Colorad ado Lourdes (“Luly”) Rosales-Guevara, M.D. Senior Medical Officer, ATSDR Agency for Toxic Substances and Disease Registry Division of Community Health Investigations

Agen ency for Toxic Substan ances es an and Diseas ease e Reg egistry (ATSDR) R) What i is A ATSD SDR? R?  A fed eder eral al p public heal ealth ag agen ency  Bas ased ed in Atlan anta, a, G Geo eorgia  Cha harge ged w with h  Assessing the presence of environmental health hazards in communities  Preventing harmful exposures to contaminants  Increasing the knowledge about the health effects from chemical and radiation exposure

Presentation O n Out utline ne • Lear earning G Goal als • Chi hildren a n and nd Environm nmental Exposur ure • Lead ead • Arse senic • ATSDR’s Colorad ado Smel elter er E Exposure I e Inves estigation • Quest stions s

Lear earning G Goal als Recogni gnize a and nd und understand nd: 1. 1. Why children en ar are m e more e vulner erab able? e? 2. 2. CDC’s r ref efer eren ence e level el for l lead ead 3. 3. Sources es o of l lead ead an and ar arsen enic exposure 4. 4. The h e heal ealth ef effec ects from exposure e to lead ead an and ar arsen enic 5. 5. Met ethods o of t tes esting for l lead ead an and ar arsen enic exposure 6. 6. Ways to preven ent l lead ead an and ar arsen enic exposure e 7. The 7. he f find ndings ngs a and nd recommend ndations ns o of A ATSDR’s Colorad ado S Smel elter er Exposure e Inves estigation (EI)

Children en ar are e at H Higher er Risk t tha han A n Adul ults for Environ onment ntal Expos osure t to C o Cont ontaminant nts  Children en ar are u e uniquel ely v vulner erab able e to en environmen ental al e exposures es.  Child ildren are not just “lit little le adult lts.”  Children en’s ag age-specif ific ic ris risk f factors rs for r exposure t to en environmen ental ally rel elated ed illnes ess ar are: e:  Ex Exposure  Absor orption on  Met etab abolism  Dis istrib ibutio ion  Tar arget et organ an s suscep eptibilities es Environmen ental al Heal ealth Per erspec ectives es. Sep eptem ember er 1 1995; 103(Supplem emen ent 6):7- 12 12. How A Are D e Differ eren ent f from Adults? Bear earer er, C C F .

Chi hildren n are a at Highe gher Risk t tha han A n Adul ults for nts Environ onment ntal Expos osure t to C o Cont ontaminant (cont ont…) …)  Chi hildren n will b be in d n different environm nments thr hrougho ughout ut t the he day, depend nding ng on a n age ge.  Pr Pre-am ambulating c children en can annot rem emove t e them emsel elves es from an an unsaf afe en e environmen ent.  Y oung c ung chi hildren n ha have ag age-appr ppropr priate ha hand nd-to to-mout uth h behav avior.  The e met etab abolic r rate o e of children en is h higher er than an ad adults b bec ecau ause e of t thei eir lar arger er surfac ace-to to-volu lume r ratio io.  The a amou ount nt of of f food ood con onsumed per b bod ody weight ht is much hi highe gher in c n chi hildren n tha han n in n adul ults; t the herefore, c chi hildren n ha have hi highe gher exposur ure to i inge ngested toxins ns in f n food. Environmen ental al Heal ealth Per erspec ectives es. Sep eptem ember er 1 1995; 103( 103(Supplement 6) 6):7-12. 12. How Are C e Children en Differ eren ent from Adults? B Bear earer er, C F F .

LEA EAD

What Is t the P e Problem em? Ov Over half lf a a m millio illion child ildren (>500,000) ag ages es 1 1 to 5 y year ears in the U e U.S. h have e blood l lead ead levels hi high gh eno nough ugh to affect the heir he health. h.

s Lead ead Poisoni ning? ng? What i is Is one e of t the e most s significan ant an and p preval alen ent diseas ease o e of en environmen ental al origin am among chi hildren n living ng in n the he U U.S. a and nd… It is preven entab able! e! MMWR. November 2, 2, 2007; 2007; 56( 56(RR08) 08):1-14; 4;16 16.

Per ersonal al Ri Risk Fa Factors for L Lead ead Exp xpos osure Ri Risk f factors Prev evention s strat ategy Gen enet etics, d does es not ot cha hange nge Prev event ex exposure Age o e of o organ an d devel elopmen ent Prev event ex exposure Y oung ung males <6 year ears o of ag age Su Supervise kids/ s/Prev event ex exposure Pica b a beh ehavior Super ervise k e kids/Discourag age b e beh ehavior Poor oor n nutrition on Bala lanced d die iet, ric ich in in I Iron, Calc lciu ium, Vit itamin in C a and Vit itamin in E E Po Poverty-Inco come-Ratio (P (PIR) ) <1.3 Acces ess to WIC p program am /heal ealth c car are Cultural al prac actices es/ Avoi oid use/Prevent nt expos osure Ayurved eda/ a/spices es

Environ onment ntal Sou ources f for or Lead ead Exp xpos osure Environmen ental al s sources es Prev evention s strat ategy Y ear ear h house b e built <1978 (lead ead-bas ased ed Iden entify/Eval aluate/ e/Rem emed ediate pai aint) Dust f from lead ead-ba based pa d paint chips ps Cont ontrol ol s sou ources Soil c il contamin inated wit ith le lead Res estrict play ar area/ ea/cover er source Drink nking ng water Check infor ormation on from om water dep epar artmen ent Home r e ren enovation Prop oper c cont ontainment nt Worker er t tak ake-home e cont ontamination on Shower er/Rem emove s e shoes es an and c clothes es Some h e hobbies es Proper er u use/ e/storag age/ e/ven entilation Some i e imported ed toys, cosmet etics/spices es Avoid use se an and c cer eram amic cookwar are

CDC Ref efer eren ence e Val alue e for Lead ead Gui uidanc nce  Before 2012 2012 “ “Level el of C Concer ern”  ≥ 10 µg/ dL  All c ll child ildren  2012 – to present “Reference Value”  ≥ 5 µ 5 µg/dL dL  Children en 1 1 to 5 5 y year ears of ag age e an and preg egnan ant women en  The r e ref efer eren ence e val alue e will b be u e updated ed e ever ery 4 4 y year ears as as appr ppropr priate.  Follo llow-up r p requ quired d http:/ ://www.cdc.gov/nceh eh/lead ead/ACCLPP/blood_lead ead_level els.htm

What should b be t e the e blood l lead ead level el (BLL) for c children en 1 t to 5 year ears of ag age an e and for p preg egnan ant women en? No s saf afe b e blood lead ead l level el f for children en has as been een i iden entified ed.

Heal ealth E Effec ects from L Low L Level el Lead ead Exposure

Human an L Lead ead E Exposure In g gen ener eral al, e exposure e occurs v via o a one e or m more e of the he m main c n compone nents of t the he hum human n en environmen ent:  Inhal aled ed ai air  Soil and d du dust o of vari rious t type pes (can be ingested or inhaled)  Drink nking w ng water and nd  Food ood

Heal ealth Ef Effects in A n Adul ults (inc nclud uding p ng pregna gnant women) n) Blood ood lead ead l level el Organ sy syst stem Suffic icie ient eviden ence o e of (µg/ g/dL) i in n adul ults  Dec Ren enal al ecreas eased ed G GFR¹  Increas eased ed B BP² At At le levels ls belo low  Increas HTN ᶾ Car ardiovas ascular ar eased ed Risk H 10µg/dL 10µ dL an and ev even at levels le ls b belo low 5µ 5µg/dL dL  Increas eased ed inciden ence e of Neurol olog ogic es essen ential al t trem emors 1 GFR Glo ion rate; 2 BP Blood pressu ssure; 3 HTN H lomerula lar filt iltratio Hyper erten ension National T Tox oxicology Program (NTP). 2012. 2012.

Heal ealth Effec ects in U Unborn B Bab abies es Blood L Lead ead Level l in in Affects t the he U Unb nborn n Sufficien ent Eviden ence e of Preg egnan ant w women en Baby’s ’s  Reduc uce gr growth h in t n the he Even en a at level els bel elow Devel elopmen ent unb unborn b n baby by (SGA)  Red 5µg/dL 5µ dL educed ed p postnatal al grow owth National Toxicology Program. Monograph on Health Effects of Low-level Lead. 2012. US Department of Health and Human Services. June