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1995
CSTE ANNUAL MEETING COMMITTEE: Environmental/Occupational/Injury Committee TITLE: Adding Elevated Blood Lead Levels Among Young Children as a Condition Reportable to the National Public Health Surveillance System. ISSUE: Surveillance of blood lead levels in needed to identify children with lead exposure resulting from their home or environment. POSITION TO BE ADOPTED: CSTE recommends that elevated blood levels among young children be added as a condition reportable to the National Health Surveillance System. BACKGROUND AND JUSTIFICATION: Lead poisoning is a common environmental health problem of young children. Data from the third National Health and Nutrition Examination Survey indicate that in 1988-91 8.9 percent of children ages one through five years had blood lead levels>= 10 ug/dL, the current CDC level of concern for young children. Despite the fact that sources of lead exposure and effective preventive measures have been known for decades, environmental lead exposures continue to be a major public health problem. The feasibility and utility of laboratory-based surveillance of blood lead levels for adults and children have been shown in many states. Data from State childhood lead surveillance systems have been used to direct screening activities and to evaluate the effectiveness of prevention efforts. CDC currently supports childhood lead surveillance activities at 17 State health departments. OUTCOME FOR SURVEILLANCE AND ACTION PROPOSED: Add elevated blood lead levels among young children as a condition reportable to the National Public Health Surveillance System. GOALS FOR SURVEILLANCE: Local To identify individual cases and clusters of elevated blood lead levels; to trigger appropriate prevention and control activities for children with elevated blood lead levels; to evaluate and target screening strategies at the community level; and to assess the effectiveness of lead poisoning prevention activities. State To identify individual cases and clusters of elevated blood lead levels, to assure appropriate prevention and control activities for children with elevated blood lead levels; to describe the extent of elevated blood lead levels by likely source of exposure; to evaluate and target screening strategies; and to evaluate and target intervention programs. National To assess the public health impact of elevated blood lead levels among children; to monitor trends; to evaluate prevention activities including screening programs and efforts to reduce environmental lead exposure; to demonstrate the need for childhood lead poisoning prevention programs; and to help allocate resources for prevention activities. PROPOSED METHOD OF SURVEILLANCE: Local Laboratory reporting of blood lead levels to local public health agency. In some states, physician reporting of children with elevated blood lead levels to the local agency. State Laboratory based reporting of blood lead levels to State health departments. Pass-through of locally collected data on children with elevated blood lead levels to State health departments. National State health departments pass along laboratory data and data on children with elevated blood lead levels to CDC. PROPOSED SURVEILLANCE CASE DEFINITION: A child considered to have an elevated blood level if: a venous sample is>=10 ug/dL; or two capillary samples taken within 12 weeks of each other are both >= 10 ug/dL. Date of diagnosis is the sample collection date for an elevated venous sample or the collection date of the first elevated capillary sample that is later confirmed. DATA TO BE COLLECTED: Local The primary source of reports is public and private laboratories. These reports should include basic demographic data, and whether the laboratory participates in a child lead proficiency program. Although not required, laboratories are encouraged to report data on all children tested for lead. Collection of all test results will help programs follow sequential test results on children who have had elevated blood lead levels. It will also provide denominator data that allow calculation of screening penetrance rates and prevalence rates of elevated blood lead levels among children tested. Physician reporting of children with elevated blood lead levels may supplement laboratory reporting. Investigation of children with elevated blood lead levels will provide additional data on medical treatment and potential sources of lead exposure and results of environmental investigations. State Reports from laboratories including basic demographic data. When possible, laboratories should report all blood lead levels. Those investigating children with elevated blood lead levels should collect data on medical follow-up, potential sources of lead exposure, and results of environmental investigations. National Demographic data on all children tested for lead and the additional data on children with elevated blood lead levels collected by State health departments. SYSTEM TO COLLECT AND TRANSMIT INFORMATION to CDC: State health departments should compile childhood lead surveillance data using a standard format and transmit them electronically to CDC. STATUS: Permanent, with review of reporting need every five years. COORDINATION WITH OTHER ORGANIZATIONS: CDC, ASTHO CONTACT: Ana Maria Osorio, M.D., M.P.H. California Department of Health Services 5801 Christie Avenue, Suite 600 Emeryville, CA 94608 (510) 450-2400 telephone *Case definition is for surveillance purposes only. Elevated levels from capillary specimens should be confirmed with a venous test. The surveillance case definition is not meant to replace current recommendations for follow up of children with elevated capillary or venous blood test results.
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