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Surveillance of Elevated Blood Lead Levels Among Adults -- United States, 1992

As of May 1, 1992, health departments of 18 states required reporting of elevated blood lead levels (BLLs) in adults (Table 1). State-based lead surveillance activities have the following common features: 1) a regulation specifying a reportable level, 2) designation of reporting sources (e.g., laboratories and health-care providers), 3) a means for gathering further essential information about reported cases, and 4) a mechanism for linking case reports with follow-up activities (e.g., educational efforts and epidemiologic field investigations). In response to the recent changes in CDC's guidelines for preventing lead poisoning in children (1) and to recommendations of CDC's National Institute for Occupational Safety and Health (NIOSH) to reduce occupational lead exposures (2), many states are revising downward their reportable BLLs.

During 1991, 13 states provided 18,879 reports of elevated BLLs in adults to NIOSH (Table 2). However, lead monitoring programs may perform multiple BLL tests for individual workers: during 1991, the 10,117 reports from Illinois, New Jersey, and New York * represented 4406 persons (i.e., an average of 2.3 reports per person).

The reports in this issue of MMWR highlight the role of the field investigation in the control of occupational lead poisoning and address unique aspects of the control of lead in the workplace and in the environment. During 1992, NIOSH will begin reporting blood lead data for adults (as prevalence and incidence) on a quarterly basis in MMWR.

Reported by: B Harrell, MPA, Div of Epidemiology; CH Woernle, MD, State Epidemiologist, Alabama Dept of Public Health. N Maizlish, PhD, A Osorio, MD, Occupational Health Surveillance and Evaluation Program, California Dept of Health Svcs. N Tolentino, MPH, Connecticut State Dept of Health Svcs. J Keller, PhD, M Lehnherr, Occupational Disease Registry; H Howe, PhD, Div of Epi Studies, Illinois Dept of Public Health. R Currier, DVM, State Epidemiologist, Iowa Dept of Public Health. E Coe, MPH, Health Registries Div, Maryland Dept of the Environment. R Rabin, MSPH, Div of Occupational Hygiene, Massachusetts Dept of Labor and Industries. B Gerwel, MD, Occupational Disease Prevention Program, New Jersey State Dept of Health. R Stone, PhD, New York State Dept of Health. T O'Connor, JE Gordon, PhD, Environmental Epidemiologist, State Health Div, Oregon Dept of Human Resources. J Logue, DrPH, Div of Environmental Health, Pennsylvania Dept of Health. J Pichette, DM Perrotta, PhD, Environmental Epidemiologist, Texas Dept of Health. D Beaudoin, MD, D Thurman, MD, Bur of Epidemiology, Utah Dept of Health. L Hanrahan, MS, Wisconsin Dept of Health and Social Svcs. Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: NIOSH assists states in establishing lead surveillance and has begun to collect data from states and to routinely disseminate national data on elevated BLLs in adults. Surveillance activities 1) document the magnitude of the lead exposure problem in the workplace, 2) assist public health agencies in focusing on industries where control of lead exposure remains a problem, 3) identify new sources of industrial lead poisoning, 4) guide engineers in the design of technologies to control lead in the workplace, and 5) focus public attention and education efforts on excessive lead exposure as an ongoing occupational health problem. Efforts have been initiated to use surveillance data to monitor trends in the incidence of workplace-associated lead poisoning and to provide evaluation of prevention programs to reduce lead exposure.

Lead-induced health effects are known to occur in children and adults across a wide range of exposures. Laboratory-based surveillance is the preferred approach because symptoms of lead poisoning are not particularly sensitive or specific for lead exposure. The lowest observed health effects for children and adults have been compiled (see box, next page).

One of the national health objectives for the year 2000 is to eliminate occupational lead exposures that result in workers having blood lead concentrations greater than 25 ug/dL (objective 10.8) (2). Both the Council of State and Territorial Epidemiologists and the American Medical Association have endorsed positions encouraging health departments to make elevated BLLs in children and adults a notifiable condition nationwide.


  1. CDC. Preventing lead poisoning in young children: a statement by the Centers for Disease Control--October 1991. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1991.

  2. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

  3. CDC. Strategic plan for the elimination of childhood lead poisoning. Atlanta: US Department of Health and Human Services, Public Health Service, 1991.

  4. Agency for Toxic Substances and Disease Registry. Toxicological profile for lead. Atlanta: US Department of Health and Human Services, Public Health Service, Agency for Toxic Substances and Disease Registry, 1990; DHHS publication no. ATSDR/TP-88/17.

  5. Goldman RH, Baker EL, Hannan M, Kamerow DB. Lead poisoning in automobile radiator mechanics. N Engl J Med 1987;317:214-8.

    • The only states for which this information is available.

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