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Surveillance of Children's Blood Lead Levels -- United States, 1991

Lead poisoning is one of the most common environmental pediatric health problems in the United States (1): in 1984, an estimated three to four million children had blood lead levels (BLLs) sufficiently high to adversely affect intelligence, behavior, and development (2). Because little is known about efforts to monitor BLLs among U.S. children, in 1991, the Council of State and Territorial Epidemiologists (CSTE) and CDC conducted a survey to characterize reporting requirements and data-collection activities for BLLs among U.S. children during 1989. This report summarizes the findings from that survey.

State and territorial health departments in the 50 states, the District of Columbia, American Samoa, the U.S. Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and the Commonwealth of Puerto Rico were mailed a questionnaire. Personnel in jurisdictions that did not respond were mailed another questionnaire and were contacted by telephone. The questionnaire addressed four areas: 1) reporting requirements (including laws and regulations), 2) data collected (e.g., age, BLLs, specimen type), 3) designated report sources, and 4) availability of data on elevated BLLs in children. Of the 56 jurisdictions surveyed, 47 states, the District of Columbia, the U.S. Virgin Islands, Guam, and the Northern Mariana Islands responded to the questionnaire, an overall response rate of 91%.

Of the 51 jurisdictions that responded, 28 states and the District of Columbia (57%) required reporting of BLLs in children (Figure 1). None of the territories had mandatory reporting requirements. Massachusetts and Maryland mandated reporting of all blood lead test results (Table 1). Seventeen states and the District of Columbia required reporting of BLLs greater than or equal to 25 ug/dL, the level used to define lead poisoning at the time the survey was conducted (3). Of the 24 states specifying the ages for which reporting was required, 23 (96%) required reporting starting at birth.

Twenty-two (76%) of the 29 jurisdictions with reporting requirements mandated reporting from state laboratories, 24 (83%) from in-state private laboratories, and 13 (49%) from both in-state and out-of-state private laboratories. Three states with mandated reporting did not specifically require any laboratory reporting. Twenty-three (79%) of the 29 jurisdictions with mandated reporting required physicians to submit reports, 11 required reports from screening programs, and one required reports from school principals.

Eight states required that laboratories be licensed to perform blood lead testing. Five states that did not mandate the reporting of elevated BLLs did require that laboratories be licensed to perform blood lead analyses.

Reports had to be submitted within 7 days after laboratory test completion in 21 (72%) of 29 jurisdictions with required reporting. Five states did not specify a time limit for the submission of reports.

Reported by: State and territorial health departments. DM Perrotta, PhD, Executive Committee, Council of State and Territorial Epidemiologists, Austin, Texas. Lead Poisoning Prevention Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Although the results of national health and nutrition surveys provide information about the national and regional distribution of elevated BLLs (1), these data cannot be used to define the distribution of BLLs within state or local jurisdictions or to identify sources of exposure. In addition, adequate data do not exist to determine which communities need to institute childhood lead poisoning prevention programs. State-based surveillance can assist in identifying communities where lead poisoning is occurring; defining sources and pathways of exposure in the community; targeting appropriate activities for preventing childhood lead poisoning; and evaluating prevention programs.

In 1991, the U.S. Department of Health and Human Services released the Strategic Plan for the Elimination of Childhood Lead Poisoning, which described the first 5 years of a 20-year effort to eliminate childhood lead poisoning as a public health problem (1). This plan includes both a research and a program agenda. One of the four elements of the program agenda is national surveillance for elevated BLLs. A national surveillance system for reporting BLLs is considered essential for targeting environmental and treatment interventions and for monitoring progress in eliminating childhood lead poisoning (1).

Because data from a national surveillance system would provide an adequate foundation for policy decisions, resources for combatting childhood lead poisoning could be used more efficiently. Unlike most infectious diseases, lead poisoning usually causes no overt symptoms. Because lead poisoning is usually a laboratory diagnosis and does not require clinical judgment, laboratories are probably the best source of reports on BLLs and should form the basis of a surveillance system. For laboratory reporting to be most useful, jurisdictions must collect information from private as well as public laboratories and must receive reports on their own residents from laboratories in other jurisdictions.

During the 1992 fiscal year, as part of the effort to build a national surveillance system for monitoring children's BLLs, CDC will award funds for cooperative agreements between state and territorial health departments and CDC to establish or enhance childhood and adult blood lead surveillance. In addition, CDC will provide technical assistance to states and territories; work with states and territories to develop guidelines on surveillance; and manage, analyze, and provide feedback on data sent from the states and territories to CDC. Additional information on efforts to establish national BLL surveillance among children is available from the Lead Poisoning Prevention Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC, Mailstop F-28, 1600 Clifton Road, NE, Atlanta, GA 30333.


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

  2. Agency for Toxic Substances and Disease Registry. The nature and extent of lead poisoning in children in the United States: a report to Congress. Atlanta: US Department of Health and Human Services, Public Health Service, Agency for Toxic Substances and Disease Registry, 1988; DHHS publication no. 99-2966.

  3. CDC. Preventing lead poisoning in young children: a statement by the Centers for Disease Control, January 1985. Atlanta: US Department of Health and Human Services, Public Health Service, 1985; DHHS publication no. 99-2230.

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