Occupational Illnesses and Injuries: Adult Blood Lead Epidemiology and Surveillance Program (ABLES)

Adult Blood Lead Epidemiology and Surveillance Program (ABLES)

Health Effects of Lead
Lead is a common metal that can be found at work, at home and in the environment. People can be exposed to lead by breathing it in or by ingesting it when contaminated substances get in their mouths. If too much lead builds up in the body, it can cause serious health problems in both children and adults.

Elevated blood lead levels (BLLs) in adults can damage various systems in the body, especially the nervous system, blood, reproductive system, renal, cardiovascular system, and gastrointestinal system. Some of the health effects caused by high blood lead levels are muscle and joint pain, headaches, fatigue, slower reflexes, kidney damage, higher blood pressure, and reproductive problems. The majority of high blood lead levels result from workplace exposures, although people who have hobbies or participate in recreational activities that involve lead can be affected as well. The average BLL of adults in the U.S. is under 3 µg/dL.

About ABLES
Begun in 1987, the national Adult Blood Lead Epidemiology and Surveillance (ABLES) Program is a state-based surveillance system created to identify and prevent cases of elevated blood lead levels in adults. The Centers for Disease Control and Prevention / National Institute of Occupational Safety and Health (NIOSH), ABLES Program provides funding and technical assistance to participating states. These states are required to provide data transmissions to NIOSH for the national database biannually.

States participating in ABLES must require laboratories to report blood lead level results to the state health department or its designee. State ABLES programs collect both occupational and non-occupational blood lead level data from both private and state reporting laboratories, local health departments, and private health care providers. Most of the reports are occupational.

To prevent over-exposure to lead, ABLES Programs:

Track adult blood lead levels to find out who is exposed to lead

Conduct follow-up interviews with workers, employers, and physicians to learn more about exposure circumstances and provide guidance on exposure prevention

Perform work-site evaluations

Provide technical assistance to employers and others

Make referrals to regulatory agencies for consultation or enforcement

Develop educational materials and outreach programs

The public health goal to reduce elevated blood lead levels is set by Healthy People 2010: Reduce the number of adults who have blood lead concentrations of 25 micrograms per deciliter (µg/dL) or greater of whole blood by 2010. Recent scientific research has documented adverse health effects at blood lead levels well below levels once thought to be safe. As a result the Council of State and Territorial Epidemiologists (CSTE) has recommended that the case definition of elevated blood lead in adults be lowered from above 25 µg/dL to above 10 µg/dL. In late 2009, ABLES adopted this new case definition.

North Carolina’s ABLES Program:
The North Carolina Adult Blood Lead Epidemiology and Surveillance program was established in 1994. The mandatory reporting requirement in North Carolina requires laboratories to report any blood lead level (BLL) 40µg/dL and above for individuals 18 years and older. Physicians are exempt if laboratories report for them. In an effort to meet public health goals, North Carolina has elected to try to collect data on ALL blood lead levels for individuals 16 years old and older. N.C. Department of Labor assists NC Division of Public Health by providing consultation and enforcement services. Childhood lead poisoning is separately tracked. In North Carolina, that responsibility falls to the Children’s Environmental Health Branch, Division of Environmental Health, in the Department of Environment and Natural Resources.

Resources for Health Care Providers
The Occupational Safety and Health Administration (OSHA) lead standards provide some guidance for health professionals who care for lead-exposed workers. Much has been learned, however, about lead’s harmful effects since OSHA passed the first lead standard in 1978. Recent scientific research shows that both acute and chronic low-level exposures to lead in adults can result in adverse health effects. Levels of lead that were once thought harmless have now been shown to be toxic. There is also a concern that the current OSHA lead standards allow workers to be exposed to lead at levels now known to be harmful. Medical management guidelines (as below) have been developed that incorporate this new information and will assist physicians in providing care while working within existing regulations.

Guidelines for treating adult lead poisoning
The Association of Occupational and Environmental Clinics provides guidelines on how to treat adult lead poisoning in a document entitled Medical Management Guidelines for Lead-Exposed Adults. See topic heading Adult Lead Treatment under Principles & Guidance.

For more information on medical management of elevated adult blood lead see: Recommendations for Medical Management of Adult Lead Exposure, Kosnett, et al. March 2007 Environmental Health Perspectives 115:463-471

Resources for Workers, Employers and the Public; see Publications