LEAD_POISONINGd铅的污染、危害及其控制.ppt

1、LEAD POISONING: PREVENTION,IDENTIFICATION, AND MANAGEMENT,Educational Objectives,Educate parents annually on how to prevent lead exposure. Test all children at ages 1 and 2, and other children at risk of lead exposure. Assess children up to 6 years of age annually for risk of lead exposure.,Lead Poi

2、soning,Lead poisoning remains a significant health problem in New York City In young children, exposure to lead can result in long-lasting neurological damage, including learning and behavioral problems and lowered intelligence. Health effects of lead poisoning may persist long after a childs blood

3、lead level (BLL) has declined and may go undetected until the child enters school.,Most children with lead poisoning show no clinical symptoms. Blood lead tests are routinely required for diagnosis. New York State law requires blood lead testing for every child at both 1 and 2 years of age and for o

4、ther children found to be at risk. In 2007 only 79% of 1-year-olds and 66% of 2-year-olds in NYC were tested, and only 44% of children had been tested at both ages.,Lead Poisoning,Fetal exposure to lead may also adversely affect neurodevelopment. A pregnant woman with an elevated BLL can pass the le

5、ad to her developing fetus; children born with elevated BLLs may suffer cognitive and developmental problems as a result of prenatal exposure.,Lead Poisoning,Recent research shows that adverse health effects may occur at BLLs10g/dL and that more children may be affected than previously recognized He

6、alth care providers can help by educating families on ways to prevent lead exposure, and by identifying lead poisoning early through blood lead testing.,Lead Poisoning,NEWLY REPORTED BLOOD LEAD LEVELS 5g/dL AMONG CHILDREN ANDWOMEN OF REPRODUCTIVE AGE IN NYC,What is lead?,Lead (Pb) is a heavy, soft,

7、bluish metal, and occurs in nature in the form of ores. Once Pb is mined, processed, and introduced into the environment, it is a potential problem forever. There is no technology that will destroy lead or render it permanently harmless. Nearly all of the Pb in the environment is due to mans activit

8、ies.,What is lead poisoning?,Research tells us: Lead is a highly toxic substance that is harmful when it enters the body. There are no safe levels of lead in the body. Lead poisoning is preventable. Lead poisoning is not contagious. 2.2 % of American children age 1-5 years have lead level measuring

9、at least 10g/dL (CDC).,CDC Blood Lead Levels,Lead carbonate 2PbCO3Pb(OH)2 Paint pigment (basic white lead) and additive,Lead Compounds,Lead oxide Pb3O4 Used as a pigment (red lead) in inks and dyes, and as primer for rust protection on metal.,Lead Compounds,Lead oxide in wrapper contaminating candy

10、from Mexico,Lead chromate PbCrO4 Used as a pigment in inks and dyes, and as an artist paint pigment (chrome yellow),Lead Compounds,Tetraethyl lead Pb(C2H5)4 Antiknock additive to gasoline.,Lead Compounds,Though lead was completely phased out of gasoline by 1995 in the U.S., lead particles emitted in

11、 engine exhaust still persist in some soil near major roadways.,Lead Compounds,Lead arsenate Pb3(AsO4)2 Insecticide,Lead azide Pb(N3)2 Cartridge primers, primer cord for explosives Lead azide is a rare source of lead contamination, as most people in the general public will not be working with explos

12、ive devises.,Lead Compounds,Lead silicate PbSiO3 Glazes for china, porcelain, tiles,The Roman techniques of glazing were most likely discovered sometime in the first century B.C. However, it is important to note that lead glazing holds a long history in the ancient world which spans far before Roman

13、 times. After the Roman period, the tradition spread and eventually the process became a practice for mass produced ceramics.,Lead Compounds,Lead sulfide PbS Most abundant lead ore.,Lead Compounds,Lead sulfide is the most abundant lead ore. The Gingival “lead line” pictured, also known as the “Burto

14、n line,” represents precipitation of lead sulfide along the gum line and is associated with lead toxicity and poor oral hygiene.,Lead History,6200 BC. - Lead discovered in Turkey, first mine. 500 BC-300 AD.- Roman lead smelting produces dangerous emissions. 100 BC. - Greek physicians give clinical d

15、escription of lead poisoning. Lead makes the mind give way. 1904 - Child lead poisoning linked to lead-based paints. 1922 - League of Nations bans white-lead interior paint; U.S. declines to adopt 1923 - Leaded gasoline goes on sale in selected markets 1971- U.S. Lead-Based Paint Poisoning Preventio

16、n Act passed 1986 - Primary phase out of leaded gas in US completed,Where might lead be found?,Paint (before 1978) In soil around homes Gasoline (phase-out 1973) Household dust Drinking water Workplaces Old painted toys and furniture,Food and liquids stored in lead crystal or lead-glazed pottery or

17、porcelain Industries that release lead into the air Hobbies that use lead Folk remedies that contain lead,Possible Sources of Lead In Your Home,Lead Paint,Dusting, flaking and peeling lead paint is the leading source of lead poisoning in children. Lead was used in many paints until it was banned for

18、 household use in 1978. Homes built before 1978 may contain lead paint. Lead paint can also be found on old playground equipment and on old painted toys and furniture. You cannot tell just from looking whether or not paint contains lead.,Lead Paint,Children ages 1-3 are especially susceptible to lea

19、d exposure; they spend considerable time crawling on, touching, or mouthing dust covered surfaces like their hands, their toys, and windowsills. Young children will also readily eat visible chips of flaking paint. The Consumer Product Safety Commission (CPSC) has determined that daily ingestion over

20、 about 15-30 days of as little as one-tenth of a square inch of paint (about the size of the head of a pencil eraser) could result in blood lead levels at or above 10 ug/dl.,A child presented to the emergency department with colicky abdominal pain. The x-ray below was obtained; the child had numerou

21、s paint chips in the area of the rectum. A blood lead level was 47 g/ml.,Lead Paint,Vinyl Mini-blinds,Vinyl mini-blinds were recalled and banned from US shelves in 1997, but prior to 1997 millions of these blinds were imported from China, Taiwan, Mexico, and Indonesia, and are likely still in many U

22、S homes.,Soil,Though lead was completely phased out of gasoline by 1995, lead particles emitted in engine exhaust still persist in some soil near major roadways. Also deteriorating exterior lead paint may contaminate the soil around old homes. Children who play in bare soil risk exposure to lead, an

23、d family members may track contaminated soil into the home on their shoes.,Lead in Water,Lead water pipes and lead-soldered plumbing used to be widespread. Lead pipes were used for transporting water in ancient Rome, and have been cited as a contributing factor to the downfall of that civilization.

24、The Environmental Protection Agency (EPA) banned the use of lead water pipes in 1988. Public systems that transport water from a main source to a building have had lead pipes replaced. However, many older buildings and homes still have lead pipe or lead-soldered internal plumbing.,Lead can leach int

25、o the water from lead pipes, especially if it sits in these pipes for more than 8 hours. Hot and/or acidic water leaches lead from pipes at a faster rate. The EPA considers water with a lead content of 15 ppb (parts per billion) to be safe. The lead level allowed for bottled water is 5 ppb. Water fr

26、om public sources is routinely tested. The EPA rules do not apply to privately owned wells. Most states have their own rules about testing well water.,Lead in Water,Lead in Imported Candy,Packaging Lead may be in wrappers printed with lead- containing ink Candy may come in small, glazed pots. A glaz

27、e called Greta contains lead that leaches into candy Ingredients Lead from dirt may be on chilies not cleaned before they are milled Tamarind is sticky, and lead from pesticides, fertilizers, or dirt can attach to it,Lead in Low-cost Metal Jewelry,Jewelry made with metal may have lead A study found

28、that 4 out of 10 pieces of low-cost jewelry have dangerous levels of lead,Lead-glazed Pottery,Pottery made outside of the US may contain lead Foods or drinks cooked or stored in lead-glazed pottery can poison the family The bean pots found in many Hispanic homes sometimes have high levels of lead,Le

29、ad in Herbal Medicines,Some herbal medicines have dangerous levels of lead The US government does not test herbal medicines to see if they are safe or if they work (Dietary Supplement Health and Education Act of 1994 (DSHEA) A study about herbal medicines from Asia found that nearly 1 out of 5 herba

30、l medicines had high levels of lead and other dangerous metals,Profile of NYC Lead-Poisoned Children,Lead poisoning can affect children of all ages, races, and income groups, but certain populations are at greater risk. These groups include children less than 3 years of age, low-income children livi

31、ng in older, deteriorated housing, and children of color. In addition, children born outside the United States (US) are among lead-poisoned children in NYC.,In 2007, of the children newly identified with venous BLLs 15g/dL: 87% were black, Asian, or Hispanic 82% lived in homes built before 1950 76%

32、had lead-based paint hazards found on inspection of their addresses 60% were less than 3 years old 17% were foreign-born,Profile of NYC Lead-Poisoned Children,Lead Prevention,Annually educate parents of children 6 months to 6 years of age by providing anticipatory guidance as required by NYS law Hel

33、ping parents minimize their childrens exposure to lead is the best way to prevent the developmental and cognitive deficits associated with lead poisoning.,Provide parents with the following educational messages: Keep your child away from peeling paint and home repairs that disturb lead paint Report

34、peeling paint to your landlord. If your landlord does not make repairs, call 311 Frequently wash hands, toys, pacifiers, bottles, and other items your child puts in his or her mouth,Educational Messages For Parents,Clean floors, windowsills, and dusty places often with wet mops and wet cloths; Avoid

35、 using health remedies and eye cosmetics (such as kohl, kajal, surma) from other countries. Use caution when using candies, spices, snack foods, and childrens toys and jewelry made in other countries. Use only cold tap water for making baby formula, drinking, and cooking. Let the water run for a few

36、 minutes before use;,Educational Messages For Parentscontinued,Keep your child away from the work clothes and tools of household members who do construction work or other work and hobbies that may expose them to lead. Wash work clothes separately from other laundry. Remove shoes and work clothes bef

37、ore entering your home; Use safe work methods when doing home repair that disturbs paint. For information on lead-safe work methods, call 311.,Educational Messages For Parentscontinued,Lead Prevention,Test all children at ages 1 and 2, and test other children found to be at risk. Annually assess chi

38、ldren from 6 months to 6 years of age for lead exposure risk. Children between 9 months and 36 months of age are at risk of lead exposure due to normal hand-to-mouth toddler behavior. Rapid growth and development at these ages also makes them more vulnerable to leads toxic effects. Household lead ex

39、posure, in either the childs home or homes they regularly visit, remains a concern. Although lead-based paint for residential use in NYC was banned in 1960, about 67% of NYC housing was built before 1960.,RECOMMENDED LEAD RISKASSESSMENT QUESTIONS FOR PARENTS,1. Is your child between 9 and 36 months

40、of age? 2. Have any of your children or their playmates ever had a high blood lead level? 3. Does your child live in, or regularly visit, an older home or other place with peeling or damaged paint? 4. Does your child live in, or regularly visit, an older home or other place that is being or was reno

41、vated within the last 12 months?,RECOMMENDED LEAD RISKASSESSMENT QUESTIONS FOR PARENTS,5. Does your child have any developmental delays, have hand-to-mouth behavior, or put non-food items, such as paint chips or soil, in their mouth? 6. Has your child moved to the US from or traveled to a foreign co

42、untry where lead poisoning may be common? 7. Does your family use products from other countries such as health remedies, spices, food, or pottery? 8. Does your child play near a heavily traveled highway, bridge, or elevated train where there is peeling paint?,9. Does your child come into contact wit

43、h an adult whose job or hobby involves exposure to lead (e.g., bridge painting and repair, building demolition, home renovation and repair, automotive and electronics repair, furniture refinishing, working with firearms, and arts/crafts work involving ceramics, metals, and color pigments)? 10. Is yo

44、ur child enrolled in or planning to enroll in Medicaid or the NYC Early Intervention Program?,RECOMMENDED LEAD RISKASSESSMENT QUESTIONS FOR PARENTS,VENOUS VS FINGERSTICK BLOOD LEADSPECIMENS,Venous specimens are more accurate than fingerstick specimens. Environmental contamination of fingerstick spec

45、imens can result in false positives, and finger squeezing can dilute blood and result in false negatives. All fingerstick blood lead results 10g/dL must be confirmed with venous specimens within the time frames specified.,FOLLOW-UP BLOOD LEAD TESTSCHEDULES FOR CHILDREN,FOLLOW-UP BLOOD LEAD TESTSCHED

46、ULES FOR CHILDREN,RECOMMENDED MANAGEMENT,BLL (g/dL) Recommended Action 59 Recognize that a BLL of 59g/dL may indicate lead exposure. Provide educational messages Evaluate for adequate intake of calcium, iron, and vitamin C If initial positive test is a fingerstick specimen, confirm with a venous spe

47、cimen within time frame specified. Monitor BLLs by retesting as per follow-up schedule,RECOMMENDED MANAGEMENT,1014 All actions for BLLs of 5-9g/dL, plus: Patients complete name, date of birth, complete address (including apartment number), and phone number. -Health care provider name and phone numbe

48、r. -Type of sample (venous or fingerstick) and date of collection. DOHMH will send educational information to the family and health care provider.,1544 All actions for BLLs 5-14g/dL, plus: Provide a complete medical evaluation including a detailed environmental history, thorough developmental and nu

49、tritional assessment, and physical exam. Evaluate for iron deficiency anemia, often associated with lead poisoning. Consider abdominal x-ray if paint chip or other lead solid ingestion suspected; if radio-opaque particles found or recent ingestion witnessed, use cathartic. Consider monitoring erythr

50、ocyte protoporphyrin levels (EP) for BLL 25g/dL to help assess timing of exposure.,RECOMMENDED MANAGEMENT,1544 All actions for BLLs 5-14g/dL, plus: Monitor development even after BLLs decrease. Consider this child at higher risk for developmental delays and behavior problems. DOHMH will: - Inspect t

51、he childs home to identify potential lead sources. - Order the landlord to repair any lead paint hazards identified. - Refer families to temporary, lead-safe housing as necessary. - Refer children 36 months of age to DOHMH Early Intervention Program.,RECOMMENDED MANAGEMENT,45 All actions for BLLs 5-

52、44g/dL, plus: Arrange hospitalization and chelation therapy at a facility with expertise in treating lead-poisoned children Perform complete neurological exam. Confirm BLL with venous specimen processed as emergency test before providing chelation therapy, unless symptoms of encephalopathy are prese

53、nt. Obtain abdominal x-ray to look for paint chip or other lead solid ingestion; if radio-opaque particles found or recent ingestion witnessed, use cathartic. Child must receive chelation therapy in, and be discharged to, a lead-safe environment. Do not discharge until DOHMH inspects the home.,RECOMMENDED MANAGEMENT,45 All actions for BLLs 5-44g/dL, plus: Inform NYC DOHMH of hospital admission b