A Risk Assessment - Lead

Poisoning
Deion Cardwell, Hyett Farah, Jenn McCaffrey, Meredith
Wills
Introduction

What is Lead?

● Naturally occuring metal

● Highly dense, easily malleable
● Cumulative toxicant that affects multiple body systems
● Children are more vulnerable
● Preventable
 Hazard identification
Lead Toxicity

● Lead - a highly dense organic metal

● Human Health Risks

○ Central Nervous System
○ Musculoskeletal System
○ Circulatory System
○ Endocrine System
○ Reproductive System

Source: (ACS, 2018), (Kathuria, 2017)

 Hazard identification
Agents potential for negative health impacts

● Adults: can cause problems with fertility, memory, concentration, joints, nerve
disorders, and increased blood pressure.
● Children: Kids under the age of 7 are at a higher risk of harm due to the fact
that their brains and nervous system is still maturing.
○ Exposure to lead can cause learning difficulties, behavioral disorders,
ADHD, and developmental delays.

Sources: (ACS, 2018)

Hazard identification
Evaluation of Likelihood Adverse Effects

● 1 million children have BLLs above 5µg/dL

● Affects biological pathways physical, emotional, and behavioral health.

● Mimics calcium and damages neurotransmitter systems

○ Increase in emotional response, distractibility, and hyperactive behavior
○ Linked to non-communicable diseases (child obesity and asthma)
○ Increased risk of childhood depression and anxiety

Sources: (WHO, 2018), (Wolpaw, 2015)

Hazard identification
Lead activity in living organisms

Humans:
○ Lead enters the body and is absorbed, distributed, and excreted.
○ Lead is distributed into three places
● Blood
● Soft tissue zones: brain, liver, kidneys, bone marrow
● Mineralizing tissues: bones, teeth
○ Body collects lead and releases it slowly: Even small doses of lead overtime can be toxic
○ The total body accumulation of lead is what leads to adverse effects.

Source: (ACS, 2018)

Hazard Identification
Possible Human Exposure

● The EPA lists lead as a hazardous inorganic waste

● Boiling point: 3180°F
● Melting point: 621.4°F
● Volatility: highly volatile in high temperatures
● Solubility: Lead compound in pure water is 17 mg, while in blood serum it
amounts to 1150 mg
● Resistance to corrosion: Use in plumbing pipes

Sources: (Health NY, 2009), (Needleman, 1981), (RSC, 2018), (CDC, 2016), (Fairhall, 1924), (Jaroslawiecka, 2014),
(Lenntech, 2018)
Dose-Response Assessment
For children

● BLLs at 10 µg/dL cause learning difficulties

● Complications associated with high BLLs:
○ Abdominal pain
○ Seizures
○ Neurodevelopmental problems
○ Behavior disorders
○ Delays in development
○ Anemia

Source: (Stark, 2013), (Winter, 2017)

Dose-Response Assessment
For adults

● The safe BLLs for U.S. adults = 10 µg/dL

● Elevated exposure for adults would be:

○ 10-25 µg/dL: Build up of lead in the body is occuring
○ 25-40 µg/dL: Regular elevated lead exposure; start of negative
symptoms
○ 40-80 µg/dL: Seriously elevated BLLs; serious health damage
○ 80 µg/dL and above: Permanent health damage will occur
Dose-Response Assessment
Exposure vs. Risk

● Mild toxicity - paresthesia, fatigue, muscle pain, and abdominal pain

● Moderate toxicity- joint pain, abdominal pain, vomiting, concentration
difficulty, weight loss, headache, fatigue, and tremor
● Severe toxicity- muscular weakness, nerve damage, paralysis, seizures,
brain damage, hearing loss, severe abdominal problems, coma, and death

Source: (Stark, 2013)

Dose-Response Assessment
Epidemiologic Study - Prospective Cohort Study

● A study looked at children in Detroit Public Schools who had exposure to lead
at an early age
○ Poor academic achievement
○ Strong influence on a child’s development and performance in school
○ Negative health impacts even in small doses

Source: (Zhang, 2013)

Sources: (Zhang, 2013)
Exposure Assessment
Amount within the environment
● Half-life
○ Lead can stay in the body for long period of time
○ Half of lead will be excreted in 25 days
● Storage of lead
○ Soft tissues,bones, and teeth
● 4 million households
● Occupational lead & Environmental lead
● High-risk states: California, Michigan, Illinois, Ohio, Pennsylvania

Source: (Assi et al., 2016), (Alvarez, 2001), (CDC, 2017)

Agent’s Properties
Possible routes of exposure

● Lead is a natural occurring element found in Group 14 of the periodic table

○ It is not an abundant element, however the deposits of ore are generally used around the
world.
○ The element exists in 3 states:
■ Pb (0), the metal
■ Pb (II)
■ Pb (IV)
● The major routes of exposure is linked to:
○ Food, dust, and water
○ 30-50% of lead travels through the lungs
○ Digestive system

Sources: (Abadin et al., 2007), (Needleman, 1981), (Alvarez, 2001)

Discrepancies: Amount of substances measured
Measurements Assessed
Retrospective study: Elevated Blood Lead Level

○ compiled data on children younger than the age of 5

○ Sample size consisted of 1473 children residing in the city of Flint (Genesee County)

Results

○ Before outbreak:
■ 2.4% of children had elevated blood levels
○ Post outbreak:
■ 4.9% of children had high amounts of lead found in their bloodstream

Source: (Hanna-Attisha et al.,2016)

Table

(Hanna-Attisha et al.,2016)
 Exposure Assessment: Flint, Michigan
Level of Exposure

● Lead poisoning outbreak

○ 99,000 residents were exposed to contaminated tap water
○ Water sources from the Detroit Water Authority was switched over to the Flint’s Water system
● Lack of Corrosion Controls
● Before the outbreak:
○ The 90th percentile lead level recorded at the end of sampling was 6 ug/L, which was below the
action level of 15 ug/L
○ Inspection of community water suppliers

Source: (Kennedy et al., 2016), (Butler & Scammell, 2016)

Groups with Exposure Risk
Special attention

● Pregnant women
○ The inhalation of polluted air and wearing contaminated clothing can cause adverse effects on
fetal development.
● Children
○ Paint poisoning is the leading cause for children under the age of 5.
○ Inhalation of airborne metallic matter
○ Old houses containing paint chips
● Industrial workers
○ Majority of lead absorption is found in industrial settings

Source: (Landrigan,1982),(Hipkins,1998)
Type of Exposure
Occupational exposure:

● High dose
○ Manufacturing companies handling batteries,glass, and brass etc.
● Low dose
○ Airborne lead is categorized as small source of exposure
○ Car industries are responsible for releasing chemical particles in the air

Community exposure:

● Canned foods
● Lead fumes
● Cigarette smoke - consists of cadmium
Source: (Landrigan,1982)
Chemical Properties
Characteristics

● When lead is exposed to water and air:

○ Particles of lead sulfate, lead oxides , and lead carbonates are created.
○ Films of the three lead sources functions as a protective wall to prevent corrosion of a metal.

● Lead is amphoteric can react as a base & an acid

○ Can form plumbous and plumbic salts in acid
○ Form as plumbites and plumbates in alkali

Source: (Abadin et al.,2007)

Cumulative Effects
Chronic effects:

● Exposure can damage many organ systems within the human body
○ Nervous system
○ Immune system
○ Kidney,liver, and stomach
● Exposed adults:
○ Peripheral nerves are severely impaired and causes muscular degeneration.
● Exposed children:
○ Central nervous system damage are commonly found for at-risk children.
○ More likely to engage in violent and risky behavior.
○ Low IQ and disabilities

Sources: (Assi et al., 2016), (Wolpaw Reyes, 2015)

Agent’s ability to travel

● Resistant to corrosion, high malleability, and low-melting point

● Lead-based plumbing:
○ Ability to travel through the plumbing system
● Lead in gasoline:
○ Particles travel through air - humans can ingest directly
○ In highly populated areas, it can be found in soil and dirt

Sources: (Wolpaw Reyes, 2015),(Hanna-Attisha et al., 2016),(Lee et al.,2016)

 Risk Characterization
Severity, Likelihood, and Consequences

According to WHO:

● 0.6% of the global burden of disease

● 143,000 deaths per year
● 99% of children affected live in in low and middle-income countries
● 9 million DALYs (disability-adjusted life years)
● Shortens life expectancy by 10-20 years

Sources: (WHO, 2013), (CDC, 2017)

 Risk Characterization
Severity, Likelihood, and Consequences

According to the CDC:

● Contributes to 600,000 new cases of children disabilities per year

● 4 million households contain high levels of lead in the U.S.
● Approx. half a million U.S. children ages 1-5 have BLLs above 5 µg/dL
● Fraction of absorption is 40% in children (10% in adults)
● Affects nearly every system of the body with no obvious systems
● Causes damage to brain & nervous system, slowed growth & development,
learning & behavior problems, and hearing & speech problems

Sources: (WHO, 2013), (CDC, 2017)

 Risk Management
Risk Factors

● Educational Factors: Lack of education

● Cultural Factors: African Americans and Hispanics have a higher rate of lead
poisoning

● Socioeconomic Factor:
○ Low-income families are more likely to reside near industrial plants
○ Low-income children may have low calcium/iron diet

Sources: (Zhang, 2013), (Iriani, 2012)

Risk Management
Political Pressures

● 1978 - Limited the amount of lead in paint to 0.06%

● 1986 - Safe Drinking Water Act
● 1990 - Removal of lead from gasoline
● 1991 - Preventing Lead Poisoning in Young Children strategy
● 2008 - Consumer Product Safety Improvement Act limits lead in children’s
products to less than 90 parts per million
● U.S. Dept. of Housing and Urban Development (HUD) - guidelines for lead
inspections
● EPA’s Lead Based Paint Disclosure Regulation Law

Sources: (Alvarez, 2001), (Bliss, 2016),

Risk Management
Best Course of Action

● Lead inspection on home

● Removing lead sources from home
● Wash hands and toys regularly
● Prevent children from placing wood or painted furnishings into mouth
● Potential bioremediation w/ microorganisms to removal lead from soil
● Adding alkaline compost to soil when gardening
● Chelation treatment

Source: (CDC, 2018), (Floridahealth.gov, 2018), (Darwish, 2018)

Risk Communication
Factsheet to be distributed to low-income urban neighborhoods and public &
private schools of high-risk cities: California, Michigan, Illinois, Ohio,
Pennsylvania.

● Identifying Lead as a hazard

● Illustrating potential health risks for children
● Illustrating potential secondary risks - correlation to poor grades
● Renovation, Repair and Painting Program
● National Lead Information Center (NLIC)
● Safe Drinking Water Hotline https://www.epa.gov/ground-water-and-drinking-water/safe-drinking-water-hotline
● Local contact information for support
Sources: (Health NY, 2009), (Li, 2018), (EPA, 2017)
Risk Communication
Plan for Delivery

● Survey on Perception of Lead as a Health Hazard to teachers and parents

distributed on first day of school year

● Distribute factsheet one month later

● Redistribute another factsheet six months later

Sources: (Health NY, 2009), (Li, 2018), (EPA, 2017)

References
Abadin H, Ashizawa A, Stevens YW, et al. Toxicological Profile for Lead. Atlanta (GA): Agency for Toxic Substances and
Disease Registry (US); 2007 Aug. 4, CHEMICAL AND PHYSICAL INFORMATION. Available from
https://www.ncbi.nlm.nih.gov/books/NBK158769/

Assi, M. A., Mohd Hezmee, M. N.,Haron, A. W., Mohd Sabri, M. Y., & Rajion, M. A. (2016). The detrimental effects of lead on
human and animal health. Veterinary World, 9(6), 660-671. doi:10.14202/vetworld.2016.660-671

Alvarez, M. (2001, May 26). The Health Hazards of Lead. Retrieved April 11, 2018, from
http://www.osh.net/articles/archive/osh_basics_2001_may26.htm

Bliss, L. (2016, February 9). The Long, Ugly History of the Politics of Lead Poisoning. Retrieved April 11, 2018, from
https://www.citylab.com/equity/2016/02/the-long-ugly-history-of-the-politics-of-lead-poisoning/461871/Bliss,
L. (2016, February 9).

Butler, Lindsey & Scammell, Madeleine & B. Benson, Eugene. (2016). The Flint, Michigan Water Crisis: A Case Study in
Regulatory Failure and Environmental Injustice. Environmental Justice. 9. 10.1089/env.2016.0014.

CDC.gov. (2018). CDC - Lead - Prevention Tips. [online] Available at: https://www.cdc.gov/nceh/lead/tips.htm [Accessed 12
Apr. 2018].
 References
CDC’s State Surveillance Data. (2016, July 19). Retrieved March 28, 2018, from https://www.cdc.gov/nceh/lead/data/state.htm

Darwish, L. (n.d.). Lead Remediation. Retrieved April 8, 2018, from http://earthrepair.ca/resources/scenarios/lead-remediation/

Fairhall, L. (1924). Lead Studies. The Solubility of Various Lead Compounds in Blood Serum. The Journal of Biological
Chemistry. Retrieved March 28, 2018, from http://www.jbc.org/content/60/3/481.full.pdf

Floridahealth.gov. (2018). About the Lead Poisoning Prevention Program | Florida Department of Health. [online] Available at:
http://www.floridahealth.gov/environmental-health/lead-poisoning/index.html [Accessed 10 Apr. 2018].

Gupta, S. (Producer). (2016, January 21). The effects of Flint's lead poisoning disaster[Video file]. Retrieved February 12,
2018, from https://www.youtube.com/watch?v=hqnaq2Vn-CA

Hanna-Attisha, M., LaChance, J., Sadler, R. C., & Champney Schnepp, A. (2016). Elevated Blood Lead Levels in Children
Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response.
American Journal of Public Health, 106(2), 283–290. http://doi.org/10.2105/AJPH.2015.303003
References
Hipkins KL, Materna BL, Kosnett MJ, Rogge JW, Cone JE. Medical Surveillance of the Lead Exposed Worker. AAOHN
Journal 46(7): 330-339, 1998. ( exposure assessment) Retrieved April 10,2018
,https://www.ncbi.nlm.nih.gov/pubmed/9748913

Iriani, D. U., Matsukawa, T., Tadjudin, M. K., Itoh, H., & Yokoyama, K. (2012). Cross-sectional Study on the Effects of
Socioeconomic Factors on Lead Exposure in Children by Gender in Serpong, Indonesia . International Journal of
Environmental Research and Public Health, 9(11), 4135–4149. http://doi.org/10.3390/ijerph9114135

Jarosławiecka, A. (2014, January 01). Lead resistance in micro-organisms. Retrieved March 28, 2018, from
http://mic.microbiologyresearch.org/content/journal/micro/10.1099/mic.0.070284-0;jsessionid=BYuCpt4SjT5stTC
m2In3Qvni.x-sgm-live-02#tab2

Kathuria, P. (2017, January 31). Lead Toxicity. Retrieved March 5, 2018, from
https://emedicine.medscape.com/article/1174752-overview
References
Kennedy, C., Yard, E., Dignam, T., Buchanan, S., Condon, S., Brown, M., Raymond, J., Rogers, H., Sarisky, J., de
Castro, R., Arias, I. and Breysse, P. (2016). Blood Lead Levels Among Children Aged <6 Years — Flint, Michigan,
2013–2016.https://www.cdc.gov/mmwr/volumes/65/wr/mm6525e1.htm

Landrigan, P. J. (1982). Occupational and Community Exposures to Toxic Metals: Lead, Cadmium, Mercury and Arsenic.
Western Journal of Medicine, 137(6), 531–539.

Lead Exposure in Adults - A Guide for Health Care Providers. (2009, March). Retrieved February 26, 2018, from
https://www.health.ny.gov/publications/2584/

Lead Hotline - The National Lead Information Center. (2017). Retrieved April 05, 2018, from
https://www.epa.gov/lead/forms/lead-hotline-national-lead-information-center

Lee, C. M., Terrizzi, A. R., Bozzini, C., Piñeiro, A. E., Conti, M. I., & Martínez, M. P. (2016). Chronic lead poisoning
magnifies bone detrimental effects in an ovariectomized rat model of postmenopausal osteoporosis. Experimental
and Toxicologic Pathology, 6847-53. doi:10.1016/j.etp.2015.09.007 (exposure assessment)
References

Lenntech.com. (2018). Metals occurring in aquatic freshwater. [online] Available at:

https://www.lenntech.com/aquatic/metals.htm [Accessed 10 Apr. 2018].

Li, C., Ni, Z., Ye, L., Chen, J., Wang, Q., & Zhou, Y. (2018). Dose-response relationship between blood lead levels and
hematological parameters in children from central China. Environmental Research, 164501-506.
doi:10.1016/j.envres.2018.03.018

Needleman HL, Landrigan PJ: The health effects of low level exposure to lead. Annu Rev Publ Health 1981; 2:277-298
Periodic Table- Lead. (n.d.). Retrieved March 10, 2018, from http://www.rsc.org/periodic-table/element/82/lead
Pubs.acs.org. (2018). A Chemistry on the Volatility of Some Trace Elements during Coal Combustion and
Pyrolysis.[online] Available at: https://pubs.acs.org/doi/pdf/10.1021/ef020251o [Accessed 10 Apr. 2018].
References
Stark, S. (2013). Lead Poisoning. Magill’s Medical Guide. Retrieved March 29, 2018, from
http://eds.b.ebscohost.com.dax.lib.unf.edu/eds/detail/detail?vid=3&sid=abb3c523-376d-425e-ac0f-fb0b058eeafe@se
ssionmgr120&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ==#AN=89093463&db=ers

WHO: 143,000 deaths per year from lead poisoning. (2013, October 18). Retrieved February 28, 2018, from
https://www.upi.com/WHO-143000-deaths-per-year-from-lead-poisoning/11551382150700/

Who.int. (2018). [online] Available at: http://www.who.int/ceh/publications/leadguidance.pdf [Accessed 10 Apr. 2018].

Winter, A. S. (2017). From Lead Exposure in Early Childhood to Adolescent Health: A Chicago Birth Cohort. American
Journal of Public Health,107(9), 1496-1501. http://dx.doi.org.dax.lib.unf.edu/10.2105/AJPH.2017.303903

Wolpaw Reyes, J. (2015). Lead Exposure and Behavior: Effects on Antisocial and Risky Behavior among Children and
Adolescents. Economic Inquiry, 53(3), 1580-1605.

Zhang, N. (2013). Early Childhood Lead Exposure and Academic Achievement: Evidence From Detroit Public Schools,
2008-2010. American Journal of Public Health, 103(3), 72-77. doi:10.2105/AJPH.2012.301164