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Lead(Pb)Toxicity:WhatAretheU.S.StandardsforLeadLevels?|ATSDREnvironmentalMedicine&EnvironmentalHealthEducationCSEM

EnvironmentalHealthandMedicineEducation
LeadToxicity
WhatAretheU.S.StandardsforLeadLevels?
Course:WB1105
CEOriginalDate:August20,2007
CERenewalDate:August20,2010
CEExpirationDate:August20,2012
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Addendum

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Fivemicrogramsperdeciliter(5g/dL)wasadoptedbyCDCin2012as
theupperreferencerangevalueforBLLsinchildrenasanadvisory
levelforenvironmentalandeducationalintervention[ACCLPP2012].
In2015,NIOSHdesignated5g/dLofwholeblood,inavenousblood
sample,asthereferencebloodleadlevelforadults.AnelevatedBLLis
definedasaBLL5g/dL.ThiscasedefinitionisusedbytheCDC's
AdultBloodLeadEpidemiologyandSurveillanceprogram(ABLES
trackselevatedBLLsamongadultsintheUnitedStates),theCouncilof
StateandTerritorialEpidemiologists(CSTE),andCDC'sNational
NotifiableDiseasesSurveillanceSystem(NNDSS).Previously(i.e.from
2009untilNovember2015),thecasedefinitionforanelevatedBLLwas
aBLL10g/dL.TheU.S.DepartmentofHealthandHumanServices
recommendsthatBLLsamongalladultsbereducedto<10g/dL.
IncontrasttotheCDCreferencelevel,prevailingOccupationalSafety
andHealthAdministration(OSHA)leadstandardsallowworkers
removedfromleadexposuretoreturntoleadworkwhentheirBLLfalls
below40g/dL.However,NIOSH"(theresearcharmofOSHA)"
recommendsthatthemostcurrentguidelinesformanagementoflead
exposedadultsbeimplementedbythemedicalcommunityatthe
currentCDC/NIOSHreferenceBLLof5g/dL.
http://www.cdc.gov/niosh/topics/ables/description.html

Learning
Objectives

Uponcompletionofthissection,youwillbeableto

Introduction

Becauseoflead'simportanceasacauseofpublichealthproblems,a
numberoffederalagencieshaveissuedadvisorystandardsor
enforceableregulationsthatsetleadlevelsindifferentmedia.Thetable
belowsummarizesthesestandardsandregulationsfor2006see
subsequentsectionsforfurtherexplanation.

identifytheCDC'slevelofconcernforleadinchildren'sblood
identifytheOSHAbloodleadlevelforfirstinterventionfrom
occupationalexposuretolead
describethetypesofenvironmentalstandardsintheU.S.

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Biologic
Guidelines

Asnewinformationhasemergedabouttheneurological,reproductive,
andpossiblehypertensivetoxicityoflead,andasparametersthatare
moresensitivearedeveloped,theBLLsofconcernforleadexposure
havebeenprogressivelyloweredbyCDC.(SeeFigure1below).

Figure1.LoweringofCDCrecommendedactionlevelforbloodleadin
childrenovertime.
Teng/dL(micrograms/deciliter)wasadoptedbyCDCin1991asan
actionlevelforchildren,anadvisorylevelforenvironmentaland
educationalintervention.
CDCcasemanagementguidelinesaredesignedtokeepchildren'sBLLs
below10g/dL(CDC,2002).
TherearealsorequirementsthatchildrenreceivingMedicaidbe
screened.
StudieshavefoundneurobehavioralimpairmentinchildrenwithBLLs
below10g/dL.(Canfield,2003Lanphearetal.2000)
Nobloodleadthresholdhasbeenidentifiedinchildren.
TheBiologicalExposureIndex(BEI)isaguidancevalueforassessing
biologicalmonitoringresults.
TheBEIforbloodleadis30g/dL.(ACGIH2005)
TheBEIindicatesexposureattheThresholdLimitValue(TLV)(See
"WorkplaceAir"below).

Physician
Reporting
Requirements

Moststatesaskorrequireprimarycarephysiciansandpersonsin
chargeofscreeningprogramstoreportbothpresumptiveand
confirmedcasesofleadtoxicitytotheappropriatehealthagency.Thisis
toensure
abatementoftheleadsource
educationofthepatient
remediationstepsareundertaken
Insomestates,theclinicallaboratoriesperformingbloodleadtesting
arerequiredtoreportcasesofleadtoxicity.
Evenifnotrequired,aphysicianshouldstronglyconsiderconsultinga
healthagencyinthecaseofleadtoxicity,ashealthagenciesare
importantsourcesofresourcesandinformation.
Insomestates,laboratoriesperformingBLLorEP(ZPP)testsarealso
requiredtoreportabnormalresultstotheappropriatehealthagency.

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Workplace
Air

TheOSHALeadStandard specifiesthepermissibleexposurelimit
(PEL)ofleadintheworkplace,thefrequencyandextentofmedical
monitoring,andotherresponsibilitiesoftheemployer.
OSHAhassetaPEL(enforceable)ofleadinworkplaceairat50g/m3
averagedoveran8hourworkdayforworkersingeneralindustry.
Forthoseexposedtoairconcentrationsatorabovetheactionlevelof
30g/m3formorethan30daysperyear,OSHAmandatesperiodic
determinationofBLLs.
IfaBLLisfoundtobegreaterthan40g/dL,theworkermustbe
notifiedinwritingandprovidedwithamedicalexamination.
Ifaworker'sonetimeBLLreaches60g/dL(oraverages50g/dLor
moreonthreeormoretests),theemployerisobligatedtoremovethe
employeefromexcessiveexposure,withmaintenanceofseniorityand
pay,untiltheemployee'sBLLfallsbelow40g/dL.
Acopyoftheleadstandardcanbeobtainedbycallingyourregional
officeofOSHAorfromtheCFRwebsite
(www.gpoaccess.gov/cfr/index.html ).
NIOSHatCDChassetaRecommendedExposureLimit(REL)of50
g/m3tobemaintainedsothatworkerbloodleadremains<60g/dL
ofwholeblood.http://www.cdc.gov/niosh/npg/npgd0368.html.
TheACGIHhassetathresholdlimitvalueforatimeweightedaverage
(TLV/TWA)of50g/m3forleadinworkplaceair(exceptforlead
arsenate).http://www.acgih.org/home.htm .

Soil

Leadcontaminatedsoilcanposeariskthroughdirectingestion,uptake
invegetablegardens,ortrackingintohomes.
Uncontaminatedsoilcontainsleadconcentrationslessthan50ppmbut
soilleadlevelsinmanyurbanareasexceed200ppm.(AAP1993)
TheEPA'sstandardforleadinbaresoilinplayareasis400ppmby
weightand1200ppmfornonplayareas.Thisregulationappliesto
cleanupprojectsusingfederalfunds.
Thesoilscreeninglevel [PDF1.43MB] (SSL)forleadrepresents
aconservativeestimateforalevelthatwouldbeprotectiveofpublic
healthinresidentialsoilsbasedonananalysisofthedirectingestion
pathwayforchildren.Thisvalueisforguidanceonlyandisnot
enforceable.

Drinking
Water

EPAhassetdrinkingwaterstandardswithtwolevelsofprotection.
Themaximumcontaminantlevelgoal(MCLG)iszero.Thisisthelevels
determinedtobesafebytoxicologicalandbiomedicalconsiderations,
independentoffeasibility.
EPA'sfinalruleestablishesanactionlevelissetat15g/L.

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Forfurtherinformation,calltheEPASafeDrinkingWaterHotlinetoll
freeat18004264791.http://www.epa.gov/safewater/
Theuseofleadsolderandotherleadcontainingmaterialsin
connectinghouseholdplumbingtopublicwatersupplieswasbannedby
EPAasofJune1988.
Manyolderstructures,however,stillhaveleadpipeorleadsoldered
plumbinginternally,whichmaysubstantiallyincreasetheleadcontent
ofwateratthetap.
Regulationscontrollingtheleadcontentofdrinkingwatercoolersin
schoolswentintoeffectin1989.
Residentscanbuyinexpensivedrinkingwaterleadscreeningkits(see
http://www.afhh.org/ orhireprofessionalstotesttheirwater.

Food

FDAhassetanumberofactionlevels(enforceable)andlevelsof
concernforleadinvariousfooditems.TheselevelsarebasedonFDA
calculationsoftheamountofleadapersoncanconsumewithoutill
affect.
Forexample,FDAhassetanactionlevelof0.5g/mLforleadin
productsintendedforusebyinfantsandchildrenandhasbannedthe
useofleadsolderedfoodcans.(FDA1994andFDA1995ascitedin
ATSDR1999)

Paint

Whitehousepaintcontainedupto50%leadbefore1955.Federallaw
loweredtheamountofleadallowableinpaintto1%in1971.TheCPSC
haslimitedsince1977theleadinmostpaintsto0.06%(600ppmby
dryweight).Paintforbridgesandmarineusemaycontaingreater
amountsoflead.
Table3:StandardsandRegulationsforLead

Agency

CDC

OSHA

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Media

Blood

Blood

Level

10
g/dL

40
g/dL
60
g/dL

Comments

Advisory
levelfor
individual
management

Regulation
causefor
written
notification
andmedical
exam
Regulation
causefor
medical
removal
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from
exposure

Blood

30
g/dL

Advisory
indicates
exposureat
the
threshold
limitvalue
(TLV)

OSHA

Air
(workplace)

50
g/m3
30
g/m3

Regulation
PEL(8hr
average.)
(general
industry)
Actionlevel

CDC/NIOSH

Air
(workplace)

100
g/m3

REL(non
enforceable)

150
g/m3
50
g/m3

TLV/TWA
guidelinefor
lead
arsenate
TLV/TWA
guidelinefor
otherforms
oflead

0.15
g/m3

Regulation
NAAQS3
month
average

ACGIH

ACGIH

EPA

EPA

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Air
(workplace)

Air
(ambient)

Soil
(residential)

400
ppm
(play
areas)
1200
ppm
(non
play
areas)

Soil
screening
guidance
level
requirement
forfederally
funded
projectsonly
(40CFR
Part745,
2001)
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EPA

FDA

CPSC

KeyPoints

Water
(drinking)

Food

Paint

15g/L
0g/L

Actionlevel
forpublic
supplies
Non
enforceable
goalMCLG

Various

Actionlevels
forvarious
foods
example:
lead
soldered
foodcans
nowbanned

600
ppm
(0.06%)

Regulation
bydry
weight.
Thereisa
new
standardfor
leadin
children's
jewelry.

CDCloweredtherecommendedbloodleadactionlevelforlead
exposureinchildrento10g/dLin1991.
Statesmayhavetheirownlevelsofconcernforadultsandchildren.
Moststateshavereportingsystemsforleadpoisoning.
OSHAhassetrequiredstandardsfortheamountofleadallowedin
workroomairat50g/m3averagedoveran8hourworkday.
EPAhassetastandardforleadintheambientairof0.15g/m3
averagedoveracalendarquarter.
EPAhasestablished400ppmforleadinbaresoilsinplayareasand
1200ppmfornonplayareasforfederallyfundedprojects.Thismaybe
usedasaguidancelevelelsewhere.
EPA'sactionlevelforleadinwaterdeliveredtousersofpublicdrinking
watersystemsis15g/L.Itsgoalforleadiszero.
FDAhassetvariousactionlevelsregardingleadinfooditems.Useof
leadsolderedfoodcansisnowbanned.
Today,paintintendedforresidentialuseislimitedto0.06%lead
content.

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Progress
Check

5.TheCDC'sactionlevelof10g/dLforchildren'sbloodis

A.thebloodleadlevelbelowwhichnoeffectshavebeenfound
B.alsousedbyOSHAasalevelofconcerninworkers
C.anadvisorylevelforenvironmentalandeducational
intervention
D.aregulatorylevelatwhichchildrenmustberemoved
immediatelyremovedfromanypre1978residences
Answer:

Clear

Toreviewrelevantcontent,seeBiologicGuidelinesinthis
section.

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Pagelastreviewed:August20,2007
Pagelastupdated:August25,2016
Contentsource:AgencyforToxicSubstancesandDiseaseRegistry

AgencyforToxicSubstancesandDiseaseRegistry,4770BufordHwyNE,Atlanta,GA30341
ContactCDC:8002324636/TTY:8882326348

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