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4. LEAD POISONING

Control Guideline

Last updated: 28 February 2013

1. Reason for surveillance

• To identify cases and recommend appropriate risk reduction measures
• To monitor the epidemiology to inform the development of better risk reduction strategies.

2. Case definition

A confirmed case requires:

• A person with a venous blood lead level of >0.48µmol/L (10µg/dl).

3. Notification criteria and procedure

Elevated blood lead level is to be notified by:

• Laboratories on diagnosis (by routine mail to the Public Health Unit).
• Only confirmed cases should be entered onto NCIMS.

4. The disease

Mode of transmission
Elevated blood lead levels usually derive from the ingestion of lead-containing substances, the inhalation of lead-containing dust and transfer from mother to foetus. Less commonly some forms of the metal can be absorbed through the skin. Young children and pregnant women are especially vulnerable to environmental exposure to lead, but adults engaged in particular occupations and hobbies are also at risk.

Clinical presentation
Most cases with elevated blood lead levels are asymptomatic. When symptoms do occur, they are usually non-specific, such as headache and lethargy. More severe symptoms can be experienced, including colic, irritability and aggressiveness, followed by convulsions and death. Long-term effects in children may manifest as developmental delay, learning difficulties or other behavioural problems.

Exposure to lead is especially dangerous in young children, particularly those aged 0 to 4 years. This is because they are more susceptible to the toxic effects of lead than adults, and absorb a higher proportion of lead than adults.

5. Managing single notifications

Response time
Investigation
Within 3 working days of notification of a confirmed case, begin follow-up investigation.

Data entry
Within 5 working days of notification enter confirmed cases on NCIMS.

Response procedure
The response to a notification will normally should be carried out in collaboration with the case's health carers and/or NSW Workover. Regardless of who does the follow-up, PHU staff should ensure that action has been taken to:

• Confirm the onset date and symptoms of the illness
• Find out if the case or relevant care-giver has been told what the diagnosis is before beginning the interview
• Seek the doctor's permission to contact the case or relevant care-giver
• Review case management
• Consider testing siblings of affected children, and children of adult cases whose source is exposure to old lead paint or home hobbies.

Case management
Investigation and treatment
The main treatment for adults and children involves:

• Reducing or preventing the case's exposure to lead sources
• Reducing the impact of exposure or eliminating it
• Ensuring that exposure to other sources does not occur.

Education
The case or relevant care-giver should be informed about the effect of the blood lead level and the likely causes. In particular, emphasis should be placed on minimising the exposure of young children and pregnant women to sources of lead.

Information for community members and health care professionals is available from PHUs, The Office of Environment and Heritage Pollution Line, telephone 131555 or internet site http://www.environment.nsw.gov.au/sustainbus/BuildersHazMat.htm

Exposure investigation
The case or relevant care-giver should be asked about sources of lead contamination such as:

• Lead paint on houses built before 1970 (including the case's and neighbouring houses), and in particular any renovation or demolition of these houses
• High risk occupations, including lead mining and smelting, metal repair or foundry work, painting and decorating, automotive (including radiator) repairs or breaking down old car batteries
• High risk hobbies involving lead or lead paint, including casting metal sinkers, antique furniture restoration, lead soldering, lead lighting and indoor shooting
• Living in an area associated with large and small lead industries or areas of very high traffic flow
• Household pets which may provide an exposure pathway for lead dust
• Infants who regularly chew or suck on painted toys, cots, window sills, paint chips, etc.

Isolation and restriction
None.

Environmental evaluation
An environmental assessment of the residential area should be considered if the case's blood lead level is in excess of 25 µg/dL and the implicated source is likely to affect the broader community.

Contact management
Identification of contacts
Contacts can be defined as all persons exposed to the same source as the case, or who have secondary exposures (eg children of persons who bring lead dust home on their clothes).

Treatment and investigation
In some circumstances, consideration should be given to recommending blood lead testing for contacts. The National Health & Medical Research Council (NH&MRC) recommend blood lead testing for the following children who may be at risk:

• Children aged 9 to 48 months who live in or visit older dilapidated housing with peeling paint
• Children aged 9 to 48 months who have been present during renovations of older housing painted before 1970
• Children who have siblings with elevated blood lead levels
• Children with pica, particularly if living in lead contaminated environments
• Children aged 9 to 48 months whose parents may be occupationally exposed or who are living near lead smelters, battery breaking yards, lead ore bodies or on highways or main roads with heavy traffic
• Children exposed to less common pathways such as lead hobbies or alternative medicines containing lead.

Education
Advise susceptible contacts (or parents/guardians) of the risk of elevated blood lead levels. In particular, emphasis should be placed on minimising the exposure of young children and pregnant women to sources of lead.

Isolation and restriction
None.