Blood lead levels in Jamaican school children

Effectiveness of interventions for the remediation of lead-contaminated soil to prevent or reduce lead exposure - A systematic review

OBJECTIVE

To summarize the evidence on the effectiveness of soil remediation to prevent or reduce lead exposure.

METHODS

We systematically searched MEDLINE, the Agricultural & Environmental Science Database, Web of Science, and Scopus from 1980 to February 15, 2021. We also performed reference list checking, hand-searched websites, and contacted experts. Eligible studies evaluated the effect of soil remediation to prevent or reduce lead exposure in humans of any age. We screened all records dually; one investigator performed the data extraction; a second checked for completeness and accuracy. Two investigators independently rated the risk of bias of included studies and graded the certainty of evidence. We synthesized findings narratively.

RESULTS

We identified 6614 potentially relevant publications, all focused on children, of which five studies (six records) fulfilled our prespecified inclusion criteria. The number of evaluated participants ranged from 31 to 1425, with follow-up periods of 11 months to one year. The primary soil remediation method was the replacement of the upper layer with clean soil. Outcomes were limited to blood lead levels (BLL), dust lead levels, and soil lead levels. The largest study, a controlled before- after study (n = 1425) reported favorable effects of soil remediation compared to no intervention. This finding was consistent with results from two cross-sectional studies and one uncontrolled before-after study. One year post-remediation, the mean reduction in BLL was 2.1 μg/dL (p < 0.0001) greater in the intervention group than in the control group. Two randomized controlled trials with a total of 511 participants showed no statistically significant incremental effect of soil remediation when combined with paint and/or dust abatement. The certainty of evidence for all outcomes was low.

CONCLUSION

Soil remediation appears to reduce BLL in children when used as a single intervention. The incremental benefit of soil remediation when part of other interventions is limited.

What are the blood lead levels of children living in Latin America and the Caribbean?

INTRODUCTION

Information on the prevalence of lead exposure is essential to formulate efficient public health policies. Developed countries have implemented successful public policies for the prevention and control of lead poisoning. In the United States, Canada, Japan and the European Union, for instance, periodically repeated prevalence studies show that blood lead levels (BLLs) in children have decreased overall. Although BLL of Latino children in the U.S. have also dropped in recent years, the geometric mean remains higher than that of white children. Little is known about lead exposure in children in Latin America and the Caribbean (LAC). In this review, we responded to two questions: What is currently known about lead sources and levels in children in LAC? Are there public policies to prevent children's exposure to lead in LAC?

METHOD

We conducted a literature review covering the period from January 2000 to March 2014 in the PubMed and Lilacs databases to obtain English, Portuguese and Spanish language studies reporting the prevalence of BLLs in children aged 0-18years living in LAC countries. No specific analytical method was selected, and given the scarcity of data, the study was highly inclusive.

RESULTS

Fifty-six papers were selected from 16 different LAC countries. The children's BLLs found in this review are high (≥10μg/dL) compared to BLLs for the same age group in the U. S. However, most studies reported an association with some type of "lead hot spot", in which children can be exposed to lead levels similar to those of occupational settings. Only Peru and Mexico reported BLLs in children from population-based studies.

CONCLUSIONS

Most BLLs prevalence studies carried out in LAC were in areas with known emission sources. The percentage of children at risk of lead poisoning in LAC is unknown, and probably underestimated. Thus, there is an urgent need to establish public health policies to quantify and prevent lead poisoning, specifically by prioritizing the identification and control of "hot spots".

Declining blood lead and zinc protoporphyrin levels in Ecuadorian Andean children

OBJECTIVES

To investigate current lead (Pb) exposure in children living in Andean Ecuadorian communities. Blood Pb (PbB) and zinc protoporphyrin (ZPP) levels were used respectively as biomarkers of acute and chronic Pb poisoning. The current PbB-ZPP levels were compared with previous pediatric PbB-ZPP levels recorded over years in the study area.

DESIGN AND METHODS

Samples of whole blood were collected from 22 Andean children of Quechua and Mestizo backgrounds and measured for PbB concentrations by graphite furnace atomic absorption spectroscopy. ZPP/heme ratio and ZPP whole blood (ZPP WB) levels were measured with a hematofluorometer.

RESULTS

The mean PbB level for children in the current study group was 14.5 μg/dL, which was significantly lower than the mean PbB level of 41.1 μg/dL found in the same study area in the 1996-2000 test period, and lower than the 22.2 μg/dL mean level found in the 2003-2007 period. The current mean ZPP/heme ratio was 102.1 μmol/mol, and the mean ZPP WB level was 46.3 μg/dL, both lower than values previously found in children in the study area.

CONCLUSION

While the current pediatric PbB-ZPP levels in the study area remain elevated in some children, the overall levels indicate a decline relative to levels observed in the same Pb-contaminated area in the period between 1996 and 2007. The elevated ZPP levels suggest a history of chronic Pb exposure, and potential iron deficiency in some children. The overall reduction in PbB-ZPP levels suggests a positive outcome of a Pb-exposure education and prevention program, and the therapeutic intervention of succimer chelation therapy.

Determination of toxic and essential elements in children's blood with inductively coupled plasma-mass spectrometry

Recent studies have suggested that low blood lead level, less than 50 microg L(-1), can influence the neurobehavioral performance of children. In addition, nutritional deficiencies in some essential elements may increase the toxicity of lead, and some essential elements may influence the blood concentrations of lead and other toxic metals. These findings, coupled with the scarcity of available data on some elements in children's blood and the introduction of methylcyclopentadienyl manganese tricarbonyl (MMT) to gasoline, accentuate the need to monitor the concentrations of lead, manganese, and other heavy metals and essential elements in children's blood. This study reports on the multi-element analysis of blood of South African school children using inductively coupled plasma-mass spectrometry (ICP-MS). The sample preparation consisted of a nitric acid/hydrogen peroxide open digestion and subsequent dilution with MilliQ water. The accuracy and precision were evaluated from quintuplet analyses of Seronorm trace elements whole blood reference material and human blood samples. Concentrations of lead, arsenic, manganese, copper, zinc, selenium, cobalt, and chromium in the blood of South African school children were determined. The average values were: lead 56.4 microg L(-1), arsenic 1.53 microg L(-1), manganese 8.48 microg L(-1), copper 1195 microg L(-1), zinc 3431 microg L(-1), selenium 176 microg L(-1), cobalt 0.80 microg L(-1), and chromium 1.25 microg L(-1). The level of lead was in line with some reported lower concentrations. The concentrations of arsenic and manganese were generally lower than those found in the literature. The concentrations of cobalt, copper, selenium, and chromium were higher than those found in other studies, whereas that of zinc was lower.

Erythrocyte acetylcholinesterase activity as a surrogate indicator of lead-induced neurotoxicity in occupational lead exposure in Abeokuta, Nigeria

Dose-effect and dose-response relationships in occupational neurotoxicology are rarely studied by means of biochemical methods. In order to investigate the potential neurotoxic effects of lead during occupational exposure to this metal, the activity of erythrocyte acetylcholinesterase (AcChE), as well as blood pressure and pulse, were determined in various artisans in Abeokuta, Nigeria, who have been shown to be occupationally exposed to lead, and these were related to blood lead levels. AcChE activity in the artisans was inhibited to varying extents. While AcChE activity was inhibited to the tune of 39% in the male petrol station attendants, the inhibition amounted to 32% in female petrol station attendants. In other artisans, AcChE inhibition ranged from 31% in the welders to 38% in painters. The lowest inhibition of 15% was obtained in the panel beaters. Correlations, as calculated by Pearson's method, revealed a significant (p<0.001) inverse linear relationship between AcChE activity and blood lead levels (r=-0.40; y=-120.38x+13935.59; p<0.001). Blood pressure and pulse were not significantly different between control and lead-exposed subjects. Our findings suggest that erythrocyte AcChE activity could be used as a biomarker of lead-induced neurotoxicity in occupationally exposed subjects.

Blood lead levels of Jamaican children island-wide

An island-wide survey of 1081 basic school children, mainly in the age group 2-6 years, is reported. The range of blood lead levels (BLLs) was 1.4 to 202 microg/dL with arithmetic and geometric means of 7.3 microg/dL (standard deviation, 13 microg/dL) and 4.35 microg/dL respectively. Two hundred and thirty children were identified with blood lead levels above 10 microg/dL and among these, 80 were provided with medical attention and of eleven who received chelation, six children were desperately ill from acute lead poisoning necessitating repeated sessions of chelation therapy. The higher blood lead values were found mainly in poor areas of the urban Kingston and St. Andrew Corporate Area, and in St. Catherine where there remain observable though reduced effects from a lead-contaminated area. Environmental interventions, including building an increased national awareness, have also been carried out to reduce the immediate and future dangers of lead poisoning. The most important source of the lead exposure is the recovery of lead from old automobile batteries and even a quite small smelter can contaminate a significant area. Further work is in progress to identify and examine historical and active smelter sites, their possible effects on childhood health, and their remediation.

Lead Concentrations in Maternal Blood and Breast Milk and Pediatric Blood of Andean Villagers: 2006 Follow-up Investigation

OBJECTIVE

To determine the current lead (Pb) concentration in blood (PbB) and breast milk (PbM) of mothers and the PbB of children living in Andean Ecuadorian villages with high Pb contamination.

METHODS

Samples of whole blood from 93 participants (74 children and 19 adult women) were analyzed for Pb concentration by graphite furnace atomic absorption spectroscopy with Zeeman background correction, and milk samples from nursing mothers were analyzed by inductively coupled plasma-mass spectrometry (ICP-MS).

RESULTS

Mean PbB concentration in children in 2006 was 26.7 microg/dL (SD: 23.0), and significantly lower than the mean PbB level in 1996 to 2000, but similar to the PbB level found in 2003. The mean PbB level of 22.0 microg/dL (SD: 20.6) for the 19 women in the 2006 study group did not differ significantly from the women in the 1996 to 2000 or 2003 study group. The PbM levels (range: 1-49 microg/L) of nursing mothers in the 2006 group were similar to the PbM values observed in the breast milk of nursing mothers in the same study area in 2003, and matched high PbB levels in some mother-infant pairs.

CONCLUSION

This study found elevated, but stable, PbB and PbM levels in mothers and elevated, but stable, PbB levels in children in 2006 that were consistent with the levels observed in 2003 in the same Andean villages.

Blood lead levels in primary school children in Trinidad and Tobago

This study is the first national baseline survey of blood lead levels (BLLs) conducted on primary school children (ages 5-7 years) in Trinidad and Tobago. A total of 1,761 students from 61 schools participated in the study over a 3-month period. Measurements of capillary BLLs were assessed as well as responses to a risk assessment questionnaire. BLLs ranged from <1 microg/dL to 28.6 microg/dL with a geometric mean of 2.8 microg/dL, which compared favourably with results from the U.S. 1991-94 National Health and Nutrition Examination Survey. Fifteen (0.9%) children had a BLL>or=10 microg/dL (10.8-28.6 microg/dL) of which three (0.2%) met the U.S. criteria for lead poisoning (BLL>or=20 microg/dL). Further environmental investigations are required to identify source(s) of lead exposure in cases with high BLL.

Reversal of aminolevulinic acid dehydratase (ALAD) inhibition and reduction of erythrocyte protoporphyrin levels by Vitamin C in occupational lead exposure in Abeokuta, Nigeria

In order to investigate the toxic effects of lead during occupational exposure to this metal, the activity of aminolevulinic acid dehydratase (ALAD) and the concentrations of erythrocyte protoporphyrin (EPP) were determined in blood of various artisans in Abeokuta, Nigeria and these were related to blood lead levels. ALAD activity in the artisans was inhibited to varying extents. ALAD activity was inhibited to the tune of 77% in petrol station attendants while the lowest inhibition of 36% was obtained in the welders. EPP was also significantly increased in the artisans (p<0.001). The highest EPP level of 241.57±89.27μg/100ml of red blood cell was observed in upholsterers. A significant (p<0.001) negative correlation was observed between ALAD activity and blood lead levels on one hand (r=-0.631) and between ALAD activity and EPP on the other hand (r=-0.461). Administration of a daily dose of 500mg ascorbic acid for 2 weeks reversed the lead-induced inhibition of ALAD. Increased EPP levels observed in the artisans also responded positively to the ascorbic acid supplementation. A significant reduction (p<0.001) in blood lead was also observed in the artisans at the end of the 2-week ascorbic acid therapy. Our findings indicate that ascorbic acid may offer more advantages over the conventional agents for the treatment of lead poisoning, especially in cases where the subjects cannot be removed from the source of lead exposure.

Elemental composition of Jamaican foods 1: a survey of five food crop categories

The concentrations of 27 elements in Jamaican food categories consisting of fruit, legumes, leafy and root vegetables and other root crops are reported. The main analytical techniques used were neutron activation analysis and flame and graphite furnace atomic absorption spectrophotometry. The results are compared, where possible, with values from Denmark, the United Kingdom, the United States and Nigeria, and with some regulatory limits. Over 75% of the results for antimony, arsenic, barium, cerium, thorium and uranium were below the respective sample detection limits but even among these, some of the maximum values observed indicate that further examination may be useful for those foods grown in the regions of highest uptake and consumed in large amounts. The other elements reported are bromine, cadmium, calcium, caesium, cerium, chromium, copper, europium, hafnium, iron, lanthanum, lead, magnesium, manganese, phosphorus, potassium, rubidium, scandium, samarium, sodium, strontium, thorium, uranium, and zinc. Many of these elements occur at concentration levels above those reported from the other countries but it seems unlikely that most of these will contribute significantly to public health risk. However, at this stage cadmium clearly appears to be the element of greatest concern in the Jamaican food chain. The observed range of cadmium concentrations suggests that factors such as land selection, coupled perhaps where necessary, with suitably modified agricultural practices, is a feasible way to reduce the cadmium content of certain local foods.

Exposure assessment of lead among Japanese children

OBJECTIVE

Lead intake from possible exposure routes among children residing in the Tokyo Metropolitan Area was estimated.

METHODS

Lead concentrations in house dust samples collected from the houses of the children and those in 24-h duplicate diet samples of the children were determined. The daily lead intake was estimated by multiplying the lead concentrations in the house dust, diet, soil and ambient air (the latter two were from the literatures) by the corresponding intake and/or inhalation rates, and summing all of the products. Bioaccessibility tests were performed on the house dust, soil and diet samples to determine the lead uptake level.

RESULTS

Children residing in the Tokyo Metropolitan Area were estimated to be exposed to 21.5 μg of lead on a daily basis, with a maximum intake of up to 70.4 μg. The average weekly intake per kg body weight for a 5-year-old Japanese child was found to be 8.0 μg/kg bw/wk, which is below the Provisional Tolerable Weekly Intake (PTWI) of 25 μg/kg bw/wk. However, the maximum weekly intake was found to be 26 μg/kg bw/wk.

CONCLUSIONS

House dust and soil ingestion can be the predominant routes of exposure to lead among children in Japan, and the source(s) of lead in such media must be specified to reduce the lead intake level of the children.

Lead poisoning in pregnancy: a case study with implications for midwives

Lead poisoning remains a significant problem in the United States affecting the health of women and children. Although the damage is greatest at higher levels of accumulation, no level of lead has been found to be safe. Over the last 25 years, the blood level of lead thought to be associated with toxicity has dropped dramatically, from to 60 mcg/dL in 1960 to 10 mcg/dL today. Studies confirm that exposure to lead causes kidney damage, encephalopathy, and impaired cognitive function in children and in adults. Recent evidence indicates children with levels less than 10 mcg/dL may suffer from compromised development and intellectual performance later in life. This article discusses the case of a woman found to have lead poisoning during pregnancy. Environmental sources of lead, implications for the immediate and future health of the fetus and mother, and techniques clinicians can use in their practice to minimize the adverse effect of lead on their clients are reviewed.

[Cytotoxic effects of lead on the endocrine and exocrine sexual function of pubescent male and female rats. Demonstration of apoptotic activity]

This study deals with the impact of chronic exposure to lead on male and female fertility in rats. Male and female rats (3 months old) were fed on commercial tablets (SICO, Sfax). For drinking, some rats were given distilled water (T = controls), the other ones were given distilled water enriched with lead acetate, either 3 (P1 group) or 6 mg ml-1 (P2 group), for 15, 30, 45, 60 or 90 days. In male rats, absolute and relative weights of testis, epididymis, prostate and seminal vesicles were found to significantly decrease at day 15 in the P2 group and at day 45 in the P1 group. However, at day 60, these absolute and relative weights returned to control values. Lead-induced pathological changes in spermatogenesis were observed at day 15 by histological study: arrest of cell germ maturation, changes in the Sertoli cells, and presence of apoptotic cells revealed by borated toluidine blue in the testis. Presence of lead deposits was observed after histochemical staining using sodium rhodizonate. Serum testosterone level was found to be lowered at day 15 in both (P1) and (P2) groups, to display a peak at day 60, then to return to controls values, in spite of the continuation of the treatment. In female rats, absolute and relative weights of ovary and uterus were found unchanged. The vaginal smears practiced in females revealed the oestrus phase in all groups. Exposed females were mated with control males, and fecundity was assessed 15 days later by counting the number of pregnancies and the number of concepti per pregnancy. Fertility was found to be reduced in females of P1 and P2 groups as compared to control females (T group). Lead level in blood was found to be poorly correlated with the level of poisoning, whereas lead accumulation in tail was found to be dose-dependent. Therefore, lead accumulation in tail appears as a more reliable biomarker of exposure to lead. In summary, our study shows that chronic exposure to lead causes a double sexual disorder in rats: first, disorder deals with the hormonal function, which is affected at the early stages of poisoning, but is rapidly corrected; second, disorder deals with the genital tract, affecting the testis and the ovary, resulting in a reduced fertility in both P1 and P2 females, in spite of the presence of a normal oestrus. The cytotoxic effect of lead in males seems to be related to an apoptotic process.