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Blood Lead Levels 2007 - Panhandle Health District 1

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2007 Bunker Hill Superfund Site
Coeur d’Alene Basin
Blood Lead Levels
Idaho Department of Health and Welfare
Idaho Department of Environmental Quality
Panhandle Health District
United States Environmental Protection Agency
February 27, 2008
Lead Health Intervention Program (LHIP)
Annual Blood Lead Surveys
• Public health service offered by the State
• Not a study or experiment
• Box since 1974/1985
• Basin since 1996
Panhandle Health District
LHIP
LHIP is an Interim Health Response Activity
- To identify children with high blood lead
and assist families to reduce exposure
Superfund is a Risk-based Cleanup Action
- To prevent future exposures
Panhandle Health District
LHIP Procedures
No cash incentive for participants that live:
пѓ� within the Box and are between 6 months and 9
years of age, or
$20.00 cash incentive for participants that live:
� within the Coeur d’Alene River Basin and are between
6 months and 6 years of age
• Prior to blood draws, the parent/legal guardian or adult
participant must sign a Consent Form and complete the
appropriate Questionnaire
Panhandle Health District
LHIP Procedures
• Screening blood test is done by skin puncture (capillary
or fingerstick - FS)
• Blood samples are collected in a lead-free ESA capillary
tube and analyzed immediately using the LeadCare
Analyzer
• Results of capillary test are provided to the participant or
parent immediately after analysis
Health Effects
Decreasing “elevated”
blood lead levels
N Engl J Med
2003;348: p1517-26.
60
40
30
25
10
?
Lead Dose п‚® Response
Observed Effect
Blood Lead пЃ­g/dl
Children Adults
п‚і125
Death
Neurological
Encephalopathy
Peripheral Neuropathy
Sub-clinical
Central Nervous System
п‚Ї Hearing
п‚Ї Cognitive IQ
п‚Ї Psychomotor Function
п‚Ї Birth weight/ Term length
Anemia
п‚Ї Heme synthesis
Renal nephropathy
Hypertension
п‚Ї Vitamin D
п‚Ї Sperm count & function
Delayed female puberty
70
40
10
<10
10
10
20
10
40
25
< 30
100
40
80
10
40
40
<10
Adapted from Casserett & Doull’s TOXICOLOGY and ATSDR
At Risk Populations
• Children
• Pregnant women
• Adults with cumulative exposure
• Genetically pre-disposed Individuals
Neurotoxic Effects in Children
• Neurobehavioral effects in early
development persist into adolescence and
young adulthood
• Neurocognative effects associated blood
lead levels of 5-10 Ојg/dl
• A decline of 6.2 IQ points results from a
blood lead change from 1 to 10 Ојg/dl
(pooled results from 7 studies)
Cardiovascular Effects in Adults
• Increase in blood pressure (hypertension)
Other Organ System Effects
•
•
•
•
•
•
•
•
•
•
•
Renal effects
Immune system effects
Bone and teeth effects
Heme-synthesis effects
Reproductive and developmental effects
Adrenal effects
Liver Effects
Gastrointestinal Effects
Metabolism Effects
Genotoxic Effects
Carcinogenic Effects
Centers for Disease Control Guidance for
Children with Elevated Blood Lead
•
п‚·
blood lead concentration <10 Ојg/dl
Re-assess or re-screen in one
year.
•
п‚·
blood lead concentration 10-14 Ојg/dl
Provide family lead education. Provide
follow-up testing. Refer for social
services, if necessary.
•
п‚·
blood lead concentration 15-19 Ојg/dl
If blood lead levels persist or worsen
proceed according to actions for blood
lead concentrations in the 20-44 Ојg/dl
range.
•
п‚·
blood lead concentration 20-44 Ојg/dl
Provide coordination of care, clinical
management, environmental
investigation, and lead- hazard control.
•
п‚·
blood lead concentration 45-69 Ојg/dl
Within 48 hours, begin coordination of
care clinical management, environmental
investigation, and leadhazard control.
п‚·
blood lead concentration >70 Ојg/dl
Hospitalize child and begin medical
treatment immediately. Begin
coordination of care, clinical
management, environmental
investigation, and lead-hazard control
immediately.
•
2007 EPA Lead Criteria
Document Conclusion
“There is no level of Pb exposure that
has yet been identified, with
confidence, as clearly not being
associated with possible risk of
deleterious health effects.”
Bunker Hill Box
Superfund Site Remedial
Action Objective
• 95% of all children in each community
with blood lead levels <10 Вµg/dl
• No children (i.e. <1%) with blood lead
levels > 15 Вµg/dl
Coeur d’Alene Basin
Superfund Site Remedial
Action Objective
• 95% probability for individual children
with blood lead levels <10 Вµg/dl
• <1% probability for any child with blood
lead levels > 15 Вµg/dl
Bunker Hill Box
Average Blood Lead: 1974-2002
“Elevated” blood lead level
U.S. Average
*
*
*
*
Box Lead Health Intervention
Summary Statistics 1988-1994
Number of
children
in survey
Mean
blood Pb
(пЃ­g/dl)
1988*
230
9.9
7
35
105
46%
1989*
275
11.4
8
71
154
56%
1990
362
8.9
2
41
134
37%
1991
365
6.3
2
17
56
15%
1992
415
7.4
3
31
110
27%
1993
445
5.6
1
10
66
15%
1994
416
6.2
1
15
71
17%
Year
*does not include Pinehurst
Number of children
with blood Pb (пЃ­g/dl)
>25
>15
>10
Percent
of children
> 10 пЃ­g/dl
Box Lead Health Intervention
Summary Statistics 1995-2002
Number of
children
in survey
Mean
blood Pb
(Вµg/dl)
1995
1996
1997
1998
1999
2000
2001
405
397
337
375
370
320
322
6.0
5.8
5.4
4.8
4.7
4.3
3.2
2
2
0
0
0
0
0
20
13
6
5
3
5
4
62
49
36
31
23
17
10
15%
12%
11%
8%
6%
5%
3%
2002
368
3.1
0
3
7
2%
Year
Number of children
with blood Pb (Вµg/dl)
>25
>15
>10
Percent
of children
> 10 Вµg/dl
Percent of Box Children with Blood Lead Levels > 10 Ојg/dl,
by City, 1988-2002
% o f C h ild re n w ith B lo o d L e a d A b o v e 1 0 пЃ­ g /d l
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
R AO < 5%
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
K e llo g g
P in e h u rst
S m e lte rville
RAO
2007 Blood Lead Summary
Statistics – Box (age 0-9)
Total Number of Children (N)
Minimum (Ојg/dl)
Maximum (Ојg/dl)
Average (Ојg/dl)
Standard Deviation
Geometric Mean (Ојg/dl)
Geometric Standard Deviation
8
1.4
4.8
2.4
1.3
2.1
1.65
Percentage
Total Number of Children (N)
Number of Children > 10 Ојg/dl
Number of Children > 15 Ојg/dl
Number of Children > 20 Ојg/dl
8
0
0
0
0%
0%
0%
Percent of Children with Blood Lead Levels > 10 Ојg/dl,
Kellogg and Basin, 1988-2007
% of Children with Blood Lead Above 10 Ојg/dl
60%
50%
40%
30%
20%
10%
0%
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Kellogg
Basin
2007 Blood Lead Summary
Statistics – Basin (age 0-6)
Total Number of Children (N)
Minimum (Ојg/dl)
Maximum (Ојg/dl)
Average (Ојg/dl)
Standard Deviation
Geometric Mean (Ојg/dl)
Geometric Standard Deviation
71
1.4
8.6
2.9
1.5
2.6
1.62
Percentage
Total Number of Children (N)
Number of Children > 10 Ојg/dl
Number of Children > 15 Ојg/dl
Number of Children > 20 Ојg/dl
71
0
0
0
0%
0%
0%
Basin Blood Lead Summary
by Year, 1996 - 2001 (age 0-6 only)
Year
1996
1997
1998
1999
2000
2001
N
58
13
70
162
102
117
N ≥ 10 μg/dl
8
2
9
26
14
7
% ≥ 10 μg/dl
14%
15%
13%
16%
14%
6%
N ≥ 15 μg/dl
3
1
4
12
4
2
% ≥ 15 μg/dl
5%
8%
6%
7%
4%
2%
N ≥ 20 μg/dl
0
0
2
4
1
0
% ≥ 20 μg/dl
0%
0%
3%
2%
1%
0%
Basin Blood Lead Summary
by Year, 2002 - 2007 (age 0-6 only)
Year
2002
2003
2004
2005
2006
2007
N
103
75
82
81
69
71
N ≥ 10 μg/dl
4
3
2
1
1
0
% ≥ 10 μg/dl
4%
4%
2%
1%
1%
0%
N ≥ 15 μg/dl
0
2
1
0
0
0
% ≥ 15 μg/dl
0%
3%
1%
0%
0%
0%
N ≥ 20 μg/dl
0
0
0
0
0
0
% ≥ 20 μg/dl
0%
0%
0%
0%
0%
0%
2007 Basin Blood Lead Summary
Statistics by Age (years)
Age
1
2
3
4
5
6
N
12
14
9
15
12
9
Min (Ојg/dl)
1.4
1.4
1.4
1.4
1.4
1.4
Max (Ојg/dl)
8.6
5.3
6.2
5.5
4.3
5.8
Ave (Ојg/dl)
3.3
2.9
3.3
2.7
2.2
3.2
GeoMean
(Ојg/dl)
2.8
2.7
2.9
2.4
2.0
2.8
Annual Blood Lead Surveys and
Cleanup Activities
• Remediation is NOT based on
blood lead data.
• Remediation IS based on risk of
exposure to environmental (soils and
dust) metals concentrations.
Remediation reduces health
risks to children and women
of child-bearing age currently
residing in the Basin
and for future generations.
Percentage of Parcels that have
Consented and Refused Sampling
Consented
98%
Refused
2%
97%
3%
Silverton
Osburn
Side Gulches
94%
97%
95%
6%
3%
5%
Kingston Area
Lower Basin
Total
89%
76%
95%
11%
24%
5%
Mullan
Wallace &
Burke/Ninemile
Consents and refusals received from 2004 through December 2007.
House Dust is the
Primary Risk Driver
• Soil Remediation reduces exposure to
outside soil lead, and
• Reduces lead in house dust from those
soils
Box
House Dust
History
Community Mean Vacuum Bag Dust Lead Concentration By Year and Geographic Area,
1988-2005
1800
Geometric Mean House Dust Lead Concentration (mg/kg)
1600
1400
1200
1000
800
600
400
Community RAO <500 mg/kg
200
0
1988
1990
1991
1992
Kellogg
1993
1994
Page
1995
1996
Pinehurst
1997
Year
1998
1999
Smelterville
Note: Samples not available for Page in 1997, 1999 & 2001 (indicated with dashed lines).
2000
2001
Wardner
2002
2003
RAO
2004
2005
Basin House
Dust Trends
Community Mean Vacuum Bag Dust Lead Concentration By
Year and Geographic Area, 1996-2007
1,600
Geometric Mean Lead Concentration (mg/kg)
1,400
1,200
1,000
800
600
400
200
0
1996
Burke/Ninemile
1998
Kingston
1999
Lower Basin
2003
Mullan
2004
Osburn
2005
Side Gulches
2006
Silverton
2007
Wallace
Notes:
Vacuum samples were not collected in 1997, 2000, or 2001. 2002 had too little data to display.
In 2005, only one vacuum sample was collected from the Lower Basin. When the number of samples is 2 or less, the results are not shown in
order to maintain confidentiality.
2007 Basin Blood Lead Summary
Statistics by Area
Area
Burke/Ninemile
Kingston
Lower
Basin
Osburn
N
3
13
11
16
Min (Ојg/dl)
2.3
1.4
1.4
2.1
Max (Ојg/dl)
4.1
4.5
4.7
8.6
Ave (Ојg/dl)
3.0
2.1
2.0
4.0
GeoMean
(Ојg/dl)
2.9
1.9
1.9
3.7
2007 Basin Blood Lead Summary
Statistics by Area
Area
Side
Gulches
Silverton
Wallace
N
12
8
7
Min (Ојg/dl)
1.4
1.4
1.5
Max (Ојg/dl)
3.7
7.1
6.2
Ave (Ојg/dl)
2.5
2.9
3.9
GeoMean (Ојg/dl)
2.4
2.5
3.4
1 sample from Mullan is not shown to protect confidentiality
Box
House Dust
History
Fig u r e 3 .8 a
Ho u s e Du s t V a c u u m Ba g L e a d C o n c e n t r a t io n
His t o g r a m - 1 9 8 8
Percen tag e o f P o p u latio n
80%
70%
60%
50%
40%
30%
20%
10%
0%
0-200
200-400
400-600
600-800 800-1000
>1 0 0 0
Ho u s e Du s t V a c u u m Ba g L e a d L e v e l ( m g /k g )
Fig u r e 3.8n
Ho u s e Du s t V acu u m Bag L e ad C o n ce n t r at io n
His t o g r am - 2002
Percen tag e o f Po p u latio n
80%
70%
60%
50%
40%
30%
20%
10%
0%
0- 200
200- 400
400- 600
600- 800 800- 1000
>1000
Ho u s e Du s t V acu u m Bag L e ad L e ve l ( m g /k g )
Basin House
Dust Trends
Basin House Dust Vacuum Bag Lead Concentration
Histogram - 1996-1999
80%
Percentage of Population
70%
60%
50%
40%
30%
20%
10%
0%
0-200
200-400
400-600
600-800
800-1000
House Dust Vacuum Bag Lead Level (mg/kg)
>1000
Basin House Dust Vacuum Bag Lead
Concentration Histogram - 2006
Percentage of Population
80%
70%
60%
50%
40%
30%
20%
10%
0%
0-200
200-400 400-600
600-800 800-1000
House Dust Vacuum Bag Lead Level (mg/kg)
>1000
Health Observations 2007
• No Children with Elevated Blood Lead
Levels in Box or Basin
• Low Turnout in both Box and Basin
• High Cooperation with Yard Program
• Soil and Dust Exposures Decreasing in
most Areas
• Higher Dust Lead Levels Persistent in
Upper Basin
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