Are CDC's 1997 Recommendations For Targeted Lead Screening Of Children Justified?

In the January/February issue of Public Health Reports, researchers from the University of Maryland's School of Medicine argue that CDC's recent revision of its lead screening recommendations for children which calls for local screening decisions as opposed to universal screening are insupportable given that "lead remains the greatest environmental threat to children in the United States." In a related article, staff from CDC's National Center for Environmental Health defend their revision as "a systematic approach."

Even modestly elevated blood lead levels have subtle yet serious effects that can result in irreversible neurocognitive deficits. Research has found that highly elevated lead levels in children are associated with IQ deficits and with learning and behavior problems that may extend into adulthood. Lead screening for blood lead levels requires testing blood gathered through either a finger prick or from a vein in the arm.

The prevalence of elevated Blood Lead Levels (BLLs) among 1- to 5-year-old U.S. children has dropped from almost 90% in 1976-1980, to less than 5% for the years 1991-1994. The removal of lead from gasoline, which was largely responsible for the recent decline in BLLs was relatively easy to accomplish through regulation, but eradication of the remaining sources of lead will be more difficult given that the primary source of lead exposure for children is deteriorating lead-based paint in older homes. So despite the decline in BLLs in the population as a whole, young children who live in older housing, or who are poor, or who are members of certain minority groups continue to have BLLs that are higher than the national average of children. Recent studies put this number at 890,000 children.

The new CDC guidance recommends local decision-making about screening high-risk children. Manheimer and Silbergeld show that the incidence, severity, and probl

Contact: Anthony Robbins, MD
Public Health Reports

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