QJM Advance Access published March 22, 2015 Q J Med doi:10.1093/qjmed/hcv018
Advance Access Publication 4 February 2015
Review Investigating lead poisoning in children—could surveillance help? G. DABRERA1,2,3, B. SAMPSON4, R. RUGGLES2 and G. LEONARDI5 From the 1Field Epidemiology Training Programme, 2Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK, 3European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden, 4SAS Trace Element Laboratory, Clinical Biochemistry, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK and 5Centre for Radiation, Chemicals and Environmental Hazards, Public Health England, Chilton, Didcot, Oxon, OX11 0RQ, UK Address correspondence to G. Dabrera, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK. email: [email protected]
Introduction Lead poisoning in children (LPIC) is associated with serious health effects including neurodevelopmental problems. Population-level preventive measures have helped to reduce exposures to new sources of lead for children in high-income countries such as England. However, new LPIC cases can still occur through exposure to existing sources of lead in the environment. In this article, we discuss how development of laboratory surveillance of LPIC could aid investigation and control of environmental sources of lead. Environmental risks are a particular concern for child health due to the higher exposures in comparison to adults and also the potential effects for growth and development. In recognition of this, the World Health Organization European Region (WHO EURO) has developed The Children’s Environment and Health Action Plan for Europe (CEHAPE) to help tackle environment-related child disease among European member states. In addition to tackling morbidity related to air pollution and inadequate sanitation, a key goal of this plan is ‘to reduce the risk of disease and disability arising from exposure to hazardous chemicals (such as heavy metals)’.1 The UK is one of the EURO member states committed to ! Crown copyright 2015.
CEHAPE and has a number of pre-existing policies related to environmental risks. However, a need has been identified in the UK to improve knowledge of patterns of poisoning in children and information about the settings in which children are exposed.2 High-income countries such as the UK and USA have been successful in using population-wide measures such as legal restrictions to restrict the use of lead such as drinking water pipes, toys and paint. However, children can still be exposed to environmental lead that had accumulated prior to these interventions. These exposures can be associated with a range of health effects such as headaches, fatigue and abdominal pain.
Public health impact and management of LPIC The most recently published evidence for childhood lead poisoning in the UK comes from the Avon Longitudinal Study of Parents and Children (ALSPAC) study in the South West of England in 1995.3 In this study, investigators measured the blood lead levels of 585 children with a mean age of 2.5 years. This identified that 5.4% had concentrations greater than the limit recommended by the Page 1 of 4
Downloaded from by guest on September 15, 2015
Received 17 October 2014 and in revised form 23 December 2014
G. Dabrera et al.
Challenges in surveillance ofLPIC As with other public health threats such as communicable diseases, the public health response to individual LPIC cases is dependent on notification by clinicians to public health services such as PHE. However, it has long been recognized in England and elsewhere that communicable disease reporting by clinicians can be limited by two specific issues—incomplete case ascertainment and poor timeliness.6 In the context of LPIC, incomplete case ascertainment would lead to some cases having no public health investigation while poor timeliness would potentially delay identification of the source and prolong exposure to lead. The Surveillance of Lead in Children study in UK has been conducted to identify confirmed lead poisoning cases from
paediatricians and laboratories between June 2010 and June 2012; interim findings have indicated that
Advance Access Publication 4 February 2015
Review Investigating lead poisoning in children—could surveillance help? G. DABRERA1,2,3, B. SAMPSON4, R. RUGGLES2 and G. LEONARDI5 From the 1Field Epidemiology Training Programme, 2Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK, 3European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden, 4SAS Trace Element Laboratory, Clinical Biochemistry, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK and 5Centre for Radiation, Chemicals and Environmental Hazards, Public Health England, Chilton, Didcot, Oxon, OX11 0RQ, UK Address correspondence to G. Dabrera, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK. email: [email protected]
Introduction Lead poisoning in children (LPIC) is associated with serious health effects including neurodevelopmental problems. Population-level preventive measures have helped to reduce exposures to new sources of lead for children in high-income countries such as England. However, new LPIC cases can still occur through exposure to existing sources of lead in the environment. In this article, we discuss how development of laboratory surveillance of LPIC could aid investigation and control of environmental sources of lead. Environmental risks are a particular concern for child health due to the higher exposures in comparison to adults and also the potential effects for growth and development. In recognition of this, the World Health Organization European Region (WHO EURO) has developed The Children’s Environment and Health Action Plan for Europe (CEHAPE) to help tackle environment-related child disease among European member states. In addition to tackling morbidity related to air pollution and inadequate sanitation, a key goal of this plan is ‘to reduce the risk of disease and disability arising from exposure to hazardous chemicals (such as heavy metals)’.1 The UK is one of the EURO member states committed to ! Crown copyright 2015.
CEHAPE and has a number of pre-existing policies related to environmental risks. However, a need has been identified in the UK to improve knowledge of patterns of poisoning in children and information about the settings in which children are exposed.2 High-income countries such as the UK and USA have been successful in using population-wide measures such as legal restrictions to restrict the use of lead such as drinking water pipes, toys and paint. However, children can still be exposed to environmental lead that had accumulated prior to these interventions. These exposures can be associated with a range of health effects such as headaches, fatigue and abdominal pain.
Public health impact and management of LPIC The most recently published evidence for childhood lead poisoning in the UK comes from the Avon Longitudinal Study of Parents and Children (ALSPAC) study in the South West of England in 1995.3 In this study, investigators measured the blood lead levels of 585 children with a mean age of 2.5 years. This identified that 5.4% had concentrations greater than the limit recommended by the Page 1 of 4
Downloaded from by guest on September 15, 2015
Received 17 October 2014 and in revised form 23 December 2014
G. Dabrera et al.
Challenges in surveillance ofLPIC As with other public health threats such as communicable diseases, the public health response to individual LPIC cases is dependent on notification by clinicians to public health services such as PHE. However, it has long been recognized in England and elsewhere that communicable disease reporting by clinicians can be limited by two specific issues—incomplete case ascertainment and poor timeliness.6 In the context of LPIC, incomplete case ascertainment would lead to some cases having no public health investigation while poor timeliness would potentially delay identification of the source and prolong exposure to lead. The Surveillance of Lead in Children study in UK has been conducted to identify confirmed lead poisoning cases from
paediatricians and laboratories between June 2010 and June 2012; interim findings have indicated that
