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Childhood Lead Poisoning - World Health …

Childhood Lead PoisoningChildhoodLead PoisoningWHO Library Cataloguing-in-Publication DataChildhood lead Poisoning - etiology. Poisoning - prevention and control. exposure. Health practice. Health 978 92 4 150033 3 (NLM classification: QV 292) World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: Requests for permission to reproduce or translate WHO publications whether for sale or for noncommercial distribution should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: The designations employed and the presentation of the material in this publication))

Childhood Lead Poisoning 5 Contributors Working group members Yona Amitai, Mother Child & Adolescent Health, Ministry of Health, Jerusalem, Israel

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1 Childhood Lead PoisoningChildhoodLead PoisoningWHO Library Cataloguing-in-Publication DataChildhood lead Poisoning - etiology. Poisoning - prevention and control. exposure. Health practice. Health 978 92 4 150033 3 (NLM classification: QV 292) World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: Requests for permission to reproduce or translate WHO publications whether for sale or for noncommercial distribution should be addressed to WHO Press, at the above address (fax: +41 22 791 4806.))

2 E-mail: The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.

3 Errors and omissions excepted, the names of proprietary products are distinguished by initial capital reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. This publication contains the collective views of an international group of experts and does not necessarily represent the decisions or the policies of the World Health by the WHO Document Production Services, Geneva, Switzerland.

4 ContentsContributors 5 Abbreviations 7 Preface 8 Foreword 9 Summary 11 Introduction: lead Poisoning a persistent problem 13 The nature, sources and routes of exposure to lead 15 Lead toxicity and its effects on Health 20 Diagnosing lead Poisoning 49 References 55 Annex. Additional information 69 Childhood Lead Poisoning5 ContributorsWorking group membersYona Amitai, Mother Child & Adolescent Health , Ministry of Health , Jerusalem, IsraelHamed Bakir, WHO Regional Centre for Environmental Health Activities, Amman, JordanNida Besbelli, WHO European Centre for Environment and Health , Bonn, GermanyStephan Boese-O Reilly, University for Health Sciences, Medical Informatics and Technology, Tirol, AustriaMariano Cebrian, Centro de Investigaci n y de Estudios Avanzados del IPN.

5 Mexico City, MexicoYaohua Dai, Department of Child Health Care, Capital Institute of Pediatrics, Beijing, ChinaPaul Dargan, Medical Toxicology Unit, Guy s and St Thomas Poisons Unit, London, EnglandElaine Easson, Risk Management Section, Health Canada, Ottawa, Ontario, CanadaNathan Graber, Division of Environmental Health , New York City Department of Health and Mental Hygiene, New York, NY, United States of America Chems-Eddouha Khassouani, Laboratory of Toxicology and Pharmacology, Centre Anti-Poison, Rabat, MoroccoNorman Healy, Health Canada, Burnaby, British Columbia, CanadaZbigniew Kolacinski, Clinical Toxicology Department, Nofer Institute of Occupational Medicine, Lodz, Poland Amalia Laborde, Department of Toxicology and Poison Control Center, Universidad de la Rep blica, Montevideo, UruguayPhilip Landrigan, Mt Sinai School of Medicine, New York, NY, United States of AmericaBruce Lanphear, Cincinnati Children s Hospital Medical Center, Cincinnati, OH.

6 United States of America World Health Organization6 Angela Mathee, South African Medical Research Council, Johannesburg, South AfricaMonique Mathieu, Centre Antipoison de Lille, Centre Hospitalier R gional Universitaire, Lille Cedex, FranceGeraldine McWeeny, WHO Country Office, Belgrade, SerbiaWHO SecretariatRuth A. Etzel, Department of Public Health and Environment, World Health Organization, Geneva, SwitzerlandJenny Pronczuk, Department of Public Health and Environment, World Health Organization, Geneva, SwitzerlandReviewersDavid Bellinger, Harvard School of Public Health , Boston, MA, United States of AmericaMarie-Noel Brun , Department of Public Health and Environment, World Health Organization, Geneva, SwitzerlandLilian Corra, Asociation Argentina de M dicos por el Medio Ambiente, Buenos Aires, ArgentinaPaschal H fliger.

7 Department of Public Health and Environment, World Health Organization, Geneva, SwitzerlandKathleen M. McCarty, Yale University School of Medicine, New Haven, Connecticut USAMary Kimotho M Mukindia, United Nations Environment Programme, Nairobi, KenyaDorit Nitzan, WHO Country Office, Belgrade, SerbiaJudy Stober, Department of Public Health and Environment, World Health Organization, Geneva, SwitzerlandJoanna Tempowski, Department of Public Health and Environment, World Health Organization, Geneva, SwitzerlandChildhood Lead Poisoning7 AbbreviationsOrganizations and other entitiesASTM American Society for Testing and Materials CDC United States Centers for Disease Control and Prevention CPSC United States Consumer Product Safety CommissionEPA United States Environmental Protection AgencyHUD United States Department of Housing and Urban DevelopmentJECFA United Nations Food and Agriculture Organization and World Health Organization Joint Expert Committee on Food Additives OAS Organization of American States OECD Organisation for

8 Economic Co-operation and DevelopmentUNEP United Nations Environment ProgrammeUSPSTF United States Preventive Services Task ForceWHO World Health OrganizationTechnical termsBLL blood lead level DALYs disability-adjusted life years EBLL elevated blood lead level IQ intelligence quotient PM10 particulate matter less than 10 m in diameter World Health Organization8 PrefaceAlthough many countries have initiated programmes to lower the level of lead in the environment, human exposure to lead remains of concern to Health care providers and public Health officials worldwide.

9 For over 35 years the World Health Organization and the International Programme on Chemical Safety have been concerned about the adverse effects on Health of lead in the environment. The evaluation of human Health risks arising from foodborne lead has been carried out by the World Health Organization on four occasions since 1972. In addition, Health -based guidance values for lead in water, air and the workplace have been developed by various task groups convened by the World Health Organization. Environmental Health Criteria 3: Lead, published in 1977, examined the effects of lead on human Health , and Environmental Health Criteria 85: Lead Environmental Aspects was published in 1989.

10 During the past 10 years, a large body of knowledge on the effects of lead on neurobehavioural development of children at low levels of exposure has accumulated. This booklet focuses on what is known about Childhood lead Poisoning , an entirely preventable Lead Poisoning9 ForewordDear Colleagues,It is with great pleasure I present to you this booklet on Childhood Lead Poisoning has been a scourge to human Health for millennia. Childhood lead Poisoning has been a recognized clinical entity since the first decade of the 20th century. Lead has had devastating consequences for the Health of the World s children.


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