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

December 23, 1997

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 problems in treatment of lead poisoning supports universal screening. These researchers argue that defining "race" and poverty, as well as older housing as risk factors for elevated BLLs, CDC reinforces the stereotype that the problem exists only among poor, inner-city people of color and also creates a false sense of security among higher socioeconomic status groups.

CDC writes that screening decisions should always be based on the level of risk in the population to be screened and that it is not sound public health policy to continue to emphasize universal screening in low-risk populations. Also, without the support of the broader medical community, who oppose unnecessary screening of low-risk children, any screening policy must fail. Many high-risk children are not currently being screened, and CDC's newly recommended approach will bring about state and local decision making about how to increase screening of the very children who stand to benefit from the procedure. "Our goal at this juncture should not be to screen as many children as possible. Rather, our goal must be to find as many lead-burdened children as possible and to improve their environments. It is wasteful of all our capital--the time and goodwill of parents and health care providers as well as health care dollars for our children--to screen every child irrespective of lead exposure or plausible risk."

CONTACT: Eric W. Manheimer, MSc, Department of Epidemiology, University of Maryland at Baltimore; 410-706-0321; fax 410-328-0110; e-mail <manheim@epin.ab.umd.edu>. Other author: Ellen K. Silbergeld, PhD.

Nancy M. Tips, MA, National Center for Environmental Health, Denters for Disease Control and Prevention; 770-488-7277; fax 770-488-7335; e-mail<nmtl@cdc.gov>. Other authors, Henry Falk MD, Richard J. Jackson, MD MPH.
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Public Health Reports

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