In May 1990, the New Jersey State Department of Health (NJSDH) received laboratory reports of elevated blood lead levels ((BLLs) greater than or equal to 25 ug/dL) for 13 workers employed at a small foundry in New Jersey. Six of the workers had BLLs that exceeded 60 ug/dL; the highest was 277 ug/dL. According to the Occupational Safety and Health Administration's (OSHA) lead standard,* these six persons should have been removed immediately from further exposure to lead until their BLLs returned to acceptable ranges. NJSDH contacted the persons with elevated BLLs to obtain additional information about their lead exposures and health status. None of these persons had been evaluated medically or removed from the source of lead exposure.

After contacting company management, personnel from NJSDH and the local health department visited the foundry to assess lead exposures at the facility. The foundry, located in a residential area of a small community, manufactured valves and other small castings for the maritime industry and employed approximately 20 workers. About 60% of the casting operations involved brass and bronze alloys, which contained up to 8% lead; the remaining 40% involved pure aluminum.

On July 5, 1990, NJSDH personnel conducted medical examinations of the 15 workers who were present the day of the survey and whose jobs involved lead exposures. Blood lead and zinc protoporphyrin (ZPP) levels were obtained to assess lead exposure for the 15 employees. The highest BLL, 138 ug/dL, was present in blood obtained from the foreman (for whom the previous high level (277 ug/dL) had been detected); five other employees had BLLs greater than 50 ug/dL. ZPP levels for all 15 employees ranged from 20 to 468 ug/dL (normal: less than 50 ug/dL). Eight workers who had BLLs of 40-69 ug/dL reported symptoms compatible with lead toxicity, including unusual irritability, fatigue, memory problems, frequent headaches, sleep disturbances, and muscle or joint pain. In two employees, blood pressure was elevated (greater than 140/90 mm Hg), and a third employee had a pigmented gum line (i.e., "lead line"). All workers with symptoms or abnormal physical findings were referred for further medical evaluation. The foreman was referred for chelation therapy because of his highly elevated BLL; however, he refused treatment.

The company was referred to the OSHA area office because numerous apparent violations of the OSHA lead standard had been observed during the site visit. A subsequent OSHA investigation determined that the foundry was contaminated with lead dust and was in violation of many provisions of the lead standard. Sampling of air for lead fumes and dust performed by OSHA revealed that the OSHA permissible exposure limit of 50 ug/m3 (as an 8-hour, time-weighted average) was exceeded in certain jobs. Measured airborne lead levels ranged from 66 ug/m3 (8-hour sample) to 330 ug/m3 (200-minute sample).

NJSDH made specific recommendations, including use of personal protective equipment, engineering controls, and medical screening, to address health and safety problems identified at the foundry. The company manager has reported that a lead-monitoring program has been implemented since the NJSDH investigation, and employees requiring medical removal under the OSHA standard have been relocated to areas of acceptable air lead levels. In May 1991, NJSDH offered follow-up medical evaluations for the 15 lead-exposed employees; the company management and individual employees declined further testing. Reported by: S Marcus, MD, T Jennis, MPH, New Jersey Poison Information and Education System; I Udasin, MD, Univ of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick; B Gerwel, MD, N Long, L Trimbath, New Jersey State Dept of Health. P Kyner, J Posusney, Occupational Safety and Health Administration, US Dept of Labor. Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: In 15 states, laboratories are required to report elevated BLLs to the state health department. Even though an OSHA standard limiting lead exposure in the workplace has been in effect since 1978, cases of overexposure continue to occur (2-5). Foundries and metal-working industries have been the primary source of exposure for persons with elevated BLLs reported to state health departments; in 1988, these sites accounted for 25% of all such reports (CDC, unpublished data).

Since October 1985, NJSDH has conducted surveillance of occupational lead exposure under a state regulation that requires laboratories in the state to report all BLLs greater than or equal to 25 ug/dL in persons greater than or equal to 16 years old. The NJSDH compiles and computerizes these reports and conducts follow-up activities, including 1) medical consultations with affected persons and their private physicians; 2) industrial hygiene evaluations at workplaces identified as sources of exposure; and 3) educational efforts for affected persons, their employers, and physicians. From October 1985 through December 1990, NJSDH received 13,561 such reports for 3316 adults. Of these, 1083 persons (33%) had BLLs greater than or equal to 40 ug/dL, a level at which OSHA requires annual medical evaluation; 484 (15%) had levels greater than or equal to 50 ug/dL, an average level at which OSHA requires relocation to an unexposed job; and 103 (3%) had levels greater than or equal to 70 ug/dL, a level that usually requires medical intervention (6,7).

Elimination of occupational exposures to lead that result in BLLs greater than or equal to 25 ug/dL has been targeted by the Public Health Service as a national health objective for the year 2000 (8). In 1990, the Council of State and Territorial Epidemiologists recommended that an elevated BLL be made a notifiable condition nationwide. The increasing number and prominence of blood lead surveillance activities in state health departments are important components in the effort to achieve these goals.

References

1. Office of the Federal Register. Code of federal regulations: occupational safety and health standards. Subpart Z: Toxic and hazardous substances--lead. Washington, DC: Office of the Federal Register, National Archives and Records Administration 1985. (29 CFR Section 1910.1025).

2. CDC. Surveillance for occupational lead exposure--United States, 1987. MMWR 1989;38:642-6.

3. CDC. Lead poisoning in bridge demolition workers--Massachusetts. MMWR 1989;38:687-8, 693-4.

4. CDC. Control of excessive lead exposure in radiator repair workers. MMWR 1991;40:139-41.

5. CDC. Lead poisoning among bricklayers--Washington State. MMWR 1991;40:169-71.

6. Rempel D. The lead-exposed worker. JAMA 1989;262:532-4.

7. Cullen MR, Robins JM, Eskenezi B. Adult inorganic lead intoxication: presentation of 31 new cases and a review of recent advances in the literature. Medicine 1983;62:221-47.

8. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

*The OSHA lead standard requires medical removal of an employee from the worksite when his or her BLL exceeds 60 ug/dL on a single occasion or an average of 50 ug/dL on three separate occasions within a 6-month period (1).

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