2002～2008年门诊儿童血铅水平动态分析

[目的] 探索2002～2008年间门诊儿童血铅水平(blood lead levels,BLLs)的变化趋势和规律. [方法]收集2002年1月～2008年8月间在上海儿童医学中心进行静脉血铅筛查的所有儿童血铅筛查资料,并将结果进行统计分析,比较七年来儿童平均BLLs和血铅超标比例的动态变化情况及性别年龄间的差异. [结果] 七年间共计筛查14 596人次,平均年龄为(6.56±3.42)岁,其中男童9 829人次,血铅几何均数(xG)为(52.24±1.64)μg/L,女童4 767人次,血铅xG为(45.71±1.62)μg/L.2002～2008年,血铅xG分别为:64.63、59.65、54.17、56.09、47.59、44.88、38.08μg/L,各年度之间差异有显著性(F=262.83,P<0.01);BLLs≥100 μg/L所占百分比分别为:18.37%、12.56%、9.15%、10.15%、4.76%、4.02%、1.05%. [结论] 2002～2008年间该院门诊儿童BLLs几何均数及≥100 μg/L的比例总体上呈逐年下降趋势,可能与上海市汽油无铅进程、工业污染改善等因素有关;儿童血铅水平存在性别差异,男童显著高于女童.     

德阳市城区0～6岁儿童血铅水平调查

目的:了解德阳市城区0~6岁儿童全血中铅的浓度,以采取措施降低儿童血铅水平,预防儿童铅中毒。方法:随机抽取前来我院作儿保的婴幼儿和托儿所幼儿院的儿童男女共1 106名,测定血铅浓度,分别计算出男女0~3岁和4~6岁年龄段血铅浓度的平均值x及标准差s,以及不同血铅浓度范围所占的例数和比例。检测采用电位溶出法。结果:0~3岁男童的血铅浓度为(64.09±32.20)μg/L;女童为(63.00±32.60)μg/L。4~6岁男童为(77.56±33.00)μg/L;女童为(75.7±34.23)μg/L。0~3岁儿童的血铅中毒率男童为18.02%,女童为15.94%,0~3岁儿童血铅浓度水平主要集中在0~59μg/L,达45%以上。4~6岁儿童的血铅中毒率男童为22.67%,女童为20.69%,4~6岁儿童的血铅浓度水平主要集中在60~99μg/L,达50%。结论:血铅浓度水平与男女性别无显著相关,而与不同年龄段呈显著相关。近两成的儿童有铅中毒,且以I,II级为主。3.60μg/L以上的血铅浓度所占比例大于50%     

石家庄市2004～2006年7岁以下儿童血铅水平调查分析

目的:了解石家庄市0～6岁儿童血铅水平分布情况、铅中毒现状以及影响危险因素的相关资料,为政府制定政策和切实可行的预防措施。方法:整群分层随机抽样调查城区0～6岁儿童3687例。采用BH2100微量血测铅仪测定末梢血血铅水平,《选用中国部分城市儿童铅中毒防治项目调查表》进行问卷调查。结果:儿童的喂养方式、生活习惯、卫生习惯、户外活动时间、钙、锌、铁剂的使用是儿童血铅水平的影响因素。结论:随着年龄增长,儿童铅中毒检出率增加,以3～4岁组最高。采用科学的喂养育儿方式,培养儿童良好的生活卫生习惯,彻底治理大环境均有利于预防和减少儿童铅中毒。     

2008年宁阳县6879名2～12岁儿童血铅水平调查

[目的]了解宁阳县2～12岁儿童血铅水平及含量超标状况。[方法]按照卫生部《儿童高铅血症和铅中毒分级和处理原则(试行)》标准,采用分层整群随机抽样对县城和乡村小学或幼儿园健康儿童进行血铅检测。[结果]调查6879人,血铅异常者1 962人,异常率为28.52%,均为中度以下异常。城乡儿童血铅异常率的差异有统计学意义(P0.01)。不同性别儿童血铅异常率的差异有统计学意义(P0.05)。随年龄增加,血铅超标机率增加。[结论]农村儿童血铅水平超标现象低于城区和工业发达地区,但潜在威胁不容忽视。     

2004年6月～2005年12月信阳市儿童血铅检测结果

目的了解信阳市儿童铅中毒状况,为开展儿童铅中毒防治提供依据。方法采用电极溶出分析法对到信阳市疾病预防控制中心门诊部就诊的1 800名儿童进行检测。结果血铅≥100μg/L的儿童765人,铅中毒检出率为42.5%,男女童阳性比明显高于就诊比,年龄组中以幼儿组最高。结论儿童铅中毒总体情况较河南省的情况轻,但也应该引起重视。     

2014年重庆市涪陵区学龄儿童血铅检测结果

目的了解重庆市涪陵区学龄儿童血铅水平,为科学防治儿童铅中毒提供参考依据。方法抽取688名儿童并采集静脉血标本,用石墨炉原子吸收光谱法测定血铅含量。结果儿童的血铅平均水平为49.46μg/L,异常检出率为5.52%,儿童血铅水平及血铅异常检出率无性别差异(P>0.05),7~9岁组高于10~12岁组(P<0.05),父母的职业、不良生活行为习惯、居住环境污染等为儿童铅暴露的来源。结论涪陵区儿童的血铅水平及血铅异常情况不容忽视。     

武汉市及周边地区儿童2006～2008年血铅水平及趋势

目的:分析近3年武汉市及周边地区不同年龄儿童血铅水平及变化趋势。方法:采用钨舟原子吸收光谱法对2006～2008年来儿童医院就诊和体检的24 980例儿童手指末梢血进行铅含量检测。受检儿童按年龄进行分组,并对检测结果进行统计分析。结果:武汉市及周边地区儿童血铅总体均值为58.26μg/L。其中,男性血铅的平均值为60.12μg/L,高于女性血铅的平均值(54.24μg/L),2006～2008年儿童血铅各年度平均值分别为(67.51±31.02)μg/L、(60.97±32.58)μg/L和(50.32±27.55)μg/L。在不同年份各年龄组中,男性血铅均值皆高于女性。24 980例受检儿童血铅水平为:50μg/L以下者占44.51%,51～100μg/L占48.13%、101～200μg/L占6.68%、201μg/L以上者占0.68%。本资料显示儿童血铅水平≥100μg/L(铅中毒)者占受检总数的7.35%,2006～2008年受检儿童铅中毒率分别为15.88%、7.74%和2.13%。与门诊儿童血铅水平进行比较,体检儿童的血铅水平明显偏低,差异具有统计学意义。结论:与以往的资料比较,武汉市儿童的血铅水平以及铅中毒率已明显下降。近3年来,武汉市及周边地区儿童血铅含量呈逐年递减趋势,其中以2008年度受检儿童血铅水平下降尤为明显。     

2010年潍坊市部分0～14岁儿童血铅水平调查

[目的]了解潍坊市儿童血铅水平,以便探讨儿童铅中毒防治对策。[方法]2010年,在潍坊市抽取城乡0~14岁儿童4 223名进行调查。[结果]调查4 223人,血铅浓度为56.57±27.12μg/L(男童为58.58±27.14μg/L、女童为53.87±26.89μg/L),其中>100μg/L的233例,均为轻度铅中毒,铅中毒检出率为5.52%。铅中毒检出率,男童为5.90%,女童为5.01%(P>0.05);0~4岁为2.68%,5~6岁为8.67%,7~14岁为6.96%(P<0.01);父亲大专以上、高中、初中/小学文化者分别为4.43%、5.61%、7.82%(P<0.01);父亲从事与铅有关专业、无关工作者分别为10.20%、4.70%(P<0.01),母亲从事与铅有关、无关专业工作者分别为12.68%、5.20%(P<0.01);家庭住址位于临街、距离车流主干道>7 m、远离主干道者分别5.69%、5.67%、3.11%(P<0.01)。[结论]潍坊市0~14岁儿童血铅水平不高,5~6岁、父亲文化程度较低、父母从事与铅有关专业工作、临街居住的儿童铅中毒检出率较高。     

柳州城区学龄前儿童血铅水平分析

铅是一种具有神经发育毒性的重金属元素,它对人类健康的影响是多方面的,尤其是低浓度铅对儿童各个系统的危害已日益受到国内外学者的广泛关注。为了解近年来柳州城区学龄前儿童铅中毒状况,探讨不同年龄阶段、不同性别以及工业区跟普通市区儿童铅中毒情况,于2005年6月~2007年9月     

2008-2012年合肥市城区儿童血铅水平监测结果及分析

目的了解2008-2012年合肥市城区儿童血铅水平、高血铅率及其动态变化趋势,为预防儿童铅中毒提供科学依据。方法每年选择合肥四个城区分层整群随机抽样;用钨舟原子吸收光谱仪测定血铅值,并进行质量控制。结果2008-2012年0~6岁儿童血铅水平为32.08μg/L,儿童高血铅率平均为1.0%;5年中儿童血铅水平有统计学意义(P0.01),5年中儿童高血铅率差异无统计学意义(P=0.63);各年龄组儿童血铅水平差异有统计学意义(P0.01),各年龄组儿童高血铅率差异无统计学意义(P=0.57);男、女童血铅水平、高血铅率差异无统计学意义。合肥市城区儿童血铅水平:包河区最高,蜀山区最低,瑶海、庐阳处于中间水平;高血铅相关危险因素主要包括:不清洗玩具,饭前不洗手,不食用奶制品,不补充钙、锌、铁剂。结论合肥市儿童血铅水平处于相对污染较轻地区,要加强健康教育,促进儿童建立良好的生活行为方式。     

Association between children's blood lead levels, lead service lines, and water disinfection, Washington, DC, 1998-2006

Objective

Evaluate the effect of changes in the water disinfection process, and presence of lead service lines (LSLs), on children’s blood lead levels (BLLs) in Washington, DC.

Methods

Three cross-sectional analyses examined the relationship of LSL and changes in water disinfectant with BLLs in children <6 years of age. The study population was derived from the DC Childhood Lead Poisoning Prevention Program blood lead surveillance system of children who were tested and whose blood lead test results were reported to the DC Health Department. The Washington, DC Water and Sewer Authority (WASA) provided information on LSLs. The final study population consisted of 63,854 children with validated addresses.

Results

Controlling for age of housing, LSL was an independent risk factor for BLLs ≥10 μg/dL, and ≥5 μg/dL even during time periods when water levels met the US Environmental Protection Agency (EPA) action level of 15 parts per billion (ppb). When chloramine alone was used to disinfect water, the risk for BLL in the highest quartile among children in homes with LSL was greater than when either chlorine or chloramine with orthophosphate was used. For children tested after LSLs in their houses were replaced, those with partially replaced LSL were >3 times as likely to have BLLs ≥10 μg/dL versus children who never had LSLs.

Conclusions

LSLs were a risk factor for elevated BLLs even when WASA met the EPA water action level. Changes in water disinfection can enhance the effect of LSLs and increase lead exposure. Partially replacing LSLs may not decrease the risk of elevated BLLs associated with LSL exposure.     

Elevated blood lead levels in refugee children--New Hampshire, 2003-2004

As a result of reductions in lead hazards and improved screening practices, blood lead levels (BLLs) in children aged 1-5 years are decreasing in the United States. However, the risk for elevated BLLs (> or =10 microg/dL) remains high for certain populations, including refugees. After the death of a Sudanese refugee child from lead poisoning in New Hampshire in 2000, the New Hampshire Department of Health and Human Services (NHDHHS) developed lead testing guidelines to screen and monitor refugee children. These guidelines recommend 1) capillary blood lead testing for refugee children aged 6 months-15 years within 3 months after arrival in New Hampshire, 2) follow-up venous testing of children aged <6 years within 3-6 months after initial screening, and 3) notation of refugee status on laboratory slips for first tests. In 2004, routine laboratory telephone reports of elevated BLLs to the New Hampshire Childhood Lead Poisoning Prevention Program (NHCLPPP) called attention to a pattern of elevated BLLs among refugee children. To develop prevention strategies, NHDHHS analyzed NHCLPPP and Manchester Health Department (MHD) data, focusing on the 37 African refugee children with elevated BLLs on follow-up for whom complete data were available. This report describes the results of that analysis, which indicated that 1) follow-up blood lead testing is useful to identify lead exposure that occurs after resettlement and 2) refugee children in New Hampshire older than those routinely tested might have elevated BLLs. Refugee children in all states should be tested for lead poisoning on arrival and several months after initial screening to assess exposure after resettlement.     

Impact of lead transport on children's blood and environmental lead levels

Introduction: A lead monitoring project was established in 1996 to monitor the environmental and health effects of lead being transported through a remote town in tarpaulin‐covered trucks. Methods: Dust samples from sites on the transport route were collected at 3–6 monthly intervals between 1996 and 1999. Annual blood lead testing clinics, offering voluntary testing to children, were conducted from 1997 to 1999. Results: Of the 55 dust samples analysed, only nine contained particles of lead concentrate and these were present at very low levels. During the project 167 children were tested. The geometic mean of blood lead levels in 1997, 1998 and 1999 were 4.5 μg/dL, 5.0 μg/dL and 5.1 μg/dL, respectively (all within the normal range). Residence on the transport route was not associated with higher lead levels (P > 0.05). Conclusions: Lead transport was not associated with any detectable environmental contamination or increase in children's blood lead levels.     

Prediction of children's blood lead levels on the basis of household-specific soil lead levels

To help guide policy decisions about removing lead-contaminated soils, the authors estimated a regression model for predicting a child's blood lead level on the basis of his or her household-specific soil lead level. The data analyzed were blood lead levels (1-45 micrograms/dl) and household-specific soil lead levels (53-20,700 ppm) of 596 children aged 1-5 years who lived in the Helena Valley of Montana and the Silver Valley of Idaho during August 1983. A non-threshold, multiple linear regression model indicated that the estimated mean natural log transformed blood lead level increased by 0.231 micrograms/dl for each unit increase in natural log transformed soil lead level (ppm), after adjusting for the average number of daily outdoor play hours and whether someone in the household smoked. The model predicted that, at a soil lead level of 1,000 ppm, a child who does not play outside and who does not live in a household where someone smokes would be at low risk of lead toxicity (blood lead level between 4 and 24 micrograms/dl).     

Effect of interventions on children's blood lead levels.

Trail, Canada, has been the site of an active lead/zinc smelter for nearly a century. Since 1991, the Trail Community Lead Task Force has carried out blood lead screening, case management, education programs targeted at early childhood groups and the general community, community dust abatement, exposure pathways studies, and remedial trials. From 1989 through 1996, average blood lead levels of children tested for the first time declined at an average rate of 0.6 microg/dl/year, while blood lead levels in Canadian children not living near point sources appeared to be leveling off following the phase-out of leaded gasoline. Since there was no concurrent improvement in local environmental conditions during this time, it is possible that the continuing decline in Trail blood lead levels has been at least partly due to community-wide intervention programs. One year follow-up of children whose families received in-home educational visits, as well as assistance with home-based dust control measures, found that these specific interventions produced average blood lead changes of +0.5- -4.0 microg/dl, with statistically significant declines in 3 years out of 5. Education and dust control, particularly actions targeted toward higher risk children, appear to have served as effective and appropriate interim remedial measures while major source control measures have been implemented at the smelter site.     

An investigation of dust lead sampling locations and children's blood lead levels

The objective of this study is to provide guidance on where to collect dust lead wipe samples in homes to best characterize the risk of a resident child having a blood lead level at or above the CDC level of concern (10 microg/dl). In 1998, the Milwaukee Health Department enrolled 72 children living in pre-1950 buildings: 34 had elevated (i.e., > or = 10 microg/dl) blood lead levels (EBL); and 38 had non-elevated blood lead levels (non-EBL). This study explored dust lead sampling locations by examining loading differences between homes where children with EBL and non-EBL lived. Floor, windowsill, and window trough samples were collected in the living room, kitchen, bathroom, and child's bedroom and play area. Floor samples were collected at four locations: room entry; center of the room; under a window; and against the wall opposite the window (perimeter). Geometric mean floor dust lead levels were generally two to three times higher in homes of EBL children than homes of non-EBL children. Sampling the floor at the room entry or center is preferable to sampling under the window or from the perimeter of the room. When the central floor average was used, the room combinations that had the greatest differences between homes of EBL children and non-EBL children all included a sample from the child's bedroom and excluded the bathroom. When the entry floor average was used, the greatest differences also excluded bathrooms, but otherwise included a mix of all of the other rooms. Window samples did not distinguish where children with EBLs versus non-EBLs resided. This paper is based on Milwaukee alone, so generalizing results to other locations should be done with caution.     

Lead-contaminated imported tamarind candy and children's blood lead levels

In 1999, an investigation implicated tamarind candy as the potential source of lead exposure for a child with a significantly elevated blood lead level (BLL). The Oklahoma City-County Health Department tested two types of tamarind suckers and their packaging for lead content. More than 50% of the tested suckers exceeded the US Food and Drug Administration (FDA) Level of Concern for lead in this type of product. The authors calculated that a child consuming one-quarter to one-half of either of the two types of suckers in a day would exceed the maximum FDA Provis onal Tolerable Intake for lead. High lead concentrations in the two types of wrappers suggested leaching as a potential source of contamination. The authors used the Environmental Protection Agency's Integrated Exposure Uptake Biokinetic (IEUBK) model to predict the effects of consumption of contaminated tamarind suckers on populat on BLLs. The IEUBK model predicted that consumption of either type of sucker at a rate of one per day would result in dramatic increases in mean BLLs for children ages 6-84 months in Oklahoma and in the percentage of children wth elevated BLLs (> or =10 micrograms per deciliter [microg/dL]). The authors conclude that consumption of these products represents a potential public health threat. In addition, a history of lead contamination in imported tamarind products suggests that import control measures may not be completely effective in preventing additional lead exposure.     

Soil lead abatement and children's blood lead levels in an urban setting.

OBJECTIVES: The effect of abating soil lead was assessed among Baltimore children. The hypothesis was that a reduction of 1000 parts per million would reduce children's blood lead levels by 0.14 to 0.29 mumol/L (3-6 micrograms/dL). METHODS: In 2 neighborhoods (study and control), 187 children completed the protocol. In the study area, contaminated soil was replaced with clean soil. RESULTS: Soil lead abatement in this study did not lower children's blood lead. CONCLUSIONS: Although it did not show an effect in this study, soil lead abatement may be useful in certain areas.     

中国2004～2006年流行性脑脊髓膜炎病原学监测

目的对中国(未包括香港、澳门特别行政区和台湾地区)2004～2005年度(2004年10月～2005年9月)、2005～2006年度(2005年10月～2006年9月)流行性脑脊髓膜炎(流脑)病原学监测结果进行分析,了解脑膜炎奈瑟菌(Nm)菌株血清群分布及变迁趋势,C群Nm菌株的分布特征和Nm菌株的耐药性。方法2004～2005、2005～2006年度共收集送检菌株1 125株,均进行复核鉴定、血清分群和药物敏感性检测。结果1 125株送检菌株中,经鉴定Nm菌株为892株,菌株送检有效存活率为79.29%。2004～2005年度有效存活572株的血清群构成为:A群26.0%,B群28.6%,C群14.9%,其它血清群11.0%;2005～2006年度有效存活325株的血清群构成为:A群33.1%,B群14.3%,C群26.3%,其它群4.8%。已有20个省(自治区、直辖市,下同)分离到C群Nm菌株,其中15个省发现C群流脑病例。A群和C群Nm菌株表现出不同的抗生素敏感性。结论应加强流脑病原学监测工作,提高Nm监测中有效菌株的数量,密切关注C群流脑扩散趋势,及时监测Nm菌株的耐药性特征。     

湖北省2004—2006年流感流行株监测分析

目的通过流感病原学监测结果，为控制湖北省流感流行提供依据。方法采集病人鼻咽拭子，MDCK细胞接种，培养分离和鉴定流感病毒。结果湖北省2004—2006年分别分离出H1N1、H3N2“O”、Yamagata“B”、Victoria“B”流感病毒株。结论4种亚型流感病毒株流行优势交叉出现，打破以往一种流感病毒亚型毒株呈现单一周期性流行规律。