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HEALTH CONSULTATION

Blood Lead Results for 2001 Calendar year

HERCULANEUM LEAD SMELTER SITE
HERCULANEUM, JEFFERSON COUNTY, MISSOURI


BACKGROUND AND STATEMENT OF ISSUES

Statement of Issues

In December 2001, the Missouri Department of Health and Senior Services (DHSS)presented the preliminary results of two voluntary blood lead screening events inHerculaneum, Missouri to the Herculaneum Community Advisory Group. At the requestof that group, this health consultation will evaluate all known blood lead data collectedfrom residents in the community near the Herculaneum Lead Smelter facility inHerculaneum, Jefferson County, Missouri during 2001. Conclusions andrecommendations in this document were made based on data available as of January 18,2002.

Background

The Herculaneum lead smelter is an active facility that has been in operation in thiscommunity since 1892. The Doe Run Company currently owns and operates the smelter. The facility is located at 881 Main Street in Herculaneum, Missouri, approximately 25miles south of St. Louis, Missouri, on the Mississippi River. It abuts residentialneighborhoods on the north, west, and south, with the Mississippi River on the east. Alead ore concentrate, consisting of approximately 80% lead sulfide, is processed at thesmelter. The ore is transported by truck from eight lead mines operated by the companynear Viburnum, Missouri, approximately 75 miles south-southwest of Herculaneum. The52-acre Herculaneum facility consists of a smelter plant, 24-acre waste slag storage pile,and an onsite sulfuric acid plant (1).

The city of Herculaneum has an estimated population of 2,805 people, according to the2000 US Census. Several homes are within 200 feet of the smelter plant, and at least fourhomes are within 200 feet of the slag pile. Figures 1 and 2 display the location of thesmelter in relationship to the community (2). Three schools are in the city: a high school,a middle school and a junior high school. The elementary school is in near-by Pevely. There are no licensed day-care facilities in the city of Herculaneum.

Environmental sampling has shown lead contamination throughout the community. Forexample, lead has been found in yard soils at concentrations up to 33,100 parts permillion (ppm) (3); in air ranging from non-detectable (ND) to 85 micrograms per cubicmeter (g/m3) (4); and in dust on streets ranging from 30,000 ppm to 300,000 ppm (5). MDHSS has initiated health education for area residents and physicians to increase theirawareness of public health issues associated with lead and the benefits of routine bloodlead testing for children.

Although there may be multiple sources of lead contributing to the over all contamination(e.g., lead-based paint, lead from gasoline, etc.), it has been documented during previousscreenings that proximity to the smelter appears to be associated with higher blood leadlevels (BLL) (2).In the past year, DHSS and Jefferson County Health Department(JCHD), in cooperation with the Agency for Toxic Substances and Disease Registry(ATSDR), have offered blood lead testing to the residents of Herculaneum andsurrounding communities. Two testing efforts have occurred in Herculaneum.

During August of 2001, the DHSS and JCHD offered a voluntary community-widevenous blood lead testing in cooperation with ATSDR. Laboratory support and analysiswas provided by the Missouri State Public Health Laboratory (SPHL). Individualsparticipating in this screening included residents from Herculaneum and surroundingcommunities including Pevely, Crystal City, and Festus.

The most recent blood lead screening effort was conducted in October 2001 as part of acensus to identify all children under the age of 72 months living within the Herculaneumcity limits. Venous blood samples were collected by certified phlebotomists from DHSS,JCHD, and St. Louis County Health Department. Laboratory support and analysis wasprovided by the SPHL. Residents of adjacent communities who thought, for variousreasons, that they spent a considerable amount of time in Herculaneum were also testedupon their request. DHSS has identified a total of 199 children under the age of sixresiding within the Herculaneum city limits.

The DHSS has established elevated blood lead to be a reportable condition. CSR 20-20.020 states that all blood lead levels of 10 micrograms of lead per deciliter of wholeblood (g/dL) or higher in persons under age 18, or 25 g/dL or higher in persons age 18or greater (lead poisoning level for adults) are reportable to the DHSS by a physician,laboratory, and hospital. The State Public Health Laboratory (SPHL), private physicians,and various laboratories have provided blood lead level data to the DHSS Office ofSurveillance, which maintains databases on reportable conditions.

The data set evaluated in this health consultation includes blood lead data collected byand/or reported to the DHSS over the course of calendar year 2001, as required by thestate regulation as well as results from the two screening events conducted by the DHSS. Laboratory analytical methods are not described, and vary for all of the data. However,the data are sufficient to determine whether blood lead levels in the community wereelevated.

Only data for Herculaneum residents are considered in this analysis. For individuals whohave multiple BLL results for the year, the highest BLL reported for the individual hasbeen used in the evaluation. Only test results from venous blood draws were used; anycapillary test results have been removed from the data set.

A total of 935 people were tested; 118 of these were children under the age of 72 months,162 children between the ages of six and 17 years, and 655 adults age 18 or higher. Ofthe children less than 72 months of age, which were tested, 33 had BLLs of 10 g/dL orhigher (28%), ranging from ND-31 g/dL. In children between the ages of six and17years, 13 had BLLs of 10 g/dL or higher (8%), ranging from 10 g/dL to 19 g/dL. Ofthe 655 adults tested, two had BLLs of 25 g/dL or higher. The men range from 10g/dL to 31g/dL and women were from 10 g/dL to 55 g/dL. Tables 1, 2, and 3 containa summary of these results.

Table 1.

Blood Lead Levels of Children less than 72 months of age for January through December, 2001 reported to DHSS for Zip Code 63048
Blood lead levels in g/dL Number of individuals
0 - 9 85
10 - 19 27
20 - 29 5
30 or higher 1


Table 2.

Blood Lead Levels of Children between 6 and 17 years of age for January through December, 2001 reported to DHSS for Zip Code 63048
Blood lead levels in g/dL Number of individuals
0 - 9 149
10 - 19 13
20 - 29 0
30 or higherr0


Table 3.

Blood Lead Levels for Adults, 18 years and older for January through December, 2001 reported to DHSS for Zip Code 63048
Blood lead level (g/dL) Number of Individuals
0 - 24 653
25 - 39 1
40 - 49 0
50 and higher 1

Data for other sensitive subgroups such as fetuses, theoretically exposed through women of childbearing age 15-44 years, and the elderly (i.e., 65 and older) were examined more closely. Table 4 summarizes this evaluation. This analysis found that 197 women of childbearing age were tested. In this group, only one had a BLL of 10 g/dL or higher (55 g/dL). Twenty-one of the women tested in this group were aged 15 to 17 years; the remaining 176 were 18 or older.

A total of 166 residents 65 years of age and older were tested. Twenty-one had BLLs of10 g/dL or higher; five females and 16 males. Twenty-two g/dL was the highestfemale BLL and 24 g/dL was the highest male BLL.

Table 4.

lood Lead Levels for sensitive populations for January through December, 2001 reported to DHSS for Zip Code 63048
Blood lead level (g/dL) Women of child bearing age
15-44 years (n=197)
Elderly, 65 years and older
(n=166)
0 - 9 196 145
10 - 19 0 17
20 - 29 0 4
30 or higher 1 0


DISCUSSION

Childhood lead poisoning is a major, but preventable, environmental health problem. Children are a high risk group. They are generally assumed to be at an increased risk ofexposure to chemicals in soil due to their more frequent soil contact and tendency toingest soil, either intentionally or through normal hand-to mouth behavior. Exposure tolead in utero, in infancy, and in early childhood may slow mental development and lowerintelligence later in life. The Centers for Disease Control and Prevention (CDC)recommends that BLLs remain below 10 g/dL to decrease the likelihood of neurologicaland learning problems in children. Other unusually susceptible populations include theelderly, people with inheritable genetic diseases, alcoholics and smokers, and people withneurological dysfunction or kidney disease (6,7).

Recent data from the National Health and Nutrition Examination Survey, Blood LeadLevels in Young Children, 1996- 1999 (NHANES) conducted by the CDC, stated that themean children's BLL in the U.S. is 2.0 g/dL (8). Average BLLs in the United Stateshave fallen dramatically since the 1970's. In 1976-1980, the average BLL in childrenwas 15 g/dL, and in 1991-1994, the average was 2.7 g/dL (7). The national prevalencefor BLLs greater than or equal to 10 g/dL in children is 7.6% (8).

Based on all the blood lead data provided to DHSS, significant blood lead elevationshave been documented in this community. The data provided neither represent a randomsample of the community nor represent the entire community; these BLLs are reflectiveof physician selection and/or self-selection. During the 2001 calendar year, 118 childrenin the 63048 zip code were tested for lead. Thirty-three of these 118 were found to haveBLLs of 10 g/dL or higher (28%). This is higher than the national prevalence rate of7.6% (8) and the Missouri rate of 8%.

When BLLs for children residing east of Highway 61/Commercial Blvd. (the portion ofthe community closer to the smelter) are examined exclusively, 30 of 67 children,approximately 45%, had BLLs of 10 g/dL or higher. This is significantly higher than thenational prevalence rate of 7.6 % and the Missouri prevalence rate of 8%. The averageBLL in children less than 72 months, regardless of proximity to the smelter, was 8.0g/dL for the entire calendar year, with BLLs ranging from 2-31 g/dL. This is alsohigher than the national mean BLL of 2.0 g/dL. Based on these BLLs and prevalencerates, it is likely that adverse health effects, such as those mentioned above, may beoccurring in a considerable portion of the children in this community.

The data indicates that the average BLL for women between the ages of 15- 44 is 3.4g/dL. This is higher than the national mean BLL of 1.8 g/dL for this age group (9). Noadverse health effects would be expected for women at this level. Nevertheless, lead hasbeen demonstrated to cross the placenta at levels less than 10 g/dL (10). Adversehealth effects may be expected for the one female screened late in the year with a BLL of55 g/dL. That is, should this woman become pregnant at this BLL, adverse healtheffects may be expected for the fetus.

Individuals 65 years and older were found to have a mean blood lead level of 5.9 g/dL(9). This is slightly higher than the national mean BLL of 3.3 g/dL. No adverse healtheffects, however, would be expected from current BLLs at this level (9). Still, some pastand present occupational and recreational exposures(e.g., crafts and hobbies)have beenidentified for this subgroup that may be contributing to their elevations.


CHILD HEALTH INITIATIVE

Children and adults are exposed to lead in many of the same ways. But children are notsmall adults. They differ in the behaviors that lead to their exposures as well as theirsusceptibility to toxic effects from lead exposures. Children are more likely to playoutdoors and bring food into contaminated areas. They are also shorter than adults, soare more likely to breathe dust and soil that are close to the ground, and children aresmaller, resulting in higher doses of chemical exposure per pound of body weight. (6)

Further, children have developing body systems that can sustain permanent damage iftoxic exposures occur during critical growth stages. Compared to adults, children absorbmore of the lead they take into their bodies, retain more of the lead they take in, and aremore sensitive to its effects. (6)

Children may be exposed to lead inside their homes, outside in their yards, playgrounds,parks, and while attending school. This community is faced with widespreadenvironmental contamination. Because children depend on adults for risk identificationand management decisions, it is prudent that further lead exposure be prevented.


CONCLUSIONS

The blood lead data reviewed indicate that exposures have occurred, are occurring, andare likely to occur in the future; and short-term exposures are likely to have an adverseimpact on human health. Consequently, this site has been classified as an urgent publichealth hazard. Specifically, we conclude the following:

  1. Twenty-eight percent (28%) of children in this community have blood lead levelsknown to cause adverse health effects. Forty-five percent (45%) of the childrenresiding east of Hwy 61/Commercial Blvd. have blood lead levels known to causeadverse health effects.

  2. Of the females of childbearing age in this community tested for BLL, one has ablood lead level that could cause adverse health effects to her developing fetus ifshe became pregnant.

RECOMMENDATIONS

  1. Risk management agencies should assure that steps are taken to eliminate/reducethe source(s) of lead exposure as soon as possible.

  2. Risk management agencies should conduct environmental sampling to evaluateall lead exposure pathways for this community.

  3. DHSS and JCHD should continue health education activities for both the peoplein the community and area health care providers. These activities should focus onawareness of lead poisoning, its adverse health effects, how to reduce exposures,and encourage blood lead testing, especially for children.

  4. Consider a health study to evaluate the health impacts of lead on the community.

When additional information becomes available, DHSS will evaluate it thoroughly and, ifappropriate, update existing assessment documents. ATSDR and DHSS will respondappropriately to any request for additional information or action.


PUBLIC HEALTH ACTION PLAN

The Public Health Action Plan (PHAP) for the Herculaneum Lead Smelter site contains adescription of actions to be taken by the Missouri Department of Health and SeniorServices (DHSS), the Agency for Toxic Substances and Disease Registry (ATSDR), andothers. The purpose of the PHAP is to ensure that this health consultation not onlyidentifies public health hazards, but also provides an action plan to mitigate and preventadverse human health effects resulting from present and/or future exposure to hazardoussubstances at or near the site. Included is a commitment from DHSS and/or ATSDR tofollow-up on this plan to ensure that it is implemented. The public health actions to beimplemented by DHSS, ATSDR and /or cooperators are as follows:

  1. DHSS/ATSDR will coordinate with the appropriate environmental agencies toidentify environmental sampling that needs to occur so that exposure pathwayscan be adequately identified and characterized.

  2. DHSS/ATSDR will continue to evaluate any additional data that becomeavailable regarding human exposure or contaminants at the site, includingidentifying additional exposure pathways and evaluating health impacts of riskreduction and remediation plans.

  3. DHSS/ATSDR have developed and are implementing a comprehensive healtheducation plan in this community. Those efforts will continue and will focus onincreased childhood lead testing, awareness of lead poisoning, its adverse healtheffects, and how to reduce exposures, especially for children.

  4. JCHD/DHSS/ATSDR will continue to assure case management of children withelevated BLLs.

  5. DHSS/ATSDR are evaluating the feasibility of initiating health study activities inthis community.

PREPARERS OF REPORT

Angela Minor, Gale Carlson, Missouri Department of Health and Senior Services


CERTIFICATION

This health consultation for the Herculaneum Lead Smelter Site was prepared by theMissouri Department of Health and Senior Services under a cooperative agreement withthe federal Agency for Toxic Substances and Disease Registry (ATSDR). It is inaccordance with the approved methodology and procedures at the time the healthconsultation was initiated.

Roberta Erlwein
Technical Project Officer, SPS, SSAB, DAC


The Division of Health Assessment and Consultation (DHAC), ATSDR, has reviewedthis health consultation and concurs with its findings.

Gail D. Godfrey
for Richard Gillig
Section Chief, SPS, DHAC, ATSDR


REFERENCES

  1. Missouri Department of Natural Resources, Division of Environmental Quality,Hazardous Waste Program. Preliminary Assessment: Herculaneum Lead SmelterSite, Jefferson County, Missouri. March 30, 1999.

  2. Agency for Toxic Substances and Disease Registry. Health consultation forHerculaneum Lead Smelter site: Atlanta: US Department of Health and HumanServices; 2001 Jul 13.

  3. Environmental Protection Agency. Transmittal from Bruce Morrison to MissouriDepartment of Health and Senior Services, January 8, 2002.

  4. Missouri Department of Natural Resources. Transmittal from David Mosby toTony Petruska, Environmental Protection Agency, Sample#A58, November 28,2001.

  5. Walker P. Missouri Department of Health and Senior Services. Herculaneum,Missouri Lead Contamination Health Threat. September 13, 2001.

  6. Agency for Toxic Substances and Disease Registry, 1999. Toxicological Profilefor Lead (Update). Atlanta, Georgia: US Department of Health and HumanServices, Public Health Services, Agency for Toxic Substance and DiseaseRegistry.

  7. Centers for Disease Control and Prevention. Screening young children for LeadPoisoning: Guidance for State and Local Public Health Officials. November1997. Atlanta, Georgia: US Department of Health and Human Services, PublicHealth Services, CDC, 1997.

  8. Centers for Disease Control and Preventions. Blood Lead Levels in YoungChildren- United States and selected states, 1996-1999. MMWR 2000; 49: 1133-7.

  9. Centers for Disease Control and Prevention. Blood Lead Levels- United States,1991-1994. MMWR 1997; 46: 141-6.

  10. Agency for Toxic Substances and Disease Registry, 1990. Toxicological Profilefor Lead. Atlanta, Georgia: US Department of Health and Human Services,Public Health Services, Agency for toxic Substance and Disease Registry.

FIGURES

Site Map
Figure 1. Site Map 1

Site Map
Figure 2. Site Map 2


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