Screening

Whole-blood lead is tested at regular intervals.[6][13][67] All children and adults who have a potential for lead exposure require screening. It is critical to recognize that there is no "normal" whole-blood lead and that interventions should begin at the first sign of increased exposure.[68]

  • In the US, the Medicaid program requires blood lead screening tests at age 1 and age 2 years.[46] Children aged between 24 and 72 months, with no record of a previous blood screening test, are required to receive one.

  • The Council on Environmental Health recommends targeted screening of children for elevated blood lead concentrations if they are 12 to 24 months of age and live in communities or census block groups with ≥25% of housing built before 1960, or a prevalence of children’s blood lead concentrations ≥5 micrograms/dL of ≥5%.[49]

  • ​Risk assessment for lead exposure for pregnant or lactating women should take place at the earliest contact, and blood lead levels should be measured if a single risk factor is identified.[69]​

  • All adults employed in an environment that may expose them to lead should be periodically tested. In larger companies (e.g., battery production or construction), workers should be monitored for lead exposure. Small-business workers, such as painting contractors and plumbers are also at risk, but are not usually tested by their employers.[9][13]​​[50]​ There is considerable concern that the present standards do not adequately protect workers and do not provide adequate fetal protection for pregnant workers.

  • People with certain hobbies, such as constructing stained glass items that are soldered with lead materials, and making bullets and fishing sinkers in the home, should be tested.[6][23]

  • People who regularly shoot pistols and rifles in indoor ranges should be considered at risk. Inquiries should be made about range conditions and shooter habits regarding hygiene and eating and drinking in the range. Many of these people merit screening with a whole-blood lead test.[14]

  • There is extensive evidence that families residing in older housing during renovation activities are at risk if lead-painted surfaces are disturbed during renovation. It is strongly recommended that occupants leave the home during renovation. If they do not, they should be screened for lead exposure with a whole-blood lead test.[6][13] Lead removal or other renovation should only be conducted by trained lead hazard remediation workers.[43]

  • People who report using folk remedies or who are members of ethnic groups that commonly use such remedies should be considered for screening. This is particularly true if these remedies are used for gastrointestinal symptoms, as many lead-containing folk medicines are used for this indication.[6][13] A detailed list of exposure sources is available from the US Centers for Disease Control and Prevention (CDC).[6]

  • Screening recommendations for newly arrived refugee infants, children, adolescents, and pregnant and lactating women are available.[70]

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