Adult Blood Lead Epidemiology and Surveillance (ABLES)

ABLES is a state-based surveillance program of laboratory reported adult blood lead levels (BLLs). The National Institute for Occupational Safety and Health (NIOSH) ABLES program provides guidance and technical assistance to participating states. The national ABLES program began in 1987 with four states and grew to a peak of 41 participating states in 2013. From 1987 to 2013, NIOSH also provided funding to participating state ABLES programs. However, federal funding for State ABLES programs was discontinued in September 2013. As of December 2015, 28 states collaborate with NIOSH to conduct adult BLL surveillance. The ABLES program in Missouri began in 2001.

The public health objective of the ABLES program is objective OSH-7 in Healthy People 2020, which is to reduce the rate of adults (age 16 and older) who have elevated blood lead concentrations from work exposures. The program objective is to build state capacity to initiate, expand, or improve adult blood lead surveillance programs which can accurately measure trends in adult BLLs and which can effectively intervene to prevent lead over-exposures. In 2015, NIOSH designated 5 µg/dL (five micrograms per deciliter) of whole blood, in a venous blood sample, as the reference BLL for adults; this designation defined an elevated adult BLL the same as an elevated childhood lead level. This case definition is used by the ABLES program, the Council of State and Territorial Epidemiologists (CSTE), and CDC’s National Notifiable Diseases Surveillance System (NNDSS). Previously (i.e. from 2009 until November 2015), the case definition for an elevated BLL was a BLL ≥10 µg/dL. The U.S. Department of Health and Human Services (DHHS) recommends that BLLs among all adults be reduced to <10 µg/dL.

Lead is used in many industries, including construction, mining, and manufacturing. In each of these industries, workers are at risk of being exposed to lead, by breathing it in, ingesting it, or coming in contact with it.

Lead is a toxic metal that is also used in burning fossil fuels. It can be combined with other metals to produce alloys. Lead and lead alloys are often used to make batteries, ammunition, and other metal products. Years ago, lead was also used regularly in paint, ceramics, caulk, and pipe solder among other things. Because of its potential health problems, the amount of lead used in these products today has lessened or has been removed.

Over 90 percent of U.S. adults with elevated BLLs are exposed occupationally. Adults exposed to lead can experience anemia, nervous system dysfunction, kidney problems, hypertension, decreased fertility, and increased miscarriages. Workers can bring lead home from their workplace, and unknowingly expose their families. Children and other household members who come in contact with lead-exposed workers should be targeted for blood lead screening.