Childhood lead poisoning: a Rhode Island perspective.

The Rhode Island Department of Health recognizes lead exposure as the State's most important environmental health problem. Historically, the program has relied on secondary prevention strategies consisting primarily of screening, case-finding, limited environmental intervention and medical management. While secondary prevention of lead toxicity identifies existing cases in a preclinical stage, it does not prevent exposure to lead hazards. The sources of lead exposure need to be appropriately identified and abated if exposures and re-exposures are to be prevented. Because of the ubiquity of lead and practical limitations of available resources, a large number of children with elevated blood lead levels will continue to go unscreened and undetected unless more effective screening strategies are implemented. Present reliance on the free erythrocyte protoporphyrin (FEP) test as a primary screening tool is recognized as an insensitive way to identify children with blood lead levels below 40 micrograms %. With growing evidence of toxicity and long term health effects associated with blood lead levels in the range between 10 and 40 micrograms %, blood lead analysis will need to become part of the routine method of screening.