Zinc protoporphyrin, blood lead and clinical symptoms in two occupational groups with low-level exposure to lead.

The results of cross-sectional clinical field surveys of 45 cable manufacturing workers and 90 telephone cable splicers are presented. Despite the rare occurrence of clinically overt lead poisoning among these occupational groups, high prevalence of lead-associated central nervous system symptoms and gastrointestinal symptoms was found. Hierarchical log-linear models for multidimensional contingency tables were fitted to those data and indicate that there is a partial correlation between reported symptoms and zinc protoporphyrin: individuals with high zinc protoporphyrin levels were more likely to report symptoms than those with low levels. No significant partial association was found between symptoms and blood lead. Because of the intermittent lead exposure encountered in one of the populations, individuals were identified with "normal" blood lead levels associated with "elevated" zinc protoporphyrin concentrations, thus indicating the difference in the biological significance between indicators of lead absorption (blood lead) and of biological response tests (ZPP). Suggestion is made that both types of diagnostic tests be utilized in the medical surveillance of lead-exposed workers.