Adult Blood Lead Epidemiology and Surveillance (ABLES)

ABLES is a state-based surveillance program of laboratory reported adult blood lead levels. It is intended to identify and prevent cases of elevated blood lead levels in adults. ABLES started in 1987 with four states and has grown to 35 states in 2002. The CDC, NIOSH ABLES program provides funding and technical assistance to participating states. The public health objective of the ABLES program (Objective 20.7 in Healthy People 2010) is "Reduce the number of adults who have blood lead concentrations of 25 micrograms per deciliter(mcg/dL) or greater of whole blood."

ABLES collects blood lead level data from local health departments, private health care providers, and from both private and state reporting laboratories. ABLES programs:

1. collect, analyze, and report their data;
2. conduct follow-ups with physicians, workers, and employers;
3. target on-site inspections of work sites;
4. provide referrals to cooperating agencies;
5. identify new exposures and failures in prevention, and;
6. target educational and other interventions.

ABLES states are required to have a mandatory state requirement that laboratories report blood lead level results to the state health department or designee. While the lowest reportable blood lead level varies from state to state. However, the reporting of all blood lead levels is recommended because it is extremely useful for the analysis of trends in these data. ABLES states are strongly encouraged to develop effective working relationships with childhood lead poisoning prevention programs, and with other programs to prevent lead exposures within their state; such as: OSHA, HUD, EPA, DOT, and the military. Analysis and dissemination of results is at the core of the national approach to elimination of lead poisoning. Analysis of blood lead level data has helped in the identification of high risk industries and occupations; most recently including: home remodeling, furniture restoration and plastics compounding. The most important ABLES activity to help achieve the 25 mcg/dL blood lead objective is to direct resources toward increasing the network of states conducting lead surveillance and enhancing the surveillance systems in the states already participating.

Lead has been recognized as a health hazard since ancient times. Ninety to ninety-five percent of adults with elevated blood lead levels are exposed occupationally. In 2000 about 10,361 adults were reported by 24 ABLES states to have blood lead levels greater than or equal to 25 mcg/dL. This number is known to be an under estimate because many lead-exposed adults do not have routine blood lead level testing. Of the 10,361, 2001(19%) had blood lead levels greater than or equal to 40 mcg/dL; the level at which workers may return to work under Occupational Safety and Health Administration (OSHA) regulations. 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. It is estimated that two to three percent of children with blood lead levels of 10 mcg/dL or greater were exposed by lead brought home from work. Children exposed to low levels of lead may exhibit symptoms of neurologic damage, including learning disabilities and short attention spans. Children who come in contact with lead-exposed workers should be targeted for blood lead screening.

Nationwide data from the state ABLES programs are published in CDC's Morbidity and Mortality Weekly Report (MMWR), and elsewhere. Twenty-eight ABLES reports published in the MMWR may be viewed at: Morbidity and Mortality Weekly Report by searching for "Adult Blood Lead Epidemiology and Surveillance" for the years 1989 to 1999.