HEALTH CONSULTATION

Blood Lead Results for 2002 Calendar Year

HERCULANEUM LEAD SMELTER SITE

HERCULANEUM, JEFFERSON COUNTY, MISSOURI

STATEMENT OF ISSUES AND BACKGROUND

Statement of Issues

In March 2003, the Missouri Department of Health and Senior Services
(DHSS), in cooperation with the Agency for Toxic Substances and Disease
Registry (ATSDR), presented to the Herculaneum Community Advisory Group
preliminary results of all known blood lead data collected in 2002 from
Herculaneum, Missouri residents. This   HYPERLINK
"http://www.atsdr.cdc.gov/glossary.html" \l "Health Consultation" 
health consultation  will further evaluate that data and compare it to
the 2001 blood lead data. Additionally, this health consultation will
evaluate the blood lead data collected for children under 72 months of
age who were serially tested in both years 2001 and 2002. Conclusions
and recommendations in this document were made on the basis of data
available as of March 14, 2003.

Background

The Herculaneum lead smelter is an active facility that has been in
operation in the community since 1892. The Doe Run Company currently
owns and operates the smelter. The facility is located at 881 Main
Street in Herculaneum, Missouri, approximately 25 miles south of St.
Louis, Missouri, on the Mississippi River. It abuts residential
neighborhoods on the north, west, and south, with the Mississippi River
on the east. A lead ore concentrate, consisting of approximately 80%
lead sulfide, is processed at the smelter. The ore is transported by
truck from eight lead mines operated by the company near Viburnum,
Missouri, approximately 75 miles south-southwest of Herculaneum. The
52-acre Herculaneum facility consists of a smelter plant, a 24-acre
waste slag storage pile, and an onsite sulfuric acid plant [1].

The city of Herculaneum has an estimated   HYPERLINK
"http://www.atsdr.cdc.gov/glossary.html" \l "Population"  population  of
2,805 people, according to the 2000 US Census. Several homes are within
200 feet of the smelter plant, and currently at least three homes are
within 200 feet of the slag pile, of which one is being occupied.  
HYPERLINK "http://www.atsdr.cdc.gov/HAC/PHA/herculaneum3/lss_p1.html" \l
"F1#F1"  Figures 1  and   HYPERLINK
"http://www.atsdr.cdc.gov/HAC/PHA/herculaneum3/lss_p1.html" \l "F2#F2" 
2  display the location of the smelter in relationship to the community
[2]. Three schools are in the city: a high school, a middle school, and
a junior high school. The elementary school is in nearby Pevely. No
licensed day-care facilities are in the city of Herculaneum. 

Environmental sampling has indicated that there is lead contamination
throughout the community. For example, lead has been found in yard soils
at   HYPERLINK "http://www.atsdr.cdc.gov/glossary.html" \l
"Concentration"  concentrations  up to 33,100 parts per million (ppm)
[3]; in air ranging from non-detectable (ND) to 85 micrograms per cubic
meter (µg/m3) [4]; and in dust on streets up to 300,000 ppm [5].
Although multiple sources of lead could be contributing to the overall
contamination (e.g., lead-based paint), an   HYPERLINK
"http://www.atsdr.cdc.gov/glossary.html" \l "Exposure Investigation" 
Exposure Investigation (EI)  conducted by ATSDR in 2001 indicated that
lead in paint and water at the two homes evaluated did not appear to be
significant sources of lead   HYPERLINK
"http://www.atsdr.cdc.gov/glossary.html" \l "Exposure"  exposure  in the
children with elevated blood lead concentrations from these homes [6].
Additionally, it has been documented that proximity to the smelter
appears to be associated with higher blood lead levels (BLL) [2]. In
2001, 28 percent of the children in this community under 72 months of
age who were tested had BLLs equal to or above 10 micrograms of lead per
deciliter of blood (10 µg/dL) [7]. In the area closest to the smelter,
east of U.S. Hwy 61/Commercial Blvd., 45% of the children under 72
months of age who were tested in 2001 had BLLs equal to or above 10
µg/dL [7]. BLLs above 10 µg/dL have been associated with the
development of   HYPERLINK "http://www.atsdr.cdc.gov/glossary.html" \l
"Adverse Health Effect"  adverse health effects  [8]. 

Efforts to address the overall contamination in the community have been
ongoing since September 2001, when the Missouri Department of Natural
Resources (MDNR) and the Environmental Protection Agency (EPA) confirmed
that spillage of lead concentrate was occurring along transportation
routes in the city [9]. This information prompted DHSS to alert MDNR
that the risks to the public surrounding the site were clear and present
and that they were an imminent and substantial endangerment to the
health of residents of Herculaneum [9]. Subsequently, MDNR and EPA
directed the Doe Run Company to expedite activities to clean up existing
contamination and reduce/eliminate future contamination throughout
Herculaneum. The Doe Run Company, with oversight from MDNR and EPA, has
implemented several exposure reduction activities since that time,
including the following:

smelter air emissions and fugitive dust have been reduced by
installation of a number of equipment up-grades and process
modifications [9]. Only since the fall of 2002 has the facility come
into compliance with the National   HYPERLINK
"http://www.atsdr.cdc.gov/glossary.html" \l "Ambient"  Ambient  Air
Quality Standards for lead emissions of 1.5 micrograms per dry standard
cubic meter (quarterly average); 

soil removal and replacement is being performed by the Doe Run Company
(with oversight by EPA) in public and private yards, parks, and schools,
as well as along roadsides, where lead levels are greater than 400 ppm
(as determined by established methods). First priority was given to
those yards where children under 72 months reside [9]; 

in-house dust is being removed by the Doe Run Company in accordance with
established methods, with oversight from EPA, in those residences with
elevated lead dust levels [9]; 

residences are being offered HEPA filter vacuums, regardless of whether
their homes have been cleaned, to assist in controlling interior dust
levels [9]; 

the Doe Run Company has made modifications in the handling and
transportation of the lead ore concentrate [9]; and, 

the Doe Run Company is offering a voluntary property acquisition of
homes within a specified geographic area approximately 3/8 mile around
the smelter. Priority was placed on those homes where children under 72
months of age reside [9]. 

Additionally, DHSS, in cooperation with ATSDR, has initiated   HYPERLINK
"http://www.atsdr.cdc.gov/glossary.html" \l "Health Education"  health
education  for area residents and physicians to increase their awareness
of public health issues associated with lead and the benefits of routine
blood lead testing. In the past, DHSS and the Jefferson County Health
Department (JCHD), in cooperation with ATSDR, have offered blood lead
testing to the residents of Herculaneum and surrounding communities. One
such testing effort occurred in Herculaneum in the past year. In
September 2002, DHSS and JCHD offered a voluntary community-wide venous
blood lead testing event. 

According to Missouri state regulation 19 CSR 20-20.020, the results of
all persons' blood lead tests, regardless of age or BLL, must be
reported to DHSS by physicians, laboratories, and hospitals. The State
Public Health Laboratory (SPHL), private physicians, and various
laboratories have provided BLL data to the DHSS Office of   HYPERLINK
"http://www.atsdr.cdc.gov/glossary.html" \l "Surveillance"  Surveillance
, which maintains databases on all reported blood lead tests. 

The data set evaluated in this health consultation includes blood lead
data collected by and/or reported to DHSS over the course of calendar
year 2002, as required by the state regulation, as well as results from
the screening event conducted in Herculaneum in September 2002.
Additionally, this health consultation will include a comparison of the
blood lead data collected in both 2001 and 2002 for children under 72
months of age. Laboratory analytical methods are not described, and they
vary for all the data. However, the data are sufficient to permit a
determination of whether BLLs in the community were elevated in 2002,
and they are adequate to permit performance of a comparison of blood
lead data of children serially tested in both 2001 and 2002.

Only data for Herculaneum residents are considered in this analysis (zip
code 63048). For individuals who have multiple BLL results for the year,
the highest BLL reported for the individual has been used in the summary
of the 2002 data and in the comparison of the 2002 data with data from
2001. The evaluation of blood lead data for children under 72 months of
age and serially tested in both 2001 and 2002 includes all blood lead
data for those children tested in both years. For those children who
have multiple BLL results for each year, the highest BLL reported in
2001 was compared to the last BLL reported in 2002. This comparison
method was chosen in order to determine the overall decline in BLLs from
the highest in 2001 to the most recent in 2002. Only test results from
venous blood draws were used; any capillary test results have been
removed from the data set. 

2002 Blood Lead Data Summary

A total of 340 people were tested in 2002; 58 of these were children
under the age of 72 months, 129 were children between the ages of 6 and
17 years, and 153 were adults age 18 or more. Of the children under 72
months of age, 8 had BLLs of 10 µg/dL or higher (14%). The children in
this age group had BLLs ranging from 2-28 µg/dL, with an average BLL of
approximately 6.4 µg/dL. Among children between the ages of 6 and 17
years, 2 had BLLs of 10 µg/dL or higher (1.5 %). The BLL range for this
age group was from 2 to 14 µg/dL. Of the 153 adults tested, 6 had BLLs
of 25 µg/dL or higher. The BLLs of men ranged from 2 to 33 µg/dL, and
women's BLLs ranged from 1 µg/dL to 42 µg/dL. 

  HYPERLINK "http://www.atsdr.cdc.gov/HAC/PHA/herculaneum3/lss_p1.html"
\l "T1#T1"  Tables 1 ,   HYPERLINK
"http://www.atsdr.cdc.gov/HAC/PHA/herculaneum3/lss_p1.html" \l "T2#T2" 
2 , and   HYPERLINK
"http://www.atsdr.cdc.gov/HAC/PHA/herculaneum3/lss_p1.html" \l "T3#T3" 
3  contain a summary of these results.

Table 1. Blood Lead Levels of Children less than 72 months of age for
January through December, 2002, reported to DHSS for Zip Code 63048 

Blood lead levels in µg/dL 	Number of individuals

0-9	50

10-19	6

20-29	2

30 or higher	0



Table 2. Blood Lead Levels of Children between 6 and 17 years of age for
January through December, 2002, reported to DHSS for Zip Code 63048 

Blood lead levels in µg/dL 	Number of Individuals

0-9	127

10-19	2

20-29	0

30 or higher	0



Table 3. Blood Lead Levels for Adults 18 years and older for January
through December, 2002, reported to DHSS for Zip Code 63048 

Blood lead level (µg/dL) 	Number of Individuals 

0-24	147

25-39	5

40-49	1

50 and higher	0

Data for other sensitive subgroups, such as fetuses theoretically
exposed through women of childbearing age (15-44 years) and the elderly
(i.e., 65 and older), were examined more closely.   HYPERLINK
"http://www.atsdr.cdc.gov/HAC/PHA/herculaneum3/lss_p1.html" \l "T4#T4" 
Table 4  summarizes this evaluation. This analysis found that 63 women
of childbearing age were tested. In this group, only 1 had a BLL of 10
µg/dL or higher (42 µg/dL). Twenty-three of the women tested in this
group were aged 15 to 17 years; the remaining 40 were 18 or older. 

A total of 36 residents 65 years of age and older were tested. Six had
BLLs of 10 µg/dL or higher, 2 females and 4 males. Twelve µg/dL was
the highest female BLL, and 19 µg/dL was the highest male BLL.

Table 4. Blood Lead Levels for sensitive populations for January through
December, 2002, reported to DHSS for Zip Code 63048 

Blood lead level (µg/dL)	Women of child bearing age

15-44 years (n=63)	Elderly, 65 years and older (n=36)

0-9	62	30

10-19	0	6

20-29	0	0

30 or higher	1	0

Comparison of the 2001 blood lead data with 2002 data 

In 2001, a total of 935 people were tested; 118 were children under the
age of 72 months, 162 were children between the ages of 6 and 17 years,
and 655 were adults age 18 or higher [7]. There was a 64% reduction in
the number of individuals tested in 2002 compared to those tested in
2001.

Of the children tested in 2001 between the ages of 6 and 17 years, 13 of
162 had BLLs of 10 µg/dL or higher (8%), ranging from 10 to 19 µg/dL
[7]. In comparison and as stated earlier, in 2002, 2 of the 129 children
in this age group had BLLs of 10 µg/dL or higher (1.5%). A comparison
of data from 2001 to 2002 shows an apparent 81% reduction in the  
HYPERLINK "http://www.atsdr.cdc.gov/glossary.html" \l "Prevalence" 
prevalence  of BLLs of 10 µg/dL or higher for children tested in this
age group. 

Additionally, in 2001 there were 655 adults tested. Two had BLLs of 25
µg/dL or higher [7]. The men ranged from non-detect (non-detect = BLLs
too low to be detected by laboratory instrument) to 31 µg/dL, and women
were from non-detect to 55 µg/dL [7]. In 2002, 6 of the 153 individuals
had BLLs of 25 µg/dL or higher. For this age group, there were notably
fewer people tested in 2002 than in 2001. Overall, there were no notable
changes in the ranges of BLLs for the adult age group. However, there
was an increase in the prevalence of adults with BLLs of 25 µg/dL or
higher. Fewer than 1% of the adults tested in 2001 had BLLs higher than
25 µg/dL, compared to slightly less than 4% of adults tested in 2002.
This change in rates could be due to increased awareness and screening
of individuals most at   HYPERLINK
"http://www.atsdr.cdc.gov/glossary.html" \l "Risk"  risk  for exposure
to lead.

In 2001, 197 women of childbearing age were tested (15-44 years) [7].
With the exception of one woman who had a BLL of 55 µg/dL in 2001 and
42 µg/dL in 2002, all other women of childbearing age tested had BLLs
less than 10 µg/dL. Of the 166 residents 65 years and older tested in
2001, 21 had BLLs of 10 µg/dL or higher--5 females and 16 males [7].
Twenty-one µg/dL was the highest female BLL, and 24 µg/dL was the
highest male BLL [7]. Comparatively, in 2002, 6 of the 36 people tested
had BLLs of 10 µg/dL or higher, 2 females and 4 males. In 2002, 12
µg/dL was the highest female BLL and 19 µg/dL was the highest male
BLL.

When comparing the data, DHSS evaluated the children under 72 months who
were tested in 2001 and 2002 more closely. Of the children under 72
months tested in 2001, 33 of the 118 had BLLs of 10 µg/dL or higher
(28%), ranging from 10-31 µg/dL [7]. Comparatively, in 2002, 8 of the
58 children tested had BLLs of 10 µg/dL or higher (14%), ranging from
10-28 µg/dL. The 2002 blood lead numbers indicate an apparent 50%
reduction in the prevalence of elevated BLLs for children tested in 2001
in this age group. 

When BLLs for children under 72 months of age residing east of Highway
61/ Commercial Blvd. (the portion of the community closer to the
smelter) were examined exclusively, 30 of the 67 children tested had
BLLs of 10 µg/dL or higher (45%) in 2001[7]. In 2002, 8 of the 46
children tested in this age group had BLLs of 10 µg/dL or higher (17%).
The 2002 blood lead data for the children under 72 months of age
residing in this area show an apparent 62% reduction in the prevalence
of elevated BLLs compared to 2001 data. 

  HYPERLINK "http://www.atsdr.cdc.gov/HAC/PHA/herculaneum3/lss_p1.html"
\l "T5#T5"  Table 5  summarizes the comparison of 2001 and 2002 blood
lead data for children under 72 months of age. 

Table 5. Summary of Blood Lead Levels for Children under 72 months of
age for Calendar Years 2001 and 2002, reported to DHSS for Zip Code
63048 

	2001	2002

Total number of children under 72 months of age blood lead tested.	118
58

Range of BLLs for children tested who were under 72 months of age.
Non-detect*-31 µg/dL	2 µg/dL-28 µg/dL

Average BLL for children tested who were under 72 months of age. 	8.0
µg/dL	6.4 µg/dL

Children under 72 months of age with BLLs of 10 µg/dL or higher. 	33
(28%) of 118 	8 (14%) of 58 

Children under 72 months of age residing east of Highway 61/Commercial
Blvd. (the portion of the community closer to the smelter) who were
blood lead tested.	67	46

Children under 72 months of age residing east of Hwy. 61/Commerical
Blvd. with BLLs of 10 µg/dL or higher.	30 (45%) of 67	8 (17%) of 46

* Non-detect = BLLs too low to be detected by laboratory instrument. 

Additionally, DHSS reviewed the blood lead data collected from January
1, 2001 though December 31, 2002 with a focus onthe subset ofchildren
under 72 months of age living in Herculaneum who were tested in both
years 2001 and 2002 . A total of 141 different children were tested for
BLL during that time period, 35 of which had serial blood lead
screenings in both 2001 and 2002. Of the 35 children tested in both
years, 31 were located east of Hwy 61/Commercial Blvd. (the portion of
the community closer to the smelter). For those children who have
multiple BLL results for each year, the highest BLL reported in 2001 was
compared to the last BLL reported in 2002. This comparison method was
chosen in order to determine the overall decline in BLLs from the
highest in 2001 to the most recent in 2002. Twenty of the 35 children
tested in both years had BLLs that remained less than 10 µg/dL. Twelve
of these children who had BLLs less than 10 µg/dL in 2001 had a
decrease in BLL in 2002. The remaining 8 of the 20 children who had BLLs
less than 10 µg/dL in both years had BLLs that were either unchanged or
because they were below the various laboratories' reporting limits, DHSS
was unable to verify the change definitively. Nine of the 35 children
with BLLs higher than or equal to 10 µg/dL in 2001 had a decrease to a
BLL of less than 10 µg/dL in 2002. Five children had BLLs higher than
or equal to 10 µg/dL in 2001 and a decreased BLL that was still higher
than or equal to 10 µg/dL in 2002. One child had an increase in BLL
from 2001 to 2002. The blood lead level for this child increased from 11
µg/dL to 25 µg/dL. This child and his/her family have moved away from
Herculaneum. The most recent venus blood lead level for the child,
collected in 2003, has decreased to less than 10 µg/dL.

  HYPERLINK "http://www.atsdr.cdc.gov/HAC/PHA/herculaneum3/lss_p1.html"
\l "T6#T6"  Table 6  contains a summary of these results. A further
breakdown of this data is shown in   HYPERLINK
"http://www.atsdr.cdc.gov/HAC/PHA/herculaneum3/lss_p1.html" \l
"appa#appa"  Appendix A .

Table 6. Summary of Blood Lead Levels for Children under 72 months of
age who were serially tested in both years 2001 and 2002, reported to
DHSS for Zip Code 63048. 

Individuals	Numbers

Total number of children tested in both 2001 and 2002 

31 of the 35 children located east of Hwy 61 & Commercial Blvd 	35

Number of children with blood lead levels always less than 10 µg/dL in
2001 and 2002 

12 of the 20 children in this group had a decrease in blood lead level
from 2001 to 2002 	20

Number of children with blood lead levels higher than or equal to 10
µg/dL in 2001 with a decrease to a blood lead level of less than 10
µg/dL in 2002 	9

Number of children with blood lead levels higher than or equal to 10
µg/dL in 2001 with a decreased blood lead level but still higher than
or equal to 10 µg/dL in 2002	5

Children with an increase in blood lead level from 2001 to 2002 

One child had a blood lead level higher than 10 µg/dL in 2001 with an
increase in blood lead level in 2002 	1



DISCUSSION

Childhood lead poisoning is a major, but preventable, environmental
health problem. Children are a high-risk group. They are generally
assumed to be at an increased risk of exposure to chemicals in soil
because of their more frequent soil contact and their tendency to ingest
soil, either intentionally or through normal hand-to-mouth behavior.
Exposure to lead in utero, in infancy, and in early childhood may slow
mental development and lower intelligence later in life. The Centers for
Disease Control and Prevention (CDC) recommends that BLLs remain below
10 µg/dL to decrease the likelihood of neurological and learning
problems in children. Other unusually susceptible populations include
the elderly, people with inheritable genetic diseases, alcoholics and
smokers, and people with neurological dysfunction or kidney disease [8,
10].

Recent data from the Second National Report on Human Exposure to
Environmental Chemicals, 1999-2000 (NHANES) conducted by the CDC stated
that the mean children's BLL in the United States is 2.23 µg/dL [11].
Average BLLs in the United States have fallen dramatically since the
1970s. In 1976-1980, the average BLL in children was 15 µg/dL, and in
1991-1994, the average was 2.7 µg/dL [8]. The national prevalence rate,
1999-2000 (NHANES), of BLLs higher than or equal to 10 µg/dL in
children is 2.2% [11]. 

According to all the blood lead data provided to DHSS, there have been
notable reductions in BLLs in the community from 2001 to 2002. However,
blood lead elevations continue to be documented in this community. The
data provided neither represent a random sample of the community nor
represent the entire community; these BLLs are reflective of physician
selection and/or self-selection. Although there has been an apparent 50
% reduction in the prevalence of elevated BLLs from 2001 to 2002 for
children tested under 72 months of age living in this community, 8 of
the 58 children tested in 2002 (14%) were found to have BLLs of 10
µg/dL or higher. This percentage is still notably higher than the
national prevalence rate of 2.2% [11] and the State of Missouri rate of
5.0% for calendar year 2002 [12].

When BLLs for children residing east of Highway 61/Commercial Blvd. (the
portion of the community closer to the smelter) are examined
exclusively, 8 of the 46 children under 72 months of age tested in 2002
(17%) had BLLs of 10 µg/dL or higher. The 2002 blood lead data for the
children residing in this area show an apparent 62% reduction in the
prevalence of elevated BLLs compared to 2001 data for this age group.
The average BLL in children under 72 months, regardless of proximity to
the smelter, was approximately 8.0 µg/dL for 2001[7]. In 2002, there
has been a reduction in the average BLL to approximately 6.4 µg/dL.
Although there has been a decrease in the average BLL for tested
children of this age group, the average BLL is still notably higher than
the national mean BLL of 2.23 µg/dL [11].

Twenty-six children of 35 tested in both years had decreases in BLL in
2002. Of the 35 children tested in both years, one child had an increase
in BLL from 2001 to 2002. 

In 2002, 2 of the 129 children between the ages of 6 and 17 had BLLs of
10 µg/dL or higher (1.5%), compared to 13 of 162 children in 2001 (8%).
A comparison of data from 2001 to 2002 reveals an apparent 81% reduction
in the prevalence of BLLs of 10 µg/dL or higher for children tested in
this age group. 

Several factors could be responsible for the apparent reduction in the
prevalence of elevated BLLs in children living in Herculaneum from 2001
to 2002. These factors include the actions taken by the MDNR and EPA to
ensure that the Doe Run Company eliminates or reduces the sources of
exposure; the community's increased awareness of potential pathways of
exposure; modifications of home cleaning methods and changes in hygienic
practices; and the actions taken by DHSS, ATSDR, and the JCHD to
increase childhood lead testing in order to increase awareness of lead
poisoning and its adverse health effects and to provide information
about how to reduce exposures, especially for children. In addition,
some of the children in the area most at risk to lead exposure from the
smelter no longer reside in that area as a result of property buy-outs. 

Although there have been notable reductions in the prevalence of
elevated BLLs in children residing in this community, the prevalence of
elevated BLL remains unacceptably high. 

Any effects of lead at these levels on the health of children are likely
to be subtle. Therefore, blood lead levels alone are not an indicator of
adverse effects for an individual child. However, in considering
populations (groups of individuals) exposed to lead, adverse health
effects can be seen in groups with elevated blood lead levels [8].
Therefore, it is important that efforts to reduce exposure to lead in
Herculaneum continue.

The 2002 data indicate that the average BLL for women between the ages
of 15-44 is approximately 3.6 µg/dL. Comparatively, in 2001 the
approximate average BLL for women in this age group was essentially the
same--3.4 µg/dL [7]. However, in both years, the BLL has been higher
than the national mean of 1.8 µg/dL for this age group [13]. No adverse
health effects would be expected for women at this BLL level.
Nevertheless, lead has been demonstrated to cross the placenta at levels
less than 10 µg/dL and could potentially impact the health of the fetus
[14]. The one female having a BLL of 55 µg/dL in 2001 and 42 µg/dL in
2002 has been advised that should she become pregnant she should alert
her physician to her history of elevated blood lead levels. This
individual was also given guidance on actions that could be taken to
reduce exposure.

Individuals 65 years and older were found to have an approximate mean
BLL of 5.7 µg/dL in 2002, slightly less than the approximate mean BLL
of 5.9 µg/dL in 2001 [7]. However, again, the 2002 mean BLL is higher
than the national mean BLL of 3.3 µg/dL. Six of the 36 people in this
age group that were tested had BLLs of 10 µg/dL; however, no individual
had a BLL of 25 µg/dL or greater. No adverse health effects would be
expected from current BLLs [13]. Still, some past and present
occupational and recreational exposures(e.g., crafts and hobbies)have
been identified for this subgroup that may be contributing to the
elevations. 

Child Health Considerations

Children and adults are exposed to lead in many of the same ways. But
children are not small adults. They differ in the behaviors that lead to
their exposures as well as in their susceptibility to toxic effects from
lead exposures. Children are more likely to play outdoors and bring food
into contaminated areas. They are also shorter than adults, so they are
more likely to breathe dust and soil that are close to the ground.
Children are also smaller, resulting in higher doses of chemical
exposure per pound of body weight [10]. 

Further, children have developing body systems that can sustain
permanent damage if toxic exposures occur during critical growth stages.
Compared to adults, children absorb more of the lead they take into
their bodies, retain more of the lead they take in, and are more
sensitive to its effects [10].

Children may be exposed to lead inside their homes, in and around their
schools, and outside in their yards, playgrounds, and parks. This
community is faced with widespread environmental contamination. Because
children depend on adults for risk identification and management
decisions, it is prudent that further lead exposure be prevented.

CONCLUSIONS

The blood lead data reviewed indicate that exposures have occurred, are
occurring, and are likely to occur in the future and that these
exposures may have an adverse impact on human health. Consequently, this
site has been classified as a public health hazard. Specifically, DHSS
concludes the following:

Fourteen percent (14%) of children living in this community who were
tested in 2002 have blood lead levels known to cause adverse health
effects (BLLs above 10 µg/dL). Seventeen percent (17%) of the children
who were tested in 2002 who reside east of Hwy 61/Commercial Blvd. (the
portion of the community closer to the smelter) have blood lead levels
known to cause adverse health effectson a population level.

Of the females of childbearing age in this community tested for BLLs in
2001 and 2002, one female had BLLs in both years that could cause
adverse health effects to her developing fetus if she became pregnant.

Although there have been sixty-four percent (64%) fewer people blood
lead tested in 2002 compared to 2001, the data seem to indicate that
less lead exposure occurred in 2002 than in 2001. This fact is evidenced
by the apparent decrease in prevalence rates of elevated BLLs among
children tested in 2002 when compared to those tested in 2001 and the
notable number of children with decreased BLLs who were serially tested
in both 2001 and 2002. 

RECOMMENDATIONS

EPA and MDNR should continue to ensure that steps are taken by the lead
smelter owners to eliminate/reduce the source(s) of lead exposure as
soon as possible.

The one female of child bearing years who has an elevated blood lead
level should make her physician aware of her history, especially if she
should become pregnant, and take steps to reduce her current exposures
to lead.

EPA and MDNR should continue to conduct environmental sampling to
evaluate all lead exposure pathways for this community.

DHSS and JCHD should continue health education activities for the people
in the community as well as for area health care providers. These
activities should focus on awareness of lead poisoning, its adverse
health effects, and how to reduce exposures and encourage blood lead
testing, especially for children.

A health study should be conducted to evaluate the health impacts of
lead on the community. 

When additional information becomes available, DHSS will evaluate it
thoroughly and, if appropriate, update existing assessment documents.
ATSDR and DHSS will respond appropriately to any request for additional
information or action.

PUBLIC HEALTH ACTION PLAN

The Public Health Action Plan (PHAP) for the Herculaneum Lead Smelter
site contains a description of actions to be taken by the Missouri
Department of Health and Senior Services (DHSS), the Agency for Toxic
Substances and Disease Registry (ATSDR), and others. The purpose of the
PHAP is to ensure that this health consultation not only identifies
public health hazards, but also provides an action plan to mitigate and
prevent adverse human health effects resulting from present and/or
future exposure to hazardous substances at or near the site. Implicit in
this plan is a commitment from DHSS and/or ATSDR to follow-up on this
plan to ensure that it is implemented. The public health actions to be
implemented by DHSS, ATSDR, and /or cooperators are as follows:

DHSS/ATSDR will coordinate with the appropriate environmental agencies
to identify environmental sampling that needs to occur so that exposure
pathways can be adequately identified and characterized.

DHSS/ATSDR will continue to evaluate any additional data that become
available regarding human exposure or contaminants at the site,
including identifying additional exposure pathways and evaluating health
impacts of risk reduction and remediation plans.

DHSS/ATSDR have developed and are implementing a comprehensive health
education plan in this community. Those efforts will continue, and they
will focus on increased childhood lead testing, awareness of lead
poisoning and its adverse health effects, and how to reduce exposures,
especially for children.

JCHD/DHSS/ATSDR will continue to assure case management of children and
other sensitive populations such as women of child bearing age with
elevated BLLs.

DHSS/ATSDR are in the preliminary stages of initiating health study
activities in this community. 

PREPARERS OF REPORT

Rachelle Kuster, Missouri Department of Health & Senior Services

Gale Carlson, Missouri Department of Health & Senior Services

Scott Clardy, Missouri Department of Health & Senior Services

CERTIFICATION

This health consultation for the Herculaneum Lead Smelter Site was
prepared by the Missouri Department of Health and Senior Services under
a cooperative agreement with the federal Agency for Toxic Substances and
Disease Registry (ATSDR). It is in accordance with the approved
methodology and procedures at the time the health consultation was
initiated.

Alan G. Parham

Technical Project Officer, SPS, SSAB, DAC

The Division of Health Assessment and Consultation (DHAC), ATSDR, has
reviewed this health consultation and concurs with its findings.

Gail Godfrey

for Richard Gillig

Section Chief, SPS, DHAC, ATSDR

REFERENCES

Missouri Department of Natural Resources, Division of Environmental
Quality, Hazardous Waste Program. Preliminary Assessment: Herculaneum
Lead Smelter Site, Jefferson County, Missouri. 1999 Mar 30.

Agency for Toxic Substances and Disease Registry. Health Consultation
for Herculaneum Lead Smelter Site: Atlanta: US Department of Health and
Human Services; 2001 Jul 13.

Environmental Protection Agency. Transmittal from Bruce Morrison to
Missouri Department of Health and Senior Services, January 8, 2002.

Missouri Department of Natural Resources. Transmittal from David Mosby
to Tony Petruska, Environmental Protection Agency, Sample#A58, November
28, 2001.

Walker P. Herculaneum, Missouri Lead Contamination Health Threat.
Missouri Department of Health and Senior Services; 2001 Sep13.

Agency for Toxic Substances and Disease Registry. Health Consultation on
Exposure Investigation on Herculaneum Lead Smelter Site, Herculaneum,
Missouri. Atlanta: US Department of Health and Human Services; 2001 Sep
14.

Agency for Toxic Substances and Disease Registry. Health Consultation on
Blood Lead Results for 2001 Calendar Year, Herculaneum Lead Smelter
Site, Herculaneum, Missouri. Atlanta: US Department of Health and Human
Services; 2002 Feb 26.

Centers for Disease Control and Prevention. Screening Young Children for
Lead Poisoning: Guidance for State and Local Public Health Officials.
Atlanta, Georgia: US Department of Health and Human Services; 1997 Nov.

Agency for Toxic Substances and Disease Registry. Health Consultation on
Determination if Remedial Actions are Protective of Public Health,
Herculaneum Lead Smelter Site, Herculaneum, Missouri. Atlanta: US
Department of Health and Human Services; 2002 Apr 16.

Agency for Toxic Substances and Disease Registry. Toxicological Profile
for Lead (update). Atlanta: US Department of Health and Human Services;
1999.

Centers for Disease Control and Prevention. Second National Report on
Human Exposure to Environmental Chemicals, NCEH Pub, No. 03-0022. 2003
Jan.

Missouri Department of Health and Senior Services. 2002 Calendar Year
Blood Lead Testing Data, January through December 2002, Children Less
than Six Years of Age; 2003 Jun 4.

Centers for Disease Control and Prevention. Blood Lead Levels--United
States, 1991-1994. Morb Mortal Wkly Rep 1997; 46: 141-6.

Agency for Toxic Substances and Disease Registry. Toxicological Profile
for Lead. Atlanta: US Department of Health and Human Services; 1990. 

FIGURES

 

 

