Adult Blood Lead Epidemiology & Surveillance (ABLES)

Iowa Department of Health and Human Services ABLES

The Iowa Adult Blood Lead Epidemiology and Surveillance (ABLES) is a program in the Iowa Department of Health and Human Services Acute Disease Prevention, Emergency Response, and Environmental Health Division that helps employers, workers, medical providers, and families learn about the risks of Iowa adult lead exposure in the workplace, community, or at home. ABLES is part of the Bureau of Environmental Health Services.

The Iowa HHS ABLES Program collects all blood lead test results for Iowa adults 16 years of age or older as required by Iowa Administrative Code 641: Chapter 1. This information is used to report:

  • The number of Iowa adults with lead exposure
  • How Iowa adults get exposed
  • Progress on objectives stated in Healthy Iowans: Iowans Health Improvement Plan 2017-2021

The program also helps clinical laboratories and medical providers comply with adult blood lead reporting requirements.

Finally, the program provides resources:

  • For doctors, nurses, and other medical providers who care for lead-exposed adults
  • For Iowans to help them avoid lead exposure on or off the job
  • For workers to prevent “take-home lead” that can expose families
  • For employers and workers to improve work-site lead safety practices, especially for low-level chronic exposures

Did You Know?

Data reported to Iowa HHS shows that about 3,210 Iowa adults were tested for lead in 2020. This number is significantly lower than the 4,000 Iowa adults tested in 2019 and may be due to work impacts from the COVID-19 pandemic. Data subject to change.

  • 865 Iowa adults had BLLs of 5 mcg/dL or higher - 27% of all adults tested.
  • Less than 5 Iowa adults had a BLL of 40 mcg/dL or higher.
  • Work was the likely source of lead exposure for 404 out of 423 Iowa adults with BLLs of 10 mcg/dL or higher (97%) in 2020.

Iowa workers have significantly higher rates of lead exposure compared to all U.S. workers.

  • In 2019 the national prevalence rate of reported cases of elevated blood lead levels of 10 mcg/dL or higher in the U.S. was 15.0 cases/100,000 employed adults, while it was 42.9 cases/100,000 employed adults in Iowa. The national rate at levels of 25 mcg/dL or higher was 2.2 cases/100,000 workers but it was 5.4 cases/100,000 workers in Iowa. National rates for 2019 were calculated on data from states that reported to NIOSH. Interactive maps can be found on the NIOSH Worker Health Charts web page. 

In late 2015, the National Institute for Occupational Safety and Health (NIOSH) adopted a new reference level for adult blood lead tests. A venous BLL of 5 mcg/dL or higher is currently considered to be elevated for adults for public health purposes. The Iowa ABLES program also adopted the new reference level and has updated materials to reflect the change.

Lead Testing Recall

The CDC released a health alert on July 6, 2021 regarding the recall of some Magellan test kits used for Point of Care blood lead testing. The company expanded the recall on September 1, 2021 as posted on this FDA website. 

The Iowa Department of Public Health Lead Poisoning Prevention Program is available to answer questions.  Our toll-free phone is 800-972-2026 or see the contact information at the bottom of this page.

Iowa Data and Additional Information

Data

County level data tables from previous years are available at Iowa Publications Online.

Resources

OSHA: change for approval of laboratories to do occupational lead testing

The OSHA Lead Standards for General Industry (29 CFR 1910.1025) and Construction (29 CFR 1926.62) require employers to provide biological monitoring for workers exposed to airborne lead above the action level. Employers are required to have these samples analyzed by a laboratory which meets OSHA accuracy requirements in blood lead proficiency testing (PT). Samples must be analyzed for lead and zinc protoporphyrin (or free erythrocyte protoporphyrin).

On October 1, 2018, OSHA issued a memo that provided updated guidance for Compliance Safety and Health Officers (CSHOs) on how to evaluate employers’ use of clinical laboratories for employee blood lead testing under the general industry lead standard (29 CFR 1910.1025(j)(2)(iii)) and the construction lead standard (29 CFR 1926.62(j)(2)(iii)). For reasons described in the memo, OSHA no longer directly approves blood lead testing laboratories, as OSHA recognizes that the Clinical Laboratory Improvement Amendments (CLIA) criteria for blood lead proficiency testing constitute the federal government’s legal requirements for laboratories performing human blood lead testing. This approach will reduce costs and burdens on employers and at the same time reduce costs and increase efficiency to OSHA, as OSHA will no longer duplicate the work already performed by the U.S. government agency that administers the CLIA programs. If you need additional assistance, please contact Fern Stones (OSHA's former Blood Lead Lab Coordinator) or refer to the information by State on our State Registries page.

Source: www.osha.gov/SLTC/bloodlead/index.html 

OSHA MEMO: www.osha.gov/laws-regs/standardinterpretations/2018-10-01

NOTE: As of September 2021, the current FDA recommendation to discontinue using Magellan’s’ LeadCare® System Testing Systems with venous blood samples is still in effect. See information below.

FDA Issues Warning on Magellan LeadCare Analyzers - Prior

The U.S. Food and Drug Administration (FDA) has issued a safety communication warning about the use of Magellan Diagnostics’ LeadCare® analyzers (LeadCare, LeadCare II, LeadCare Ultra and LeadCare Plus) with venous blood samples because they may result in falsely low test results. The FDA is now advising that Magellan Diagnostics’ LeadCare® analyzers should no longer be used with venous blood samples. The safety alert does not currently apply to capillary blood lead test results collected by fingerstick or heelstick. The purpose of the Health Advisory is to notify state and local health departments, healthcare providers, and laboratories about CDC’s testing guidance in light of the safety alert.

Venous specimens are recommended for adult blood lead testing, especially for any adults being monitored for lead exposure in the workplace or from a known hobby involving lead products. Elevated capillary tests are not considered confirmatory tests and need to be retested using venous specimens. Laboratories and health care professionals using LeadCare instruments need to find alternative methodologies for venous testing, such as mass spectrometry or atomic absorption methods due to the current FDA warning to discontinue use of Magellan’s LeadCare testing systems for venous blood samples. These other technologies are not usually available as point-of-care tests in clinics, and may only be available from larger-capacity or reference laboratories, including the State Hygienic Laboratory at the University of Iowa. 

Program Contact

epht@idph.iowa.gov