Children's health/regional collaboration to reduce lead exposure in children.

As Safi et al. (2006) discussed, environmental contamination does not stop at international boundaries. An excellent example of a collaborative effort to address regional environmental exposures is that of the public health communities in Israel, Jordan, and the Palestinian Authority to assess and limit lead exposure of young children. Their dedication to this project in the face of significant political upheavals and episodic violence has demonstrated a remarkable commitment among international public health colleagues to improve environmental public health.

Safi et al. (2006) underscored the three most important strategies to prevent lead exposure in young children. First, eliminate leaded gasoline. In countries where this strategy has been successfully implemented, blood lead levels have significantly decreased (Pirkle et al. 1994; Schnass et al. 2004). More than 50 nations have eliminated lead in gasoline, and many others will initiate phase-outs over the next few years (Landrigan 2002).

Second, identify other consequential sources of lead and take action to control or eliminate them. Smelting remains a prevalent hazard in many parts of the world (ATSDR 1999). Efforts such as recycling batteries in controlled facilities have been successful in some countries.

Third, expand surveillance to ensure that recurrent or new sources of lead exposure are identified and that appropriate actions are taken. Both children and exposure sources travel. In the United States, we have found that the risk of lead exposure is much higher among immigrants when they arrive in the United States, usually as a result of use of lead-containing products; this elevated risk for exposure continues after immigrants relocate when the children are exposed to lead in paint and house dust (CDC 2005).

This collaborative project in the Middle East is an outstanding model for other international efforts to control environmental contaminants in complex regional settings. Safi et al. (2006) have shown tremendous vision, integrity, and commitment to public health under very difficult circumstances.

The authors declare they have no competing financial interests.

Mary Jean Brown

Division of Emergency and Environmental Health Services National Center for Environmental Health Centers for Disease Control and Prevention Atlanta, Georgia

E-mail: [e-mail]

Henry Falk

Coordinating Center for Environmental Health and Injury Prevention Centers for Disease Control and Prevention Atlanta, Georgia

Howard Frumkin

National Center for Environmental Health Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention Atlanta, Georgia

REFERENCES

ATSDR. 1999. Toxicological Profile for Lead (Update). Atlanta, GA: Agency for Toxic Substances and Disease Registry.

CDC. 2005. Elevated blood lead levels in refugee children--New Hampshire, 2003-2004. MMWR Morb Mortal Wkly Rep 54:42-46.

Landrigan P. 2002. The worldwide problem of lead in petrol. Bull WHO 80:768.

Pirkle JL, Brody DJ, Gunter EW, Kramer RA, Paschal DC, Flegal KM, et al. 1994. The decline in blood lead levels in the United States: the National Health and Nutrition Examination Surveys. JAMA 272:284-291.

Safi J, Fischbein A, El Haj S, Sansour R, Jaghabir M, Hashish MA, et al. 2006. Childhood lead exposure in the Palestinian Authority, Israel, and Jordan: results from the Middle Eastern Regional Cooperation Project, 1996-2000. Environ Health Perspect 114:917-922.

Schnass L, Rothenberg SJ, Flores MF, Martinez S, Hernandez C, Osorio E, et al. 2004. Blood lead secular trend in a cohort of children in Mexico City (1987-2002). Environ Health Perspect 112:1110-1115.

Editor's note: In accordance with journal policy, Safi et al. were asked whether they wanted to respond to this letter, but they chose not to do so.