Lead toxicity, vulnerable subpopulations and emergency preparedness

This paper reviews some evidence of the toxic effects of lead (Pb) in the context of vulnerable subpopulations and emergency preparedness. Pb is ubiquitous in the environment and is used in many building materials. Environmental Pb concentrations and body burdens of Pb have been shown to increase following disasters. Pb is a systemic toxicant with no known beneficial biological function and, for several endpoints, no identified threshold of toxicity. The fetus, children, pregnant and elderly are particularly susceptible to some of the toxic effects of Pb. Pb exposures in infancy have been shown in vivo to produce an equal degree of neurobehavioural impairment as exposures of much longer duration at equivalent doses during adolescence. Evidence from animal bioassays indicates that the carcinogenic potency of perinatal Pb exposure may be about 3-fold higher than adult lifetime exposure at an equivalent dose. Animal assays show up to a 12-fold difference between fetal, neonatal and adult life stages in sensitivity to the immunological effects of Pb. Pb exposure is associated with increased risk of cardiovascular and cerebrovascular morbidity and mortality-health endpoints for which the elderly are at increased risk. Finally, endogenous and exogenous variables, such as psychological and physiological stress, dietary deficiencies and concomitant exposure to other chemical, biological and radiological hazards, can also potentially modify or potentiate the toxic effects of Pb. Because of the potential for concurrent influence of these modifying variables in a post-disaster environment, emergency response planners are encouraged to consider disaster victims and responders, as a whole, as a potentially vulnerable subpopulation.