Individuals who use firearms for work or recreation may be at risk for toxic lead exposure, say Yale clinical investigators. Utilizing Connecticut Department of Public Health data, they report a rise in elevated blood-lead levels associated with the use and maintenance of firearms in the Journal of Occupational and Environmental Medicine.

The authors — who include Drs. Jacqueline M. Cook, Carine J. Sakr, Carrie A. Redlich of Yale, and Albert L. DeLoreto of the state’s Department of Public Health — became concerned when they started to see an increasing number of patients with high lead levels related to firearm use.

In one case evaluated at the Yale Occupational and Environmental medicine clinic, a 28-year-old man was referred to the clinic by the local health department for evaluation after his 1-year-old son was found to have a markedly elevated blood-lead level detected during a routine pediatric screening. As no source of lead such as lead paint or pipes was found in the home, his father was tested and found to also have an elevated blood lead level. He was a maintenance worker at an indoor shooting range and cared for his son in lead-contaminated clothing after returning from work. In other cases, children were most likely exposed to lead via lead dust contamination of family vehicles, carried home from the shooting range.

The other cases evaluated by the researchers involved a firearms instructor, salesman, shop owner, and two U.S. veterans. All had elevated levels of lead not attributed to any other source of lead. “Every one of them practiced target shooting, or were around others who shot guns, most commonly in indoor firing ranges” said Redlich, the clinic director.

The case studies mirror data collected by the state’s Department of Public Health as part of the Center for Disease Control and Prevention’s state-based Adult Blood Lead Epidemiology and Surveillance (ABLES) program. Between 2003 and 2013, the number of cases of elevated lead levels related to firing ranges rose from zero cases to 20, which represented 25% of all elevated lead levels reported to the state.

While the cause of the rise is not known, it is probably due to a combination of state educational outreach, an increased awareness of the risks of lead exposure from shooting, and increased exposure, Redlich noted.

Young children are particularly vulnerable to contact with even low levels of lead, which is associated with increased risk for neurologic, cardiovascular, renal, and reproductive health problems.

“This is a completely preventable problem from a public health point of view,” said Redlich. Lead-free ammunition is one solution being explored by the U.S. Army, for example, and the state of California is implementing a ban on lead ammunition for all hunting. Additionally, clinicians should inquire about the use of guns in patients found to have elevated lead levels and consider testing family members, especially children, the authors noted.

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