1. 2007 Bunker Hill Superfund Site Coeur d’Alene Basin Blood Lead Levels Idaho Department of Health and Welfare Idaho Department of Environmental Quality Panhandle Health District United States Environmental Protection Agency February 27, 2008

2. Public health service offered by the State Not a study or experiment Box since 1974/1985 Basin since 1996 Lead Health Intervention Program (LHIP) Annual Blood Lead Surveys

3. LHIP is an Interim Health Response Activity - To identify children with high blood lead and assist families to reduce exposure Superfund is a Risk-based Cleanup Action - To prevent future exposures Panhandle Health District LHIP

4. No cash incentive for participants that live:  within the Box and are between 6 months and 9 years of age, or $20.00 cash incentive for participants that live:  within the Coeur d’Alene River Basin and are between 6 months and 6 years of age Prior to blood draws, the parent/legal guardian or adult participant must sign a Consent Form and complete the appropriate Questionnaire Panhandle Health District LHIP Procedures

5. Screening blood test is done by skin puncture (capillary or fingerstick - FS) Blood samples are collected in a lead-free ESA capillary tube and analyzed immediately using the LeadCare Analyzer Results of capillary test are provided to the participant or parent immediately after analysis Panhandle Health District LHIP Procedures

6. Health Effects

7. Decreasing “elevated” blood lead levels 60 40 30 25 10? N Engl J Med 2003;348: p1517-26.

8. Lead Dose  Response Observed EffectBlood Lead  g/dl Children Adults Death  125 Neurological Encephalopathy70100 Peripheral Neuropathy4040 Central Nervous System  Hearing 10  Cognitive IQ <10-  Psychomotor Function10-  Birth weight/ Term length10- Anemia2080  Heme synthesis 1010 Renal nephropathy4040 Hypertension25  Vitamin D < 30  Sperm count & function40 Delayed female puberty<10 Adapted from Casserett & Doull’s TOXICOLOGY and ATSDR Sub-clinical

9. At Risk Populations Children Pregnant women Adults with cumulative exposure Genetically pre-disposed Individuals

10. Neurotoxic Effects in Children Neurobehavioral effects in early development persist into adolescence and young adulthood Neurocognative effects associated blood lead levels of 5-10 μg/dl A decline of 6.2 IQ points results from a blood lead change from 1 to 10 μg/dl (pooled results from 7 studies)

11. Cardiovascular Effects in Adults Increase in blood pressure (hypertension)

12. Other Organ System Effects Renal effects Immune system effects Bone and teeth effects Heme-synthesis effects Reproductive and developmental effects Adrenal effects Liver Effects Gastrointestinal Effects Metabolism Effects Genotoxic Effects Carcinogenic Effects

13. Centers for Disease Control Guidance for Children with Elevated Blood Lead  blood lead concentration <10 μg/dlRe-assess or re-screen in one year.  blood lead concentration 10-14 μg/dlProvide family lead education. Provide follow-up testing. Refer for social services, if necessary.  blood lead concentration 15-19 μg/dlIf blood lead levels persist or worsen proceed according toactions for blood lead concentrations in the 20-44 μg/dl range.  blood lead concentration 20-44 μg/dlProvide coordination of care, clinical management, environmental investigation, and lead- hazard control.  blood lead concentration 45-69 μg/dlWithin 48 hours, begin coordination of care clinical management, environmental investigation, and lead- hazard control.  blood lead concentration >70 μg/dlHospitalize child and begin medical treatment immediately. Begin coordination of care, clinical management, environmental investigation, and lead-hazard control immediately.

14. 2007 EPA Lead Criteria Document Conclusion “There is no level of Pb exposure that has yet been identified, with confidence, as clearly not being associated with possible risk of deleterious health effects.”

15. Bunker Hill Box Superfund Site Remedial Action Objective 95% of all children in each community with blood lead levels <10 µg/dl No children (i.e. 15 µg/dl

16. Coeur d’Alene Basin Superfund Site Remedial Action Objective 95% probability for individual children with blood lead levels <10 µg/dl 15 µg/dl

17. Bunker Hill Box Average Blood Lead: 1974-2002 * * * U.S. Average * “Elevated” blood lead level

18. Box Lead Health Intervention Summary Statistics 1988-1994 Number ofMean Number of children Percent children blood Pb with blood Pb (  g/dl) of children Year in survey(  g/dl)>25>15 >10 > 10  g/dl 1988* 230 9.9 73510546% 1989* 27511.4 87115456% 1990362 8.9 24113437% 1991365 6.3 217 56 15% 1992415 7.4 33111027% 1993445 5.6 110 6615% 1994416 6.2 115 7117% *does not include Pinehurst

19. Box Lead Health Intervention Summary Statistics 1995-2002 Number ofMean Number of children Percent children blood Pb with blood Pb (µg/dl) of children Year in survey(µg/dl) >25>15 >10 > 10 µg/dl 1995405 6.0 220 6215% 1996397 5.8 213 4912% 1997337 5.4 0 6 3611% 1998 375 4.8 0 5 31 8% 1999370 4.7 0 3 23 6% 2000320 4.3 0 5 17 5% 2001 322 3.2 0 4 10 3% 2002368 3.1 0 3 7 2%

20. Percent of Box Children with Blood Lead Levels > 10 μg/dl, by City, 1988-2002

21. 2007 Blood Lead Summary Statistics – Box (age 0-9) Total Number of Children (N) 8 Minimum (μg/dl) 1.4 Maximum (μg/dl) 4.8 Average (μg/dl) 2.4 Standard Deviation 1.3 Geometric Mean (μg/dl) 2.1 Geometric Standard Deviation 1.65 Percentage Total Number of Children (N) 8 Number of Children > 10 μg/dl 0 0% Number of Children > 15 μg/dl 0 0% Number of Children > 20 μg/dl 0 0%

23. 2007 Blood Lead Summary Statistics – Basin (age 0-6) Total Number of Children (N) 71 Minimum (μg/dl) 1.4 Maximum (μg/dl) 8.6 Average (μg/dl) 2.9 Standard Deviation 1.5 Geometric Mean (μg/dl) 2.6 Geometric Standard Deviation 1.62 Percentage Total Number of Children (N) 71 Number of Children > 10 μg/dl 0 0% Number of Children > 15 μg/dl 0 0% Number of Children > 20 μg/dl 0 0%

24. Year199619971998199920002001 N581370162102117 N ≥ 10 μ g/dl 82926147 % ≥ 10 μ g/dl 14%15%13%16%14%6% N ≥ 15 μ g/dl 3141242 % ≥ 15 μ g/dl 5%8%6%7%4%2% N ≥ 20 μ g/dl 002410 % ≥ 20 μ g/dl 0% 3%2%1%0% Basin Blood Lead Summary by Year, 1996 - 2001 (age 0-6 only)

25. Year200220032004200520062007 N1037582816971 N ≥ 10 μ g/dl 432110 % ≥ 10 μ g/dl 4% 2%1% 0% N ≥ 15 μ g/dl 021000 % ≥ 15 μ g/dl 0%3%1%0% N ≥ 20 μ g/dl 000000 % ≥ 20 μ g/dl 0% Basin Blood Lead Summary by Year, 2002 - 2007 (age 0-6 only)

26. Age123456 N1214915129 Min ( μ g/dl) 1.4 Max ( μ g/dl) 8.65.36.25.54.35.8 Ave ( μ g/dl) 3.32.93.32.72.23.2 GeoMean ( μ g/dl) 2.82.72.92.42.02.8 2007 Basin Blood Lead Summary Statistics by Age (years)

27. Remediation is NOT based on blood lead data. Remediation IS based on risk of exposure to environmental (soils and dust) metals concentrations. Annual Blood Lead Surveys and Cleanup Activities

28. Remediation reduces health risks to children and women of child-bearing age currently residing in the Basin and for future generations.

29. ConsentedRefused Mullan 98%2% Wallace & Burke/Ninemile 97%3% Silverton 94%6% Osburn 97%3% Side Gulches 95%5% Kingston Area 89%11% Lower Basin 76%24% Total 95%5% Consents and refusals received from 2004 through December 2007. Percentage of Parcels that have Consented and Refused Sampling

30. House Dust is the Primary Risk Driver Soil Remediation reduces exposure to outside soil lead, and Reduces lead in house dust from those soils

31. Box House Dust History

32. Note: Samples not available for Page in 1997, 1999 & 2001 (indicated with dashed lines).

33. Basin House Dust Trends

34. Notes: Vacuum samples were not collected in 1997, 2000, or 2001. 2002 had too little data to display. In 2005, only one vacuum sample was collected from the Lower Basin. When the number of samples is 2 or less, the results are not shown in order to maintain confidentiality.

35. AreaBurke/NinemileKingstonLower Basin Osburn N3131116 Min ( μ g/dl) 2.31.4 2.1 Max ( μ g/dl) 4.14.54.78.6 Ave ( μ g/dl) 3.02.12.04.0 GeoMean ( μ g/dl) 2.91.9 3.7 2007 Basin Blood Lead Summary Statistics by Area

36. AreaSide Gulches SilvertonWallace N1287 Min ( μ g/dl) 1.4 1.5 Max ( μ g/dl) 3.77.16.2 Ave ( μ g/dl) 2.52.93.9 GeoMean ( μ g/dl) 2.42.53.4 2007 Basin Blood Lead Summary Statistics by Area 1 sample from Mullan is not shown to protect confidentiality

37. Box House Dust History

40. Basin House Dust Trends

43. Health Observations 2007 No Children with Elevated Blood Lead Levels in Box or Basin Low Turnout in both Box and Basin High Cooperation with Yard Program Soil and Dust Exposures Decreasing in most Areas Higher Dust Lead Levels Persistent in Upper Basin