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Original ArticleOpen Access
The Management of Environmental Lead Exposure in the Pediatric Population : Lessons from Clitty Creek, Thailand
Tantanasrikul S 
,
Chaivisuth B ,
Siriratanapreuk S ,
Padungtod C ,
Pleubreukan R ,
Boonnark T ,
Worahan S ,
Bhumiratanarak P ,
Chomchai C
,
Chaivisuth B ,
Siriratanapreuk S ,
Padungtod C ,
Pleubreukan R ,
Boonnark T ,
Worahan S ,
Bhumiratanarak P ,
Chomchai C During the month of September-October 1997, a depression storm caused massive flooding
in the area of western Kanchanaburi province, Thailand, causing lead-contaminated water from a
nearby lead refinery plant to spill into the surrounding areas of Clitty Creek; exposing the village
downstream to large amounts of lead.
The Ministry of Public Health, together with the Ministry of Science, the Ministry of
Industry, and officials from the Kanchanaburi Office of Public Health, began measures for environ-
mental deleading and assessment of exposure and health risks of the population.
Method : This was a retrospective cohort study of the effects that environmental remedia-
tion and chelation therapy had on the blood lead levels of children residing in Lower Clitty Creek
Village during the period between 1997-2001. Sixty-eight children were followed yearly for their
blood lead levels and hematocrit, beginning in early 1998. Simultaneously, programs for environ-
mental remediation had begun. The blood lead levels (BLLs) of children were followed over a
3-year period. The BLLs during the 2 year period of environmental remediation alone were com-
pared. Subsequently, when chelation therapy was instituted, levels pre and post chelation therapy,
as well as the efficacy of the two different chelation methods were compared using standard 2-tailed
t-test.
Results : The initial average BLL was 27.75
เธ‘
5.4 mg/dl (1998). After environmental
remediation began, BLL at one year (1999) was 30.64
เธ‘
4.49 mg/dl (p
=
0.072), and at two years
(2000) was 30.30
เธ‘
5.1 mg/dl (p
=
0.537). There were 18 children with BLLs
>
25 who were
elected to receive chelation therapy with CaNa2EDTA (11) and DMSA (7). Post chelation average
BLL was 18.73
เธ‘
7.50 mg/dl. The difference between pre and post chelation BLL was statistically
significant (p
<
0.001: paired t-test). The differences in average BLLs between pre and post chela-
tion for the EDTA group was 15.37 mg/dl and for the DMSA group it was 8.91 mg/dl. Children
treated with EDTA appeared, on average, to have 6.47 mg/dl (p
<
0.05: 95% CI (0.821-12.12))
lower BLL than those treated with DMSA.
Vol. 85 Suppl 2
MANAGEMENT OF CHILDHOOD LEAD EXPOSURE
S763
Conclusion : The incident at Clitty Creek serves to illustrate the importance of environ-
mental remediation as a priority to treating lead poisoning in children. Only when effective environ-
mental deleading has taken place can medical intervention in the form of chelation therapy begin.
Key word : Lead Poisoning, Children, Environmental Contamination
in the area of western Kanchanaburi province, Thailand, causing lead-contaminated water from a
nearby lead refinery plant to spill into the surrounding areas of Clitty Creek; exposing the village
downstream to large amounts of lead.
The Ministry of Public Health, together with the Ministry of Science, the Ministry of
Industry, and officials from the Kanchanaburi Office of Public Health, began measures for environ-
mental deleading and assessment of exposure and health risks of the population.
Method : This was a retrospective cohort study of the effects that environmental remedia-
tion and chelation therapy had on the blood lead levels of children residing in Lower Clitty Creek
Village during the period between 1997-2001. Sixty-eight children were followed yearly for their
blood lead levels and hematocrit, beginning in early 1998. Simultaneously, programs for environ-
mental remediation had begun. The blood lead levels (BLLs) of children were followed over a
3-year period. The BLLs during the 2 year period of environmental remediation alone were com-
pared. Subsequently, when chelation therapy was instituted, levels pre and post chelation therapy,
as well as the efficacy of the two different chelation methods were compared using standard 2-tailed
t-test.
Results : The initial average BLL was 27.75
เธ‘
5.4 mg/dl (1998). After environmental
remediation began, BLL at one year (1999) was 30.64
เธ‘
4.49 mg/dl (p
=
0.072), and at two years
(2000) was 30.30
เธ‘
5.1 mg/dl (p
=
0.537). There were 18 children with BLLs
>
25 who were
elected to receive chelation therapy with CaNa2EDTA (11) and DMSA (7). Post chelation average
BLL was 18.73
เธ‘
7.50 mg/dl. The difference between pre and post chelation BLL was statistically
significant (p
<
0.001: paired t-test). The differences in average BLLs between pre and post chela-
tion for the EDTA group was 15.37 mg/dl and for the DMSA group it was 8.91 mg/dl. Children
treated with EDTA appeared, on average, to have 6.47 mg/dl (p
<
0.05: 95% CI (0.821-12.12))
lower BLL than those treated with DMSA.
Vol. 85 Suppl 2
MANAGEMENT OF CHILDHOOD LEAD EXPOSURE
S763
Conclusion : The incident at Clitty Creek serves to illustrate the importance of environ-
mental remediation as a priority to treating lead poisoning in children. Only when effective environ-
mental deleading has taken place can medical intervention in the form of chelation therapy begin.
Key word : Lead Poisoning, Children, Environmental Contamination
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