CDC's official MMWR electronic copy of record is the MMWR in Adobe Acrobat portable document format (.pdf). The .pdf MMWR is identical in content to the paper copy of record. The MMWR text that follows is in ASCII text file format and has not been proofread. An adequate ASCII translation does not exist for each character possibly present in the .pdf file, and there may be other significant character translation errors. Also, the ASCII text that follows lacks the figures and tables of the electronic .pdf and paper format of MMWR. Therefore, CDC does not consider this ASCII text file to represent a copy of record of the MMWR. -------------------------------------------------------------- Outbreak of Salmonellosis Associated With Beef Jerky -- New Mexico, 1995 In February 1995, the New Mexico Department of Health (NMDOH) was notified of cases of salmonellosis in two persons who had eaten beef jerky. An investigation by the New Mexico Environment Department determined that these cases were associated with beef jerky processed at a local plant. An investigation by NMDOH identified 91 additional cases. This report summarizes the investigation of this outbreak. On January 26, 1995, two men presented to the emergency department of a local hospital after onset of diarrhea and abdominal cramps. On January 24, the men had purchased and consumed carne seca, a locally produced beef jerky. Cultures of leftover beef jerky and stool obtained from one patient grew Salmonella. On February 7, NMDOH identified both isolates as Salmonella serotype Montevideo. NMDOH initiated efforts to determine whether other cases of salmonellosis associated with beef jerky had occurred. On February 8, NMDOH issued a news release advising the public not to eat the implicated brand of beef jerky and to contact the local health department if illness had occurred after eating the product. Cases also were identified through a review of NMDOH records for isolates matching those identified in jerky samples. A confirmed case of beef jerky-related salmonellosis was defined as isolation of Salmonella from a stool sample obtained from a person who had consumed the implicated jerky. A probable case was defined as onset of diarrhea, abdominal cramps, vomiting, and/or nausea in a person who had consumed the implicated jerky. Illness in 93 persons met the probable or confirmed case definitions. Ill persons reported purchasing the jerky at the local processing plant and eating the jerky during January 21-February 7; onset of symptoms occurred during January 22-February 11 (Figure 1). Incubation periods for most (89%) persons were less than or equal to 3 days. The median age of ill persons was 22 years (range: 2-65 years); 56 (60%) were male. Symptoms of the 93 persons included diarrhea (93%), bloody diarrhea (13%), abdominal cramps (87%), headache (74%), fever (61%), vomiting (43%), and chills (40%). The median duration of illness was 7 days (range: 1-40 days). Five persons (5.4%) were hospitalized. Of the 93 cases, 40 were culture-confirmed. From the stool samples of these 40 ill persons, three Salmonella serotypes were isolated: Salmonella Typhimurium (31 persons), Salmonella Montevideo (12), and Salmonella Kentucky (11). Stool samples from 12 persons yielded two serotypes, and the sample from one patient contained all three serotypes. Samples of leftover beef jerky were obtained from five ill persons and from the manufacturer; 11 of the 12 samples tested contained one or more of the three Salmonella serotypes isolated from the patients. Each of the Salmonella Typhimurium isolates obtained from 31 persons with culture-confirmed cases and from the beef jerky were the same uncommon phenotypic variant. The processing plant that manufactured the contaminated beef jerky was inspected by state authorities on January 31. However, because the plant was not in production, processing-stage temperatures could not be obtained. The owner of the plant described the processing to include placement of slices of partially frozen beef on racks in a drying room at 140 F (60 C) for 3 hours, then holding the meat at 115 F (46 C) for approximately 19 hours; however, temperatures of the meat were never measured. After processing, the jerky was placed in uncovered plastic tubs for sale to the public. The plant owner, who performed all the work in the plant, denied a history of recent gastrointestinal illness but declined to provide a stool specimen. The plant voluntarily closed permanently on February 10. Salmonella was not isolated from environmental swabs taken from 20 surfaces within the plant on February 20. Reported by: FH Crespin, MD, B Eason, K Gorbitz, T Grass, C Chavala, Public Health Div, PA Gutierrez, MS, J Miller, LJ Nims, MS, Scientific Laboratory Div, M Tanuz, M Eidson, DVM, E Umland, MD, P Ettestad, DVM, Div of Epidemiology, Evaluation and Planning, CM Sewell, DrPH, State Epidemiologist, New Mexico Dept of Health; T Madrid, K Smith, C Hennessee, Div of Field Svcs, New Mexico Environment Dept. Foodborne and Diarrheal Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases; Div of Field Epidemiology, Epidemiology Program Office, CDC. Editorial Note: Although beef jerky and other processed meat products are considered to be ready-to-eat and, therefore, are expected to be pathogen-free, some recent foodborne disease outbreaks have been associated with ready-to-eat meat products, including salami and sausage (1,2). In the outbreak described in this report, the isolation of the same Salmonella serotype from leftover beef jerky and the stool specimen of an ill person who reported eating the jerky warranted the rapid intervention initiated by NMDOH. Isolation of the combination of uncommon Salmonella serotypes from leftover jerky and the stool specimen of one patient confirmed beef jerky as the source of the outbreak. In addition to this outbreak, NMDOH investigated five outbreaks of salmonellosis associated with locally produced beef jerky during 1966-1988 (3,4) and one outbreak of staphylococcal food poisoning in 1982; none of the beef jerky implicated in these outbreaks had been shipped to other states. To determine whether consumption of jerky had been associated with foodborne outbreaks in other states during 1976-1995, NMDOH and CDC during May-August 1995 conducted an electronic mail survey with telephone follow-up of all other state health departments. Of the 47 state health departments that responded, 24 (51%) reported that processors of beef jerky were located within their state; however, only four states reported foodborne disease outbreaks associated with locally produced or homemade jerky during 1976-1995, and these outbreaks were caused by Trichinella spiralis and nitrite poisoning. In addition to beef, jerky implicated in these outbreaks had been produced from meat obtained from cougar and bear. Potential explanations for the larger number of jerky-related cases in New Mexico include higher prevalences of consumption of beef jerky, enhanced surveillance for outbreaks, and differences in production methods. This outbreak underscores the risk for foodborne disease associated with consumption of locally produced beef jerky and the need for preventive measures. Conditions recommended for the prevention of bacterial growth during jerky production include rapid drying at high temperatures (i.e., initial drying temperature greater than 155 F [68.3 C] for 4 hours, then greater than 140 F [60 C] for an additional 4 hours) and decreased water activity (i.e., aw=0.86) (5,6). In 1989, because of several beef jerky-related foodborne outbreaks, the New Mexico Environment Department promulgated regulations regarding the commercial production of jerky made from meat or poultry. The outbreak described in this report is the first jerky-related outbreak to be recognized in New Mexico since the regulations were implemented. As a result of this outbreak, the New Mexico Environment Department plans to evaluate the production processes, including temperatures of meat during drying, of all jerky processors in New Mexico and to assist processors in implementing changes necessary to comply with the regulations. References 1. CDC. Escherichia coli O157:H7 outbreak linked to commercially distributed dry-cured salami--Washington and California, 1994. MMWR 1995;44:157-60. 2. CDC. Community outbreak of hemolytic uremic syndrome attributable to Escherichia coli O111:NM--South Australia, 1995. MMWR 1995;44:550-1,557-8. 3. CDC. Salmonellosis associated with carne seca--New Mexico. MMWR 1985;34:645-6. 4. CDC. Salmonellosis--New Mexico. MMWR 1967;16:70. 5. Holley RA. Beef jerky: viability of food-poisoning microorganisms on jerky during its manufacture and storage. Journal of Food Protection 1985;48:100-6. 6. Holley RA. Beef jerky: fate of Staphylococcus aureus in marinated and corned beef during jerky manufacture and 2.5 C storage. Journal of Food Protection 1985;48:107-71. Blood Lead Levels Among Children -- Rhode Island, 1993-1995 Since January 1993, screening of children aged less than 6 years for elevated blood lead levels (BLLs) has been mandatory in Rhode Island.* Erythrocyte protoporphyrin was eliminated as a method of lead screening in February 1993; since then, all children in the state have been screened for lead poisoning by testing capillary or venous blood samples for lead. From March 1993 through February 1995, results of blood lead tests of 56,379 children aged less than 6 years were reported to Rhode Island's lead surveillance system. This report summarizes an analysis of these data by the Rhode Island Department of Health (RIDH) to better characterize the burden of childhood lead poisoning in the state. In Rhode Island, recommendations for screening children aged less than 6 years adhere to CDC's guidelines (1) and are based on a child's risk for lead poisoning and the results of previous blood lead tests. In a previous analysis through September 1994 (2), 99% of all children born in Rhode Island during September 1990-August 1991 had at least one BLL recorded in the RIDH screening database. For children who were tested from March 1993 through February 1995, age, sex, and socioeconomic status were reported for greater than 97%, and race/ethnicity was reported for 86%. Race/ethnicity is presented in this report because it is a risk factor for elevated BLLs independent of socioeconomic status (3). Venous screening samples were obtained from 10,717 (33%) children screened during March 1993-February 1994 (year 1), and from 11,403 (47%) children screened during March 1994-February 1995 (year 2). These data represent initial screens and do not include follow-up tests. Because capillary samples sometimes may be contaminated with lead dust from incompletely cleaned fingers, resulting in an overestimate of BLLs, this report presents results for the analysis of venous samples only. From year 1 to year 2, the overall percentage of children with elevated BLLs (greater than or equal to 10 ug/dL) among all age groups declined (Table 1). However, the percentage of children with very high BLLs (i.e., greater than or equal to 45 ug/dL) was similar for the 2 years. For both years, most children with BLLs greater than or equal to 10 ug/dL lived in poverty** (66.9%) and were members of racial/ethnic minority groups (63.5%). From year 1 to year 2, the geometric mean BLL declined from 5.4 ug/dL to 4.1 ug/dL (Table 2). Declines occurred in all racial/ethnic, socioeconomic, and age groups. However, the mean BLL was higher for children who were members of racial/ethnic minority groups and for those living in poverty. In particular, children with BLLs greater than or equal to 20 ug/dL disproportionately included Hispanics (35% and 33% for years 1 and 2, respectively), who constituted 4.6% of the total population of Rhode Island, blacks (24% and 29%), who constituted 3.9% of the population, and Asian/Pacific Islanders (11% and 7%), who constituted 1.8% of the state's population. In both years, the highest mean BLLs occurred among children aged 2 years. Reported by: B Matyas, MD, P Simon, MD, W Dundulis, MS, R Vanderslice, PhD, L Boulay, MS, Rhode Island Dept of Health. Surveillance and Programs Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health; Div of Field Epidemiology, Epidemiology Program Office; CDC. Editorial Note: The findings in this report indicate that, although BLLs were elevated among high proportions of children in Rhode Island, overall mean BLLs and the prevalence of elevated BLLs among children receiving initial venous tests declined during 1993-1995. These declines may have reflected the effect of 1) sampling (i.e., targeting of children at high risk for lead poisoning in year 1 may have resulted in fewer at-risk children undergoing initial testing in the second year); 2) a change in the pattern of use of venous versus capillary methods for initial tests of high-risk children; 3) prevention activities, which may have decreased the number of children exposed to lead hazards; and/or 4) decreases unrelated to current prevention activities. The patterns of elevated BLLs in Rhode Island are similar to those in the Third National Health and Nutrition Examination Survey (NHANES III) (3): BLLs were highest among racial/ethnic minority children and children living in poverty. Despite declines in BLLs in Rhode Island, the persistent high prevalence of elevated BLLs indicates the need for continued screening and prevention activities in the state. The Rhode Island lead surveillance data will assist in ongoing evaluation of the effectiveness of RIDH's intervention and prevention efforts. The Rhode Island lead program provides environmental inspections of homes of children with elevated BLLs, nutritional information, education about approaches to reducing lead exposure to families of children with elevated BLLs, educational materials to the general public and health professionals, funds for the primary lead poisoning treatment clinic in the state, and financial assistance for lead inspection and abatement. Surveillance for BLLs enables the monitoring of trends and distributions of BLLs among young children. In May 1995, the Council of State and Territorial Epidemiologists added elevated BLLs among children and adults to the National Notifiable Diseases Surveillance System. CDC is collaborating with 24 states to develop laboratory-based surveillance for BLLs among children, which can be used to target resources and assess the effectiveness of intervention efforts. References 1. CDC. Preventing lead poisoning in young children: a statement by the Centers for Disease Control, October 1991. Atlanta: US Department of Health and Human Services, Public Health Service, 1991. 2. Buchner J, Simon P, Dundulis W, et al. Health by numbers: lead poisoning among Rhode Island preschoolers. Rhode Island Medicine 1995;4:120. 3. Brody DJ, Pirkle JA, Kramer RA, et al. Blood lead levels in the U.S. population: phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991). JAMA 1994;272:277-83. * Rhode Island Rules and Regulations for Lead Poisoning Prevention (R23-24.6-PB) section A.2.3 as amended. ** As determined by the Bureau of the Census, which designates the socioeconomic status of every census tract in the United States. Progress Toward Poliomyelitis Eradication -- South East Asia Region, 1988-1994 Since the adoption of the poliomyelitis eradication initiative by the World Health Organization (WHO) in 1988, substantial progress toward the eradication of polio has been achieved in the Region of the Americas and in the Western Pacific Region of WHO (1-3). A major step toward global eradication was made in 1994, when polio eradication activities--specifically the implementation of biannual National Immunization Days* (NIDs)--were accelerated in the member countries of the South East Asia Region (SEAR) of WHO**. In August 1994, Thailand became the first SEAR country to conduct NIDs; by February 1996, seven of the 10 member countries will have conducted NIDs. This report summarizes progress toward the eradication of polio in SEAR countries from 1988 though 1994 and is based on data reported through June 1995. Regional Summary From 1988 through 1994, the number of paralytic polio cases reported in the region decreased by 82%, from 25,711 cases to 4373 cases (Figure 1); however, in 1994, cases reported from SEAR accounted for 58% of the total number of paralytic polio cases reported worldwide. Within SEAR, during 1994, four subcontinent countries--Bangladesh, India, Myanmar, and Nepal--accounted for 4368 (99%) of the 4373 reported cases. By 1994, five (Bangladesh, Indonesia, Nepal, Sri Lanka, and Thailand) of the 10 member countries were conducting surveillance for acute flaccid paralysis (AFP)*** (Table 1) (3). Of these five countries, Sri Lanka and Thailand routinely conducted surveillance for both AFP and wild polioviruses. India Regional progress toward eradication primarily reflects achievements in India, where reported polio cases declined 83% during 1988-1994, from 24,257 to 4052, respectively. During 1992-1994, the median age of persons with polio was 18 months, the same median age as in the early 1980s (4). The proportion of persons aged less than 3 years with polio ranged from 79% in 1992 to 82% in 1993 and 1994; the proportion aged less than 4 years ranged from 88% in 1992 to 91% in 1993. In 1993, stool specimens were collected for viral culture from 604 (14%) of 4236 reported polio cases; polioviruses were isolated from the specimens for 193 (32%) cases. Of the 193 polioviruses isolated, 46 (24%) were wild poliovirus type 1; 46 (24%), wild poliovirus type 2; 59 (31%), wild poliovirus type 3; 34 (18%), a mixture of at least two types; and eight (4%), unknown. In 1994, stool specimens were collected for viral culture from 1075 (27%) of 4052 reported cases; polioviruses were isolated from the specimens for 397 (37%) cases. Of the 397 polioviruses isolated, 299 (75%) were type 1; 35 (9%), type 2; 42 (11%), type 3; and 21 (5%), a mixture. The proportion of cases with type 2 poliovirus isolates decreased from 24% in 1993 to 11% in 1994. The first NIDs in India ("Pulse Polio Immunization Days") will be conducted on December 9, 1995, and January 20, 1996, with a target of vaccinating approximately 75 million children aged less than 3 years with one dose of oral poliovirus vaccine (OPV) in each of two rounds. Bangladesh In 1994, Bangladesh reported 289 cases of polio, a 46% decline from the 540 cases reported in 1988. In 1993, stool specimens were collected for viral culture from 61 (26%) of 233 AFP cases; polioviruses were isolated from the specimens for 17 (28%) cases. Of the 17 polioviruses isolated, 16 (94%) were type 1, and one (6%) was type 2. In 1994, stool specimens were collected for viral culture from 123 (43%) of 289 AFP cases; polioviruses were isolated from the specimens for nine (7%) cases. Of the nine polioviruses isolated, six (67%) were type 1, and three (33%) were type 3. During March-April 1995, Bangladesh conducted its first NIDs. Of the 19.8 million children aged less than 5 years in the country, 90% received at least one dose of OPV, and 83% received two doses. Myanmar In 1994, Myanmar reported 25 polio cases, a 58% decline from the 60 cases reported in 1988. Vaccination coverage levels with three doses of OPV at age 1 year increased from 10% in 1987 to 77% in 1994. The first NIDs in Myanmar will be conducted on February 10 and March 10, 1996. Because China, an adjacent country that has nearly eliminated polio, will be conducting NIDs for the third consecutive year during December 1995-January 1996, the implementation of NIDs in Myanmar in early 1996 is critical to the expansion of the polio-free zones in neighboring countries. Nepal In 1986, the government of Nepal intensified its vaccination program by implementing the Universal Childhood Immunization project. From 1986 through 1990, reported coverage with three doses of OPV among children aged 1 year had increased from 34% to 74%; however, by 1994, coverage had gradually declined to 64%. Nepal reported nine polio cases in 1988, compared with two cases in 1994. In 1994, the reported rate of AFP was 0.05 cases per 100,000 children aged less than 15 years (Table 1). Indonesia In 1994, Indonesia reported nine polio cases, a 99% decline from the 773 cases reported in 1988. Because AFP reporting was not implemented until 1994, estimated rates of AFP through 1994 were low (Table 1). In 1993, stool specimens were collected for viral culture from four AFP cases; poliovirus was isolated from the specimen of one case. In 1994, stool specimens were collected from viral culture from 13 AFP cases; wild poliovirus type 1 was isolated from the specimen of one case. In September 1995, Indonesia conducted its first NIDs. Because the population of the country is dispersed among approximately 3000 islands, NIDs were conducted during a 1-week period. Preliminary reports indicate that greater than 95% of all children aged less than 5 years received OPV during the campaign. Thailand In 1994, Thailand reported one polio case, a decline of 91% from the 11 cases reported in 1988. Reported rates of AFP cases per 100,000 persons aged less than 15 years were 0.5 (1992), 1.0 (1993), and 0.6 (1994). Stool specimens for viral culture were collected from 151 (94%) of the 161 AFP cases reported in 1993 and 90 (92%) of the 98 AFP cases reported in 1994. The percentage of AFP cases with at least two stool specimens collected within 14 days of onset of paralysis increased from 37% in 1992 to 53% in 1994. Of 11 specimens from culture-confirmed polio cases reported in 1993, five were type 1; two, type 2; and four, type 3. The last reported culture-confirmed case of polio occurred in June 1994 and was associated with type 1 wild poliovirus. In 1994, poliovirus was isolated from three other AFP cases; all were vaccine-related polioviruses, one each of types 1, 2, and 3. In August 1994, Thailand accelerated efforts to eradicate polio by conducting the first NIDs in the region; approximately 95% of the 5.3 million children aged less than 5 years were vaccinated. Sri Lanka In 1994, Sri Lanka reported no cases of polio, compared with 16 cases in 1988. During 1992-1994, the annual rate of AFP exceeded 1.0 cases per 100,000 persons aged less than 15 years (1.4 in 1992, 1.6 in 1993, and 1.4 in 1994). The percentage of AFP cases for which two stools were collected within 14 days of paralysis onset increased from 27% in 1992 to 69% in 1994. The last culture-confirmed case of polio in Sri Lanka occurred in November 1993 and was associated with wild poliovirus type 1. In 1994, stool specimens were collected for viral culture from 80 AFP cases; only a vaccine-related type 2 poliovirus was isolated from the specimen of one case. The first NIDs in Sri Lanka will be conducted on November 4 and December 9, 1995, with a target of vaccinating approximately 1.8 million children aged less than 5 years. Mongolia Mongolia reported no polio cases in 1994, compared with one case in 1988. In 1993, stool specimens were collected for viral culture from one AFP case; poliovirus was not isolated. In 1994, stool specimens were collected for viral culture from 26 AFP cases; one specimen was positive for wild poliovirus type 1. Bhutan, Democratic People's Republic of Korea, and Maldives Three countries in the region--Bhutan, Democratic People's Republic of Korea, and Maldives--reported no polio cases during 1989-1994, which suggests that wild poliovirus transmission has been interrupted. However, in addition to interruption of wild poliovirus transmission for at least 3 years, certification of polio eradication requires adequate AFP surveillance, which has not been implemented in these countries. Reported by: Expanded Program on Immunization, South East Asia Regional Office, World Health Organization, New Delhi, India. Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Polio Eradication Activity, National Immunization Program, CDC. Editorial Note: The findings in this report document substantial progress toward polio eradication in SEAR, with an 82% reduction in annual reported cases during 1988-1994. Although wild poliovirus infection is endemic in at least seven (Bangladesh, India, Indonesia, Myanmar, Nepal, Sri Lanka, and Thailand) of the 10 countries of SEAR, six of these seven countries plan to have conducted NIDs by February 1996. Despite this progress, member countries of SEAR reported 4373 polio cases in 1994, accounting for 58% of the global total. This region and sub-Saharan Africa are the two persistent and major reservoirs of polio worldwide (2). Worldwide eradication of wild poliovirus requires the implementation of NIDs and the establishment and maintenance of strong AFP surveillance systems in polio-endemic countries (5). In the Americas, eradication of wild poliovirus was accomplished primarily by targeting NIDs to children aged less than 5 years in polio-endemic countries during the low season of transmission (1). Rapid mass vaccination of children with OPV effectively interrupts community transmission of wild poliovirus (6). Further progress in SEAR is contingent on the identification of sufficient resources--in addition to those provided by international organizations such as WHO, the United Nations Children's Fund (UNICEF), and Rotary International--to implement NIDs. In India, upcoming Pulse Polio Immunization Days will be restricted to children aged less than 3 years because of financial and operational constraints to including additional birth cohorts of approximately 25 million children each. Because recent surveillance data suggest that 8%-9% of reported polio cases occur in children aged 3 years, inclusion of these children in future NIDs will be critical. Because most polio cases in the world are reported from SEAR, the ability of member countries in the region to strengthen integrated AFP and virologic surveillance will be critical to the success of the global polio eradication initiative (7). References 1. de Quadros CA, Andrus JK, Olive J-M, de Macedo CG, Henderson DA. Polio eradication from the Western Hemisphere. Annu Rev Publ Health 1992;13:239-52. 2. World Health Organization. Progress towards poliomyelitis eradication, 1994. Wkly Epidemiol Rec 1995;70:97-104. 3. Yang B, Zhang J, Otten MW, et al. Eradication of poliomyelitis: progress in the People's Republic of China. Pediatr Infect Dis J 1995;14:308-14. 4. Basu RN, Sokhey J. Prevalence of poliomyelitis in India. Indian J Pediatr 1984;51:515-9. 5. Andrus JK, de Quadros CA, Olive J-M. The surveillance challenge: final stages of eradication of poliomyelitis in the Americas. MMWR 1992;41(no. SS-1):21-6. 6. Sabin AB, Ramos-Alvarez M, Alvarez-Amezquita J, et al. Live, orally given poliovirus vaccine: effects of rapid mass immunization on population under conditions of massive enteric infection with other viruses. JAMA 1960;173:1521-6. 7. Cochi SL, Orenstein WA. Commentary: China's giant step toward the global eradication of poliomyelitis. Pediatr Infect Dis J 1995;14:315-6. * Mass campaigns over a short period (days to weeks) in which two doses of oral poliovirus vaccine are administered to all children in the target age group, regardless of prior vaccination history, with an interval of 4-6 weeks between doses. ** Member countries of SEAR are Bangladesh, Bhutan, Democratic People's Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, and Thailand. Mongolia, formerly a member country, was administratively transferred in 1995 to the Western Pacific Region of WHO; this report includes data for Mongolia through 1994. *** Any case of AFP in a person aged less than 15 years is reported as a suspected case of polio. Effective AFP surveillance can detect an annual incidence of at least one case of AFP per 100,000 persons aged less than 15 years. Adult Blood Lead Epidemiology and Surveillance -- United States, Second Quarter, 1995 CDC's National Institute for Occupational Safety and Health (NIOSH) Adult Blood Lead Epidemiology and Surveillance program (ABLES) monitors elevated blood lead levels (BLLs) among adults in the United States (1). Twenty-three states, representing 64% of the U.S. population, report BLL surveillance results to ABLES. This report presents data from ABLES for the second quarter, 1995. Based on the total U.S. population, the 26,832 reports (2) of adults with BLLs greater than or equal to 25 ug/dL reported to ABLES in 1994 represents approximately 42,000 reports throughout the United States, and the 12,137 persons on whom these reports were made represents approximately 19,000 persons. During April-June 1995, ABLES received 5870 reports of BLLs greater than or equal to 25 ug/dL, a decrease of 7% from the 6314 reports for the same period in 1994 (Table 1). Compared with the second quarter, 1994, reports for 1995 decreased 4% for BLLs 25-39 ug/dL, 17% for BLLs 40-49 ug/dL, and 21% for BLLs 50-59 ug/dL; reports increased 4% for BLLs greater than or equal to 60 ug/dL. During January-June 1995, cumulative reports of BLLs greater than or equal to 25 ug/dL increased 1% over reports for the same period in 1994 (Table 1). Cumulative reports increased for BLLs 25-39 ug/dL but decreased for all higher levels. Although there was some variation in the second quarter of 1995, the trend of increasing reports at the lower reporting levels and decreasing reports at the higher levels is consistent with the data for 1994 (2). Reported by: JP Lofgren, MD, Alabama Dept of Public Health. C Fowler, MS, Arizona Dept of Health Svcs. S Payne, MA, Occupational Lead Poisoning Prevention Prog, California Dept of Health Svcs. BC Jung, MPH, Connecticut Dept of Public Health and Addiction Svcs. M Lehnherr, Occupational Disease Registry, Div of Epidemiologic Studies, Illinois Dept of Public Health. R Gergely, Iowa Dept of Public Health. B Carvette, MPH, Occupational Health Program, Maine Bureau of Health. E Keyvan-Larijani, MD, Lead Poisoning Prevention Program, Maryland Dept of the Environment. R Rabin, MSPH, Div of Occupational Hygiene, Massachusetts Dept of Labor and Industries. M Scoblic, MN, Michigan Dept of Public Health. L Thistle-Elliott, MEd, Div of Public Health Svcs, New Hampshire State Dept of Health and Human Svcs. B Gerwel, MD, Occupational Disease Prevention Project, New Jersey State Dept of Health. R Stone, PhD, New York State Dept of Health. S Randolph, MSN, North Carolina Dept of Environment, Health, and Natural Resources. E Rhoades, MD, Oklahoma State Dept Health. A Sandoval, MS, State Health Div, Oregon Dept of Human Resources. J Gostin, MS, Occupational Health Program, Div of Environmental Health, Pennsylvania Dept of Health. R Marino, MD, Div of Health Hazard Evaluations, South Carolina Dept of Health and Environmental Control. D Perrotta, PhD, Bureau of Epidemiology, Texas Dept of Health. D Beaudoin, MD, Bur of Epidemiology, Utah Dept of Health. L Toof, Div of Epidemiology and Health Promotion, Vermont Dept of Health. J Kaufman, MD, Washington State Dept of Labor and Industries. V Ingram-Stewart, MPH, Wisconsin Dept of Health and Social Svcs. Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC. Editorial Note: Reporting of adults with elevated BLLs reflects monitoring practices by employers. Variation in national quarterly reporting totals may result from 1) changes in the number of participating states, 2) timing of receipt of laboratory BLL reports by state-based surveillance programs, and 3) interstate differences in worker BLL testing by lead-using industries. The data presented in this report document the persistence of work-related lead exposures as an occupational health problem in the United States. ABLES can further enhance surveillance for this preventable condition by expanding the number of participating states, reducing variability in reporting, and distinguishing between new and recurring elevated BLLs in adults. References 1. CDC. Surveillance of elevated blood lead levels among adults--United States, 1992. MMWR 1992;41:285-8. 2. CDC. Adult blood lead epidemiology and surveillance--United States, 1994 and first quarter, 1995. MMWR 1995;44:515-7. 3. CDC. Erratum: Vol. 43, No. 40, 1995. MMWR 1995;44:15. 4. CDC. Adult blood lead epidemiology and surveillance--United States, second quarter, 1994. MMWR 1994;43:741-2.