APPENDIX D

TECHNICAL ASSISTANCE AND INFORMATION RESOURCES

ALLIANCE TO END CHILDHOOD LEAD POISONING
WASHINGTON, D.C., U.S.A.

The overarching question that we face is how to use all resources to translate the conference workshop recommendations and discussions, public opinion and concern, research and reports, and setbacks and successes to date into effective and sustained action to prevent and eliminate lead poisoning. That is precisely the Alliance to End Childhood Lead Poisoning's mission. The Alliance believes that the worldwide elimination of lead poisoning would constitute a major achievement, and it would also serve as an optimism-engendering model of international cooperation to further the Post-Rio (UNCED) agenda of sustainable development and environmental protection.

The Alliance has produced a framework for action in a set of documents: the Primary Prevention Strategies Handbook (three volumes designed to convince decisionmakers to support prevention efforts, to delineate the steps involved in developing prevention programs, and to collect materials currently used in prevention programs); The Global Dimensions of Lead Poisoning: An Initial Analysis (report on the nature of lead poisoning worldwide); the Final Report of the Global Dimensions of Lead Poisoning: The First International Prevention Conference (report reflecting the work of participants from 37 countries who worked together to build the basis of coordinated solutions to lead poisoning internationally); and the International Action Plan for Preventing Lead Poisoning (framework outlining the coordinated action steps at all levels –international, regional, national, and community– needed to achieve prevention). The Alliance is committed to a worldwide advocacy campaign to accelerate and complete leaded gasoline phaseout as its international priority. The Alliance is also in the process of developing an international lead advocacy network.

For further information, please call or write to:



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LEAD IN THE AMERICAS: A call for action APPENDIX D TECHNICAL ASSISTANCE AND INFORMATION RESOURCES ALLIANCE TO END CHILDHOOD LEAD POISONING WASHINGTON, D.C., U.S.A. The overarching question that we face is how to use all resources to translate the conference workshop recommendations and discussions, public opinion and concern, research and reports, and setbacks and successes to date into effective and sustained action to prevent and eliminate lead poisoning. That is precisely the Alliance to End Childhood Lead Poisoning's mission. The Alliance believes that the worldwide elimination of lead poisoning would constitute a major achievement, and it would also serve as an optimism-engendering model of international cooperation to further the Post-Rio (UNCED) agenda of sustainable development and environmental protection. The Alliance has produced a framework for action in a set of documents: the Primary Prevention Strategies Handbook (three volumes designed to convince decisionmakers to support prevention efforts, to delineate the steps involved in developing prevention programs, and to collect materials currently used in prevention programs); The Global Dimensions of Lead Poisoning: An Initial Analysis (report on the nature of lead poisoning worldwide); the Final Report of the Global Dimensions of Lead Poisoning: The First International Prevention Conference (report reflecting the work of participants from 37 countries who worked together to build the basis of coordinated solutions to lead poisoning internationally); and the International Action Plan for Preventing Lead Poisoning (framework outlining the coordinated action steps at all levels –international, regional, national, and community– needed to achieve prevention). The Alliance is committed to a worldwide advocacy campaign to accelerate and complete leaded gasoline phaseout as its international priority. The Alliance is also in the process of developing an international lead advocacy network. For further information, please call or write to:

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LEAD IN THE AMERICAS: A call for action Alliance to End Childhood Lead Poisoning 227 Massachusetts Ave., N.E., Suite 200 Washington, D.C. 20002, U.S.A. Telephone: (202) 543-1147 Fax: (202) 543-4466 Internet: aeclp@aeclp.permanent.org CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) ATLANTA, GEORGIA, U.S.A. The Centers for Disease Control and Prevention (CDC) is an agency of the United States (U.S.) federal government. As the nation's prevention agency, its mission is to promote health and the quality of life by preventing and controlling disease, injury, and disability. Its vision is Healthy People in a Healthy World –Through Prevention. Both the mission and vision are accomplished by working with its partners throughout the United States and world to: monitor health, detect and investigate health problems, conduct research to enhance prevention, develop and advocate sound public health policies, implement prevention strategies, promote healthy behaviors, foster safe and healthy environments, and provide leadership and training. CDC's partners include U.S. state and local health departments, international agencies and organizations, academic institutions, and others. Within the CDC's public health structure, there are specialized centers, institutes, and offices. The National Center for Environmental Health (NCEH), for example, works with U.S. federal, state, and local health and environmental departments and regulatory agencies, and with international organizations such as the Pan American Health Organization, to reduce the adverse effects of environmental hazards, particularly those that affect children and the underserved. A high priority of NCEH is the prevention of childhood lead poisoning. Using the tools of prevention –surveillance, health statistics, epidemiology, health communication, laboratory services, and new program technologies – NCEH's Lead Poisoning Prevention Branch works in close collaboration with its many national and international partners in an effort to eliminate childhood lead poisoning as a major public health problem. Grants and technical assistance also are provided to state and local health agencies for the development and implementation of effective childhood lead poisoning prevention programs. NCEH is especially committed to working with the international public health commu-

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LEAD IN THE AMERICAS: A call for action nity. Based on available resources, NCEH provides consultation and works collaboratively on: development of prevention activities and strategies; surveillance and epidemiology; training, outreach, and education strategies; program development and program management; laboratory procedures and methodologies; studies on the effectiveness of interventions. For further information, please call or write to: Lead Poisoning Prevention Branch (F-42) Division of Environmental Hazards and Health Effects National Center for Environmental Health 4770 Buford Highway, N.E. Atlanta, GA 30341-3724, U.S.A. Telephone: (404) 488-7330 Fax: (404) 488-7335 ENVIRONMENTAL DEFENSE FUND (EDF) WASHINGTON, D.C., U.S.A. The Environmental Defense Fund (EDF) is a not-for-profit nongovernmental advocacy organization with nearly 300,000 members in the United States. EDF's scientists, economists, and lawyers work to create innovative, economically viable solutions to today's environmental problems. EDF's activities include publishing reports, developing public education campaigns, participating before U.S. and international standard-setting and regulating bodies, and providing technical and policy information to decisionmakers in the public and private spheres. In addition to its 1993 report The Global Dimensions of Lead Poisoning (coauthored with the Alliance to End Childhood Lead Poisoning), EDF has published Legacy of Lead: America's Continuing Epidemic of Childhood Lead Poisoning (1990); The Hour of Lead: A Brief History of Lead Poisoning in the United States (1992), and At A Crossroads: State and Local Lead-Poisoning Programs in Transition (1992). EDF is familiar with a number of sources of technical information on lead production, use, and toxicity.

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LEAD IN THE AMERICAS: A call for action For further information, please call or write to: Karen Florini Senior Attorney 1875 Connecticut Avenue, N.W. Washington, D.C. 20009, U.S.A. Telephone: (202) 387-3500 Fax: (202) 234-6049 Internet: leadinfo@edf.org. U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA) WASHINGTON, D.C., U.S.A. The U.S. Environmental Protection Agency (EPA) is responsible for implementing a wide range of environmental statutes that control pollution sources affecting the air, water, and solid wastes. The agency also implements cross-media statutes related to the control of industrial chemicals and the promotion of pollution prevention. A number of statutes give the EPA responsibility for managing and controlling lead exposures and hazards. The Clean Air Act resulted in the virtual phasing out of lead in gasoline. Currently the EPA is placing increased emphasis on reducing exposure to lead through drinking water systems and controlling lead paint hazards in the home. With progress in these areas, we expect to see continuing declines of blood lead levels in children –especially for those children who are poor, minority, and live in large inner cities. For further information, please call or write to: Joe Carra, Deputy Director Office of Pollution Prevention and Toxics Environmental Protection Agency 401 M Street, S.W. (7401) Washington, D.C. 20460, U.S.A. Telephone: (202) 260-1815 Fax: (202) 260-0575

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LEAD IN THE AMERICAS: A call for action FOGARTY INTERNATIONAL CENTER (FIC), NATIONAL INSTITUTES OF HEALTH (NIH) BETHESDA, MARYLAND, U.S.A. International Biomedical and Behavioral Research Opportunities for U.S.-Latin American and Caribbean Collaboration in Lead Research International Research Fellowships: For foreign postdoctoral and behavioral scientists, with up to two years of advanced research training and collaborative research with a host scientist at a U.S. university (6 annually), nominations by “home” country. Senior International Fellowship Program: For established U.S. scientists to conduct collaborative research abroad, on invitation from foreign institution, for 3 to 12 months (may be divided over 3-year period). Fogarty International Research Collaboration Award (FIRCA): U.S. NIH grantees may compete for small grants to collaborate with colleagues in Latin American and Caribbean countries. NIH Visiting Program: FIC administers a program to place qualified foreign scientists in NIH intramural laboratories, on a case-by-case basis; invitation from NIH Laboratory, salary provided; guest researchers, salary not provided. For further information, please call or write to: Dr. Arlene Fonaroff Program Officer for the Americas, WHO and PAHO Fogarty International Center, NIH 31 Center Drive, MSC 2220 Bethesda, MD 20892-2220, U.S.A. Telephone: (301) 496-4784 Fax: (301) 480-3414

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LEAD IN THE AMERICAS: A call for action THE U.S. FOOD AND DRUG ADMINISTRATION (FDA) WASHINGTON, D.C., U.S.A. The U.S. Food and Drug Administration (FDA) is focusing on lead exposure related to the following products under its jurisdiction: food, lead-soldered cans, calcium dietary supplements, food additives, bottled water, wines, wine bottle seals, packaging, ceramicware, and other foodware (such as silver-plated hollowware). The effort is directed toward determining the relative contribution of each source to overall exposure and taking steps that are reasonable and statutorily justified to reduce or eliminate lead exposure from these sources. This FDA program of dietary lead source identification and abatement is relevant to the Institute of Medicine's considerations of remediation efforts for lead in the Americas. For further information, please call or write to: Source identification and health effects: Michael Bolger, Ph.D., D.A.B.T. Chief, Contaminants Branch HFS-308, FDA, 200 C Street, S.W. Washington, D.C., 20204, U.S.A. Telephone: (202) 205-8705 Fax: (202) 260-0498 Internet: mzb@fdacf.ssw.dhhs.gov Regulatory efforts: Michael Kashtock, Ph.D. Chief, Regulations and Enforcement Branch HFS-306, FDA, 200 C Street, S.W. Washington, D.C., 20204, U.S.A. Telephone: (202) 205-4681 Fax: (202) 205-4422 FUNDACION NATURA QUITO, ECUADOR Fundacion Natura is a not-for-profit, nongovernmental organization specializing in the protection of biodiversity and environmental health through programs of investigation, development projects, and policy formulation. In 1991 research was carried out on the levels of lead in the environment in Quito. Blood samples of 160 people were analyzed that showed levels of

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LEAD IN THE AMERICAS: A call for action lead considerably above internationally accepted norms. Newborn children displayed levels of 14 µg/dl, while those of seven-year-olds reached 28 µg/dl. With these results, Fundacion Natura started a campaign to reduce the level of lead additives in gasoline; since then the consumption of unleaded fuel has risen by 20 percent, and one city plans to eliminate lead completely from its gasoline at the beginning of 1996. Fundacion Natura published three factsheets that focus on lead poisoning including: Lead Pollution (Contaminacion por Plomo); Risks Associated with Environmental Lead in Quito (Valoracion del Riesgo del Plomo Ambiental en Quito); and Lead –A Spoonful for Breakfast and another for Lunch (Plomo: una cucharadita en el desayuno y otra en el almuerzo). The last of these refers to the fact that children are most exposed to environmental lead produced by traffic exhaust fumes during these periods. For further information, please call or write to: Mr. Jorge Oviedo Casilla 17-01-253 Quito, Ecuador Telephone: (593) 2-447-341/2/3/4 Fax: (593) 2-447-449 Internet: natura2@natura.org.ec APC: urbana@natura.ecx.ec HEALTH RESOURCES AND SERVICE ADMINISTRATION (HRSA) U.S. DEPARTMENT OF HEALTH AND HUMAN RESOURCES WASHINGTON, D.C., U.S.A. Through our director, Dr. Ciro Sumaya, the Health Resources and Service Administration (HRSA) of the United States Public Health Service (USPHS) extends a hand to assist countries and locales in the Americas with the problem of hazardous lead exposure. HRSA staff provide consultation and assistance on request. Highlights of HRSA's program related to lead poisoning include the following. The Maternal Child Health Bureau (MCHB) has, over the last two and a half decades, provided leadership in identifying lead poisoning as a critical problem in children, advocating for lead screening and intervention as part of routine pediatric health supervision. In the early 1970s, the MCHB, under the leadership of Dr. Jane Lin-Fu, called attention to the possible damage caused by lead in children without overt symptoms of lead poisoning. Her work stimulated research into lead toxicity at relatively “low” levels. This

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LEAD IN THE AMERICAS: A call for action lead to progressive lowering of blood lead levels considered toxic in children. Dr. Lin-Fu is a recognized expert in the field and is available for consultation. HRSA's Bureau of Primary Health Care and Maternal Child Health Bureau promote public education, as well as lead screening and care through our extensive network of public and private primary care for the underserved: community and migrant health centers, health department clinics, health centers in public housing, and school and preschool programs. HRSA has also developed an alliance of primary care providers, parents, public health authorities, and other community activists. When elevated blood lead results become common in a community, parents can be brought together for education about sources of hazardous lead exposure, lead's modes of entry into children's bodies, and toxic effects of lead. Parents become active participants in developing strategies to minimize lead exposure through hygienic measures in the home. Together they can become a force with others in the community working on issues of environmental justice. For further information, please call or write to: Dr. Jane S. Lin-Fu Maternal Child Health Bureau, HRSA 5600 Rockville Lane, Rm. 18-A20 Rockville, MD 20857, U.S.A. Telephone: (301) 443-1080 Fax: (301) 443-1728 Dr. Patricia Salomon Bureau of Primary Health Care, HRSA 4350 East-West Highway Bethesda, MD 20814, U.S.A. Telephone: (301) 594-4119 Fax: (301) 594-4072 INTERNATIONAL DEVELOPMENT RESEARCH CENTRE (IDRC) OTTAWA, ONTARIO, CANADA The International Development Research Centre (IDRC) is a public corporation created by the Parliament of Canada in 1970 to support research designed to adapt science and technology to the needs of developing

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LEAD IN THE AMERICAS: A call for action countries. The Centre's activity is concentrated in five sectors: agriculture; food and nutrition sciences; health sciences; information sciences; and social sciences. IDRC is funded solely by the Parliament of Canada; its policies, however, are set by an international Board of Governors. The Centre's headquarters are in Ottawa, Canada. Regional offices are located in Africa, Asia, Latin America, and the Middle East. The IDRC, through its Health Sciences Division, supports the Lead in the Americas initiative and is interested in the environmental and occupational health impacts of free trade involving developing countries, which may involve increases and/or changes in the production and use of lead. In the past, IDRC has supported and encouraged research in a six-country South American study of heavy metals, including lead, in river water pollution; in a Chilean study of lead levels in newborns; in wastewater heavy metal pollution from Mexico City used in irrigation; in the community health effects of lead smelters in San Luis Potosi in Mexico; and in advising Jamaican researchers concerning backyard lead battery reclamation and its community health effects. We look forward to continuing this work in the future in cooperation with the welcome initiative of the Institute of Medicine, because international cooperation among researchers and funders is likely to optimize the research results for money spent and to help disseminate the results to protect community and worker health. For further information, please call or write to: Dr. John Markham Senior Program Specialist in Occupational and Environmental Health Health Sciences Division International Development Research Centre 250 Albert Street, 12th Floor Ottawa, Ontario, Canada K1G 3H9 Telephone: (613) 236.6163 Fax: (613) 567-7748 INTERNATIONAL LEAD ZINC RESEARCH ORGANIZATION, INC. (ILZRO) RESEARCH TRIANGLE PARK, NORTH CAROLINA, U.S.A. The International Lead Zinc Research Organization, Inc. (ILZRO), is a not-for-profit research management organization that serves as the cooperative research arm of the international nonferrous metal mining, smelting, and user industries involved in the production and use of lead, zinc, and

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LEAD IN THE AMERICAS: A call for action cadmium. The activities of the ILZRO are supported by member companies throughout the world. The primary purpose of ILZRO is the sponsorship of research. Research funding programs are maintained in diverse areas that include environment and health, electrochemistry, metallurgy, and galvanizing. ILZRO awards Environment and Health Research Grants to investigators throughout the international scientific community. The principal purpose of ILZRO's Environment and Health research program is to contribute to our knowledge of the human health and/or environmental health effects that might be anticipated as a result of exposure to heavy metals such as lead, zinc, or cadmium. Research proposals submitted to ILZRO are generally received in response to “requests for proposals.” ILZRO periodically evaluates areas of concern to the international community and targets high-priority areas for focused research activity. ILZRO research support is available to investigators anywhere in the international scientific community. ILZRO also undertakes a variety of technology transfer activities in all areas of its research portfolio. Technology transfer activities are diverse in nature and include informal consultations, conferences, training courses, informational materials, and seminars. A number of past ILZRO activities have been conducted in Latin America and have ranged from technology transfer conferences (for example, zinc die-casting) and the support of research (such as the effects of lead exposure on child development in Mexico City). For further information, please call or write to: Dr. Craig Boreiko Manager, Environment and Health, ILZRO P.O. Box 12036 Research Triangle Park, NC 27709, U.S.A. Telephone: (919) 361-4647 Fax: (919) 361-1957 ILZRO staff are also available for consultation on a variety of technical matters and can facilitate networking between public and private sector interests. NATIONAL CENTER FOR LEAD-SAFE HOUSING COLUMBIA, MARYLAND, U.S.A. The National Center for Lead-Safe Housing is a nonprofit organization dedicated to reducing the incidence of childhood lead poisoning, while

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LEAD IN THE AMERICAS: A call for action preserving the nation's stock of low-income, affordable housing. It conducts research to determine the most cost-effective ways to identify lead-based paint hazards in housing –for example, sampling of deteriorated paint, dust, and soil–and to control these hazards. For example, the National Center for Lead-Safe Housing prepared the new Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing, a 700-page technical document from the U.S. Department of Housing and Urban Development (available from HUD User at 1-800-245-2691). Other initiatives include studies of different types of hazard control, ranging from replacement of contaminated building components to simple cleaning and repainting. The Center also helps local governments design practical regulations, policies, and programs to help ensure that financial resources are used wisely and are available. The Center has provided testimony and technical assistance to cities and states and serves on a number of different task forces. For further information, please call or write to: Walter G. Farr Executive Director National Center for Lead-Safe Housing 10227 Wincopin Circle, Suite 205 Columbia, MD 21044, U.S.A. Telephone: (410) 992-0712 Fax: (410) 715-2310 Internet: leadsafe@access.digex.net NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS), NATIONAL INSTITUTES OF HEALTH (NIH) BETHESDA, MARYLAND, U.S.A. The National Institute of Environmental Health Sciences (NIEHS) is one of the National Institutes of Health (NIH) and is committed to reducing the burden of human illness and dysfunction from exposures to environmental agents through multidisciplinary biomedical research, and prevention and intervention efforts. Exposure to lead is one of the major concerns of NIEHS and has been the target of considerable research over the past 25 years. The objective of research is to drive public policy to prevent disease. Multidisciplinary research by scientists in NIEHS laboratories and by

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LEAD IN THE AMERICAS: A call for action scientists in universities and other research institutes supported by grants from the NIEHS has identified the effects of low-level lead exposure, particularly effects of lead on the developing nervous system of the fetus, infants, and young children. This information has provided the scientific basis for current international prevention and intervention strategies. NIEHS publishes the journal, Environmental Health Perspectives, which is a forum for discussion of environmental issues. Supplements to the journal contain scientific reviews of topics in environmental health sciences. These may include papers from scientific meetings, conferences, and workshops. The NIH/NIEHS, through the Fogarty International Center, provides opportunities for United States-Latin American and Caribbean collaboration in biomedical and behavioral research on health effects of lead and other environmental agents. Research conducted under these grants may consist of collaborations between scientists in the Americas and scientists at the NIH, including NIEHS, or with scientists conducting research supported by the NIH at a U.S. university. Full details on the specific fellowships and grants programs can be obtained by contacting the Fogarty Center (contact information given above). For further information, please call or write to: Dr. Terri Damstra Assoc. Director for International Programs and Program Coordinator Division of Intramural Research, NIEHS PO Box 12233, Mail Stop A2-07 Research Triangle Park, NC 27709, U.S.A. Telephone: (919) 541-3467 Fax: (919) 541-4075 NATURAL RESOURCES DEFENSE COUNCIL (NRDC) WASHINGTON, D.C., U.S.A. The Natural Resources Defense Council (NRDC) is a national nonprofit environmental organization, founded in 1970, dedicated to protecting the world's natural resources and ensuring a safe and healthy environment for all people. Since 1973, when we brought a lawsuit against the U.S. government to enforce the phaseout of leaded gasoline and enable the installation of catalytic converters on automobiles, NRDC has worked to reduce lead exposure in the United States and abroad. More recently, we have focused on removing lead from drinking water and well pumps. At

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LEAD IN THE AMERICAS: A call for action the international level, NRDC is promoting the phaseout of leaded gasoline as a concrete step on the road to sustainable development. We are working with the United Nations Commission on Sustainable Development and the Summit of the Americas to encourage countries to phase out leaded gasoline. NRDC has also initiated a project with Russian policymakers and scientists to create public support for lead phaseout in Russia. For further information, please call or write to: Jacob Scherr Director International Program Natural Resources Defense Council 1350 New York Avenue, N.W., Ste. 300 Washington, D.C. 20005, U.S.A. Telephone: (202) 783-7800 Fax: (202) 783-5917 Internet: nrdcint@nrdc.org CENTER FOR HUMAN ECOLOGY AND HEALTH (ECO), PAN AMERICAN HEALTH ORGANIZATION (PAHO) METEPEC, MEXICO The Center for Human Ecology and Health (ECO) of the Pan American Health Organization (PAHO) is located in Metepec, outside of Mexico City. The Center provides technical assistance to the ministries of health of Latin America and the Caribbean through the PAHO missions located in almost every country in the Americas. These missions are the principal asset of the organization, and they can be a valuable channel for multinational communication, for technical assistance to the countries, and for compiling information regarding activities and studies in the various countries of the region regarding lead. ECO has recently completed a preliminary survey of the use of lead in the countries in the region, using information collected and provided by the environmental health advisers in each of the PAHO missions. These data were presented at the conference. ECO recently produced, with the Institute of Public Health and the Federal District of Mexico, a manual on procedures for blood sampling for lead (in Spanish). The Center also recently translated into Spanish for distribution in the Americas the recommendations of the American Academy of Pediatrics regarding lead exposure in children. Other activities of the Center that involve lead, or could be adapted to facilitate multilateral

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LEAD IN THE AMERICAS: A call for action collaboration for evaluating and controlling the hazards of lead in the Americas, include: A network of quality-controlled laboratories for the evaluation of metals, currently being developed by ECO with support from the German government; A small grants program for the development of pilot research projects based on inter-American cooperation, involving U.S. and Latin American or Caribbean investigators (with support from the United States Environmental Protection Agency (EPA); A risk assessment course conducted jointly by ECO and EPA scientists, and direct to the development of pilot projects in risk assessment in countries of Latin America and the Caribbean; A scholarship program for Latin American public health professionals to obtain a masters in environmental health at the National Institute of Public Health in Mexico and to develop a thesis in the home country (in collaboration between the Institute of Public Health, the U.S. Centers for Disease Control and Prevention (CDC), and PAHO/ECO). This program may soon be expanded to include faculty exchanges; A tutorial fellowship in environmental and occupational epidemiology for epidemiologists from the ministries of health in Latin America and the Caribbean (in collaboration with ECO, the Mexican General Directorates of Epidemiology and Environmental Health, and the CDC). For more information regarding these activities, please contact: Dr. Rob McConnell Director, ECO/OPS Apartado Postal 37-473 06696 Mexico, D.F., MEXICO. Internet: ECO_DIR_at_ECO/OPS@cclink.paho.org