NASSAU COUNTY DEPARTMENT OF HEALTH

CHILDHOOD LEAD POISONING PREVENTION

PROGRAM

Abby J. Greenberg, MD, FAAP

Margaret Sherman, Epidemiologist

David Forte, Sanitarian

Overview

• One of the most preventable childhood health problems

• Children susceptible due to rapid G & D and hand to mouth behavior

• ¼ of the nation’s children are exposed at home• 400,000 children nationwide are lead-poisoned

each year• Principle source: lead-based paint• NYS Physicians are required to test• Current emphasis: primary prevention

History of NCDOH CLPPP• 1970’s-CDC grant to identify children with lead

poisoning, 9 positions, assigned to community testing

• 1980’s - funding, 1 employee, case management• Late 1980’s - grant from NYSDOH-case

management and Head Start testing • 1990’s – present - expanded grant from NYSDOH

– expanded case management, education, environmental assessment

• 1992 – Public Health Campaign – laboratory development for lead testing

CDC Acceptable BLL

Table 1. Changing definitions of acceptable blood lead levels in the United States

Year Level of Concern1960 60 mcg/dL1970 40 mcg/dL1975 35 mcg/dL1985 25 mcg/dL1991 10 mcg/dL2004 Discussions underway at CDC to determine if level should be further decreased to 5 mcg/dl, in light of growing body of research demonstrating no "safe" threshold of exposure

NYS Lead Law 1993

• Mandated testing at ages 1 and 2 years

• Annual assessment to age 6 years

• Test if + risk assessment

• All BLL reportable to LHU/database

• LHU-identify and track children, assure f/u

• LHU-provide environmental management

• Obstetricians required to screen pregnant women

Effects of Lead Poisoning

• Impaired Growth and Development and I.Q.

• Learning disabilities, behavioral problems

• Interferes with RBC production

• Kidney damage, interferes with Vit D metabolism

• Hearing loss

• Seizures, Coma, Death

Pathways Of Lead Absorption

• Ingestion

• Inhalation

• Maternal-fetal transfer

Case Management

• Receive lab reports-maintain database

40,473 in 04; 28,186 in 05

• Letters to MDs and parents – For child with lead 10 ug/dl and above– For every infant with lead 5 ug/dl and above

• Educational Home Visits-84 in 04; 67 in 05

• New Environmental Assessments -27 in 04; 18 in 05

• Referral to Child Find-13 in 04; 6 in 05

Case Management (con’t)

• Case reviews - twice monthly

• Respond to requests for information from medical professionals and the public

– pieces of literature distributed

• 14,603 in 04; 35,136 in 05

– legal requests for medical records

• 10 in 04; 14 in 05

2004-Testing in Nassau County

• 40,473 test results

• 2,709 results 5ug/dl - 10ug/dl (7%)

• 383 equal or greater than 10ug/dl (0.9%)

• 1 child hospitalized for chelation

2005-Testing in Nassau County

• 28,186 test results

• 1,930 results 5ug/dl - 10ug/dl (7%)

• 130 equal or greater than 10ug/dl (0.5%)

• 2 children hospitalized for chelation

Educational Home Visits

• Identify source of lead/temporary measures

• Nutrition

• Run tap water/Use cold tap water

• Hand washing

• Cleaning

Physician Medical Record Lead Assessment Reviews

• 14 physician practices evaluated in 2005

• 72% documented lead test at age 1

• 78% documented lead test at age 2

• Staff meet with providers for appropriate recommendations

Other Activities

• 940 letters to Pediatricians & Family Practice Physicians, 700 to OB/GYNs

• Medical Director reports to Nassau Medical Society and Pediatric Societies

• Educational programs to WIC and Community Health Worker programs

• Distribution of pamphlets at health fairs

Office of Lead Abatement

• Interview regarding potential sources

• Evaluate home and other sites

• Identify other children in dwelling

• Laboratory testing

• XRF analysis

Intervention and Education

• Limit access to affected areas

• Wet cleaning of windowsills, floor, etc

• Hand washing

• Running cold water

• Interim measures

Abatement

• Owner notification• Plan: cleanup/by a professional lead-abatement

professional, when no children are present• Enforcement• Final Inspection• Other sources: soil, solder, folk remedies,

imported candy and medicine, cosmetics, surma, tea cups, ceramics, pewter items, picture frame, furniture

Sources of Lead

• Houses built prior to 1978

• Drinking Water (lead pipes, solder)

• Soil, dust

• Occupational hazards

• Toys, jewelry, hobbies, ceramics

• Imported candy, medicines and cosmetics

                                                                                                                                                         

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Some container, pillar, votive, and tealight candles use metal wicks and CPSC found that some contained lead.

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Tapers, commonly used as dinner candles, usecotton wicks and do not contain lead.

IMPORTED PRODUCTS THAT MAY CONTAIN LEAD

• Middle East: Kohl, Al Kohl, Al Murrah, Anzroot, Bint Al Dehab, Kandu, Cebagin, Farouk, Santrinj

• India/Pakistan/Bangladesh: Surma, (aka Kohl or Al Kohl, Sindoor, Bali Goli, Bint Al Dehab, Deshi Dewa, Ghasard

• China: Ba Bow Sen, Jin Bu Huan, Poying Tan, Cordyceps

• Mexico: Greta, Azarcon (aka Alarcon, Luiga, Maria Luisa, Coral, or Rueda), Albayalde. Also candy and snacks, including Chapulines and Chaca Chaca, and glazed pottery

• Dominican Republic: Litargirio

Conclusion• Lead poisoning is preventable

– -Cleanup should be done before a baby is born or a child is exposed

• Hazards must be removed: primary prevention-remove lead before exposure

• Education of public and Health Care Providers is essential

• Children must be tested• Laws are needed to protect the health of children

through mandated testing and safe abatement, remediation and primary prevention