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 Concern 1960 60 mcg/dL 1970 40 mcg/dL 1975 35 mcg/dL 1985 25 mcg/dL 1991 10 mcg/dL 2004 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

-- Some container, pillar, votive, and tealight candles use metal wicks and CPSC found that some contained lead. Tapers, commonly used as dinner candles, use cotton 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