Transcript Slide 1

District Health Department
Serving Fillmore, Gage,
Jefferson, Saline, and
Thayer counties
Childhood Lead Poisoning Prevention Program
Guide to
Preventing Childhood Lead Exposure
This Guide is organized into three sections, each designed to inform primary health care
providers, home health visitors, and individual residents of the appropriate lead poisoning
screening, case management, and lead hazard control measures for children who have been or
are at risk for being exposed to lead. By providing this information the Department seeks to
increase screening of children who are at-risk for lead exposure, improve follow-up care of
children diagnosed with unhealthy lead exposure, and generate a pro-active stance against
lead exposure in our district among health care providers and parents.
The guide provides information organized into separate sections, for:
• Primary Health Care Providers
• Home Health Visitors
• Parents of young children
The Department is committed to the elimination of childhood lead exposure and poisoning. This guide
incorporates recommendations from the Centers for Disease Control and Prevention and the American
Academy of Pediatrics. It was developed by the PHS District Health Department.
995 East Highway 33, Suite 1  Crete, NE 68333
phone 402-826-3880  toll free 888-310-0565  fax-826-4101
www.phsneb.org
Guide to Preventing Childhood Lead Exposure
Contents
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Lead Overview
Lead in our health district
Recommendations on testing
Recommendations for managing children
with blood lead levels less than 10
micrograms per deciliter (μg/dL)
• Recommended follow-up care for children
diagnosed with lead poisoning
Lead Overview
• Toxic heavy metal
• Once used widely in paint,
gasoline, other products
• Causes damage to the blood,
brain, kidneys, heart, and sensory
organs
• Damage to a child’s brain is not
reversible
• Still the most common and the
most preventable environmental
hazard for children
Lead Overview
Not getting Not getting
tested
tested, at-risk*
Fillmore
Gage
Jefferson
Saline
Thayer
TOTAL
466
1481
510
981
409
3831
233
740.5
255
490.5
204.5
1923.5
These kids are at risk of poor
academic performance, behavioral
problems, etc. Even from low-level
lead exposure!
* Based on average housing age, not including other risk factors
Section 1: Primary Health Care Providers
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•
•
•
Clinical overview
Screening/Testing Guidelines
Screening/Testing Methods
Follow up
Section 1: Primary Health Care Providers
Clinical overview – lead poisoning
Case definition: Childhood lead poisoning is a
reportable disease. A confirmed case of lead
poisoning is defined as a child with a blood lead
level ≥10 ug/dL from a venous blood draw, or two
capillary blood draws within three months of one
another that are ≥10 ug/dL.
Health effects: Lead interferes with the production of
hemoglobin and use of calcium. It crosses the
blood-brain barrier to affect the nervous system,
causing developmental delays and learning
impairment. It also damages the kidneys, sensory
organs (especially auditory), reproductive system,
and heart.
At-Risk Populations: Children, particularly those 6
years old and younger, who are exposed to lead.
Lead exposure usually comes from the dust of
homes built before 1979. It can also come from
‘carried-in’ sources like parents working in a leadrelated industry, or contaminated toys.
Section 1: Primary Health Care Providers
Clinical overview – lead exposure
Case definition: child with a blood
lead level from 5 – 9 ug/dL
Health effects: unknown, but
suspected to impair learning and
academic performance, trigger or
worsen ADHD, increase aggressive
tendencies.
Section 1: Primary Health Care Providers
Clinical overview - Biological Fate and Transport
• Lead winds up in the mineralizing
tissue (95%), soft tissues, and
blood.
• During pregnancy and lactation, the
body can mobilize lead stores from
bone and fat to the bloodstream.
• The body accumulates lead over a
lifetime and normally releases it
very slowly.
• Both past and current elevated
exposures to lead increase patient
risks for lead effects.
HHS’s Agency for Toxic Substances and Disease Registry
Section 1: Primary Health Care Providers
Clinical overview – locally relevant risk factors
Housing: pre-1950 structures pose the highest risk, but any
property built before 1979 has the potential to provide a lead
source.
Testing Rates: low testing rates in high risk areas indicate that many
children with undetected lead exposure go without
intervention.
EBLL Rates among those tested: Particularly if testing rates
are low, a high percentage of those tested with EBLL
supports the hypothesis that a significant risk for lead
exposure exists in that population.
Borderline lead levels: As more research is published, there
is more and more support for once again lowering the
“action level” from 10 to enable more early intervention.
Section 1: Primary Health Care Providers
Symptoms and Indicators, <10 ug/dL:
• Delayed motor skill development
• Delayed speech development
• Short stature, underweight
• Very mild hearing impairment
(“my child just won’t listen)
• Low iron
• Attention deficit, hyperactivity
* Long-term damage can be done even if no symptoms
or indicators are immediately apparent
Section 1: Primary Health Care Providers
Symptoms and Indicators, 10+ ug/dL:
• More severe presentation of
previous symptoms/indicators
• Fussiness
• Abdominal pain
• Loss of appetite, nausea, vomiting
• Constipation
Section 1: Primary Health Care Providers
Minimum Screening Technique
Regardless of whether symptoms
or indicators are present
At 12 and 24 months old, or
Annually from 1-6 years if highrisk conditions exist
Section 1: Primary Health Care Providers
Minimum Screening Questions
 Does the child reside in or regularly visit a
residence that was built before 1950 (alt. 1979)?
including day care, babysitter, relative’s home
 Does the child reside in or regularly visit a
residence built before 1978, that is undergoing
a renovation or has recently (past 6 months)
been renovated?
 Does the child have a sibling or playmate
who has been diagnosed with lead poisoning?
 Is the child enrolled in Medicaid?
Section 1: Primary Health Care Providers
Testing Guidelines
Blood lead collection must be done
properly to ensure an appropriate
sample:
 Venous Blood Lead Test
 Capillary Blood Lead Test using a
capillary tube
 Capillary Blood Lead Test using an
onsite blood lead analyzer
 Capillary Blood Lead Test using
filter paper kit
Section 1: Primary Health Care Providers
Follow-up
• Blood test results
• Educational materials
• Reminder to retest (w/ date)
• Referral to PHSDHD’s
Environmental health office*
* For results that are 5ug/dL or higher
PHSDHD
5-6 ug/dL
7-9 ug/dL
• Letter with results,
informative insert
• Reminder to
retest annually
• Provide contact
info in case of
questions
• Follow-up when
retesting is due
• Offer free retest if
cost/schedule
barriers exist
• Letter with results,
informative insert
• Reminder to retest
annually (or more
often)
• Offer consultation
to help locate lead
hazards (automatic
lead hazard screen
for certain cases)
• Offer free retest if
barriers exist
• PH Nurse follow up
if necessary
** On-going relationship building efforts with
physicians to encourage testing, retesting, and
case referral to PHS
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PHSDHD
≥ 10 ug/dL
 Provide Lead Hazard
Assessment with:
• Environmental sampling
• Customized report
• Recommendations on interim
and permanent hazard
controls
• Consultation on seeking
financial assistance for hazard
control
 Follow-up on interim controls,
retesting
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PHSDHD Current case load:
As of: 20-Apr-09
Blood lead level
# children
5 to 6 ug/dL
50
7 to 9 ug/dL
29
10 + ug/dL
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TOTAL
90
Year in review: at least 10 children brought to lead levels
below 5 ug/dL due to our efforts
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PHSDHD – Cultural Competence
• Staff support for Spanish
translation/interpreting
• Relationship with local employer
to access Asian language
translators as needed
• Specialized lead risk questionnaire
to capture culturally appropriate
potential exposure sources
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