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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