NASSAU COUNTY DEPARTMENT OF HEALTH CHILDHOOD LEAD POISONING PREVENTION PROGRAM

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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

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Overview

• One of the most preventable childhood health
  problems
• Children susceptible due to rapid G D and hand
  to mouth behavior
• ¼ of the nations 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

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History of NCDOH CLPPP

• 1970s-CDC grant to identify children with lead
  poisoning, 9 positions, assigned to community
  testing
• 1980s - ? funding, 1 employee, case management
• Late 1980s - grant from NYSDOH-case management
  and Head Start testing
• 1990s present - expanded grant from NYSDOH
  expanded case management, education,
  environmental assessment
• 1992 Public Health Campaign laboratory
  development for lead testing

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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
• 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

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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

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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

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Pathways Of Lead Absorption

• Ingestion
• Inhalation
• Maternal-fetal transfer

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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

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Case Management (cont)

• 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

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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

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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

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Educational Home Visits

• Identify source of lead/temporary measures
• Nutrition
• Run tap water/Use cold tap water
• Hand washing
• Cleaning

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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

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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

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Office of Lead Abatement

• Interview regarding potential sources
• Evaluate home and other sites
• Identify other children in dwelling
• Laboratory testing
• XRF analysis

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Intervention and Education

• Limit access to affected areas
• Wet cleaning of windowsills, floor, etc
• Hand washing
• Running cold water
• Interim measures

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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

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

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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