WV STRATEGIC PLAN FOR THE ELIMINATION OF CHILDHOOD LEAD POISONING

Transcription

1 WV STRATEGIC PLAN FOR THE ELIMINATION OF CHILDHOOD LEAD POISONING Mission Statement: Assure the health and well-being of West Virginia children by supporting State and community efforts to reduce the incidence of lead poisoning in children. According to the Center for Disease Control and Prevention s (CDC) Morbidity and Mortality Weekly Report (MMWR) dated August 7 th, 2009, screening policies should be developed based on appropriate local patterns of risk for lead exposure. Unfortunately, the children of the State of West Virginia are at high risk for lead exposure. Overall Project Goal: The overall objective of the State of West Virginia Office of Maternal Child and Family Health is to decrease the number of new cases of lead poisoning, defined at a level of greater or equal to 10 mcg/dl, to less than one percent (1%) of the population of children zero to six years of age by A Statement of Purpose: The purpose of developing a childhood lead poisoning elimination plan is: a. The elimination of lead poisoning in young children and achieving the goal of protecting young children from the adverse effects of lead poisoning. b. To develop effective planning tools that will:! Identify and provide follow-up services for children zero to six years of age who are at high risk for lead poisoning.! Geographically target program activities in high risk areas using evaluation information to strengthen the Childhood Lead Poisoning Prevention WVDHHR/BPH/OMCFH/REP/CLPPP/AUG09 1

2 Project (CLPPP) Surveillance System. According to surveillance and evaluation information and risk predictions, the seven highest out of fifty five high risk counties are Brooke, Wetzel, Taylor, Barbour, Lewis, Roane and Monroe. Details are listed in Appendix A and Appendix B.! Address old housing problems and establish primary prevention activities in high risk areas.! Provide childhood lead poisoning screening and prevention education to high risk families, providers and public health professionals.! Evaluate progress in meeting goals and objectives established to reduce the incidence of lead poisoning and refine/revise strategies as indicated. Background on West Virginia Childhood Lead Poisoning Problem:! Risk Predictors: Data from the National Health and Nutrition studies indicated that three factors, in combination, predict communities at high risk for childhood blood lead poisoning - poverty level, percent of older houses and percent of population between the ages of zero and six years. In addition to these three predictors, the NHANES surveys also determined that minority children are at higher risk for childhood lead poisoning than non-minority children. In order to determine the risk for childhood lead poisoning in West Virginia, the three predictors identified by NHANES were singled out.! Pre-1980 Housing: The CDC states that lead paint is often found in homes that were built before According to the 2000 US Census seventy point thirteen percent (70.13%) of the homes in the State of West Virginia were built before The range varies per county within the State of West Virginia from a low of forty-eight point ninety-four percent (48.94%) in Berkeley to a high of eighty-six point seventy- WVDHHR/BPH/OMCFH/REP/CLPPP/AUG09 2

3 eight percent (86.78%) in Hancock. Details are listed in Appendix C.! Poverty Level: According to 2000 census data, of the children less than 12 in the State of West Virginia twenty-five point ninety-six percent (25.96%) lived in a home at or below the Federal Poverty Level. The range varies per county within the State of West Virginia from a low of eleven point thirty-two percent (11.32%) in Jefferson to a high of fifty-six point eighty-five percent (56.85%) in McDowell. Details are listed in Appendix D.! Under Six Child Population: Percent of population, children age six and under, is one of the risk predictors for childhood lead poisoning. West Virginia had 122,311 children age zero to seventy-two months, according to 1999 population data and 122,919 according to 2000 census data. Summary:! According to the 2000 Census, seventy-five point two percent (75.2%) of occupied housing units within West Virginia are owned by the occupant, ranking number two in the nation.! According to the 2000 Census, twenty-seven percent (27%) of occupied pre-1960 housing is renter occupied and seventy-three percent (73%) is owner occupied, compared to sixty-six percent (66%) nationally. Median value of owner-occupied housing units in 2000 was $72,800 compared to $119,600 nationally. Immunization Matching Project The Office of Maternal Child and Family Health and the Office of Immunizations had a data matching project of children with birth dates between Jan. 1, 2005 and Dec. 31, WVDHHR/BPH/OMCFH/REP/CLPPP/AUG09 3

4 2008 in February According to the Patient Matching Project, sixty-eight point eight percent (68.8%) of children with immunizations had been tested for lead poisoning. The range varies per county within the State of West Virginia from a low of fifteen point two percent (15.2%) to a high of eighty-seven point five percent (87.5%) in Roane. Details are listed in Appendix E. A Strategic Work Plan Annual objectives are evaluated at the end of each year. Program activities related to the corresponding objectives will be refined/revised according to evaluation results and new objectives will be included according to need. Screening Plan Goal: The Case Management plan which can be viewed at builds upon the established CLPPP in WV. Our Screening/Case Management plan implements and evaluates a jurisdiction-wide screening plan targeting resources to impact the largest number of children age zero to seventy-two months at high risk for lead poisoning. 1. Objective: Increase compliance of providers to test children in accordance with the targeted screening plan by one hundred percent (100%) of providers within designated areas. Activities: a. Distribute childhood lead poisoning risk analysis and targeted screening information to all providers who care for young children in targeted high risk counties. b. Distribute information to all providers about blood lead specimen collection methods that prevent difficulty collecting specimens and facilitate the collection of specimens along with other required blood testing measures. c. Provide feedback about county specific elevated blood lead levels and prevalence information to providers annually. WVDHHR/BPH/OMCFH/REP/CLPPP/AUG09 4

5 d. Evaluate, review and refine the targeted blood lead levels screening plan annually. Include additional activities as needed. 2. Objective: Increase compliance of newly Medicaid-eligible families with the existing screening policy by educating at least eighty five percent (85%) of families in the targeted high risk counties and at least seventy-five percent (75%) of families in the remaining counties about the need to screen young children for blood lead levels (BLLs). Activities: a. Continue the partnership with the HealthCheck program. They currently attach a lead flyer, see Appendix F, with the initial contact letter they send out to every child that is six years old or younger. b. Partner with the WIC Program, Automated Health System, HMO s, primary care clinics and local health departments for distribution of blood lead level screening and prevention information to Medicaid-eligible families. c. Evaluate, review, refine, and plan screening strategies to increase screening rates in Medicaid- eligible children annually. 3. Objective: Screen at least eighty percent (85%) of Medicaid-eligible children zero to seventy-two months of age in the targeted high risk counties and at least sixty percent (60%) of Medicaid-eligible children in the remaining counties. Activities: a. Coordinate screening activities with local organizations and primary care clinics to screen Medicaid-eligible children in high risk counties. b. Monitor screening rates and prevalence of elevated blood lead levels in Medicaid-eligible children and provide feedback to CLPPP partners and providers annually. c. Match the Medicaid-eligible data with CLPPP surveillance data. Identify children who had not been screened, and request providers to screen children and report corresponding BLLs. WVDHHR/BPH/OMCFH/REP/CLPPP/AUG09 5

6 Surveillance Plan Goal: Maintain, refine, and strengthen the WV CLPPP active, centralized, lab-based, blood lead screening and surveillance system by enhancing the ability to identify screening rates and prevalence by county, and develop program activities using surveillance evidence. Enhance the capacity to track screening rates and prevalence in Medicaid-eligible children. 1. Objective: Maintain collection of demographic information, including information about the county of residence, at ninety five percent (95%) or above of all children screened for BLLs. Activities: a. Maintain working relationships with primary care physicians to ensure that a complete address for any child screened for a blood lead level is provided. b. Review the status of the completeness of surveillance information and reporting issues and plan for additional activities to improve the reliability of CLPPP surveillance information. c. Continue to monitor the quality of surveillance information and complete entry of demographic information in the CLPPP database. 2. Objective: Support and maintain the capacity to use surveillance data linkage to monitor lead screening and prevalence for Medicaid-eligible children. Develop and distribute an annual report document with screening rates and prevalence for Medicaideligible children. Evaluate and refine strategies to identify and prevent lead poisoning in Medicaid-eligible children. Activities: a. Monthly match the Medicaid eligibility with CLPPP data for the same time period and update the CLPPP data with the matched file. b. Evaluate the outcomes and risk of childhood lead poisoning and review and refine the screening and prevention strategies in Medicaid-eligible children. WVDHHR/BPH/OMCFH/REP/CLPPP/AUG09 6

7 Assurance for Case Management Goal: Support and promote continuous and timely team case management through concerted collaboration with the Office of Environmental Health Services (OEHS), local health departments and laboratories, utilizing efforts to identify, reduce and eliminate all lead hazards in the environment of a child diagnosed with elevated BLL s. Maintain and continue the policy of receiving Medicaid reimbursement for environmental assessments provided to Medicaid-eligible children. 1. Objective: Ensure that one hundred percent (100%) of children reported with a BLL of 10g/dl are referred to the Children with Special Health Care Needs (CSHCN) Program for follow-up services within one week after receiving confirmation. Activities: a. The Children s Reportable Disease Program case manager will refer children with blood lead levels of > 10 mcg/dl to the CSHCN Program for follow-up services through various child service programs (e.g. Birth to Three, WIC, Head Start, Department of Education-Special Education, etc.) within seven working days of receiving elevated blood lead level confirmatory reports. Primary Prevention Goal: Building upon the WV Lead Abatement Act of 1998 and the Lead Screening Bill of 2002, partner with community and government resources to facilitate primary prevention activities of addressing old housing issues, and public education on improving/maintaining older housing. Details of the West Virginia Senate Bill No. 216 are listed in Appendix G. 1. Objective: Provide community education opportunities for the targeted high risk counties to support primary prevention education efforts for the high risk population, including pregnant women. Activities: a. Partner with local and State level organizations and primary care clinics to educate families in high risk areas about primary prevention of lead poisoning, WVDHHR/BPH/OMCFH/REP/CLPPP/AUG09 7

8 and screening of young children to identify and prevent lead. b. Partner with the West Virginia Right From The Start Program s (RFTS) Designated Care Coordinators to educate pregnant women about primary prevention strategies and blood lead level screening. The Designated Care Coordinators will continue to provide information to pregnant women during prenatal visits. Through the RFTS Program, infants receive home health visits until one year of age. RFTS personnel will be instructed to ask if the child has had a blood lead level screening before they sign off the case. Families will be encouraged to have their child s blood lead level tested and be referred to their primary care physician for an appointment. 2. Objective: Evaluate the impact of primary prevention efforts in the targeted high risk counties for further planning of lead hazard reduction activities. Activities: a. Identify the outcomes of lead poisoning prevention efforts in the targeted high risk counties. b. Disseminate information about the outcomes of primary prevention efforts to providers, partners at the local level, and CLPPP Advisory Committee members and solicit feedback from partners. c. Review, the primary prevention activities for lead hazard reduction in targeted high risk counties and revise as indicated to meet goals. Evaluation Plan The impact of Project activities will be evaluated in light of established goals and objectives. The blood lead level screening data for children less than six years of age, case management, and environmental assessment data will be used to measure the established objectives and evaluate Project impact. Outcomes, such as screening rates, elevated blood lead levels of 10mcg/dl and prevalence of elevated blood lead levels will be monitored over time to measure progress. CLPPP intends to use evaluation outcomes for the following activities: WVDHHR/BPH/OMCFH/REP/CLPPP/AUG09 8

9 a. Estimate the extent of the childhood lead poisoning problem by county, identify high risk areas, and focus on screening and educational activities in these areas. b. Increase awareness of providers about childhood lead poisoning problems in their county by dissemination of county specific screening rates and prevalence information to providers c. Estimate the lead poisoning problem and refine prevention strategies in Medicaid-eligible children. d. Target primary prevention activities in high risk areas. WVDHHR/BPH/OMCFH/REP/CLPPP/AUG09 9

10 APPENDIX A

11 HANCOCK BROOKE OHIO MARSHALL BERKELEY HAMPSHIRE HARRISON MARION MINERAL MONONGALIA MORGAN PRESTON TAYLOR TYLER WETZEL JEFF- ERSON ANTS PLEAS- DODD- BARBOUR GILMER GRANT HARDY JACKSON LEWIS MASON RANDOLPH RITCHIE ROANE TUCKER UPSHUR WIRT WOOD RIDGE HOUN CAL- BRAXTON CABELL CLAY KANAWHA MASON NICHOLAS PENDLETON POCAHONTAS PUTNAM ROANE WEBSTER BOONE FAYETTE GREENBRIER LINCOLN LOGAN MINGO RALEIGH WAYNE High Risk Targeted MCDOWELL MERCER MONROE SUMMERS WYOMING Targeted Counties

12 APPENDIX B

13 BLL's Per County Non-Duplicate Tests From 07/01/2007 Thru 06/30/2008 County Total Tested Confirmed Percent Confirmed Elevated BARBOUR % BERKELEY BOONE % BRAXTON BROOKE % CABELL % CALHOUN 49 0 CLAY DODDRIDGE 38 0 FAYETTE % GILMER 64 0 GRANT GREENBRIER HAMPSHIRE % HANCOCK HARDY HARRISON % JACKSON % JEFFERSON % KANAWHA 1, % LEWIS % LINCOLN LOGAN % MARION % MARSHALL % MASON MCDOWELL MERCER % MINERAL % MINGO % MONONGALIA % MONROE MORGAN NICHOLAS % Tuesday, September 29, 2009 Page 1 of 2

14 County Total Tested Confirmed Percent Confirmed Elevated OHIO % PENDLETON 68 0 PLEASANTS 46 0 POCAHONTAS 69 0 PRESTON % PUTNAM % RALEIGH % RANDOLPH RITCHIE 60 0 ROANE % SUMMERS 82 0 TAYLOR 99 0 TUCKER 53 0 TYLER 41 0 UNKNOWN 42 0 UPSHUR WAYNE WEBSTER 52 0 WETZEL % WIRT % WOOD % WYOMING TOTALS 15, % Tuesday, September 29, 2009 Page 2 of 2

15 Confirmed Elevated Blood Lead Lvls Sample = "V" And BLL >=10 Sample = "V" And BLL >=10 Sample = "V" And BLL >=10 Sample = "V" And BLL >=10 County 07/01/ /30/ /01/ /30/ /01/ /30/ /01/ /30/2008 BARBOUR BERKELEY BOONE BRAXTON BROOKE CABELL CALHOUN CLAY DODDRIDGE FAYETTE GILMER GRANT GREENBRIER HAMPSHIRE HANCOCK HARDY HARRISON JACKSON JEFFERSON KANAWHA LEWIS LINCOLN LOGAN MARION MARSHALL MASON MCDOWELL MERCER MINERAL Monday, September 28, 2009 Page 1 of 2

16 Sample = "V" And BLL >=10 Sample = "V" And BLL >=10 Sample = "V" And BLL >=10 Sample = "V" And BLL >=10 County 07/01/ /30/ /01/ /30/ /01/ /30/ /01/ /30/2008 MINGO MONONGALIA MONROE MORGAN NICHOLAS OHIO PENDLETON PLEASANTS POCAHONTAS PRESTON PUTNAM RALEIGH RANDOLPH RITCHIE ROANE SUMMERS TAYLOR TUCKER TYLER UNKNOWN UPSHUR WAYNE WEBSTER WETZEL WIRT WOOD WYOMING TOTALS: Monday, September 28, 2009 Page 2 of 2

17 APPENDIX C

18 PERCENTAGE OF WEST VIRGINIA HOMES BUILT BEFORE 1980 FROM THE 2000 US CENSUS' DATA County Before 1980 Between 1980 And 2000 Total Percentage BARBOUR BERKELEY BOONE BRAXTON BROOKE CABELL CALHOUN CLAY DODDRIDGE FAYETTE GILMER GRANT GREENBRIER HAMPSHIRE HANCOCK HARDY HARRISON JACKSON JEFFERSON KANAWHA LEWIS LINCOLN LOGAN MARION MARSHALL MASON MERCER MINERAL MINGO 5,402 1,946 7, % 16,107 16,806 32, % 7,607 3,968 11, % 4,535 2,839 7, % 9,310 1,840 11, % 35,723 9,892 45, % 2,596 1,252 3, % 2,920 1,916 4, % 2,528 1,133 3, % 16,647 4,969 21, % 2,583 1,038 3, % 3,489 2,616 6, % 12,039 5,605 17, % 5,778 5,407 11, % 12,781 1,947 14, % 3,610 3,505 7, % 24,444 6,668 31, % 7,621 4,624 12, % 9,864 7,759 17, % 73,834 19,954 93, % 5,587 2,357 7, % 5,673 4,173 9, % 11,198 5,609 16, % 21,498 5,162 26, % 13,187 2,627 15, % 8,041 4,015 12, % 21,541 8,602 30, % 8,491 3,603 12, % 7,522 5,376 12, % Page 1 of 2

19 County Before 1980 Between 1980 And 2000 Total Percentage MONONGALIA MONROE MORGAN MCDOWELL NICHOLAS OHIO PENDLETON PLEASANTS POCAHONTAS PRESTON PUTNAM RALEIGH RANDOLPH RITCHIE ROANE SUMMERS TAYLOR TUCKER TYLER UPSHUR WAYNE WEBSTER WETZEL WIRT WOOD WYOMING Total Numbers Statewide: 24,042 12,653 36, % 4,795 2,472 7, % 4,312 3,764 8, % 10,949 2,633 13, % 7,563 4,843 12, % 19,514 2,652 22, % 3,320 1,782 5, % 2, , % 4,267 3,327 7, % 8,581 4,863 13, % 10,786 10,835 21, % 25,598 10,080 35, % 9,119 4,359 13, % 3,873 1,640 5, % 5,262 2,098 7, % 5,319 2,012 7, % 4,816 2,309 7, % 2,632 2,002 4, % 3,705 1,075 4, % 6,810 3,941 10, % 12,874 6,233 19, % 3,369 1,904 5, % 6,216 2,097 8, % 2,077 1,189 3, % 30,204 9,581 39, % 7,926 3,772 11, % 592, , , % Page 2 of 2

20 APPENDIX D

21 WEST VIRGINIA'S POVERTY PERCENTAGE OF CHILDREN LESS THAN 12 YEARS OLD FROM THE 2000 US CENSUS' DATA County BARBOUR BERKELEY BOONE BRAXTON BROOKE CABELL CALHOUN CLAY DODDRIDGE FAYETTE GILMER GRANT GREENBRIER HAMPSHIRE HANCOCK HARDY HARRISON JACKSON JEFFERSON KANAWHA LEWIS LINCOLN LOGAN MARION MARSHALL MASON MCDOWELL Below Poverty Level At or Above Poverty Total Percentage 823 1,431 2, % 2,011 10,506 12, % 1,164 2,661 3, % 566 1,452 2, % 593 2,602 3, % 3,370 9,207 12, % % 660 1,039 1, % , % 2,344 4,152 6, % % 419 1,295 1, % 1,244 3,299 4, % 778 2,497 3, % 760 3,643 4, % 290 1,666 1, % 2,520 7,445 9, % 1,055 3,232 4, % 740 5,796 6, % 6,312 21,265 27, % 709 1,654 2, ,269 1,920 3, % 1,980 3,481 5, % 1,732 5,609 7, % 1,338 3,855 5, % 1,004 2,764 3, % 2,223 1,687 3, % Page 1 of 2

22 County MERCER MINERAL MINGO MONONGALIA MONROE MORGAN NICHOLAS OHIO PENDLETON PLEASANTS POCAHONTAS PRESTON PUTNAM RALEIGH RANDOLPH RITCHIE ROANE SUMMERS TAYLOR TUCKER TYLER UPSHUR WAYNE WEBSTER WETZEL WIRT WOOD WYOMING Total Numbers Statewide: Below Poverty Level At or Above Poverty Total Percentage 2,605 5,860 8, % 885 3,172 4, % 1,813 2,465 4, % 2,050 7,680 9, % 464 1,358 1, % 252 1,930 2, % 1,033 2,624 3, % 1,510 4,987 6, % , % , % , % 1,202 2,965 4, % 1,062 7,189 8, % 3,406 7,437 10, % 1,109 2,934 4, % 356 1,124 1, % 686 1,440 2, % 625 1,066 1, % 685 1,726 2, % % , % 1,020 2,261 3, % 1,670 4,679 6, % , % 719 1,918 2, % % 2,894 9,892 12, % 1,400 2,186 3, % 66, , , % Page 2 of 2

23 APPENDIX E

24 1 Patient Matching Project: Lead/WVSIIS February 11, 2009 Intro: The Office of Maternal and Child Health maintains a database of West Virginia children born from 1/1/05 through 12/31/08 by county who have had their blood lead level checked. For grant reporting purposes, they need to determine how many of these children have also received at least one immunization, by county. Method: A birth cohort was extracted from West Virginia Statewide Immunization Information System (WVSIIS) that contained children born from 1/1/05 through 12/31/08 and have at least one immunization recorded in the registry. Child demographic data was extracted from the WVSIIS h33_patient_master table. Children with out-of-state and null county address data were excluded from the query. Immunization counts >=1 was based on all immunizations recorded in the WVSIIS h33_vaccination_master table. To eliminate non-vaccine related records, tuberculin testing related codes were excluded from the query. The lead dataset was checked for completeness and data ranges. Records with no county listed were removed prior to analysis (n=124) to avoid inflating the proportion matched. Fuzzy matching by patient first name, last name, date of birth was performed between the lead dataset (n=73,070) and the WVSIIS dataset (n=26,430) using SAS to determine the proportion of children in the lead database that were also present in the WVSIIS dataset (children in the birth cohort with at least one recorded immunization). Results: Overall, 77.5% of children in the lead database could be matched with children in the WVSIIS dataset with one or more recorded vaccinations (see Table 1). Discussion: Matching rates varied by county. The median match rate by county was 78.8%. To account for within-state moves, children were initially not matched on county; however, this resulted in rates exceeding 100% for 4 counties. One reason for this discrepancy is suspected to be related to changes in county of residence that may have occurred for children since the blood lead level and most recent patient demographic update in WVSIIS. Patient demographics in the WVSIIS h33_patient_master table are updated constantly by providers as to reflect current patient status. It should also be noted that duplicate patients in WVSIIS could result in matching rates above 100%. Patient data could be queried on the basis of being reported as birth record data from Vital Statistics (from WVSIIS h33_patient_reserve table), but it would cause any child in the lead dataset not born within the State to automatically not be matched, even if a current WVSIIS record exists for the child. Table 2 depicts matching results for patients matched on county as well as first name, last name and date of birth. However, the primarily limitation with data matched in this way is that it assumes patients have not moved out of their original county listed in the lead dataset. It should also be noted that two counties (regardless of how matched) Nicholas and Mineral had more patients in the lead dataset than were found in the WVSIIS dataset. The reason for this may be related to providers in these counties not updating patient demographic data in WVSIIS to reflect current county of residence. Submitted by: Jonah M. Long, MPH Epidemiologist II Immunization Program / SIIS WVDHHR/BPH/OEHP/DSDC Patient matching project_rev090211

25 Table 1. Matching results by county for lead dataset and WVSIIS dataset (children with at least 1 immunization) for children born 1/1/05 through 12/31/08/ 2 COUNTY WVSIIS Counts* Lead Counts Match Counts** %Match BARBOUR BERKELEY BOONE BRAXTON BROOKE CABELL CALHOUN CLAY DODDRIDGE FAYETTE GILMER GRANT GREENBRIER HAMPSHIRE HANCOCK HARDY HARRISON JACKSON JEFFERSON KANAWHA LEWIS LINCOLN LOGAN MARION MARSHALL MASON MCDOWELL MERCER MINERAL MINGO MONONGALIA MONROE MORGAN NICHOLAS OHIO PENDLETON PLEASANTS POCAHONTAS PRESTON PUTNAM RALEIGH RANDOLPH RITCHIE ROANE SUMMERS TAYLOR TUCKER TYLER UPSHUR WAYNE WEBSTER WETZEL WIRT WOOD WYOMING Missing (removed) n/a TOTALS 73,070 26,430 20, *Number of children in WVSIIS born from 1/1/2005 through 12/31/2008 and have at least 1 shot recorded in WVSIIS **Number of children in lead database matched with WVSIIS children with at least 1 shot recorded in WVSIIS as of 2/11/09 Patient matching project_rev090211

26 Table 2. Matching results by county for lead dataset and WVSIIS dataset (children with at least 1 immunization) for children born 1/1/05 through 12/31/08/ when also matched on county. 3 COUNTY WVSIIS Counts* Lead Counts Match Counts** %Match BARBOUR BERKELEY BOONE BRAXTON BROOKE CABELL CALHOUN CLAY DODDRIDGE FAYETTE GILMER GRANT GREENBRIER HAMPSHIRE HANCOCK HARDY HARRISON JACKSON JEFFERSON KANAWHA LEWIS LINCOLN LOGAN MARION MARSHALL MASON MCDOWELL MERCER MINERAL MINGO MONONGALIA MONROE MORGAN NICHOLAS OHIO PENDLETON PLEASANTS POCAHONTAS PRESTON PUTNAM RALEIGH RANDOLPH RITCHIE ROANE SUMMERS TAYLOR TUCKER TYLER UPSHUR WAYNE WEBSTER WETZEL WIRT WOOD WYOMING Missing (removed) n/a TOTALS 73,070 26,430 18, *Number of children in WVSIIS born from 1/1/2005 through 12/31/2008 and have at least 1 shot recorded in WVSIIS **Number of children in lead database matched with WVSIIS children with at least 1 shot recorded in WVSIIS as of 2/11/09 Patient matching project_rev090211

27 APPENDIX F

28 DID YOU KNOW? Lead poisoning is a problem in children less than six years of age. Lead can cause learning difficulties, behavior problems and lower IQ levels. CAUSES OF LEAD POISONING: Lead-based paints Lead Dust Houses built before 1978 are likely to have lead-based paint. Contaminated Drinking Water PREVENTIVE MEASURES: Screen Children at ages 1 & 2 Wet m op to clean up dust W ash children s hands & toys frequently Frequent meals rich in calcium & low fat Parents should check for lead poisoning in their children as early as possible, instead of waiting for problems to develop Children should be tested for lead poisoning at 1 & 2 years of age AND between ages 3 & 6, if they have Not been tested previously ASK YOUR DOCTOR OR CLINIC TO TEST YOUR CHILDREN FOR BLOOD LEAD LEVELS & KEEP THE TESTING SCHEDULES HOW DO WE HELP? THE W EST VIRGINIA CHILDHOOD LEAD POISONING PREVENTION PROJECT CAN PROVIDE FOLLOW-UP SERVICES TO ALL CHILDREN WITH BLOOD LEAD LEVELS OF 10mcg/dL. West Virginia Of fice of Maternal, Child & Family H ealth WVDHHR/OMCFH/REP/CLPPP/NOV2000 FOR FURTHER INFORMATION, PLEASE CONTACT THE WEST VIRGINIA OFFICE OF MATERNAL, CHILD & FAMILY HEALTH, 350 CAPITOL STREET, RM 427, CHARLESTON, WV PHONE:

29 APPENDIX G

30 1 ENROLLED 2 Senate Bill No (By SENATORS REDD, BURNETTE, CALDWELL, HUNTER, MINARD, 4 ROWE, SNYDER, WOOTON, FACEMYER, MITCHELL AND ANDERSON) 5 6 [Passed march 9, 2002; in effect ninety days from passage.] AN ACT to amend article thirty-five, chapter sixteen of the code of 10 West Virginia, one thousand nine hundred thirty-one, as 11 amended, by adding thereto a new section, designated section 12 four-a, relating to the screening of children under six years 13 of age for lead poisoning. 14 Be it enacted by the Legislature of West Virginia: 15 That article thirty-five, chapter sixteen of the code of West 16 Virginia, one thousand nine hundred thirty-one, as amended, be 17 amended by adding thereto a new section, designated section four-a, 18 to read as follows: ARTICLE 10. LEAD ABATEMENT a. Duty of director to establish program for early 22 identification of lead poisoning in children. 23 (a) The director shall establish a program for early 24 identification of cases of lead poisoning. The program shall 25 include a systematic screening of all children under six years of 26 age for the presence of lead polsonlng. The director shall, after

31 1 consultation with recognized professional medical groups and such 2 other sources as he deems appropriate, propose legislative rules 3 establishing: (1 ) The means by which and the intervals at which 4 children under six years of age shall be screened for lead 5 poisoning; and (2) guidelines for the medical follow-up of children 6 found to be lead poisoned. Such identification program shall, to 7 the extent that all children residing in thi s state are not 8 systematically screened, give priority in screening to children 9 residing, or who have recently resided, in areas where significant 10 numbers of lead poisoning cases have recently been reported or 11 where other reliable evidence indicates that significant numbers of 12 lead poisoning cases may be found. If the director is informed of 13 any person having a medically confirmed elevated blood-lead level, 14 the director shall cause to have screened all other children under 15 six years of age, and such other children as he or she finds 16 advisable to screen, residing or recently residing in the household 1 7 of the victim, unless the parents of such child obj ect to the 18 screening because it conflicts with their religious beliefs and 19 practices. The results of the screenings shall be reported to the 20 director, to the person or agency reporting the original case and 21 to such other persons or agencies as the director deems advisable. 22 (b) The director shall maintain comprehensive records of all 23 screenings conducted pursuant to this section. The records shall be 24 geographically indexed in order to determine the location of areas 25 of relatively high incidence of lead poisoning. The records shall 26 be public records, except that the names of screened individuals ~,

32 1 may not be public. A summary of the results of all screenings 2 conducted pursuant to this section shall be released quarterly, or 3 more frequently if the director so determines, to all interested 4 parties. 5 (c) All cases or probable cases of lead poisoning, as defined 6 by legislative rule proposed by the director, found in the course 7 of screenings conducted pursuant to this section shall be reported 8 immediately to the affected individual, to a child's parent or 9 legal guardian if the child is a minor, and to the director. The 10 director shall inform such persons or agencies as the director 11 determines is advisable of the existence of the case or probable 12 case of lead poisoning. 13.j

33 WEST VIRGINIA SECRETARY OF STATE JOE MANCHIN,m ADMINISTRATIVE LAW.DIVISION Fonn#6C Do Not Mark In This Box Cll ED.. ~ :-..-" ZGOq i'.pr 2q P 3: 05,. ;::~,';:.,;~:.S I" \i:rginia SEC:'i~:I~.~tY OF STATE NOTICE OF FINAL FILING AND ADOPTION OF A LEGISLATIVE RULE AUTHQRIZED BY THE WEST VIRGINIA LEGISLATURE AGENCY: DHHR-Bureau for Public Health AMENDMENT TO AN EXISTING RULE: YES - NO.1L.TITLE NUMBER' 64 IF YES, SERIES NUMBER OF RULE BEING AMENDED: TITLE OF RULEBEINGAMENDED: IF NO, SERIESNUMBEROF RULEBEING PROPOSED: 42 TITLE OF RULE BEINGPROPOSED: Childhood Lead Screenin~ THE ABOVE RULE HAS BEEN AUTHORIZEDBY THE WEST VIRGINIALEGISLATURE. AUTHORIZATION IS CITED IN (house or senate bill number) HB 4205 SECTION 2(f). PASSEDON March 13,2004 THIS RULE IS FILED WITH THE SECRETARY OF STATE. THlS RULE BECOMES EFFECTIVEON THE FOLLOWINGDATE: A ~r'l I ~ 9 I ~o4 ~ L (W;~- I Authorized Signature - -'. H

34 General TITLE 64 WEST VIRGINIA LEGISLATIVE RULE BUREAUFOR PUBLIC HEALTH r:'!j,. : :... "'-!= D DEPARTMENTOF HEALTH ANDHUMANRESO~<1,* 2q P 3: 05 SERIES 42 CErnUDBOODLEADSCREENING,,;' ':L~' :is!' V1RGIHIA S:::~i~f::'ij~,RYOF STATE 1.1. Scope. - This rule establishesand implementsa statewidechildhoodlead poisoning screening and identification program. This rule should be read in conjunction with W. Va. Code a, -35, and -18. The W. Va. Code is available in public libraries and on the Legislature's web page, Authority. - W. Va. Code and a Filing Date. - December 8, A. EffectiveDate. - March 13, Application and Enforcement This rule applies to all physicians,hospitals,health care facilities, and health care providerswho conductor overseemedicalexaminationsof childrenunderthe age of six (6)years Enforcement - This rule is enforcedby the Commissionerof the Bureau for Public Health DefmitioDS Bureau. - The West VirginiaBureaufor PublicHealth Commissioner.- The Commissionerof thebureaufor PublicHealth Elevated Blood Lead LeveL -:-A concentration of lead in the blood stream as defined in the reference manual provided by the United States Centers for Disease Control and Prevention, ""Managing Elevated Blood Lead Levels Among Young Children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention," Health Care Provider. - A physician,or his or her designee,at any medical facility, includingbut notlimitedto, privateclinics,healthdepartments,and hospitals Laboratory.- A facilityor place,however,named.,for the biological,microbiological, serological,chemical,immuno-hematological, hematological,biophysical,crytological,pathological, UO-n u u

35 or other examinationof materials derivedfrom the human body for the purposeof providing informationfor the diagnosis, preventionor treatment of any disease or impairmentof, or the assessmentof the health of human beings and is participatingin the United StatesCenters for DiseaseControland Preventionblood leadlaboratoryproficiencyprogram Screening. - The assessment of a child's environment and social conditionsto determine risk for lead poisoning Protocol for Screening of Children West Virginia health care providers shall, to the greatest extent possible, screen all children before the age of six (6) years for risk of elevated blood lead levels in accordance with the United States Centers for Disease Control andprevention reference, "Screening Young Children for Lead Poisoning: Guidance for State and LocalOfficials," November, a. All children shall be screenedusing a risk assessment at one(1)year and again at two (2) years of age, and children thirty-six (36) to seventy-two (72) months of age if they have not been screened previously; and 4.1. b. The risk assessment screeningshall be recorded in each child's medical record at the physician's office. This information shall include the date of screening, the child's address, the location where the screening was conducted and the physician's name. 4.I.c. If a child is determined to be at risk for lead poisoning, the health care provider shall perform or authorize a blood test to identify the blood lead level The protocol for confirmation of elevated blood lead levels shall be in accordance with the United States Centers for Disease Controland Prevention reference, "ManagingElevated Blood- Lead Levels Among Young Children: Recommendations from the Advisory Committee on Crnldhood Lead Poisoning Prevention," March, Follow-up Testing and Information In addition to the follow-up testingprescribed in WVCode a,when a child's results are confirmed as an elevated blood lead level, the Bmeau fotpublic Health shall advise pregnant women residing at the same addressof the need to be tested as soon as possible The health care provider shallprovide all information concerninga child' s blood lead level to the legal parent or guardian and other agencies involved in lead poisoning testing The Bureau shall refer childrenwith elevated blood lead levelsto the following services: 5.3.a. Childrenwithblood lead levels of greaterthanor equal to ten (10) microgramsper deciliter shall be referredto Children's SpecialtyCare, a program.offered by the ---m- -n n n u

36 Officeof Maternal,Childand FamilyHealthin the Bureau,within ten (10)days of confinnation; 5.3.b. Children with two (2) consecutive blood lead levels of greater than or equal to fifteen (15) micrograms per deciliter, and children with blood lead levels of greater than or equal to twenty (20) micrograms per deciliter shall be referred to environmental assessments and nurse home visits within two (2) days of confinnation; and 5.3.c. All children with elevated blood lead levels of greater than or equal to ten (10) micrograms per deciliter shall have a follow-up blood lead level screening every three (3) months Reporting Requirements The Bureau shall review this program at least every three (3) years and make available to all interested parties a summary of the quarterly testing results, beginning in July of the effective year of this rule Samples Submitted to a Laboratory The healthcareprovidershall submitall bloodsamplesto a laboratoryfor analysis When submitting blood samples, the health care provider shall include a laboratory requisition oburined from the Bureau that contains the child's name, address, the county of residence, the name and address of the physician who completed the screening, and other infonnation requested on the form Laboratories processing blood lead samples for analysis shall submit all required data to the Bureau within seven (7) working days of analysis, or sooner if available Confidentiality Recordsreceived and informationassembledby the Bureau are confidentialmedical recordsand shallnot be disclosedexceptas pennittedby law Reports published using statistical compilations relating to childhood lead poisoning may not in any manner identify individual patients, individual addresses, or individual enforcement action, or be reported for such small geographic areas or other categories with few entries that a person could, with other publicly available information, reasonably be able to identify the patients Enforcement Action The Commissionermay investigateall suspectedviolationsof this rule or ofw. Va. Code et seq., and upon the finding of a violation in connectionwith this rule, the Commissioner shallinitiateappropriatenforcementaction.. u_- -- _u_-u_- u-. u-u - un -- u- - u_-- ---un - -

37 Penalties Any person who violates the provisions ofw. Va. Code aorthis rule is subject to the penaltiesprovidedin W. Va. Code and Administrative Due Process Those individuals adversely affected by the enforcementof this rule desiring a contested case hearing to determine anyrights, duties, interests, or privilegesshall do so in a manner prescribed in the division of health, Rules and Procedures for Contested Case Hearing and Declaratory Ruling, 64CSRl.