Public Health Brief March

Transcription

1 Public Health Brief March 27, 2013 Updated Guidelines for Childhood Blood Lead Testing Michele Kinshella, MS, CIH Donna Hite, Disease Intervention Specialist Based on a number of studies that blood lead levels (BLLs) < 10 µg/dl indicate risk of harm to children, the Centers for Disease Control and Prevention (CDC) recommended the elimination of the use of the term blood lead level of concern, which, prior to that time, was 10 µg/dl. This recommendation is based on evidence from a large number of studies including diverse groups of children that low BLLs are associated with IQ deficits, attention-related behaviors, and poor academic achievement. Since no safe BLL in children has been identified, a blood lead level of concern cannot be used to define individuals in need of intervention. In place of level of concern CDC is issuing a BLL reference value based on the 97.5 th percentile of the population BLL in children 1 to 5 years of age to identify children and environments associated with lead exposure hazards. Currently the reference value is 5µg/dL. CDC will update the reference level every 4 years using the two most recent National Health and Nutrition Examination Surveys. 1. How is Tri-County Health Department (TCHD) addressing lead poisoning in children within our jurisdiction (Adams, Arapahoe and Douglas Counties) given these new recommendations from the CDC? Reminding medical providers to conduct a blood lead test on patients who are recommended to be tested (see question #2 below) If a patient s BLL is 5 µg/dl, TCHD will send a fax to medical providers reminding them to conduct a second, confirmatory test. In addition, if a patient s BLL is 10µg/dL, TCHD will call the medical provider to ensure that the confirmatory test will be completed. If a second, confirmatory test is 10 µg/dl, a home investigation and assessment will be completed with the parent/guardian to evaluate potential sources of lead exposure. 2. Who should be screened for lead? Child who has had one EBLL of 5 µg/dl Child who is a recent immigrant, refugee, or foreign adoptee Neonates and infants born to women with lead exposure during pregnancy and lactation All Medicaid-enrolled children at ages 12 and 24 months and once between 36 to 72 months of age in those without prior screening in jurisdictions without formal recommendations until those recommendations are issued. Child who is suspected by a parent or a health-care provider to be at risk for lead exposure Child who has a sibling or frequent playmate with elevated blood lead level (EBLL) Child with parent or guardian works professionally or recreationally with lead Child who has a household member who uses traditional, folk, or ethnic remedies or cosmetics or who routinely eats food imported informally (e.g., by a family member) from abroad Tri-County Health Department Serving Adams, Arapahoe and Douglas Counties 6162 S. Willow Dr, #100 Greenwood Village, CO

2 Child whose family has been designated at increased risk for lead exposure by the health department because the family has local risk factors for lead exposure (e.g., residence in a designated high-risk zip code or near a known point source) Child who has a clinical presentation for lead poisoning with one or more of the following symptoms: Neurological symptoms Difficulty sleeping Developmental delay Attention deficit Hyperactivity Aggression Irritability Behavior disorders School problems Imported painted toys Anemia Hearing loss Headaches Constipation Abdominal pain and cramping Decreased appetite and energy Vomiting, ataxia, muscle weakness, seizures, or coma can occur with severe cases Abdominal pain and cramping (often an early sign of high doses of lead poisoning) 3. What is the appropriate test for blood lead? The first test can be a capillary or venous sample Please note: If the first test is a capillary, wash the child s hands with soap and water to avoid surface contamination; it is very easy to get a false positive if hands are not clean. The second test must be a venous sample 4. What are some common potential sources of lead in a home? Older homes undergoing remodeling Soil contaminated with lead Brass keys and fixtures Old plumbing leaking lead into tap water Dishware Lead fishing sinkers and bullets Ceramic tiles Plastic and painted furniture Old bathtubs Stained glass Imported painted toys Toy jewelry Lipstick Older, imported mini-blinds Alternative medicines Spices Food made or stored in lead-glazed ceramics 5. How are children with Elevated Blood Lead Levels (EBLL) reported to public health? We recommend that medical providers also report these findings. The sooner the health department receives the report, the sooner health department staff can investigate cases to try to identify and remediate the sources of lead that have caused the elevated BLL. Laboratories are required to report any BLL for persons <18 years of age regardless of results within 30 days. Levels in persons <18 years of age found to be above 5 mcg/dl must be reported within 7 days. Tri-County Health Department Serving Adams, Arapahoe and Douglas Counties 6162 S. Willow Dr, #100 Greenwood Village, CO

3 Please note: A standard disease-reporting form can be used, such as the one included in this report, and faxed to Tri-County Health Department s secure fax line: , or the report can be made by phone to Also included with this report is the most recent (August, 2012) Colorado Department of Public Health and Environment s Childhood Blood Lead Retesting and Case Management Chart, which outlines the current recommended procedures for a child s primary medical provider based on the child s BLL, is attached to this Public Health Brief. For more information, please contact: Michele Kinshella Donna Hite Tri-County Health Department Serving Adams, Arapahoe and Douglas Counties 6162 S. Willow Dr, #100 Greenwood Village, CO

4 TRI-COUNTY HEALTH DEPARTMENT REPORTABLE DISEASE NOTIFICATION FORM FOR PHYSICIANS AND OTHER HEALTH CARE PROVIDERS Case Information Case s Name: Parent s Name: Age: Date of Birth: Sex: ( ) Male ( ) Female Race: Home Phone(s): Work Phone(s): Address: City: Zip: County of Residence: ( ) Adams ( ) Arapahoe ( ) Douglas If another county, please specify: School/Employer: Medical Information Disease: Onset Date: Specimen: Specimen Collect Date: Lab Tests Performed: Lab Confirmed: ( ) Yes ( ) No Name of Lab Used: Other Relevant Medical/Rx/Immunization Info: Doctor s Information Doctor s Name: Doctor s Phone: Doctor s Address: City: Zip: Report Submitted By: Phone: Organization: Date Reported: For your convenience, you may report diseases by phone Monday through Friday, 8:00 A.M. to 5:00 P.M. at (303) or you may complete this form and fax it 24 hours a day to (303) For after hour and weekend emergencies: Contact the Tri-County Health Department at (303) or the Colorado Department of Public Health and Environment at (303) For Internal Use: Date Report Received: Received By Tri-County Health Department Serving Adams, Arapahoe and Douglas Counties 6162 S. Willow Dr, #100 Greenwood Village, CO

5 Tri-County Health Department Serving Adams, Arapahoe and Douglas Counties 6162 S. Willow Dr, #100 Greenwood Village, CO