The Story of a Lead Disaster Averted

A Sick Child and the Search for Answers

This week is National Lead Poisoning Prevention Week. The following fictional story of take-home lead exposure among children exemplifies a very real problem.

A state health department is notified about a three-year-old boy who had recently been seen by his pediatrician due to ongoing vomiting, appetite loss, and fatigue. A series of diagnostic tests revealed that the child had an extremely elevated blood lead level (BLL).

This discovery triggered an in-depth investigation by the state health department. An initial assessment ruled out the most common sources of lead exposure: The boy’s home was built in 2001, making it unlikely that lead paint was the source of the lead exposure. Further assessment of the boy’s home eliminated soil, drinking water, toys, and food as possible sources. During an interview, the state health department learned that the mother worked at a hospital and the father worked at a lead-acid battery manufacturing company. It is later confirmed that the child’s lead exposure was due to lead dust brought home on his father’s work clothes.

Identifying Other Children with Take-home Lead Exposures

Stories of take-home childhood lead exposure are unfortunately common. After a real case similar to the one above, a state health department made the decision to integrate their child and their adult lead surveillance programs into one surveillance system. An integrated system combines and maintains information on sources of lead exposure and blood lead test results from both children and adults. This system links household and workplaces, describing a broader spectrum of lead exposure across the state.

To determine if there were other children accidently being exposed to lead, the state health department then examined the combined adult and child lead surveillance data. The health department identified an additional 47 children of employees at this company, and tested them. Fourteen of the tested children were found to have an elevated BLL (≥5 µg/dL). The state health department has since worked with the company to establish interventions that help prevent take-home lead exposure.

Benefits of an Integrated System

If the state health department simply closed the case after identifying the father’s worksite as the lead source of the index case the extent of take-home lead exposure among other workers at the site could have gone undetected. Their children would have continued to be exposed to lead. Integrating adult and child lead surveillance systems is a more proactive step towards better lead exposure prevention.

No level of lead exposure is safe, and early detection of lead exposure is especially vital among children to protect their health. Early childhood lead exposure can result in:

• damage to the brain and nervous system
• slowed growth and development
• learning and behavior problems
• hearing and speech problems

The negative impact of lead can last a lifetime.

Integration is the Solution

An integrated child and adult lead surveillance system at the state-level has much potential and could:

• help identify and investigate cases where lead exposure is not from the child’s primary residence
• identify children whose parents or other caregivers work in occupations with possible high-level lead exposure
• identify additional cases in homes where an elevated BLL has been found in both a child and an adult
• allow for long-term follow-up of cases and potentially affected household members

An integrated system would improve the state health department’s ability to link and identify high-risk children who need BLL testing (e.g., other children in the household, children of other adults who work in same workplace). We encourage states to move towards an integrated system to further eliminate childhood lead poisoning.

This blog is part of a take-home exposure series. Other blogs in this series include: ‘Take-Home’ Exposures Still Persist and Work-related Fatigue Reaches Beyond the Workplace.

More Information on Take-home Lead

Recent Publications:

• Integrating Childhood and Adult Blood Lead Surveillance to Improve Identification and Intervention Efforts
• Eliminating Take-home Exposures: Recognizing the Role of Occupational Health and Safety in Broader Community Health
• Occupational and Take-home Lead Exposure Among Lead Oxide Manufacturing Employees, North Carolina, 2016

MMWR

• Take-Home Lead Exposure Among Children with Relatives Employed at a Battery Recycling Facility — Puerto Rico, 2011
• Investigation of Childhood Lead Poisoning from Parental Take-Home Exposure from an Electronic Scrap Recycling Facility — Ohio, 2012

Health Hazard Evaluation Reports

• Boston Edison Company
• Evaluation of employees’ exposures to lead, noise, and heat at an auto-motive lead-acid battery recycling company
• Evaluation of occupational exposures at an electronic scrap recycling facility

Lead Poisoning Surveillance and Heath

• CDC/NIOSH. Adult Blood Lead Epidemiology and Surveillance Program
• CDC/NIOSH. Lead
• CDC/NCEH. Childhood Lead Poisoning Prevention Program
• Environmental Protection Agency (EPA) Protect your family from sources of lead
• World Health Organization. Lead Poisoning and Health
• Occupational Safety and Health Administration. Take-home Lead Quick Card

Rebecca Tsai, PhD, is an Epidemiologist in NIOSH’s Health Informatics Branch in the Division of Field Studies and Engineering.

Kathryn Egan, PhD, is an Epidemiologist in the Lead Poisoning Prevention and Environmental Health Tracking Branch at the National Center for Environmental Health.

Amy Mobley, MEn, is a Health Communications Specialist in NIOSH’s Health Informatics Branch in the Division of Field Studies and Engineering.

Diana Ceballos, PhD, MS, CIH, is an Assistant Professor in the Department of Environmental Health at the Boston University School of Public Health. She was an industrial hygienist at the NIOSH HHE Program from 2010-2015.