Childhood lead poisoning from commercially manufactured French ceramic dinnerware--New York City, 2003

Lead poisoning adversely affects children worldwide. During 1999-2000, an estimated 434,000 children aged 1-5 years in the United States had elevated blood lead levels (BLLs) >/=10 microg/dL. Glazes found on ceramics, earthenware, bone china, and porcelain often contain lead and are a potential source of lead exposure. Children are especially vulnerable to the neurotoxic effects of lead. Exposures to lead in early childhood can have adverse effects on the developing nervous system, resulting in decreased intelligence and changes in behavior. In addition, certain behaviors (e.g., thumb sucking) place children at greater risk for exposure to lead. In 2003, the New York City Department of Health and Mental Hygiene's Lead Poisoning Prevention Program (LPPP), and the Mount Sinai Pediatric Environmental Health Specialty Unit (PEHSU) investigated a case of lead poisoning in a boy aged 20 months. This report summarizes that case investigation, which identified ceramic dinnerware imported from France as the source of lead exposure. This case underscores the susceptibility of children to a toxic exposure associated with 1) the high proportion of time spent in the home and 2) dietary habits that promote exposure to lead leached from ceramic ware.     

Lead poisoning in South African children: the hazard is at home

Lead is a toxic heavy metal that has been used extensively in modern society, causing widespread environmental contamination even in isolated parts of the world. Irrefutable evidence associates lead at different exposure levels with a wide spectrum of health and social effects, including mild intellectual impairment, hyperactivity, shortened concentration span, poor school performance, violent/aggressive behavior, and hearing loss. Lead has an impact on virtually all organ systems, including the heart, brain, liver, kidneys, and circulatory system, resulting in coma and death in severe cases. In recent years, a consensus was reached regarding the absence of a threshold for the key health effects associated with lead exposure and the permanent and irreversible nature of many health and social consequences of lead exposure. The public health problem of environmental lead exposure has been widely investigated in developed countries like the United States of America, where actions taken have led to significant reductions in children's blood lead concentrations. In contrast, there is a relative dearth of information and action regarding lead poisoning in developing countries, particularly in African countries, despite evidence of widespread and excessive childhood lead exposure. In this paper, we will review the information from available published papers, the 'grey literature', and unpublished reports to give an overview of lead exposure in South African children over the past two decades, with particular emphasis on sources of exposure in the home environment.     

Lead poisoning of a child associated with use of a Cambodian Amulet --- New York City, 2009

Lead poisoning in children is a preventable public health problem that can adversely affect the developing nervous system and result in learning and behavior problems. The most common source of exposure for lead-poisoned children aged <6 years in the United States is lead-based paint. However, nonpaint sources have been identified increasingly as the cause of lead poisoning, particularly in immigrant communities. This report describes a case of lead poisoning in a child aged 1 year that was investigated by the New York City Department of Health and Mental Hygiene's (NYC DOHMH) Lead Poisoning Prevention Program in 2009. The likely source of exposure was an amulet made in Cambodia with leaded beads that was worn by the child. Health-care providers and public health workers should consider traditional customs when seeking sources of lead exposure in Southeast Asian populations. Health-care providers should ask parents about their use of amulets, especially those in Southeast Asian families and those with children found to have elevated blood lead levels (BLLs). Educational efforts are needed to inform Southeast Asian immigrants that amulets can be a source of lead poisoning.     

Childhood Lead Poisoning in a Somali Refugee Resettlement Community in New Hampshire

Despite the gradual decrease in childhood lead poisoning in the United States, the risk for lead poisoning among African refugee children who resettle in the United States remains elevated. Communication methods implemented by resettlement agencies in the public health system for preventing childhood lead poisoning in this at-risk population warrant further investigation. We utilized structured interviews with key stakeholders (resettlement agencies, social service agencies developed by African refugees and resettled Somali refugees) involved in the refugee resettlement process to (1) describe the agency’s role in the refugee resettlement process; (2) examine communication methods utilized and barriers experienced by the public health system in reference to childhood lead poisoning; (3) describe the refugee population’s perception of childhood lead poisoning; (4) examine general challenges experienced by the public health system and the refugee population during the resettlement process; and (5) describe stakeholders’ recommendations to improve health communication efforts. Based on our findings, we propose that communities are important determinants in health-related problems for refugee populations. Each community has its own environment and public health system that interacts with each other to influence health risks and risk perceptions of its populations. We advocate that understanding a community’s ecology and implementing a culture-centered approach is essential for the public health system to help educate and prevent communication inequalities and health disparities among an at-risk African refugee population. This action can reduce a population’s resistance to communication and help build a community’s capacity to address a persistent public health problem, such as childhood lead poisoning.     

Childhood lead poisoning associated with tamarind candy and folk remedies--California, 1999-2000

Lead poisoning affects children adversely worldwide. In the United States, elevated blood lead levels (BLLs) (>10 microg/dL) result primarily from exposure to lead-based paint or from associated lead-contaminated dust and soil; however, other sources of lead exposure, including folk remedies, Mexican terra cotta pottery, and certain imported candies, also have been associated with elevated BLLs in children. This report describes five cases in California of lead poisoning from atypical sources. Health-care providers should be aware of the potential hazards of certain food products, and community members should be educated about potential sources of lead poisoning for children.     

儿童铅中毒及防治的回顾与新进展

铅是一种多亲和性毒物,主要损害中枢神经系统,尤其是发育中的大脑。儿童血铅目前公认没有安全阈值,血铅水平仅用于界定是否需要实施干预措施。儿童铅中毒已成为一个全球性的公共安全问题。随着我国近年来对环境铅污染的治理,儿童铅中毒防治取得了实质性进步。儿童铅中毒重在预防,健康教育和减少铅暴露机会为主,排铅治疗为辅。驱铅主要药物目前仍是沿用了数十年的金属络合剂,儿童用药安全性尚存争议。经口暴露作为儿童铅摄入的主要途径,阻断铅消化道吸收有望成为儿童铅中毒防治的新举措之一。     

Immigration and risk of childhood lead poisoning: findings from a case control study of New York City children

Objectives. We investigated whether foreign birthplace and residence were associated with an increased risk of childhood lead poisoning.Methods. We conducted a matched case–control study among New York City children (mean age=3 years) tested for lead poisoning in 2002 (n=203 pairs). Children were matched on age, date of test, and residential area. Blood lead and housing data were supplemented by a telephone survey administered to parents or guardians. Conditional logistic regression analysis was used to examine the relationship of lead poisoning status to foreign birthplace and time elapsed since most recent foreign residence after adjustment for housing and behavioral risk factors.Results. Both foreign birthplace and time since most recent foreign residence had strong adjusted associations with lead poisoning status, with children who had lived in a foreign country less than 6 months before their blood test showing a particularly elevated risk of lead poisoning relative to US-born children with no foreign residential history before their blood test (odds ratio [OR]=10.9; 95% confidence interval [CI]=3.3, 36.5).Conclusions. Our findings demonstrate an increased risk of lead poisoning among immigrant children.Despite a dramatic decline in childhood lead poisoning in the United States, an estimated 1.6% of US children aged 1 to 5 years (approximately 310000 children) have elevated blood lead levels of at least 10 μg/dL. Furthermore, the growing scientific evidence on cognitive impairments associated with blood lead levels below 10 μg/dL suggest that even a greater number of children are at risk of being adversely affected by low-level exposure to lead.2^–4The most common high-dose source of lead exposure among US children is interior lead-based paint,5^–8 but children who spend time outside the United States may be exposed to additional sources. The literature on lead poisoning among immigrant children living in the United States is scant. Surveillance and case studies have revealed a higher prevalence or incidence of elevated blood lead levels among refugee and internationally adopted children living in the United States than among the general US population of children.9^–12 However, these reports have lacked a comparison group and presented results not adjusted for confounding factors.To our knowledge, a recent national study involving Mexican American children is the only investigation in which individual- and family-level characteristics (e.g., age, family income, language spoken at home) and source of drinking water were controlled for in any examination of the association between foreign birthplace and lead poisoning. The results of that study revealed higher blood lead levels among foreign-born children than among US-born children of Mexican descent.13In this study, we examined the associations of childhood lead poisoning with birth and residence in a foreign country among a multiethnic urban sample while accounting for child and family demographic characteristics, child behaviors, and current residential building characteristics. We hypothesized that lead poisoning would be positively associated with birth and residence in a foreign country after control for known risk factors.     

Childhood lead poisoning in Washington state: A statewide survey

Although childhood lead poisoning is an important health issue in the United States, it is not distributed evenly across the country. To estimate the prevalence of childhood lead poisoning in Washington State, the authors conducted a birth certificate follow-back survey of 1- to 2-year-old children. Interviewers visited participating families at their homes to conduct blood lead tests with a portable testing device. The estimated prevalence of lead poisoning for all 1- to 2-year-old children in the state was 0.9% (95% confidence interval [CI]: 0.3-2.7); for Hispanic children in central Washington, it was 3.7% (95% CI: 1.3-10.2), and their risk of lead poisoning was significantly higher than that of all other children in the state (relative risk [RR] = 5.8, 95% CI: 1.3-24.9). Lead poisoning prevalence in Washington State children is lower than the US average and is highest among Hispanic children in central Washington.     

"Cater to the children": the role of the lead industry in a public health tragedy, 1900-1955

A major source of childhood lead poisoning, still a serious problem in the United States, is paint. The dangers of lead were known even in the 19th century, and the particular dangers to children were documented in the English-language literature as early as 1904. During the first decades of the 20th century, many other countries banned or restricted the use of lead paint for interior painting. Despite this knowledge, the lead industry in the United States did nothing to discourage the use of lead paint on interior walls and woodwork. In fact, beginning in the 1920s, the Lead Industries Association and its members conducted an intensive campaign to promote the use of paint containing white lead, even targeting children in their advertising. It was not until the 1950s that the industry, under increasing pressure, adopted a voluntary standard limiting the amount of lead in interior paints.     

Reformulating lead-based paint as a problem in Canada

Leaded gasoline was officially removed from the Canadian market in December 1990. The removal of a major lead source and the subsequent decline in children's blood lead levels marked an important transition point and sparked the emergence of new discourse on lead in Canada. Today, childhood lead poisoning is viewed as a problem of the past or a problem of the United States. Sparse Canadian surveillance data supported this view. Moreover, tensions among federal agencies evolved into a power struggle, with Health Canada ultimately becoming the dominant authority, thereby relegating important research initiatives to obscurity and also shaping a vastly weaker regulatory response to lead than occurred in the United States.     

Childhood lead exposure in Oporto, Portugal

The study aims were to evaluate childhood lead poisoning in Oporto, Portugal, characterize childhood exposures, find solutions to reduce them, and call the community's attention to the need for preventive measures. Children aged 1-5 years living in Oporto Historical Center, were the target population. Data were gathered by means of a questionnaire and blood lead analyses for 240 children who attended four randomly selected kindergartens. The geometric mean blood lead concentration was 13.9 microg/dl and lead poisoning prevalence (blood lead levels > 10 microg/dL) was 85.8%. Important sources of lead poisoning were father's occupation, mother's smoking habits, and poor hygiene and pica associated with contaminated soils and lead paint. Families were unaware of the problem of lead exposure and its harmful effects. The data indicate that high levels of childhood lead exposures still prevail in Oporto City, an important public health finding that deserves authorities' attention.     

Human Rights Perspective on Pesticide Exposure and Poisoning in Children: A Case Study of India

Pesticide exposure and poisoning among children can lead to devastating long-lasting health effects that impact their human rights, with communities in low- and middle-income countries experiencing the negative impacts of pesticides more profoundly than those in high-income countries. While United Nations agencies recommend banning highly hazardous pesticides responsible for serious pesticide poisonings, childhood pesticide poisoning is rarely discussed, especially from a human rights perspective. In India, a country with a large population of children and widespread pesticide use, no law or policy addresses pesticide poisoning among children. This lack of prioritization leads to gaps in poisoning surveillance and lack of government action to prevent poisoning, causing violations of children’s rights. The proposed pesticides ban can reduce pesticide poisoning among children in India, but to fully protect children’s rights, the government needs to establish comprehensive pesticide poisoning surveillance and ensure the mainstreaming of pesticide poisoning prevention into law and policy based on a human rights framework.     

Renal effects of environmental and occupational lead exposure.

Environmental and industrial lead exposures continue to pose major public health problems in children and in adults. Acute exposure to high concentrations of lead can result in proximal tubular damage with characteristic histologic features and manifested by glycosuria and aminoaciduria. Chronic occupational exposure to lead, or consumption of illicit alcohol adulterated with lead, has also been linked to a high incidence of renal dysfunction, which is characterized by glomerular and tubulointerstitial changes resulting in chronic renal failure, hypertension, hyperuricemia, and gout. A high incidence of nephropathy was reported during the early part of this century from Queensland, Australia, in persons with a history of childhood lead poisoning. No such sequela has been found in studies of three cohorts of lead-poisoned children from the United States. Studies in individuals with low-level lead exposure have shown a correlation between blood lead levels and serum creatinine or creatinine clearance. Chronic low-level exposure to lead is also associated with increased urinary excretion of low molecular weight proteins and lysosomal enzymes. The relationship between renal dysfunction detected by these sensitive tests and the future development of chronic renal disease remains uncertain. Epidemiologic studies have shown an association between blood lead levels and blood pressure, and hypertension is a cardinal feature of lead nephropathy. Evidence for increased body lead burden is a prerequisite for the diagnosis of lead nephropathy. Blood lead levels are a poor indicator of body lead burden and reflect recent exposure. The EDTA lead mobilization test has been used extensively in the past to assess body lead burden. It is now replaced by the less invasive in vivo X-ray fluorescence for determination of bone lead content.     

Lead poisoning from ingestion of a toy necklace--Oregon, 2003

Although ingestion of dust from lead-based paint is the most common source of lead exposure among children in the United States, lead also can be present in unsuspected objects. Ingestion of these objects can result in elevated blood lead levels (BLLs). This report describes an investigation by the Deschutes County Health Department and the Oregon Department of Human Services of lead poisoning in a boy who swallowed a medallion pendant from a necklace sold in a toy vending machine. The investigation resulted in a nationwide recall in September 2003 of the implicated toy necklace. Clinicians and caregivers should consider lead poisoning in any child who ingests, or puts in his mouth, a metal object. Cases of lead poisoning should be reported immediately to public health authorities to prevent other children from being exposed to the same sources of lead.     

Biologic effects of lead on school children of urban and suburban Tokyo

Summary There are few reports on lead exposure of children in or near large cities which compare the blood lead values of those who live towards the center of cities and those living in the suburbs. Since lead poisoning among children in the United States is a serious problem, the authors wished to study the effects of lead in the environment on the young population in and near Tokyo. The results indicated much lower blood lead levels in school children than in adults in Tokyo. There is a statistically significant difference in PbB levels between urban and suburban children although the actual difference was only 1 – 2 g/100 g. Thus children living in urban Tokyo seem to have slightly higher body burdens of lead than suburban children. This difference in lead body burden is most probably not attributable to lead in ambient air but to other factors such as food. However, the possibility of the contribution of lead in ambient air cannot be totally rejected. Further investigation is required to identify the factor or factors which are responsible for this phenomenon.     

Epidemiology of childhood poisonings leading to hospitalization in the United States, 1979-1983

Since 1979 unintentional childhood poisonings have accounted for about 75 deaths annually in the United States, and for each death thousands of ingestions are reported to poison control centers. Little is known about childhood ingestions that lead to hospitalization. To address this issue, we analyzed National Hospital Discharge Survey data from the National Center for Health Statistics for 1979-1983. For these years, an estimated 108,280 children from birth to 9 years of age were hospitalized because of unintentional poisonings. Overall, the annual rate for hospitalization because of childhood poisoning was 65.1 per 100,000 children aged 0-9 years. Hospitalization rates for poisoning were highest for children aged 1 and 2 years (216.2 and 184.3 per 100,000, respectively) and lowest for those aged 5-9 years (11.3 per 100,000). Rates for children less than 1 year old and for those 3-4 years old were moderate. Children of other races had higher hospitalization rates for poisoning than did white children (124.2 per 100,000 compared with 51.9 per 100,000). White male patients were hospitalized more frequently than white female patients, but this sex difference did not occur in children of other races. Rates were consistently highest for children in the Northeast and South and lowest for children in the West. From 1979 to 1983, the length of a hospital stay for childhood poisoning declined by 26 percent. Our results provide new information on childhood poisonings requiring hospitalization.     

Prenatal and postnatal effects of low-level lead exposure: integrated summary of a report to the U.S. Congress on childhood lead poisoning

This article provides an integrated summary of a report to Congress from the Federal government (ATSDR) on childhood lead poisoning in the United States, with particular reference to low-level lead exposure and its effects on the fetus and the preschool child. As mandated by Section 118(f)(1)(C) of the 1986 Superfund Amendments and Reauthorization Act (SARA), ATSDR has examined the full spectrum of human in utero and postnatal lead toxicity, with emphasis on low-level neurotoxicity and adverse impacts on growth indices in risk populations. Especially important has been assessment of the relative persistence of these effects in later life as discernible from a number of longitudinal studies now under way around the world. Included in the Congressional report were discussions of dose-effect and dose-response relationships using blood lead levels as the indicator of lead dose.     

Recent developments in low-level lead exposure and intellectual impairment in children

In the last decade children's blood lead levels have fallen significantly in a number of countries, and current mean levels in developed countries are in the region of 3 Mu g/dL. Despite this reduction, childhood lead poisoning continues to be a major public health problem for certain at-risk groups of children, and concerns remain over the effects of lead on intellectual development in infants and children. The evidence for lowered cognitive ability in children exposed to lead has come largely from prospective epidemiologic studies. The current World Health Organization/Centers for Disease Control and Prevention blood level of concern reflects this and stands at 10 Mu g/dL. However, a recent study on a cohort of children whose lifetime peak blood levels were consistently less than 10 Mu g/dL has extended the association of blood lead and intellectual impairment to lower levels of lead exposure and suggests there is no safety margin at existing exposures. Because of the importance of this finding, we reviewed this study in detail along with other recent developments in the field of low-level lead exposure and children's cognitive development. We conclude that these findings are important scientifically, and efforts should continue to reduce childhood exposure. However, from a public health perspective, exposure to lead should be seen within the many other risk factors impacting on normal childhood development, in particular the influence of the learning environment itself. Current lead exposure accounts for a very small amount of variance in cognitive ability (1-4%), whereas social and parenting factors account for 40% or more.     

Early Childhood Lead Exposure and Academic Achievement: Evidence From Detroit Public Schools, 2008–2010

Objectives. We assessed the long-term effect of early childhood lead exposure on academic achievement in mathematics, science, and reading among elementary and junior high school children.Methods. We linked early childhood blood lead testing surveillance data from the Detroit Department of Health and Wellness Promotion to educational testing data from the Detroit, Michigan, public schools. We used the linked data to investigate the effect of early childhood lead exposure on academic achievement among school-aged children, both marginally and adjusted for grade level, gender, race, language, maternal education, and socioeconomic status.Results. High blood lead levels before age 6 years were strongly associated with poor academic achievement in grades 3, 5, and 8. The odds of scoring less than proficient for those whose blood lead levels were greater than 10 micrograms per deciliter were more than twice the odds for those whose blood lead levels were less than 1 micrograms per deciliter after adjustment for potential confounders.Conclusions. Early childhood lead exposure was negatively associated with academic achievement in elementary and junior high school, after adjusting for key potential confounders. The control of lead poisoning should focus on primary prevention of lead exposure in children and development of special education programs for students with lead poisoning.Despite a dramatic decline in blood lead concentrations, childhood lead poisoning continues to be the most important and preventable environmental problem among children and contributes significantly to the burden of childhood diseases.1 Numerous studies have shown the biological and neurological damage linked to cognitive and behavioral impairment, even at low blood lead levels (BLLs).2–5 In, 2012, the Centers for Disease Control and Prevention (CDC) lowered the level of concern to 5 micrograms per deciliter (μg/dL).6 The 2009–2010 National Health and Nutrition Examination Survey (NHANES) data show that 4.3% of US children aged 1 to 6 years experience BLLs at or above 5 μg/dL, with a geometric mean BLL of 1.84 μg/dL.7 These data indicate that more than 1 million children aged 6 years or younger have BLLs at or above the new CDC blood lead action level of 5 μg/dL.8Early childhood lead exposure can lead to a wide range of problems in children. The most common effects are subclinical impact on the central nervous system,9 leading to cognitive impairment and behavioral problems.10–12 Elevated blood lead concentration is associated with lower IQ scores2,3,13–16; students with elevated blood lead concentrations are more inattentive, hyperactive, disorganized, aggressive, and more likely to be delinquent.17–19 Clinically, children with excessive BLLs (> 60 μg/dL) may experience headaches, loss of appetite, agitation, clumsiness, or somnolence.17Numerous studies have shown that lead exposure is associated with lower scores in standardized IQ tests in children.2,14,16 Schwartz estimated a 2.6-point decrease in IQ level for every 10 μg/dL increase in blood lead.3 Needleman and Landrigan, basing their results on 3 studies,2–4 found that significant damage occurs even at BLLs below 5 μg/dL.5 Reviews suggest that no level of lead exposure appears to be safe, and even very low levels of exposure in children are associated with learning and behavioral deficits.16,19Although many studies have focused on the effect of early childhood lead exposure on intellectual and behavioral deficits, very few have related early childhood lead exposure to academic performance in school-aged children. Bellinger et al. found that among middle-class and middle-upper-class school-aged children, low levels of lead exposure negatively affected children’s intelligence and academic performance.4 Miranda et al., using data from North Carolina, found that early childhood BLLs as low as 2 μg/dL had a discernible impact on end-of-grade tests in elementary school.20 Miranda et al. demonstrated that early childhood lead exposure significantly influences the likelihood of being designated exceptionally challenged and contributes to achievement gap.21As public health resources dwindle in cities and states, the focus on preventing and eliminating childhood lead poisoning is placed low on the public health and education agenda. This becomes increasingly problematic as a significant number of properties in heavily lead-polluted cities have been poorly maintained because of the national housing crisis. Inadequate attention to this issue may lead to the reemergence of this preventable environmental problem, turning the clock back on years of national, state, and local successes.We assessed the long-term effect of early childhood lead exposure on academic achievement using data from Detroit, Michigan, one of the large cities in the United States with the most severe lead exposure and poisoning problem in children.22 Linking blood lead testing surveillance data with standardized test score data for students in Detroit public schools, we explored the relationship between early childhood lead exposure and academic achievement in elementary and junior high schools (grades 3, 5, and 8). To the best of our knowledge, this study is the first to investigate the long-term effect of early childhood lead exposure on academic achievement in the classroom, specifically in mathematics, science, and reading in elementary and junior high schools.Because childhood lead poisoning also involves racial and socioeconomic disparities, with elevated BLLs more common among minority children and children of low-income families, our analysis also adjusted for these disparities.     

The health impact of environmental pollutants: a special focus on lead exposure in South Africa

Studies have shown blood lead levels of some children in South Africa at levels of health concern. New studies show even relatively low lead levels to have detrimental effects on cognitive function in young children. Large numbers of South African inner-city and other children have been shown to have unacceptably high blood lead levels. Studies indicate that blood lead levels of children living in South Africa's urban areas are higher than those of children in most developed countries, including Great Britain, Europe, and the United States. Although data and reported studies are very sparse, mean blood lead levels of approximately 15 microg/dl have been reported in children. Elevated blood lead levels were associated with socioeconomic status and housing conditions. Key environmental risk factors for elevated blood levels were contaminated soil and dust in the urban environment, and the still large number of automobiles using leaded gasoline. In view of emerging evidence linking lead at increasingly lower levels to adverse effects in children, the South African government is taking actions to reduce lead exposure among vulnerable groups. Currently, South Africa has no national lead surveillance program. The government, therefore, has developed international and regional partnerships to prevent and address the problem of lead exposure.