Lead Poisoning Cases Identified “Take-Home Lead” Poisoning Among Children in Florida 2010-2014 Sudha Rajagopalan, MPH; Bureau of Epidemiology, Division of Disease Control and Health Protection, Florida Department of Health BACKGROUND All blood lead test results are reportable electronically to the Florida Department of Health (DOH). No safe blood lead level (BLL) has been identified. Even low levels of lead exposure can result in damage to brain and nervous system. The DOH lead poisoning prevention program recommends targeted screening focusing on high-risk children. Lead dust particles or “take-home lead” can be brought into the home on work clothes and equipment. Certain occupations are more prone to this type of exposure. Take-home lead is absorbed more efficiently than lead-based paint chips. Children <6 years are at increased risk as they put hands on other objects, which may be contaminated with lead, into their mouths. Lead poisoning data were analyzed to determine the burden of take-home lead in children in Florida and to: Identify where data are not being captured or are entered incorrectly. Assess case linking within the reportable disease surveillance system. RESULTS 173 (13.4%) take-home lead poisoning cases identified among 1,285 lead poisoning cases reported 131 (75.7%) among children <6 years old 42 (24.2%) among children 6 to 15 years old 133 (76.9%) were Medicaid recipients Number of cases in children <6 years old decreased after 2010, increased slightly in 2013, and decreased again in 2014 (see Figure 4) Higher counts of cases in Central and South Florida (see Figure 2) Majority of lead recycling plants and construction firms located here Data issues identified: Only 4 (2%) cases were linked to parents Only 9 (5%) cases documented control measures Missing follow-up BLLs Follow-up BLLs, clinical symptoms, and control measures not recorded in fields provided Most common parental occupations (see Figure 3) Lead renovation/construction (n=28,16.1%) Auto repair/battery recycling (n=24,13.8%) Missing parental occupation (n=78, 45%) Lead Poisoning Cases Identified Bureau of Epidemiology receives all blood lead levels (BLLs) BLLs ≥10 µg/dL flagged for case management in Merlin Case Management County Health Department staff enter case-related follow-up information into Merlin Cases linked in Merlin if ≥2 cases are associated with an exposure Provide educational interventions to parent/caregiver Communicate assessments and interventions to health care provider Follow-Up Monitor timeliness and levels of follow-up blood lead tests Initiate appropriate interventions if BLLs rise Conduct enhanced investigation for BLLs ≥20 µg/dL Recommend testing siblings and other household contacts Case Closure Make referrals to local Children’s Medical Services or Woman Infant and Child Program (WIC), if necessary Provide ongoing evaluation to see if BLLs decline Close case when child’s BLL is <10 µg/dl for six months Jacksonville Orlando Tampa St. Petersburg Miami-Dade Note: Red circles indicate areas of large population density Figure 1: Process Flow of Lead Poisoning Case Management Figure 2: Number of Take-Home Lead Poisoning Cases in Florida Residents ≤15 Years Old, 2010-2014 Type of Occupation METHODS Lead poisoning: BLL ≥10 micrograms per deciliter (μg/dL) Period of analysis: January 1, 2010 - December 31, 2014 Data source: Florida’s reportable disease surveillance system (Merlin) Case interviews with parents/caregivers of confirmed lead poisoning cases Environmental history data include patient foreign travel, patient behaviors, take home lead exposure and other potential sources of lead collected Case-related information entered into Merlin (see Figure 1) Control measures (steps taken to prevent exposure) and other data are not required for case reporting Analysis limited to confirmed cases in Florida residents ≤15 years old Analyzed age, source of exposure, environmental history, control measures, county of exposure, and insurance status CONCLUSIONS Analysis yielded a small number of cases overall. Decrease in cases may be partially due to reduction of workforce in the lead industry post economic recession. Activities identified for improvement: Link adult and child cases involved in take-home lead exposures will improve monitoring of adult and child BLLs. Target educational outreach should focus on Medicaid recipient children as they are at an increased risk for take-home lead poisoning (and lead poisoning as a whole). Improve data collection of risk factors such as parental occupational details, parental BLLs, and follow-up lead test results by improving interview efficiency by county health department staff and enhance efficient data entry. Improvements identified will enhance data quality, increase data sharing with public health partners for research purposes and lead to improved processes for reducing exposures. Figure 3: Number of Parental Occupations Contributing to Take-Home Lead Poisoning in Florida Residents ≤15 Years Old, 2010-2014 Figure 4: Number of Take-Home Lead Poisoning Cases by Age Group in Florida Residents ≤15 Years Old, 2010-2014