1. Lead Poisoning Cases Identified
“Take-Home Lead” Poisoning Among Children in Florida 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,
Type of Occupation
METHODS
Lead poisoning: BLL ≥10 micrograms per deciliter (μg/dL)
Period of analysis: January 1, 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,
Figure 4: Number of Take-Home Lead Poisoning Cases by Age Group in Florida Residents ≤15 Years Old,