CDC Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children Medical Provider Module

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CDC Recommendations for Lead Poisoning Prevention
in Newly Arrived Refugee ChildrenMedical
Provider Module

• U.S. Department of Health and Human Services
• Centers for Disease Control and Prevention

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Refugee AssistanceModule Outline

• What is the problem?
• Effects on the refugee population
• Sources of lead exposure
• CDC recommendations
• Resources

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Childhood Lead Poisoning

• Lead poisoning is a common and preventable
  childhood health problem
• Lead is everywhere in the environment due to
  industrialization
• Lead exposure is measured in children by blood
  lead testing

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Blood Lead Levels in the U.S. Population
1976-2002 (NHANES)
14.9
Blood Lead Levels (µg/dL)
3.6
2.7
1.9
Year
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Why are Children at High Risk?

• Childrens nervous systems are still developing
• Young children have more hand-to-mouth activity
  than older children
• Children absorb more lead than adults

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Blood Lead Levels Associated with Adverse Health
Effects
Lead Concentration in Blood (?g/dL)
Children
Adults
150
Encephalopathy
Death
Nephropathy
100
Encephalopathy
Nephropathy
Frank Anemia
Frank Anemia
Male Reproductive Effects
Colic
50
Hemoglobin Synthesis and Female Reproductive
Effects
40
Nerve Conduction Velocity
Hemoglobin Synthesis
30
Elevated Blood Pressure
Vitamin D Metabolism
Erythrocyte Protoporphyrin (men)
20
Nerve Conduction Velocity
Erythrocyte Protoporphyrin (women)
Erythrocyte Protoporphyrin
Vitamin D Metabolism(?)
10
Developmental Toxicity IQ, Hearing, Growth
Transplacental Transfer
Note increased function and decreased
function. Source ATSDR, 1992
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Refugee AssistanceModule Outline

• What is the problem?
• Effects on the refugee population
• Sources of lead exposure
• CDC recommendations
• Resources

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Refugee Migration
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Elevated Blood Lead Levels (BLLs)in Refugee
Children

• Newly arrived refugee children are twice as
  likely as U.S. children to have elevated BLLs
• Some sub-populations of refugee children are
• 12-14.5 times more likely to have elevated
  BLLs
• Data suggest that refugee children are also at
  risk for elevated BLLs in the U.S.

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Risk Factors for Elevated BLLs Among Refugees

• Living in older homes
• Presence of lead hazards
• Cultural practices and traditional medicines
• Lack of awareness about the dangers of lead
• Compromised nutritional status

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Refugee AssistanceModule Outline

• What is the problem?
• Effects on the refugee population
• Sources of lead exposure
• CDC recommendations
• Resources

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Lead Hazard Sources

• Most lead hazards come from lead paint chips that
  have been ground into tiny bits.
• These tiny bits of lead become part of the dust
  and soil in and around our homes.

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U.S. Housing

• 24 million housing units (25 of the nations
  housing) have significant lead-based paint
  hazards
• 1.2 million homes with significant lead-based
  paint hazards housed low-income families who had
  children younger than 6 years of age

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Environmental Sources of Childhood Lead Exposure
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Refugee AssistanceModule Outline

• What is the problem?
• Effects on the refugee population
• Sources of lead exposure
• CDC recommendations
• Resources

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Blood Lead Testing Recommendations for Refugee
Children

• Federal standards recommend
• Initial blood lead test within 90 days of arrival
  into the United States
• American Academy of Pediatrics recommends testing
• Age is not a significant risk factor
• Test ALL refugee children

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Blood Lead Testing Recommendations for Refugee
Children

• Repeat blood lead test
• 3 to 6 months after placed in permanent residence
• Considered a medical necessity

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Post-Arrival Evaluation and Therapy

• Nutritional evaluation
• At a minimum, should include an evaluation of the
  childs iron status including a
  hemoglobin/hematocrit and one or more of the
  following
• Mean corpuscular volume (MCV) combined with red
  cell distribution width (RDW)
• Ferritin
• Transferring saturation
• Reticulocyte hemoglobin content

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Treatment of an Elevated BLL

• Medical interventions and treatments vary
  depending on the confirmed BLL
• Consult www.cdc.gov/nceh/lead for specific
  treatment information

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Long-term Sequelae

• Neurodevelopmental monitoring should continue
• Refer the child to Early Intervention or
  Stimulation Programs
• A childs elevated BLL history should be part of
  his permanent record

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Refugee AssistanceModule Outline

• What is the problem?
• Effects on the refugee population
• Sources of lead exposure
• CDC recommendations
• Resources

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Resources

• State and local childhood lead poisoning
  prevention programs
• http//www.cdc.gov/nceh/lead/grants/contacts/CLPP
  P20Map.htm
• CDCs Lead Poisoning Prevention Program
• http//www.cdc.gov/nceh/lead/
• Office of Refugee Resettlement
• http//www.acf.hhs.gov/programs/orr/
• American Academy of Pediatrics
• http//www.aap.org