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

Refugee Assistance:Module Outline

What is the problem?

Effects on the refugee population

Sources of lead exposure

CDC recommendations

Resources

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

Blood Lead Levels in the

U.S. Population 1976-2002 (NHANES)

0

2

4

6

8

10

12

14

16

1976-1980 1988-1991 1991-1994 1999-2002

Year

Blo

od

Le

ad L

eve

ls (µ

g/d

L)

2.7

3.6

1.9

14.9

Why are Children at High Risk?

Children’s nervous systems are still developing

Young children have more hand-to-mouth activity than older children

Children absorb more lead than adults

Blood Lead Levels Associated with Adverse Health Effects

ChildrenLead Concentration in Blood

(g/dL) Adults

150

100

50

40

30

20

10

Death

Note: = increased function and = decreased function. Source: ATSDR, 1992

Encephalopathy

EncephalopathyNephropathy

Frank AnemiaColic

Nephropathy

Frank Anemia

Male Reproductive Effects

Hemoglobin Synthesis andFemale Reproductive Effects

Nerve Conduction VelocityHemoglobin Synthesis

Vitamin D Metabolism

Nerve Conduction Velocity

Erythrocyte ProtoporphyrinVitamin D Metabolism(?)

Developmental ToxicityIQ, Hearing, Growth

Transplacental Transfer

Elevated Blood Pressure

Erythrocyte Protoporphyrin (men)

Erythrocyte Protoporphyrin (women)

Refugee Assistance:Module Outline

What is the problem?

Effects on the refugee population

Sources of lead exposure

CDC recommendations

Resources

Refugee Migration

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.

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

Refugee Assistance:Module Outline

What is the problem?

Effects on the refugee population

Sources of lead exposure

CDC recommendations

Resources

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.

Lead Hazard Sources

U.S. Housing

24 million housing units (25% of the nation’s 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

Environmental Sources of Childhood Lead Exposure

Refugee Assistance:Module Outline

What is the problem?

Effects on the refugee population

Sources of lead exposure

CDC recommendations

Resources

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

Blood Lead Testing Recommendations for Refugee Children

Repeat blood lead test 3 to 6 months after placed

in permanent residence

Considered a “medical necessity”

Post-Arrival Evaluation and Therapy Nutritional evaluation

At a minimum, should include an evaluation of the child’s 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

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

Long-term Sequelae

Neurodevelopmental monitoring should continue

Refer the child to Early Intervention or Stimulation Programs

A child’s elevated BLL history should be part of his permanent record

Refugee Assistance:Module Outline

What is the problem?

Effects on the refugee population

Sources of lead exposure

CDC recommendations

Resources

Resources

State and local childhood lead poisoning prevention programshttp://www.cdc.gov/nceh/lead/grants/contacts/CLPPP%20Map.htm

CDC’s 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