cdc recommendations for lead poisoning prevention in newly arrived refugee children medical provider...
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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
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