Recommendations for blood lead screening of young children enrolled in Medicaid: targeting a group at high risk

Children aged 1-5 years enrolled in Medicaid are at increased risk for having elevated blood lead levels (BLLs). According to estimates from the National Health and Nutrition Examination Survey (NHANES) (1991-1994), Medicaid enrollees accounted for 83% of U.S. children aged 1-5 years who had BLLs > or = 20 microg/dL. Despite longstanding requirements for blood lead screening in the Medicaid program, an estimated 81% of young children enrolled in Medicaid had not been screened with a blood lead test. As a result, most children with elevated BLLs are not identified and, therefore, do not receive appropriate treatment or environmental intervention. To ensure delivery of blood lead screening and follow-up services for young children enrolled in Medicaid, the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) recommends specific steps for health-care providers and states. Health-care providers and health plans should provide blood lead screening and diagnostic and treatment services for children enrolled in Medicaid, consistent with federal law, and refer children with elevated BLLs for environmental and public health follow-up services. States should change policies and programs to ensure that young children enrolled in Medicaid receive the screening and follow-up services to which they are legally entitled. Toward this end, states should a) ensure that their own Medicaid policies comply with federal requirements, b) support health-care providers and health plans in delivering screening and follow-up services, and c) ensure that children identified with elevated BLLs receive essential, yet often overlooked, environmental follow-up care. States should also monitor screening performance and BLLs among young children enrolled in Medicaid. Finally, states should implement innovative blood lead screening strategies in areas where conventional screening services have been insufficient. This report provides recommendations for improved screening strategies and relevant background information for health-care providers, state health officials, and other persons interested in improving the delivery of lead-related services to young children served by MedicaidAdvisory Committee on Childhood Lead Poisoning Prevention (ACCLPP).December 8, 2000.The following CDC staff members prepared this report: Alan B. Bloch, _Lisa R. Rosenblum, Division of Environmental Hazards and Health Effects, National Center for Environmental Health; in collaboration with Anne M. Guthrie, Alliance to End Childhood Lead PoisoningIncludes bibliographical references

Recommendations for preventing lead poisoning among the internally displaced Roma population in Kosovo from the Centers for Disease Control and Prevention

Environmental HealthPrevention and ControlCurrent"Lead exposure is a continuing urgent health problem for Roma in Kosovo. The Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) have collaborated in blood lead surveillance of the Roma children living in displacement camps in Kosovo. In the last 3 rounds of blood lead testing, conducted between 2005 and 2007, on average, 30% of children tested had capillary blood lead levels > 45 \u3bcg/dL, the level at which CDC recommends chelation therapy. Few if any children in the camps have maintained a blood lead level < 10 \u3bcg/dL for their entire childhood. These children are at tremendous risk for a lifetime of developmental and behavioral disabilities and other adverse health conditions. The Cesmin Lug camp is the most highly contaminated camp and should be closed immediately. The situation in Cesmin Lug is made more critical because Roma living in Serbia and Montenegro are now moving into vacant dwellings in the camp. Dwellings that are currently vacant should be demolished immediately. These dwellings are not only contaminated by lead but a clear and present fire hazard. In addition, uncontrolled informal smelting at the now closed Kablar camp must be stopped. These activities result in lead exposure to children in both Cesmin Lug and Osterode Camps. Lack of data has hampered decision making and resulted in confusion on the part of Roma and others as to the seriousness of the problem and the extent of the environmental contamination. A periodic, systematic review of the data would provide important information about the quality of the children's clinical care. Reportedly 39 children have been chelated. Perhaps as many as 90 children are candidates for therapy. The actual number cannot be determined at this time. Lead exposure should be a priority for repatriation to the Roma Mahala. Plans should be developed for continued medical surveillance of these children when they are repatriated to Roma Mahala." - p. 3Mary Jean Brown and Barry Brooks, Lead Poisoning Prevention Branch, U. S. Centers for Disease Control and Prevention."October 27, 2007"Available on the internet as an Acrobat .pdf file (629.5 KB, 12 p.)

Look out for lead : what happens during an environmental lead assessment of my home?

An environmental lead assessment is a visit to your home by trained staff to help identify possible sources of lead. The nurse and an EPA certified lead risk assessor will come to your home. They will ask you questions to help find possible sources of lead. During the visit, the lead risk assessors will use a machine, called an X-ray fluorescence (XRF) analyzer. The XRF machine can check painted surfaces, inside and out, and help the assessors identify lead hazards. The visit might take a couple of hours, depending upon the size of the house, the condition of the paint, and other factors

Safety and health in manufactured structures

This report identifies and summarizes safety and health issues in manufactured structures based on a wide expanse of research. The end result is a thorough characterization of health and safety hazards in manufactured structures, along with mitigation strategies and discussions of opportunities for health/ safety enhancements and at-risk populations.Millions of people in America live in manufactured structures--a range of units that includes manufactured homes, travel trailers, camping trailers, and park trailers. Manufactured structures are used for long- term residence; for temporary housing following disasters; for recreational and travel purposes; and also for classrooms, day care centers, and workplaces. Housing is a primary purpose of these structures, with manufactured homes accounting for 6.3% of the housing units in the U.S. and housing 17.2 million persons. Manufactured homes offer flexibility and affordability, and comprise an important part of the U.S. housing stock. Whether used for long-term housing or for short-term shelter following a disaster, for classrooms or for offices, manufactured structures should be safe and healthy for the people who live, work, study, and play in them. With Americans spending the vast majority of their time indoors, it is vital that buildings protect occupants from the elements and provide privacy, comfort, and peace of mind. At the same time, these structures should not present risks to occupant's health and safety due to design, construction, or maintenance problems. This report identifies and summarizes safety and health issues in manufactured structures based on a wide expanse of research. The end result is a thorough characterization of health and safety hazards in manufactured structures, along with mitigation strategies and discussions of opportunities for health/ safety enhancements and at-risk populations. Many of the hazards discussed in this report are not unique to manufactured structures, while other issues have been identified as particular problems for this form of housing. Further, when manufactured structures are used as interim housing following a disaster, additional health/safety issues can arise. The specific topics covered in this report are an introduction to manufactured structures, fire safety, moisture and mold, indoor air quality (IAQ), pests and pesticides, siting and installation, utilities, postdisaster housing, and potential opportunities for future enhancements. The health and safety hazards related to fire safety, moisture and mold, IAQ, pests and pesticides, and other issues generally fall into the categories of design, construction, and maintenance. Thus, for an issue like effective moisture management to prevent mold and related problems, strategies range from good product selection in the design phase to proper grading of the site during construction all the way to regular maintenance of the building envelope after many years of service. Most other health and safety hazards are similar in nature, with multiple parties playing an important role in managing risks from the design of the manufactured home through its use as a home for years to come. Fortunately, the challenges of managing health and safety risks in manufactured structures are well documented, along with appropriate strategies and solutions. This report documents and summarizes this information, with the intent of serving as a comprehensive resource to inform discussions and future decisions regarding the design, construction, maintenance, and deployment of manufactured structures in the United States.Glossary -- 1. Introduction -- 2. Fire safety -- 3. Moisture and mold -- 4. Indoor air quality -- 5. Pests and pesticides -- 6. Siting and installation -- 7. Utilities -- 8. Postdisaster housing: keeping safe and healthy -- 9. Potential opportunities -- Referencesedited by Don Ryan, Liza Bowles."218685-A."The manual was developed as a follow-up to the Safe and Healthy Manufactured Structures working meeting held on October 17, 2008. Meeting participants representing federal, state, and local government; community and environmental groups; industry; professional associations; and academic institutions reviewed and commented on formative materials for this document.On cover: U.S. Department of Health and Human Services, U.S. Department of Housing and Urban Development.Available via the World Wide Web as an Acrobat .pdf file (2.92 MB, 108 p.).Centers for Disease Control and Prevention and U.S. Department of Housing and Urban Development. Safety and health in manufactured structures. Atlanta: U.S. Department of Health and Human Services; 2011.Malasky8/27/14Environmental HealthPrevention and ControlCurren

Risk factors for children’s blood lead levels in metal mining and smelting communities in Armenia: a cross-sectional study

Background: Children's exposure to lead poses a significant risk for neurobehavioral consequences. Existing studies documented lead contamination in residential soil in mining and smelting communities in Armenia. This study aimed to assess blood lead levels (BLL) in children living in three communities in Armenia adjacent to metal mining and smelting industries, and related risk factors. Methods: This cross-sectional study included 159 children born from 2007 to 2009 and living in Alaverdi and Akhtala communities and Erebuni district in Yerevan - the capital city. The BLL was measured with a portable LeadCare II Blood Lead Analyzer; a survey was conducted with primary caregivers. Results: Overall Geometric Mean (GM) of BLL was 6.0 μg/dl: 6.8 for Akhtala, 6.4 for Alaverdi and 5.1 for Yerevan. In the sample 68.6 % of children had BLL above CDC defined reference level of 5 μg/dl: 83.8 % in Akhtala, 72.5 % in Alaverdi, and 52.8 % in Yerevan. Caregiver's lower education, dusting furniture less than daily, and housing distance from toxic source(s) were risk factors for higher BLL. Additional analysis for separate communities demonstrated interaction between housing distance from toxic source(s) and type of window in Erebuni district of Yerevan. Conclusions: The study demonstrated that children in three communities adjacent to metal mining and smelting industries were exposed to lead. Investigation of the risk factors suggested that in addition to promoting safe industrial practices at the national level, community-specific interventions could be implemented in low- and middle-income countries to reduce BLL among children

Exploring Childhood Lead Exposure through GIS: A Review of the Recent Literature

Childhood exposure to lead remains a critical health control problem in the US. Integration of Geographic Information Systems (GIS) into childhood lead exposure studies significantly enhanced identifying lead hazards in the environment and determining at risk children. Research indicates that the toxic threshold for lead exposure was updated three times in the last four decades: 60 to 30 micrograms per deciliter (µg/dL) in 1975, 25 µg/dL in 1985, and 10 µb/dL in 1991. These changes revealed the extent of lead poisoning. By 2012 it was evident that no safe blood lead threshold for the adverse effects of lead on children had been identified and the Center for Disease Control (CDC) currently uses a reference value of 5 µg/dL. Review of the recent literature on GIS-based studies suggests that numerous environmental risk factors might be critical for lead exposure. New GIS-based studies are used in surveillance data management, risk analysis, lead exposure visualization, and community intervention strategies where geographically-targeted, specific intervention measures are taken

Using GIS to assess and direct childhood lead poisoning prevention: guidance for state and local childhood lead poisoning prevention programs

These guidelines were prepared to help new lead epidemiologists quickly learn how to use geographic information systems (GIS) mapping technology to assess and direct childhood lead poisoning elimination efforts."Purpose of these guidelines -- Who is at risk for lead exposure -- How Can GIS help? -- What is GIS? -- Data sources -- Getting started -- Obtaining tax assessor data -- Analysis -- How CDC can help CLPPPs -- Summary -- Case studies -- Healthy People 2010 objectives related to lead poisoning, and GIS -- Internet resources -- Glossary -- References -- Appendix A: Preparing data for GIS Use-problems to avoid -- Appendix B: Surveillance data specifications for CDC lead database -- Appendix C: Census 2000 content -- Appendix D: Desired tax assessor data -- Appendix E: Census 2000 variables in LPPB shapefilesdeveloped by the Childhood Lead Poisoning Prevention Program Geographic Information System Workgroup."December, 2004."Also available via the World Wide Web as an Acrobat .pdf file (1.85 MB, 46 p.).Includes bibliographical references (p. 26-28)