Lead Poisoning Surveillance: A Collaborative Effort between Epidemiology and WIC

IntroductionThere is no safe level of lead in the body, and elevated lead inchildren can lead to decreased Intelligence Quotients (IQ) andbehavioral problems. The American Academy of Pediatricsrecommends lead testing of children with a positive risk assessment.Children who live in low socioeconomic areas may be at higher riskfor lead exposure. As recent events have shown, having an elevatedlead poisoning surveillance system can be critical to ensure that thereis not a community-wide lead exposure. To reach the children thatmay not have been screened by a primary care physician, on March1, 2016 the Sedgwick County Health Department Women, Infants,and Children (WIC) program began offering lead screenings to allchildren in the WIC program and their mothers. Per Centers forDisease Control and Prevention (CDC) guidelines, the SedgwickCounty Health Department Epidemiology program (Epi) investigatesanyone who has an elevated blood lead test (5μg/dL or greater).There are two types of lead tests – screening (capillary finger stick)and confirmatory (venous blood draw).MethodsSedgwick County WIC clients are offered screening lead testingat their WIC appointments. Education to reduce lead exposure isprovided at the time the test is performed. The filter papers used in thistesting are sent to the Kansas Health and Environmental Laboratories(KHEL) for analysis, and the results are reported to Epi. Epi reportsthe lead testing results to WIC, who track the results in their patientcharts. Epi receives KHEL results of <5μg/dL via fax and resultsof >= 5μg/dL via electronic laboratory reporting in the EpiTraxdisease investigation software maintained by the Kansas Departmentof Health and Environment. Epi notifies any WIC clients with results>= 5μg/dL, while WIC staff notify all other clients about their results.Education is provided to the client a second time by Epi staff and/ora WIC nurse or dietician. For clients with elevated blood lead tests,Epi interviews the case or guardian using an enhanced blood leadexposure questionnaire which asks about potential lead exposures,both in the home and at other locations (work, hobbies, etc.). If only ascreening test was performed, Epi recommends confirmatory testing.WIC lead testing program measures, including types of exposuresidentified, are monitored over time using data obtained from EpiTrax.ResultsBetween March 1 and July 21, of the 2,150 WIC clients offeredlead testing, 89% self-reported never having received a lead testpreviously. Of the 1,427 clients with WIC lead screening results,seven cases of elevated blood lead were identified. Of the seven, fivedid not have a previous elevated lead test in EpiTrax. The averagescreening test result was 8.6μg/dL (range 6.8 to 13.4). The averageage of the cases was 2 years (range 1-4). Of the seven cases, two(29%) were confirmed as 10.0 and 11.0μg/dL through venous testingat their primary care provider’s office. The remaining five cases havenot received confirmatory testing. One of the three cases interviewedreported that their babysitter lived in an old home, which could bethe source of lead exposure. While interviewing a child’s guardianabout an elevated 2016 test (7.9μg/dL), Epi discussed a previous2015 elevated lead test (6.0μg/dL) of which the client’s guardianwas unaware.ConclusionsThe ease of access to lead testing in the Sedgwick County WICprogram and the joint effort between WIC and Epi to implement anenhanced lead poisoning surveillance system identified six childrenwith elevated lead levels whose guardians did not know they hadelevated lead levels. This new surveillance program educates WICparents about lead, determines the lead levels in children for guardianknowledge (low level) and further follow-up (elevated level), andidentifies lead exposures of WIC children with elevated lead tests.