Abby J. Greenberg, MD, FAAP
Margaret Sherman, Epidemiologist
David Forte, Sanitarian
• One of the most preventable childhood health
• Children susceptible due to rapid G & D and hand
to mouth behavior
• ¼ of the nation’s children are exposed at home
• 400,000 children nationwide are lead-poisoned
each year
• Principle source: lead-based paint
• NYS Physicians are required to test
• Current emphasis: primary prevention
History of NCDOH CLPPP
• 1970’s-CDC grant to identify children with lead
poisoning, 9 positions, assigned to community
• 1980’s -  funding, 1 employee, case management
• Late 1980’s - grant from NYSDOH-case
management and Head Start testing
• 1990’s – present - expanded grant from NYSDOH
– expanded case management, education,
environmental assessment
• 1992 – Public Health Campaign – laboratory
development for lead testing
CDC Acceptable BLL
Table 1. Changing definitions of acceptable blood lead levels
in the United States
Year Level of Concern
1960 60 mcg/dL
1970 40 mcg/dL
1975 35 mcg/dL
1985 25 mcg/dL
1991 10 mcg/dL
2004 Discussions underway at CDC to determine if level
should be further decreased to 5 mcg/dl, in light of growing
body of research demonstrating no "safe" threshold of exposure
NYS Lead Law 1993
Mandated testing at ages 1 and 2 years
Annual assessment to age 6 years
Test if + risk assessment
All BLL reportable to LHU/database
LHU-identify and track children, assure f/u
LHU-provide environmental management
Obstetricians required to screen pregnant
Effects of Lead Poisoning
Impaired Growth and Development and I.Q.
Learning disabilities, behavioral problems
Interferes with RBC production
Kidney damage, interferes with Vit D
• Hearing loss
• Seizures, Coma, Death
Pathways Of Lead Absorption
• Ingestion
• Inhalation
• Maternal-fetal transfer
Case Management
• Receive lab reports-maintain database
40,473 in 04; 28,186 in 05
• Letters to MDs and parents
– For child with lead 10 ug/dl and above
– For every infant with lead 5 ug/dl and above
• Educational Home Visits-84 in 04; 67 in 05
• New Environmental Assessments -27 in 04;
18 in 05
• Referral to Child Find-13 in 04; 6 in 05
Case Management (con’t)
• Case reviews - twice monthly
• Respond to requests for information from
medical professionals and the public
– pieces of literature distributed
• 14,603 in 04; 35,136 in 05
– legal requests for medical records
• 10 in 04; 14 in 05
2004-Testing in Nassau County
40,473 test results
2,709 results 5ug/dl - 10ug/dl (7%)
383 equal or greater than 10ug/dl (0.9%)
1 child hospitalized for chelation
2005-Testing in Nassau County
28,186 test results
1,930 results 5ug/dl - 10ug/dl (7%)
130 equal or greater than 10ug/dl (0.5%)
2 children hospitalized for chelation
Educational Home Visits
Identify source of lead/temporary measures
Run tap water/Use cold tap water
Hand washing
Physician Medical Record Lead
Assessment Reviews
14 physician practices evaluated in 2005
72% documented lead test at age 1
78% documented lead test at age 2
Staff meet with providers for appropriate
Other Activities
• 940 letters to Pediatricians & Family
Practice Physicians, 700 to OB/GYNs
• Medical Director reports to Nassau Medical
Society and Pediatric Societies
• Educational programs to WIC and
Community Health Worker programs
• Distribution of pamphlets at health fairs
Office of Lead Abatement
Interview regarding potential sources
Evaluate home and other sites
Identify other children in dwelling
Laboratory testing
XRF analysis
Intervention and Education
Limit access to affected areas
Wet cleaning of windowsills, floor, etc
Hand washing
Running cold water
Interim measures
• Owner notification
• Plan: cleanup/by a professional lead-abatement
professional, when no children are present
• Enforcement
• Final Inspection
• Other sources: soil, solder, folk remedies,
imported candy and medicine, cosmetics, surma,
tea cups, ceramics, pewter items, picture frame,
Sources of Lead
Houses built prior to 1978
Drinking Water (lead pipes, solder)
Soil, dust
Occupational hazards
Toys, jewelry, hobbies, ceramics
Imported candy, medicines and cosmetics
Some container, pillar, votive, and tealight
candles use metal wicks and CPSC found that
some contained lead.
Tapers, commonly used as
dinner candles, use
cotton wicks and do not
contain lead.
• Middle East: Kohl, Al Kohl, Al Murrah, Anzroot,
Bint Al Dehab, Kandu, Cebagin, Farouk, Santrinj
• India/Pakistan/Bangladesh: Surma, (aka Kohl or
Al Kohl, Sindoor, Bali Goli, Bint Al Dehab, Deshi
Dewa, Ghasard
• China: Ba Bow Sen, Jin Bu Huan, Poying Tan,
• Mexico: Greta, Azarcon (aka Alarcon, Luiga,
Maria Luisa, Coral, or Rueda), Albayalde. Also
candy and snacks, including Chapulines and
Chaca Chaca, and glazed pottery
• Dominican Republic: Litargirio
• Lead poisoning is preventable
– -Cleanup should be done before a baby is born or a
child is exposed
• Hazards must be removed: primary preventionremove lead before exposure
• Education of public and Health Care Providers is
• Children must be tested
• Laws are needed to protect the health of children
through mandated testing and safe abatement,
remediation and primary prevention