Objectives. To examine trends in blood lead levels (BLLs) among US children aged 5 years or younger using national and state data. Methods. We analyzed 2011 to 2023 National Health and Nutrition Examination Survey (NHANES) data by year and available demographic characteristics. We report geometric means, the prevalence of BLLs of 3.5 micrograms per deciliter or above and 5.0 micrograms per deciliter or above, and linear trends. In addition, we summarize 2017 to 2023 surveillance data from 7 states. Results. National BLLs continue to decline. In 2021 to 2023, geometric mean BLLs and the prevalence of BLLs of 3.5 micrograms per deciliter or above were lower for all groups than in previous years. Small recent NHANES sample sizes and limited state-level subgroup data constrained detailed analyses. However, state-level data revealed disparities by geography, race, and ethnicity. Conclusions. National data indicate decreasing BLLs among children and elimination of racial disparities, but state and local BLL data unmask ongoing disparities. Public Health Implications. To better describe childhood lead exposures, NHANES should increase its sample size, oversample high-risk populations, and release timely data, and states should expand surveillance and risk factors and make data publicly available. Together, the data assessed here provide benchmarks to target prevention efforts and warn of emerging risks. (Am J Public Health. 2026;116(9): 1343-1351. https://doi.org/10.2105/AJPH.2026.308468).

This study estimates productivity losses resulting from intellectual decrement due to paediatric lead exposure in low- and middle-income countries (LMICs). The published literature on blood lead levels in LMICs was reviewed and summarised. Intelligence Quotient decrement and consequent productivity losses were calculated for a one-year cohort of 5-year-old children in each country. We calculated the present value of lifetime earnings as the discounted average earning potential for workers in a specific economy. Blood lead level (BLL) data for children were available for 39 countries and could be interpolated for additional 82 countries, resulting in 121 countries in the final analysis. Total lead-attributable productivity losses in LMICs ranged from USD 305 billion in our high discount scenario to USD 499 billion in our low discount scenario for each one-year cohort of 5-year-old children (2019 USD). As a share of GDP, these costs ranged from 0.7 to 4.2% by region, depending on discount scenario used. Total economic impacts were generally consistent with previous estimates and further validate those efforts with a substantially expanded dataset. Differences in the findings resulted primarily from the use of a more conservative dose-response model in the present study. Improved reporting of BLLs is essential and could be facilitated through a centralised registry of study results.

BACKGROUND AND AIM: Despite the well-documented impacts of lead on children, exposure to this toxic metal remains a pressing public health issue, particularly in LMICs. Ongoing research has revealed varied sources of exposure across different regions of the world. One source of concern in India are lead-acid battery (LAB) manufacturing and recycling sites; ~90% of such sites assessed in the Indian states of Bihar and Jharkhand were found to have elevated levels of lead in soil. However, following the remediation of one such site in the city of Patna, a consistent reduction in blood lead levels among local children was not observed. Other potential sources had been reported in India, but their relative contribution had not yet been characterized. METHOD: An international consortium of US- and Indian-based organizations implemented a representative, cross-sectional population-based cluster design survey, which evaluated the blood lead levels (BLLs) and risk factors in 135 children 6 years old in areas considered to be impacted by LAB operations and control areas. RESULTS: Households in proximity to LAB operations were compared to households distal to these operations. Overall, the geometric mean (GM) BLL was 11.6 μg/dL, with ~87% of children exceeding the WHO's threshold value of 5 μg/dL. GM BLLs of children in proximal and distal households were not significantly different. Lead concentrations in certain environmental media (soil and dust) were significantly higher in proximal households whereas concentrations in spices and turmeric specifically were higher in distal households. CONCLUSIONS: The results demonstrate the complexity of exposure scenarios even within a single city. The results raised new research questions into under-studied sources such as metal cookware. This study has prompted new research into the extent of spice adulteration across North India, and the prevalence of elevated blood leads across Bihar, the results of which are forthcoming.

Context: Childhood lead poisoning prevention in the United States was marked by a largely failed medical approach from 1971 to 1990; an emergent (but small) healthy housing primary prevention strategy from 1991 to 2015; and implementation of large-scale proven interventions since then. Program: Childhood Lead Poisoning Prevention & Healthy Housing. Methods: Historic and recent health and housing data from the National Health and Nutrition Examination Survey (NHANES) and the American Healthy Homes Survey (AHHS) were retrieved to analyze trends and associated policy gaps. Evaluation: Approximately 590 000 US children aged 1 through 5 years had elevated blood lead levels of 3.5 μg/dL and greater in 2016, and 4.3 million children resided in homes with lead paint in 2019. Despite large improvements, racial and other disparities remain stubbornly and statistically significant. The NHANES and the AHHS require larger sample sizes. The Centers for Disease Control and Prevention has not published children's blood lead surveillance and NHANES data in several years; the Department of Housing and Urban Development (HUD) has no analogous housing surveillance system; and the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA) have not updated training, Superfund, and occupational standards in decades. Discussion: The nation has been without a plan and an associated budget for more than 2 decades. Congress has not reformed the nation's main lead poisoning prevention laws in more than 30 years. Such reforms include stopping US companies from producing new residential lead paint in other countries; enabling the disclosure law to identify all residential lead hazards; closing loopholes in federally assisted housing regulations and mortgage insurance standards; harnessing tax policy to help homeowners mitigate lead hazards; streamlining training requirements; increasing the size of health and housing surveys and surveillance systems; and updating housing codes, medical guidance, dust lead standards, training, Superfund, and worker exposure limits. Congress and the president should reauthorize a cabinet-level task force (dormant since 2010) to develop a new strategic plan with an interagency budget to implement it. These reforms will scale and optimize markets, subsidies, enforcement, and other proven interventions to end ineffective, costly, harmful, and irrational cost shifting that threatens children, workers, and affordable housing.

INTRODUCTION:Prevalence surveys conducted in geographically small areas such as towns, zip codes, neighborhoods or census tracts are a valuable tool for estimating the extent to which environmental risks contribute to children's blood lead levels (BLLs). Population-based, cross-sectional small area prevalence surveys assessing BLLs can be used to establish a baseline lead exposure prevalence for a specific geographic region.MATERIALS AND METHODS:The required statistical methods, biological and environmental sampling, supportive data, and fieldwork considerations necessary for public health organizations to rapidly conduct child blood lead prevalence surveys at low cost using small area, cluster sampling methodology are described.RESULTS:Comprehensive small area prevalence surveys include partner identification, background data collection, review of the assessment area, resource availability determinations, sample size calculations, obtaining the consent of survey participants, survey administration, blood lead analysis, environmental sampling, educational outreach, follow-up and referral, data entry/analysis, and report production.DISCUSSION:Survey results can be used to estimate the geographic distribution of elevated BLLs and to investigate inequitable lead exposures and risk factors of interest.CONCLUSIONS:Public health officials who wish to assess child and household-level blood lead data can quickly apply the data collection methodologies using this standardized protocol here to target resources and obtain assistance with these complex procedures. The standardized methods allow for comparisons across geographic areas and over time.

We are facing new challenges from an old adversary: children's exposure to lead. First, in response to compelling evidence that blood lead levels (BLLs) once thought harmless have significant impact on children's ability to learn, the Centers for Disease Control and Prevention (CDC) formally announced a reduction from the reference value (RV) of 5 µg/dL, established in 2012, to 3.5 µg/dL in October 2021.1 The RV is based on the 97.5% of the distribution of BLLs in US children as determined by the National Health and Nutrition Examination Survey. Second, blood lead testing for children has decreased both as a consequence of coronavirus disease precautions and the recall of the BLL point-of-care (POC) testing instrument.The challenges to pediatric health care providers (PHCPs) posed by these concurrent events are many. The revision of the RV has resulted in a doubling in the estimate of the number of children who require follow-up. This increased number will require additional time and effort investments by pediatric practices in connecting these children and their families to community services. At the same time, the rate of testing young children for lead exposure dramatically decreased early during the coronavirus disease crisis.2 In the first months of the pandemic in 2020, many office practices paused all well-child care. Families were in lockdown; many were afraid to risk exposure to the virus by taking children for a doctor's appointment.3 More time spent at home, coupled with unsafe do-it-yourself home renovation projects, also increased the risk of lead exposure. Nationally, lead screening rates fell by an estimated 34% during the first 5 months of 2020.4 In 34 jurisdictions during January to May 2019, some 1 429 016 children were tested for lead and reported to the CDC compared with 948 844 during the same period in 2020.4 Thus, >480 000 children went untested between January and May 2020 versus the same period in 2019; an estimated 9600 children with elevated levels were missed because of the decline in testing.4 Although "catch-up" well-child care was reinstituted later in 2020 and has continued during 2021 and 2022, some states may not have seen a return to prepandemic rates of adherence with lead testing of eligible preschool children. Many children, now aged >3 years and missed during the pandemic, will never receive testing or remediation of lead hazards. Low-income, disadvantaged families, including those living in poorly maintained, older housing in disadvantaged "environmental justice" communities, who also face considerable barriers to accessing quality health care, will be disproportionately impacted by these circumstances.5,6 African-American children and immigrant and refugee children are more likely to have elevated BLLs, but because of disparities in access, may not have the necessary testing done.7Against this backdrop, a major recall of the POC blood lead testing instrument, LeadCare II was announced.8 All testing with those devices was temporarily discontinued during the latter half of 2021; LeadCare II kit distribution has only resumed starting in February 2022. Because of the recall, office practices reverted to sending families to commercial or hospital-based laboratories for testing. Because families need to travel to the laboratory for testing and sometimes need to make a separate appointment for their child at the laboratory, parents may not follow through. The rate of adherence with lead testing is known to increase when POC testing is available.9 There are also concerns that some pediatric practices may not return to POC testing, even though the Food and Drug Administration has approved the resumption of LeadCare II kit production.Renewed focus on children with BLLs greater than or equal to the RV provides an opportunity to promote dialogue about the importance of follow-up. PHCPs should: Explore creative strategies, responsive to local conditions, to overcome barriers to BLL testing (eg, scheduling laboratory testing before an office visit, using e-systems to remind parents about needed tests, and/or using the electronic health record to identify missed screenings).Counsel parents to get their homes inspected for lead hazards.Ask about hobbies or occupations that may involve lead or imported goods, firearms rounds, jewelry, spices, ethnic remedies, or other contaminated products in the home.Ask about the source of the family's drinking water.Inquire about recent home renovation projects.Offer nutritional guidance to maximize dietary source of iron, calcium, and other essential minerals and vitamins.Review with parents the child's developmental progress and refer families for assessment by local early intervention programs for children meeting age eligibility.Inquire about behaviors that put children at risk including excessive oral exploratory habits and pica.Offer simple measures to reduce the risk of further lead contamination, for example, removing shoes when entering the house; frequent dusting and damp mopping; cleaning up and covering chipping or peeling paint or plaster; opening older windows from the top; and frequent hand-washing.Advocate for policies and statutes that control or eliminate sources of lead in the environment.The public health community is also facing challenges in its efforts to decrease children's BLLs. A nearly 45-year trend of BLL decreases over time has stalled.10 The 97.5% BLL in children not declined in a decade.11 This leaves open the question of whether activities at the individual home level can be expected to reduce BLLs as low as 3.5 µg/dL. In most cases, no "smoking gun" for the lead exposure has been identified.12 The decrease in BLL testing also hampers state and local lead surveillance systems. Public health surveillance is critical for the identification and prevention of emerging/reemerging lead sources. The use of such local data to target populations and areas with disproportionate risk for lead exposure is foundational for population-based efforts to decrease exposure. In addition, jurisdictions' ability to use surveillance data to compare progress within that jurisdiction over time has been hampered.Widespread reduction in lead pollution has been the most effective strategy for reducing population BLLs. Public health agencies must integrate primary prevention strategies into their existing work. Efforts to reduce water lead levels by replacing lead pipes is expected to reduce average BLL.Public health agencies should: Ensure the entire lead pipe is replaced during system updates and maintenance.Revise protocols and local ordinances to ensure that all units in multifamily housing are made lead-safe when a child with a BLL greater than or equal to their RV is identified in any unit.Work with nonprofit and advocacy groups to advocate for increased resources for lead hazard abatement.Work with refugee resettlement agencies to ensure that families are placed in lead-safe housing and children have BLL tests.Work with local housing authorities to ensure that properties with rental subsidies comply with lead-safe regulations.Work with local code enforcement and building departments to ensure that renovation of older homes is done safely.No safe BLL threshold has been identified for children. Public health and clinical care providers need to implement and sustain open communication systems for exchanging information about cases, emerging sources, and areas with disparities in risk for BLLs greater than or equal to the RV. We urge parents, PHCPs, and the public health community to rise to these new challenges and continue to fight against childhood lead exposure by eliminating residential leaded paint and other environmental lead hazards. Together, we can work toward the overarching goal of bringing every newborn home to a lead-safe environment.

Lead is ubiquitous in our environment and contaminates urban and roadside soils, paint and plaster in older homes, toxic waste sites, house dust, and other sources. Lead is still used in the manufacture of a variety of commercial products. Occupational exposures are a problem in many industries, including mining and smelting operations, building demolition, and residential construction and remodeling. When the price of gold rose during the worldwide recession years 2008–10, people in the Zamfara State in Nigeria began to undertake small artisanal mining operations near their homes to take advantage of the opportunity to make money. These unregulated activities inadvertently exposed the people to the real hazard of lead contamination because lead was also present in the gold-containing ore and was spread in dust in high concentrations. Hundreds of children were sickened and over 400 children died from lead poisoning before the government and nonprofit organizations could step in to stop such mining operations and remediate the heavily contaminated environment.

Centuries of human activities, particularly housing and transportation practices from the late 19th century through the 1980's, dispersed hundreds of millions of tons of lead into our urban areas. The urban lead burden is evident among humans, wild and domesticated animals, and plants. Animal lead exposures closely mirror and often exceed the lead exposure patterns of their human partners. Some examples: Pigeons in New York City neighborhoods mimicked the lead exposures of neighborhood children, with more contaminated areas associated with higher exposures in both species. Also, immediately following the lead in drinking water crisis in Flint MI in 2015, blood lead levels in pet dogs in Flint were 4 times higher than in surrounding towns. And combining lead's neurotoxicity with urban stress results in well-characterized aggressive behaviors across multiple species. Lead pollution is not distributed evenly across urban areas. Although average US pediatric lead exposures have declined by 90% since the 1970s, there remain well defined neighborhoods where children continue to have toxic lead exposures; animals are poisoned there, too. Those neighborhoods tend to have disproportionate commercial and industrial lead activity; a history of dense traffic; older and deteriorating housing; past and operating landfills, dumps and hazardous waste sites; and often lead contaminated drinking water. The population there tends to be low income and minority. Urban wild and domesticated animals bear that same lead burden. Soil, buildings, dust and even trees constitute huge lead repositories throughout urban areas. Until and unless we begin to address the lead repositories in our cities, the urban lead burden will continue to impose enormous costs distributed disproportionately across the domains of the natural environment. Evidence-based research has shown the efficacy and cost-effectiveness of some US public policies to prevent or reduce these exposures. We end with a series of recommendations to manage lead-safe urban environments.

* Abbreviation: CDC — : Centers for Disease Control and Prevention A core principle of screening is that there should be a direct benefit to the patient. This restriction undervalues the impact that screening could have by not considering the population-level benefits to others, including family members, close contacts of affected individuals, and the broader community. Screening for lead poisoning offers an example of how individual screening has resulted in long-term health improvements for many by identifying and abating lead from the environment. The US Preventive Services Task Force states that the balance of information regarding the benefits and harms of screening for elevated blood lead levels is insufficient to recommend for or against it.1 However, lead screening has been associated with significant overall public health improvement. In this commentary, we identify generalizable lessons about when it might be appropriate to screen even if there may be limited direct benefit to the child being screened. Childhood blood lead testing of asymptomatic children began in the 1970s.2 Initially, most blood lead screening was done through local health departments, maternal and child health programs, and other community-based organizations, with support from the Centers for Disease Control and Prevention (CDC) and other federal agencies. Screening was also recommended to occur within primary care and required for Medicaid-enrolled children at 1 and 2 years or by 6 years if not previously done. Regardless of setting, screening was often inconsistent. As late as 1998, only ∼20% of Medicaid-enrolled children had ever received a blood lead test.3 In addition, many children with elevated blood lead levels did not receive follow-up care.4,5 Specific … Address correspondence to Mary Jean Brown, ScD, RN, 157 Leeder Hill Dr #201, Hamden, CT 06517. E-mail: mbrown{at}hsph.harvard.edu

Urban residence is a risk factor for children's elevated lead exposures. Evidence from domesticated and wild animals shows that the phenomenon crosses species lines. Plants also suffer under lead's phytotoxicity. The Industrial Revolution lured and drove more than half of the US populations from the countryside into cities. Leaded paint, lead in public water systems and later, leaded gasoline, were the principal contributors to lead contamination of US cities. Lead's incredible utility has resulted in thousands of commercial applications in electronics, hardware, paints and pigments, many types of glass, ceramic glazes and coatings, cable sheaths, machinery and manufacturing, light industry, radiation protection, post and telecommunications, metallurgy, chemical production, transportation (rail, automobile and aviation), construction, weapons, aerospace, oil, plastics and petrochemicals, plumbing, pesticides, hair products, etc. Historically, commercial and industrial activities occurred coterminously to habitation, so the beginnings of all these uses occurred within urban areas. Consequently, urban areas have high lead pollution levels. Lead toxicosis in urban areas is evident across animal species, including pets (Zook et al 1998, Langlois et al 2017), feral pigeons (Cai and Calisi 2016), wild raccoons (Hamir et al 1995) and foxes (Dip et al 2000) and gazing animals (Ward and Savage 1994), Indeed, in 1970, pigeons were considered a sentinel for urban lead pollution (Tansy and Roth); society has continued to use children. Plants in urban areas are also significantly affected by high lead levels (EPA 1984). We used an integrated One Health approach to assess lead's urban burden in humans, animals and plants. In the future, we will develop conceptual and pragmatic guidance for urban planners and decision makers to address the urban lead burden in humans, animals and plants.

BACKGROUND:Lead can adversely affect maternal and child health across a wide range of exposures; developing fetuses and breastfeeding infants may be particularly vulnerable. We describe the distribution of blood lead levels (BLLs) in U.S. women of childbearing age and associations with sociodemographic, reproductive, smoking, and housing characteristics over a 40-y period. METHODS:Data from the National Health and Nutrition Examination Survey (NHANES) II, NHANES III Phase I and Phase II, and 1999-2016 continuous NHANES were used to describe the distribution of BLLs (given in micrograms per deciliter; 1μg/dL=0.0483μmol/L) in U.S. women 15-49 years of age between 1976 and 2016. For all women with valid BLLs (n=22,408), geometric mean (GM) BLLs and estimated prevalence of BLLs ≥5μg/dL were calculated overall and by selected demographic characteristics. For NHANES II, estimated prevalence of BLLs ≥10 and ≥20μg/dL were also calculated. RESULTS:The most recent GM BLLs (2007-2010 and 2011-2016, respectively) were 0.81μg/dL [95% confidence interval (CI): 0.79, 0.84] and 0.61μg/dL (95% CI: 0.59, 0.64). In comparison, GM BLLs in earlier periods (1976-1980, 1988-1991, and 1991-1994) were 10.37μg/dL (95% CI: 9.95, 10.79), 1.85μg/dL (95% CI: 1.75, 1.94), and 1.53μg/dL (95% CI: 1.45, 1.60), respectively. In 2011-2016, 0.7% of women of childbearing age had BLLs ≥5μg/dL, and higher BLLs were associated with older age, other race/ethnicity, birthplace outside the United States, four or more live births, exposure to secondhand tobacco smoke, and ever pregnant or not currently pregnant. DISCUSSION:Lead exposure in U.S. women of childbearing age is generally low and has substantially decreased over this 40-y period. However, based on these estimates, there are still at least 500,000 U.S. women being exposed to lead at levels that may harm developing fetuses or breastfeeding infants. Identifying high-risk women who are or intend to become pregnant remains an important public health issue. https://doi.org/10.1289/EHP5925.

In 2017, Puerto Rico sustained extensive damage from Hurricane Maria, increasing the risk of fires and carbon monoxide (CO) poisonings. Using a population-based, in-person survey of households with children less than 6 years old in Puerto Rico, we collected data in 2010 concerning the presence of smoke alarms and CO alarms in these households. We generated national estimates by extrapolating the number of households in each stratum using data from the 2010 Census. We determined which household characteristics predicted the presence of these alarms. Of 355 households analyzed, 31% had functional smoke alarms, or an estimated 109,773 households territory wide. The presence of smoke alarms was associated with living in multifamily housing and no child in the household receiving government medical insurance. Public housing or publicly subsidized housing, as compared to owner-occupied housing and unsubsidized rental housing, was associated with having a functional smoke alarm in households with children aged less than 6 years. Based on only six houses having CO alarms, we estimated only 7685 (2%) households had CO alarms. The low prevalence of functional smoke or CO alarms 7 years before Hurricane Maria is unfortunate and should be remedied by ensuring that such alarms are widely installed in current rebuilding activities.

The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the reference value has been used to guide clinical and public interventions for individual children. As the distribution of blood lead levels in the population has been lowered over time, the blood lead level at which interventions are recommended has also been reduced. The use of a reference value of 3.5 μg/dL, based on the 98 percentile of blood lead levels for children in 2011–2014 National Health and Nutrition Examination Survey is under review. For several reasons, adopting the new reference value to guide clinical and public health management puts practitioners in an untenable position. First, the changes in the brain caused by lead are significant and persistent. However, these adverse impacts are subtle and although clearly identified at the population level, not predictive for individual children. In addition, the recommended interventions have not been shown to reduce blood lead levels once they are elevated. Finally, clinical laboratory and office-based blood lead testing devices are not required to quantify blood lead levels < 4 μg/dL and in many cases cannot reliably test for low blood lead levels. Revising the reference value also will undoubtedly result in diversion of resources away from those population-based interventions which have demonstrated success. We argue for second approach, in the management of lead poisoning in the US from one of evaluation and management at the individual level to one of population based primary prevention. This would require a strategy directed at controlling or eliminating lead in children’s environment before they are exposed. The reference value, as a benchmark, is essential to ensure that primary prevention efforts are successful.

INTRODUCTION:Several urban neighborhoods in Philadelphia, Pennsylvania, have a history of soil, household lead paint, and potential lead-emitting industry contamination.OBJECTIVES:To (1) describe blood lead levels (BLLs) in target neighborhoods, (2) identify risk factors and sources of lead exposure, (3) describe household environmental lead levels, and (4) compare results with existing data.METHODS:A simple, random, cross-sectional sampling strategy was used to enroll children 8 years or younger living in selected Philadelphia neighborhoods with a history of lead-emitting industry during July 2014. Geometric mean of child BLLs and prevalence of BLLs of 5 μg/dL or more were calculated. Linear and logistic regression analyses were used to ascertain risk factors for elevated BLLs.RESULTS:Among 104 children tested for blood lead, 13 (12.4%; 95% confidence interval [CI], 7.5-20.2) had BLLs of 5 μg/dL or more. The geometric mean BLL was 2.0 μg/dL (95% CI, 1.7-2.3 μg/dL). Higher geometric mean BLLs were significantly associated with front door entryway dust lead content, residence built prior to 1900, and a child currently or ever receiving Medicaid. Seventy-one percent of households exceeded the screening level for soil, 25% had an elevated front door floor dust lead level, 28% had an elevated child play area floor dust lead level, and 14% had an elevated interior window dust lead level. Children in households with 2 to 3 elevated environmental lead samples were more likely to have BLLs of 5 μg/dL or more. A spatial relationship between household proximity to historic lead-emitting facilities and child BLL was not identified.CONCLUSION:Entryway floor dust lead levels were strongly associated with blood lead levels in participants. Results underscore the importance to make housing lead safe by addressing all lead hazards in and around the home. Reduction of child lead exposure is crucial, and continued blood lead surveillance, testing, and inspection of homes of children with BLLs of 5 μg/dL or more to identify and control lead sources are recommended. Pediatric health care providers can be especially vigilant screening Medicaid-eligible/enrolled children and children living in very old housing.

We present an examination of BLLs among a cohort of refugee children living in the United States by country of overseas medical examination and other variables. BACKGROUND:Elevated blood lead levels (EBLLs; >= 5 mu g/dL) are more prevalent among refugee children resettled in the United States than the general US population and contribute to permanent health and neurodevelopmental problems. The Centers for Disease Control and Prevention recommends screening of refugee children aged 6 months to 16 years on arrival in the United States and retesting those aged 6 months to 6 years between 3- and 6-months postarrival.METHODS:We analyzed EBLL prevalence among refugee children aged 6 months to 16 years who received a domestic refugee medical examination between January 1, 2010 and September 30, 2014. We assessed EBLL prevalence by predeparture examination country and, among children rescreened 3 to 6 months after initial testing, we assessed EBLL changes during follow-up screening.RESULTS:Twelve sites provided data on 27284 children representing nearly 25% of refugee children resettling during the time period of this analysis. The EBLL prevalence during initial testing was 19.3%. EBLL was associated with younger age, male sex, and overseas examination country. Among 1121 children from 5 sites with available follow-up test results, EBLL prevalence was 22.7%; higher follow-up BLLs were associated with younger age and predeparture examination country.CONCLUSIONS:EBLL decreased over the time period of our analysis in this population of refugee children. Refugee children may be exposed to lead before and after resettlement to the United States. Efforts to identify incoming refugee populations at high risk for EBLL can inform prevention efforts both domestically and overseas.

Event Abstract Back to Event The Lead Poisoning Control in Zamfara and Niger States, Nigeria: A 2010-2018 Review Nasir Tsafe Umar-Tsafe1, 2*, Adebola T Olayinka3, 4, Saad Ahmed4, Muhammad S Shehu4, Gaby Poggensi2, Abdulrazaq Habib5, Kabir Sabitu2, 4, Patrick M Nguku2, Abubakar Jafiya2, Mairo Kachalla2, Aishatu Binu Gubio2, Hawwa Inna Muhammad2, Sagir Aliyu6, Bashir Idris1, Bara’atu Shehu1, Abdulrahman Isah1, Halilu Ahmad1, Yusuf Madaro1, Rabi Usman1, Ibrahim Halilu1, Habibu Yalwa1, Hauwa Kolo7, Endie Waziri2, Saheed Gidado2, Mahmud Dalhat2, Benjamin J Mwangombe8, Ruth Olabiyo8, Gbemisola Oloruntuyi8, Abdullahi Zakariyya Yauri8, Balkisu A Shinkafi9, Nasir Sani-Gwarzo7, Zubairu Iliyasu5, Aisha Indo Mamman4, Hassan S Isah4, Shehu Akuyam4, John I. Anetor10 and Mary Jean Brown11 1 Ministry of Health, Zamfara State, Nigeria 2 Nigeria Field Epidemiology and Laboratory Training Program (NFELTP), Nigeria 3 Nigerian Centre for Disease Control (NCDC), Nigeria 4 Faculty of Medicine, College of Health Sciences, Ahmadu Bello University, Nigeria 5 Bayero University Kano, Nigeria 6 Zamfara Environmental Sanitation Agency, Nigeria 7 Federal Ministry of Health (Nigeria), Nigeria 8 Medicines Sans Frontiers (Nigeria), Nigeria 9 School of Science, Federal University of Technology, Nigeria 10 College of Medicine, University of Ibadan, Nigeria 11 National Center for Environmental Health (CDC), United States Background The lead poisoning (LP) disasters in Zamfara (2010) and Niger States (2015), Nigeria, were described as largest in modern times by scope and magnitude. LP due to artisanal gold-ore processing activities, affected children less than five years old (U5) with acute-severe outbreaks. This review provides an update on magnitude, scope, environmental, clinical, safety and other interventions applied to control and prevent further menace. Methods Secondary data reviewed on reports, publications from LP outbreaks and related studies (2010-2018): house-to-house cross-sectional, scoping-chain-referral and cluster sampling surveys. These covered 14 and 1 local government areas of Zamfara and Niger States, respectively. Standard interventions were applied by stakeholders based on Lead contamination (LC) values: >400 ppm defined elevated soil lead levels (ESLL), ≥5 and ≥10 µg/dL defined elevated blood lead levels (EBLL), confirming LP in U5 and animals, respectively. LCs were analysed in blood samples from U5s/animals, soil, water, food-items/crops, air, gold-ore materials and other environmental samples, using lead care II, X-ray fluorescence, atomic absorption and inductively-coupled-mass spectrometers. Data were analysed using SPSS, OpenEpi 2.3 and Epi-Info 7. Results The highest ESLL, EBLL were >150,000ppm, >700µg/dL (2010) and >550,000ppm, 300µg/dL (2015), in Zamfara and Niger States, respectively. These reduced to 10,000ppm, 30µg/dL and 1,000ppm, 29.7µg/dL (2018). Highest animal-EBLL were >300µg/dL (Zamfara,2010) and >270µg/dL (Niger,2015). LC Levels in other samples were significantly above their respective US-EPA standards. The strongest risk-factor associations between U5s requiring chelation therapy and environmental LCs were significant (OR: 5.8, 95% CI: 1.7, 19.1, P<0.01, Zamfara) and (OR: 32.8, 95% CI: 7.6, 141.9, P<0.001, Niger). Over 10,200 and 281 U5s were screened, with >7,200 and 180 successfully treated of LP, in Zamfara and Niger States, respectively (2010-2018). Conclusion LP-based U5 mortality (734-Zamfara and 28-Niger) has ceased. Zamfara LP morbidity-prevalence effectively reduced from >97%(2010) to <3%(2018), Niger’s reduced from 98%(2015) to <1%(2018). LP control program in Niger was so successful, handing-over by December 2018, whereas in Zamfara, >3,000 LP U5s are continuously exposed to LCs. Zamfara disaster remains an emergency, due to ineffective re-contamination control, access to low-cost intervention mechanisms, inadequate Government responses. Recommendations: environmental remediation, chelation therapy, safer mining practices/health education, continuous surveillance, other control and prevention measures. Keywords: Lead Poisoning, Chelation Therapy, Soil remediation, Zamfara, Niger, Nigeria, EBLL, Safer mining Conference: International Conference on Drug Discovery and Translational Medicine 2018 (ICDDTM '18) “Seizing Opportunities and Addressing Challenges of Precision Medicine”, Putrajaya, Malaysia, 3 Dec - 5 Feb, 2019. Presentation Type: Poster Presentation Topic: Miscellaneous Citation: Umar-Tsafe N, T Olayinka A, Ahmed S, S Shehu M, Poggensi G, Habib A, Sabitu K, M Nguku P, Jafiya A, Kachalla M, Binu Gubio A, Inna Muhammad H, Aliyu S, Idris B, Shehu B, Isah A, Ahmad H, Madaro Y, Usman R, Halilu I, Yalwa H, Kolo H, Waziri E, Gidado S, Dalhat M, J Mwangombe B, Olabiyo R, Oloruntuyi G, Zakariyya Yauri A, A Shinkafi B, Sani-Gwarzo N, Iliyasu Z, Indo Mamman A, S Isah H, Akuyam S, Anetor JI and Jean Brown M (2019). The Lead Poisoning Control in Zamfara and Niger States, Nigeria: A 2010-2018 Review. Front. Pharmacol. Conference Abstract: International Conference on Drug Discovery and Translational Medicine 2018 (ICDDTM '18) “Seizing Opportunities and Addressing Challenges of Precision Medicine”. doi: 10.3389/conf.fphar.2019.63.00028 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 05 Nov 2018; Published Online: 17 Jan 2019. * Correspondence: Dr. Nasir Tsafe Umar-Tsafe, Ministry of Health, Zamfara State, Zamfara, Nigeria, untsafe@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Nasir Tsafe Umar-Tsafe Adebola T Olayinka Saad Ahmed Muhammad S Shehu Gaby Poggensi Abdulrazaq Habib Kabir Sabitu Patrick M Nguku Abubakar Jafiya Mairo Kachalla Aishatu Binu Gubio Hawwa Inna Muhammad Sagir Aliyu Bashir Idris Bara’atu Shehu Abdulrahman Isah Halilu Ahmad Yusuf Madaro Rabi Usman Ibrahim Halilu Habibu Yalwa Hauwa Kolo Endie Waziri Saheed Gidado Mahmud Dalhat Benjamin J Mwangombe Ruth Olabiyo Gbemisola Oloruntuyi Abdullahi Zakariyya Yauri Balkisu A Shinkafi Nasir Sani-Gwarzo Zubairu Iliyasu Aisha Indo Mamman Hassan S Isah Shehu Akuyam John I Anetor Mary Jean Brown Google Nasir Tsafe Umar-Tsafe Adebola T Olayinka Saad Ahmed Muhammad S Shehu Gaby Poggensi Abdulrazaq Habib Kabir Sabitu Patrick M Nguku Abubakar Jafiya Mairo Kachalla Aishatu Binu Gubio Hawwa Inna Muhammad Sagir Aliyu Bashir Idris Bara’atu Shehu Abdulrahman Isah Halilu Ahmad Yusuf Madaro Rabi Usman Ibrahim Halilu Habibu Yalwa Hauwa Kolo Endie Waziri Saheed Gidado Mahmud Dalhat Benjamin J Mwangombe Ruth Olabiyo Gbemisola Oloruntuyi Abdullahi Zakariyya Yauri Balkisu A Shinkafi Nasir Sani-Gwarzo Zubairu Iliyasu Aisha Indo Mamman Hassan S Isah Shehu Akuyam John I Anetor Mary Jean Brown Google Scholar Nasir Tsafe Umar-Tsafe Adebola T Olayinka Saad Ahmed Muhammad S Shehu Gaby Poggensi Abdulrazaq Habib Kabir Sabitu Patrick M Nguku Abubakar Jafiya Mairo Kachalla Aishatu Binu Gubio Hawwa Inna Muhammad Sagir Aliyu Bashir Idris Bara’atu Shehu Abdulrahman Isah Halilu Ahmad Yusuf Madaro Rabi Usman Ibrahim Halilu Habibu Yalwa Hauwa Kolo Endie Waziri Saheed Gidado Mahmud Dalhat Benjamin J Mwangombe Ruth Olabiyo Gbemisola Oloruntuyi Abdullahi Zakariyya Yauri Balkisu A Shinkafi Nasir Sani-Gwarzo Zubairu Iliyasu Aisha Indo Mamman Hassan S Isah Shehu Akuyam John I Anetor Mary Jean Brown PubMed Nasir Tsafe Umar-Tsafe Adebola T Olayinka Saad Ahmed Muhammad S Shehu Gaby Poggensi Abdulrazaq Habib Kabir Sabitu Patrick M Nguku Abubakar Jafiya Mairo Kachalla Aishatu Binu Gubio Hawwa Inna Muhammad Sagir Aliyu Bashir Idris Bara’atu Shehu Abdulrahman Isah Halilu Ahmad Yusuf Madaro Rabi Usman Ibrahim Halilu Habibu Yalwa Hauwa Kolo Endie Waziri Saheed Gidado Mahmud Dalhat Benjamin J Mwangombe Ruth Olabiyo Gbemisola Oloruntuyi Abdullahi Zakariyya Yauri Balkisu A Shinkafi Nasir Sani-Gwarzo Zubairu Iliyasu Aisha Indo Mamman Hassan S Isah Shehu Akuyam John I Anetor Mary Jean Brown Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. 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Water-soluble vitamin B6 is widely present in many foods, including meat, fish, nuts, beans, grains, fruits and vegetables. Additionally, B6 is present in many multivitamin preparations for adults and children and added to foods as a supplement to breakfast foods, power bars, and powders.There are several active compounds or vitamers which fall under the generic B6. These include (1) pyridoxine an alcohol, (2) pyridoxal an aldehyde, (3) pyridoxamine which differs from the first two with an amine group, and (4) a 2,5' phosphate esters. The major esters are the active coenzyme form and are pyridoxal 5'phosphate(PLP) and pyridoxamine 5'phosphate(PMP). The major form of B6 in meats are the esters, and the major plant source is pyridoxine, which is less bioavailable. Pyridoxine is the most common form found in multivitamins. As a coenzyme, B6 is involved as a cofactor in over 100 enzyme reactions including amino acid metabolism, particularly homocysteine; carbohydrate metabolism, including gluconeogenesis and glycogenolysis; and lipid metabolism. B6 has a role in cognitive development thru neurotransmitter synthesis, immune function with interleukin-2 production, and hemoglobin formation.Fetal brain development requires adequate B6, and this continues throughout infancy. Vitamin B6 recommendations are made in accordance with age and life stage with pregnancy and breastfeeding involving the highest recommended daily allowance.

In 2017, the American Academy of Pediatrics Council on Environmental Health clarified the use of terminology related to testing children’s blood lead levels in an erratum to its June 2016 Policy Statement, “Prevention of Childhood Lead Toxicity.”1 Although we applaud this effort to develop consistent terminology, we offer the following cautions for consideration.First, all but 5 states have regulatory language that defines health care providers’ obligations in terms of blood lead testing or screening in children <6 years old. The language in these regulations is not necessarily consistent with that proposed by the … E-mail: aettinger{at}cdc.gov

Background: In 2010, Médecins Sans Frontières (MSF) discovered extensive lead poisoning impacting several thousand children in rural northern Nigeria. An estimated 400 fatalities had occurred over 3 mo. The US Centers for Disease Control and Prevention (CDC) confirmed widespread contamination from lead-rich ore being processed for gold, and environmental management was begun. MSF commenced a medical management programme that included treatment with the oral chelating agent 2,3-dimercaptosuccinic acid (DMSA, succimer). Here we describe and evaluate the changes in venous blood lead level (VBLL) associated with DMSA treatment in the largest cohort of children #5 y of age with severe paediatric lead intoxication reported to date to our knowledge. Methods and Findings: In a retrospective analysis of programme data, we describe change in VBLL after DMSA treatment courses in a cohort of 1,156 children #5 y of age who underwent between one and 15 courses of chelation treatment. Courses of DMSA of 19 or 28 d duration administered to children with VBLL $ 45 mg/dl were included. Impact of DMSA was calculated as end-course VBLL as a percentage of pre-course VBLL (ECP). Mixed model regression with nested random effects was used to evaluate the relative associations of covariates with ECP. Of 3,180 treatment courses administered, 36% and 6% of courses commenced with VBLL $ 80 mg/dl and $ 120 mg/dl, respectively. Overall mean ECP was 74.5% (95% CI 69.7%–79.7%); among 159 inpatient courses, ECP was 47.7% (95% CI 39.7%–57.3%). ECP after 19-d courses (n = 2,262) was lower in older children, first-ever courses, courses with a longer interval since a previous course, courses with more directly observed doses, and courses with higher pre-course VBLLs. Low haemoglobin was associated with higher ECP. Twenty children aged #5 y who commenced chelation died during the period studied, with lead poisoning a primary factor in six deaths. Monitoring of alanine transaminase (ALT), creatinine, and full blood count revealed moderate ALT elevation in ,2.5% of courses. No clinically severe adverse drug effects were observed, and no laboratory findings required discontinuation of treatment. Limitations include that this was a retrospective analysis of clinical data, and unmeasured variables related to environmental exposures could not be accounted for. Conclusions: Oral DMSA was a pharmacodynamically effective chelating agent for the treatment of severe childhood lead poisoning in a resource-limited setting. Re-exposure to lead, despite efforts to remediate the environment, and nonadherence may have influenced the impact of outpatient treatment. Please see later in the article for the Editors’ Summary. Citation: Thurtle N, Greig J, Cooney L, Amitai Y, Ariti C, et al. (2014) Description of 3,180 Courses of Chelation with Dimercaptosuccinic Acid in Children #5 y with Severe Lead Poisoning in Zamfara, Northern Nigeria: A Retrospective Analysis of Programme Data. PLoS Med 11(10): pmed.1001739. doi:10.1371/journal.pmed.1001739 Academic Editor: Bruce P Lanphear, Simon Fraser University, Canada Received September 16, 2013; Accepted August 19, 2014; Published October 7, 2014 This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Data Availability: The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. Research data are accessible via the MSF open data policy for researchers who meet the criteria for access to confidential data (http://fieldresearch.msf.org/msf/handle/10144/306501). Funding: This study was funded as part of MSF operations. Lundbeck donated some DMSA, but had no role in the treatment programme or in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry and should not be construed to represent any agency determination or policy. Competing Interests: The authors have declared that no competing interests exist. Abbreviations: ALT, alanine transaminase; BD, twice daily; CaNa2EDTA, calcium disodium versenate; CDC, US Centers for Disease Control and Prevention; DMSA, 2,3-dimercaptosuccinic acid; DOT, directly observed therapy; ICPMS, inductively coupled plasma mass spectrometry; IV, intravenous; ECP, end-course venous blood lead level as a percentage of pre-course venous blood lead level; MSF, Médecins Sans Frontières; TDS, thrice daily; VBLL, venous blood lead level. * Email: Jane.Greig@london.msf.org PLOS Medicine | www.plosmedicine.org 1 October 2014 | Volume 11 | Issue 10 | pmed.1001739

Background. Lead exposure is linked to intellectual disability and anemia in children. The United States Centers for Disease Control and Prevention (CDC) recommends biomonitoring of blood lead levels (BLLs) in children with BLL ≥5 μg/dL and chelation therapy for those with BLL ≥45 μg/dL. Objectives. This study aimed to determine blood and environmental lead levels and risk factors associated with elevated BLL among children from Owino Uhuru and Bangladesh settlements in Mombasa County, Kenya. Methods. The present study is a population-based, cross-sectional study of children aged 12–59 months randomly selected from households in two neighboring settlements, Owino Uhuru, which has a lead smelter, and Bangladesh settlement (no smelter). Structured questionnaires were administered to parents and 1–3 ml venous blood drawn from each child was tested for lead using a LeadCare ® II portable analyzer. Environmental samples collected from half of the sampled households were tested for lead using graphite furnace atomic absorption spectroscopy. Results: We enrolled 130 children, 65 from each settlement. Fifty-nine (45%) were males and the median age was 39 months (interquartile range (IQR): 30–52 months). BLLs ranged from 1 μg/dL to 31 μg/dL, with 45 (69%) children from Owino Uhuru and 18 (28%) children from Bangladesh settlement with BLLs >5 μg/dL. For Owino Uhuru, the geometric mean BLL in children was 7.4 μg/dL (geometric standard deviation (GSD); 1.9) compared to 3.7 μg/dL (GSD: 1.9) in Bangladesh settlement (p<0.05). The geometric mean lead concentration of soil samples from Owino Uhuru was 146.5 mg/Kg (GSD: 5.2) and 11.5 mg/Kg (GSD: 3.9) (p<0.001) in Bangladesh settlement. Children who resided <200 m from the lead smelter were more likely to have a BLL ≥5 μg/dL than children residing ≥200 m from the lead smelter (adjusted odds ratio (aOR): 33.6 (95% confidence interval (CI): 7.4–153.3). Males were also more likely than females to have a BLL ≥5 μg/dL (39, 62%) compared to a BLL<5 μg/dL [aOR: 2.4 (95% CI: 1.0–5.5)]. Conclusions. Children in Owino Uhuru had significantly higher BLLs compared with children in Bangladesh settlement. Interventions to diminish continued exposure to lead in the settlement should be undertaken. Continued monitoring of levels in children with detectable levels can evaluate whether interventions to reduce exposure are effective. Participant Consent. Obtained Ethics Approval. Scientific approval for the study was obtained from the Ministry of Health, lead poisoning technical working group. Since this investigation was considered a public health response of immediate concern, expedited ethical approval was obtained from the Kenya Medical Research Institute and further approval from the Mombasa County Department of Health Services. The investigation was considered a non-research public health response activity by the CDC. Competing Interests. The authors declare no competing financial interests.