Child lead poisoning on rise, prevalence unknown
Reported cases of lead poisoning among children are on the rise in Southern Nevada. The increase is attributed in part to more testing. But researchers, pointing to a legacy of inadequate screening in the state, are also calling for stepped up measures to detect lead poisoning in children.
“We currently only test three percent of children under six in the entire state,” said Erika Marquez, a research associate for the Nevada Institute for Children’s Research and Policy.
In 2015 there were 43 reported cases of lead poisoning, and in 2017 there were 175 cases reported — 100 of which were children, according to disease statistics tracked by the Southern Nevada Health District.
Doctors warn that there’s no safe level of lead exposure. High doses of lead can lead to seizures, coma, and death. But even blood lead levels below 10 micrograms per deciliter in children can lead to poor performance in school, loss of IQ, attention deficits, and behavioral issues.
“It is such a tiny amount,”said Dr. Shawn Gerstenberger, the dean of the School of Community Health Sciences at UNLV. “Amounts smaller than grains of salt is sufficient to poison individuals.”
In one reported case for the 2018 fiscal year, testing found a blood lead level of 25 micrograms per deciliter in a female child. Several pieces of ceramic dishware, house keys, and the tile in the master bedroom were identified as lead hazards.
Gerstenberger said the rise in lead poisoning cases is the result of increased lead screenings in children less than 6 years of age in Clark County, as part of a collaboration with UNLV and the Southern Nevada Health District.
The collaboration is under The Nevada Childhood Lead Poisoning Prevention Program, a program funded by the Centers for Disease Control and Prevention through a $1.2 million dollar grant last year.
Nevada had not received funding for its childhood lead poisoning prevention program since 2011.
The rise in lead poisoning cases are likely the result of increased blood lead level screening in children but they also reveal gaps in Nevada’s lead screening policies.
The Centers for Disease Control and Prevention recommends screening children at 12 and 24 months, or at least once before 6 years of age.
And while Nevada has formal written recommendations for childhood lead screening it does not require medical providers to screen children for lead nor does it require physicians to report elevated blood lead levels to state or county health officials like many other states do.
A 2017 study by UNLV revealed that 48 percent of physicians throughout Clark County who serve patients under the age of six did not follow CDC guidelines for testing children for blood lead levels.
Physicians indicated that they did not test either because it was not a state mandate, because they believed that only children in high-risk housing required testing, or they did not test because colleagues had informed them that testing was not a standard practice in Nevada.
“There is a perception that there is no problem here,” said Marquez, who coauthored the study. “We just had a provider tell us they hadn’t been screening kids because their trainer told them it wasn’t an issue.”
Low-levels of lead appear symptomless but can lead to serious damage, which develops over time. The lack of obvious symptoms also helps account for lower levels of testing from physicians.
As part of their childhood lead poisoning prevention programs, most states gather information and track data for characteristics such as population dynamics, immigration, age, race, ethnicity, income level, Medicaid enrollment, and age of housing for children found with elevated blood lead levels.
Nevada does not.
Clark County is the only county in the state that has any kind of Lead Poisoning Surveillance Program to investigate environmental sources of lead poisoning.
The lack of mandatory blood lead reporting in Nevada has hindered effective monitoring or surveillance of lead in the population. Consequently, this lack of data has created a perception that Nevada has no serious lead problems.
“You don’t know it’s there unless you look for it and that was certainly the case before these programs,” Gerstenberger said. “We were not testing and everyone said it’s not a problem here. It’s not a problem because we didn’t look.”
Marques said researchers need to gather demographic information to effectively push for legislation to make childhood blood lead level screening mandatory throughout the state.
“Ideally we want [childhood lead screening] to be mandatory but we need stronger data to go in that direction,” Marquez said.
As part of the Nevada Childhood Lead Poisoning Prevention Program’s mission, Marquez said they are pushing to get physicians to screen all children according to CDC guidelines and to report their results along with these data points to improve prevention efforts.
“The bonus is that hopefully, we get more demographic information so we can tell a story about what we are seeing here in Nevada to the legislature,” Marquez said.
In one case investigated by the Southern Nevada Health District, a child was found to have a blood lead level of 21 micrograms per deciliter, well over the 10 micrograms per deciliter result that triggers SNHD to test the home.
After analyzing the family car and finding lead hazards on the driver’s seat and floor mats, it was determined the likely contamination was from the child’s father, who works with scrap metal in the construction industry.
Of the adults who were tested for lead poisoning in Nevada in 2018, 25 percent were exposed to lead through their occupation, according to the SNHD.
U.S. Occupational Safety and Health Administration (OSHA) limits the concentrations of lead in air in the workplace but lead can travel to workers homes on clothing and shoes, harming vulnerable children.
Michelle Turk, a historian and instructor at UNLV who studies occupational health and safety, said that historically Nevada only enacts strict mandates for workplace hazards after large-scale disasters and, at times, even large-scale disasters are still not enough to cause Nevada to change regulations. She said low numbers of lead poisonings have likely not produced enough public outcry to inspire stricter mandates.
“When people are identified in the workplace to have an elevated blood lead level it’s not always connected to an additional follow up to find out if their children have an elevated blood lead level,” Marquez said.
Nationally, lead poisoning of children is usually caused by lead-based paint or dust in older buildings, or older water lines, such as those that have elevated the instances of lead poisoning among the children of Flint, Mich.
“More often than not in Nevada we see nontraditional sources of lead poisoning, cultural practices, hobbies, workplace things like that,” Marquez said.
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