ENVIRONMENTAL HEALTH
Efforts Toward a Lead-Free Future
by Raya Hudhud, intern, Environmental Health and Jennifer Liebreich, MPH, senior specialist, Environmental Health
Mona Hanna-Attisha, MD, or “Dr.
Mona,” passionately describes her
role in uncovering the Flint, Michigan
community’s exposure to lead in the city’s
water supply in her book What the Eyes
Don’t See. With upwards of 400 attendees
at the Katherine Kelley Lecture at APHL
2019, Dr. Mona received a standing ovation
and inspired APHL members like Henry
Leibovitz, PhD, of Rhode Island.
“[Dr.Mona’s] story motivated me to
advocate for family and pediatric
physicians to inform their patients about
the importance of knowing the source and
quality of their household drinking water,”
he said. “Doing so will protect the health
of the generations to come.”
Immediately following Dr. Mona’s lecture
at APHL 2019, Jennifer Lowry, MD, chair
of the American Academy of Pediatrics
(AAP) Council on Environmental Health,
and Patrick Breysse, PhD, Director of
the US Centers for Disease Control and
Prevention’s (CDC’S) National Center
for Environmental Health/Agency for
Toxic Substances and Disease Registry
(NCEH/ATSDR), discussed the health
consequences of low-level lead exposure
and the role of public health laboratories
in addressing lead poisoning in children.
According to Dr. Lowry, current agreement
is that that laboratory precision at 3.5
μg/dL would not be able to match the
laboratory precision available at the
current reference level of 5 μg/dL. Given
the variability in precision at 3.5 μg/dL it is
unlikely that CDC will lower the reference
value from 5 μg/dL until better precision
can be achieved.
Current Lead Screening Programs
and Technology
Different laboratory instruments,
analytical methods and expertise for
lead testing yield results that may
vary in accuracy, precision, reportable
range and detectable levels. As lower
reference levels are established, there
is even greater need to ensure that lead
present in the environment does not
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LAB MATTERS Summer 2019
Lead exposure in children continues
to be a priority topic for APHL’s
Environmental Health Committee
(EHC). Thanks to Dr. Leibovitz,
the EHC is working on a position
statement on well water with AAP.
contaminate specimens and specimen
collection materials. The uncertainty
in the influence of this range of factors
affects the interpretation of results
and, ultimately, patient care. CDC offers
resources to encourage accurate lead
testing such as the Lead and Multi-
Element Proficiency Program (LAMP) and
informational video, Mission Unleaded:
How to Test Children with Maximum
Accuracy. Other efforts to eliminate
the threat of lead exposure in children
include the establishment of the
federal Lead Exposure and Prevention
Advisory Committee (LEPAC) and
CDC’s enhancement of lead poisoning
prevention and surveillance in 14 new
state and local health departments.
APHL Steps Up to the Challenge
In February 2019, APHL surveyed local
and state public health laboratories in an
effort to increase understanding of blood
lead testing programs across the country.
Of the 35 total survey participants, 24
laboratories currently perform routine
pediatric lead testing and pediatric lead
testing in emergencies. Twenty reported
testing blood lead levels from specimens
collected through venipuncture, 19 testing
through finger stick and four testing dried
blood spots.
The majority of funding for the 24
laboratory pediatric lead testing
programs came from medical billing (12
laboratories), state, country or municipal
appropriations (11) and fee-for-service
sources (8). At laboratories no longer
offering pediatric lead tests, the primary
reason provided was resource limitations.
If additional resources were available to
expand a pediatric lead testing program,
92% of respondents expressed interest in
doing so.
In April 2019, with funding support from
NCEH/ATSDR, APHL awarded grants of
$60,000 each to the Louisville Metro Public
Health and Wellness Laboratory and
the Vermont Public Health Laboratory
to enhance each laboratory’s blood lead
testing program.
Looking to the Future
In July 2019 the US Environmental
Protection Agency (EPA) announced a
final rule lowering the dust-lead hazard
standards from 40 micrograms of lead
per square foot (µg/ft 2 ) to 10 µg/ft 2 on
floors and from 250 µg/ft 2 to 100 µg/ft 2 on
window sills. The standards will apply
to inspections, risk assessments and
abatement activities in pre-1978 housing
and certain schools, child care facilities
and hospitals. EPA Administrator Andrew
Wheeler said “(the) final rule is the first
time in nearly two decades EPA is issuing
a stronger, more protective standard
for lead dust in homes and child care
facilities across the country.”
In September 2019, APHL will host
webinars focusing on pediatric blood
lead testing, highlighting the increasing
importance of lot testing as advances
in analytical technology are made, and
addressing best practices for analysis
of toxic and trace elements in blood
using inductively coupled plasma
mass spectrometry (ICP-MS), including
performing low concentration blood lead
measurements. Fact sheets and a synopsis
of the lead survey data will be available
with the webinars. n
DIGITAL EXTRA:
Listen to APHL’s full podcast interview
of Dr. Mona Hanna-Attisha.
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