Lab Matters Summer 2019 - Page 16

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 14 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. PublicHealthLabs @APHL