Lead concerns

Public drinking water has been in the news recently due to the crisis in Flint, Michigan. It is important for the people of Maine to know that their public drinking water is well-regulated and safe to drink. Kenneth Albert, Director and Chief Operating Officer of Maine CDC, recently wrote an op ed about lead in Maine. Read it at https://www.centralmaine.com/2016/03/28/maine-is-not-flint-michigan/

Changes to pediatric blood lead testing guidelines

Maine CDC has updated its pediatric blood lead testing guidelines and services. Effective March 2015, for children less than 6 years old, providers should:

• confirm all capillary blood lead levels > 5 µg/dL with venous samples, and
• follow-up on all venous blood lead levels > 5 µg/dL.

These changes align Maine CDC's recommendations with the reference value for pediatric blood lead of 5 µg/dL set by the U.S. CDC in 2012. The reference value is the 97.5th percentile of the blood lead distribution in children 1-5 years of age in the U.S., which is currently 5 µg/dL. 

For more on the reference value:http://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm.

Maine CDC initiates a tiered response on all venous blood lead levels > 5 µg/dL. Services range from providing free home lead dust testing, to comprehensive, professional environmental lead investigations.

Providers are reminded that Maine law requires children who are covered by MaineCare be tested for lead at ages 1 and 2 years. All other children less than 6 years old should be tested unless an annual risk assessment for lead exposure is negative.

Visit http://go.usa.gov/3xmfF to get the complete updated confirmation, follow-up and screening guidelines, including the annual risk assessment questionnaire. 

In-office blood testing

The Maine Childhood Lead Poisoning Prevention Program is pleased to announce rules adopted Nov. 5 now allow providers two options for blood lead testing:


1. Continue to submit blood lead samples to the State Health and Environmental Testing Laboratory; or

2. Perform capillary blood lead analysis using a CLIA waived in-office blood lead testing device, such as a LeadCareII, and directly report all test results to Maine Childhood Lead Poisoning Prevention Program.

Providers must have approval from the Maine Childhood Lead Poisoning Prevention Program before they can begin in-office testing.

The intent of the law is to increase blood lead testing of children under age 6 years by removing barriers to testing, such as travelling to an off-site location to have blood drawn. Using a direct-read blood lead analyzer, providers will be able to perform a capillary blood lead test and within minutes report the result to the patient’s parent/guardian. (Note: All elevated blood lead levels will require a venous confirmation through the State Health and Environmental Testing Laboratory.)

For more information, visit http://go.usa.gov/YhnT

Childhood lead poisoning prevention

US CDC has issued its response to their Advisory Committee on Childhood Lead Poisoning Prevention’s recommendations presented in its report:  Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention (http://go.usa.gov/prD).

The most notable response is that for the first time in 20 years, US CDC will revise the blood lead level considered to be elevated.  The Advisory Committee recommended adopting a new reference value of 5 micrograms per deciliter (5 ug/dL) for identifying children with an elevated blood lead level, and US CDC has announced that it concurs with the use of this value.   The new reference value replaces the value of 10 ug/dL, which has been used as the benchmark for identifying children having an elevated blood lead level since 1991.

This change was motivated by a growing body of studies concluding that blood lead levels (BLLs) <10 μg/dL harm children, resulted in decreased IQ and other behavioral deficits such as attention-related behaviors and academic achievement.  Since no safe blood level in children has been identified, the Advisory Committee recommended the reference level be set at a value that represents a high level of exposure in the U.S. population – a level present in no more than 2.5 percent of young children.

Maine has tracked the number of children with a blood lead level of 10 ug/dL and higher for years, with the number of children above this benchmark dropping from over 200 in 2003 to about 100 children in 2010.   Maine estimates that there about 400 children under age 6 years were identified as having a blood lead level above 5 ug/dL in 2010.

Since no safe blood level in children has been identified, US CDC also concurred in principle with the Advisory Committee’s  recommendation  for an increased focus on primary prevention.  Fortunately for Maine children, a shift to primary prevention has already occurred because of action by the Maine Legislature to establish the Lead Poisoning Prevention Fund to support primary prevention efforts.  Maine CDC’s Childhood Lead Prevention Program already mails primary prevention information to all families in Maine with a 1- or 2-year-old.  In addition, the program will soon be offering free lead dust test kits to all families with a child with a blood lead level of 5 ug/dL lead or more.

US CDC also concurred with the Advisory Committee’s recommendation that clinicians should monitor children with a confirmed BLL ≥ 5 μg/dL for subsequent changes in blood lead levels until all recommended environmental investigations and mitigation strategies have been completed. US CDC plans to assist with provider training and develop guidance for implementing this recommendation. 

For more information about childhood lead poisoning, visit http://go.usa.gov/prK