Bureau of Epidemiology
Bureau of Epidemiology June 2001 Utah Department of Health
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Lead Poisoning – Still A Concern In Utah
Quarterly Report of Diseases of Low Frequency
Printing Error in May Newsletter
Exceptional Efforts In Public Health
Important Information
Monthly Morbidity Summary

 

Lead Poisoning – Still A Concern In Utah

Lead Poisoning is one of the most common and preventable childhood health problems in the United States today. Lead poisoning could be considered a “silent disease.” Many children who are exposed to lead do not exhibit any signs that they have the disease. Any signs or symptoms the child may have could be mistaken for other illnesses and the child goes undiagnosed. Lead poisoning may cause behavioral problems, decreased muscle and bone growth, learning disabilities and damage to the nervous system, kidneys, and brain. These symptoms may not be apparent until later in the child’s life. It is important to increase awareness by educating the public and identifying the possible exposures of this silent disease.

In the summer of 2000, the Utah Department of Environmental Quality (UDEQ) tested residential soils in the rural community of Eureka, Utah and found high levels of lead. Eureka has an estimated population of 700 and is approximately 84 miles south of Salt Lake City, Utah, in the center of the historical and scenic Tinitc Mining district. Gold, silver, copper, and lead was mined and milled in Eureka from 1870 through 1965. In response to this testing and funding by the Centers for Disease Control and Prevention, the Central Utah Public Health Department (CUPHD) and the Utah Department of Health (UDOH)/Environmental Epidemiology Program (EEP), performed blood lead testing in June and July to try to determine if any children in Eureka had been exposed to lead. Nineteen children were tested under the age of 18. Of those children, 11 had an elevated blood lead level (EBLL) defined as greater than or equal to 10 micrograms per decileter (>10 g/dL), with a range of 11.0 g/dL to 32.5 g/dL and a geometric mean of 15.4 g/dL.

In August of 2000, a public meeting was held in Eureka to discuss the concern for the EBLL in the children and the high levels of lead found in the soil. Further discussion was directed toward blood lead testing of Eureka residents and a more comprehensive testing of the soil, water, dust, and paint in and around their homes. This testing would assist in ascertaining how, where, and why these residents were being exposed to lead and provide education and support to the community.

A three day clinic was held in September 2000, to screen Eureka residents for lead exposure. The screening was focused on children 6 months to 6 years of age who are at the most risk due to their normal habits of hand-to-mouth activity, becoming more mobile, and their developing brain and nervous system. Residents were notified of the three day clinic by an article written in the local newspaper and flyers were posted around the city and mailed directly to the residents. A lead risk survey and an environmental survey were conducted for each person screened. Educational pamphlets and fact sheets on lead were distributed. During the three day clinic 209 people were screened. Twenty four of the 209 screened had an EBLL. Of those 24, 11 were children under the age of six years. In October 2000, follow-up blood lead tests were conducted to confirm those with an elevated blood lead level and to provide screening for those who had not been previously tested. Funding for the blood lead tests in September and October was provided by the Agency for Toxic Substances and Disease Registry.

Results

During the year 2000, UDOH received 271 blood lead test results from 238 Eureka residents. Of the 238 tested, 55 were children between the ages of 6-72 months, with a blood lead level range of 1.6 g/dL to 34.2 g/dL and a geometric mean of 6.9 g/dL (Tables 1-2). Of the 55 children tested, 13 had an EBLL for a prevalence of 23.6% compared to the Utah prevalence of 1.7% for this same age group. Of the 82 children between the ages of 6-18 years tested, 15 had an EBLL for a prevalence of 18.3%. Of the 98 adults tested, 2 had an EBLL for a prevalence of 2.0%. Staff from the CUPHD and EEP have visited homes of residents with EBLL to provide educational assistance and try to determine the possible sources for the their exposure to lead. Letters have been mailed to persons with EBLL for retesting and their physicians have been notified of the blood lead results.

Child Risk Survey

UDOH administered a lead risk questionnaire for each child tested. Survey questions helped identify sources and behaviors that could expose children to lead poisoning. The results indicated that those children with high levels of lead engaged in the following activities:

eating dirt

using non-U.S. made crayons

chewing on furniture

chewing on toys and placing fingers in their mouth, and

living in their house longer than one year

Chewing on toys was the only behavioral risk factor that was of statistical significance. The medical history portion of the survey also showed that those children with high levels of lead experienced a higher risk of vomiting and constipation.

Environmental Survey

In 1978 lead-based paint was banned for use in residential housing. Homes built prior to 1978 could contain lead-based paint which is the primary risk factor for childhood lead poisoning in other regions of the state of Utah. UDOH conducted an environmental survey on 113 homes in Eureka, Utah. Eighty-five homes reported an approximate year their home was built and UDOH found that 21% of the homes were built prior to 1901, 15% were built before 1950, and 64% were built before 1978. The results indicated that living in a home built prior to 1950, visiting an older home, or having peeling or chipping paint in or around their home were not significant risk factors for lead poisoning in Eureka. Based on the environmental data available, soil appears to be the primary source of lead exposure in Eureka.

Follow-up

UDOH sent letters to families and their physicians regarding the blood lead test results of those children with EBLL. Also, the EEP continues to send letters to parents/guardians to remind them to have their children retested. A child with an EBLL should be retested every 3 months until 2 consecutive blood lead tests are below 10 g/dL. Limited retesting has shown that the blood lead levels in children and adults has decreased since prior tests, which could be due to education and/or seasonal changes.

In April 2001, the CUPHD and the EEP provided lead education to students in all grades at the Eureka elementary and high schools.

UDOH continues to work with local health department officials and other state and federal agencies to ensure that Eureka children are retested and provided with educational materials on diet and nutrition. The community of Eureka will be proposed as a Superfund site during 2001.

State of Utah 2000

With funding from the Centers for Disease Control and Prevention awarded July 1, 1996, the Bureau of Epidemiology has developed a surveillance system for elevated blood lead levels in Utah children. Beginning July 1, 1999, the Child Blood Lead Epidemiology and Surveillance project was changed to a Childhood Lead Poisoning Prevention Program (CLPPP).

During 2000, the CLPPP collected reports of blood lead levels on 3,526 children ages 0-5 years old living in Utah, of which 59 were >10 g/dL. The prevalence of EBLL was found to be 1.7% in 2000, down from 1.8% in 1999. Based on these numbers, as many as 4,245 Utah children ages 0-5 years may have EBLL. There were 1,196 of the 3,526 children identified as being enrolled in Medicaid. Twenty of the 1,196 Medicaid children tested had an elevated blood lead level for a prevalence of 1.7%. During 2000, there were an estimated 249,658 children ages 0-5 in Utah, and approximately 49,316 (20%) were on Medicaid. Only 2.4% of this high risk group were identified as having been screened for lead poisoning.

The Bureau of Epidemiology/Environmental Epidemiology Program continues to improve and enhance the surveillance for lead poisoning of Medicaid-eligible children and to identify and encourage screening of other high risk communities and populations. Data obtained through the surveillance activities will direct efforts by federal, state and local public health officials to reduce childhood lead poisoning in Utah.

Table 1. Blood lead levels by gender among Eureka and Utah children 6-72 months of age in the year 2000.

Resident
Status

Participants

# of Children with EBLL

Prevalence of EBLL

Geometric Mean of Blood Lead Levels

Range of Blood Lead Levels

Gender

# tested

% of All

Eureka
Children
2000

Male

27

49%

8

30.0 %

8.1 g/dL

2.5—34.2 g/dL

Female

28

51%

5

17.9 %

5.9 g/dL

1.6—16.9 g/dL

All

55

100%

13

23.6 %

6.9 g/dL

1.6—34.2 g/dL

Utah Children
2000

All

3488

100%

59

1.7 %

2.6 g/dL

0.0—34.2 g/dL

 

Table 2. Blood lead levels by age group among Eureka and Utah children 6 - 72 months of age in the year 2000.

Resident Status

Participants

# of Children with EBLL

Prevalence of EBLL

Geometric Mean of Blood Lead Levels

Range of Blood Lead Levels

Age in months

# tested

% of All

Eureka Children
2000

6-36

24

44%

7

29.2%

6.6 g/dL

2.0—16.9 g/dL

37-72

31

56%

6

19.4%

7.1 g/dL

1.6—34.2 g/dL

All

55

100%

13

23.6%

6.9 g/dL

1.6—34.2 g/dL

Utah
Children
2000

6-36

2675

77%

36

1.3%

2.8 g/dL

0.0—31.2 g/dL

37-72

813

23%

23

2.8%

2.4 g/dL

0.0—34.2 g/dL

All

3488

100%

59

1.7%

2.6 g/dL

0.0—34.2 g/dL

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Quarterly Report of Diseases of Low Frequency Year to Date,
January—June 2001
(including a comparison for same time period 1997-2000)

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Printing Error in May Newsletter

There was a printing error in the May 2001 Epidemiology Newsletter. In the article “Influenza Surveillance for the 2000-2001 Season”, some of the participants in the influenza surveillance project were left off. They were: West Point Elementary School, Academy Park Elementary School, Lone Peak Elementary School, Viewmont Elementary School, Backman Elementary School, Carbon School District, Washington School District, South Summit Elementary, Provo School District, Wasatch Middle School and Midland Elementary School. Once again, we would like to thank all those that participated in the 2000-2001 Influenza Surveillance.

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Exceptional Efforts In Public Health

The Bureau of Epidemiology recently received a report of a rubella case in a visitor from another state. The suspected case reported to a friend in Utah that he had been diagnosed in his home state after his visit to Utah. The Utah resident was concerned about being exposed to rubella so she contacted the local health department for advice. As rubella is a nationally reportable disease, a formal report was immediately sent to the suspected case’s home state health department. An investigation began by contacting the suspected case to verify the information that was provided. The investigation was abruptly concluded when the suspected case admitted making up the story to avoid further contact with his “friend” in Utah. Although much time was wasted investigating this false report, it proved the reporting system worked and everyone involved responded thoroughly and rapidly. Had this been an actual case, further follow up would have been necessary to determine the extent of any exposures to susceptible persons, especially pregnant women. The very bad man who made up the story was threatened with the consequences of being the cause of a government investigation based on false information. He was told to think of another excuse next time.

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Important Information

When Reporting a Communicable Disease:

Call: (801) 538-6191

Or:

Fax: (801) 538-9923

The June 2001 Newsletter is the most current Newsletter online.
For Information on Fact Sheets for Diseases or Annual Report
Information, as well as The
Epidemiology Newsletter, you can browse our website:

health.utah.gov/epi/

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Utah Department of Health, Bureau of Epidemiology
Monthly Morbidity Summary - June 2001 - Provisional Data

wpe2.jpg (82624 bytes)

The Epidemiology Newsletter is published monthly by the Utah Department of Health, Division of Epidemiology and Laboratory Services, Bureau of Epidemiology, to disseminate epidemiologic information to the health care professional and the general public.

 Send comments to:  The Bureau of Epidemiology, Box 142104, Salt Lake City, UT 84114-2104 or call (801) 538-6191

Approval 8000008:  Appropriation 3705

Rod Betit, Executive Director, Utah Department of Health
Charles Brokopp, Dr.P.H., Division of Epidemiology and Laboratory Services
Gerrie Dowdle, MSPH, Managing Editor
Connie Dean, Production Assistant

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