Upstate NY Regional Lead Resource Centers
Newsletter October 2022

This online continuing education module for NYS physicians, nurses, and licensed social workers provides the latest information about lead as well as the 2019 changes to the NYS regulations related to assessment and follow-up of children with elevated blood lead levels. Physicians, nurses and social workers can obtain 1.0 hour of CME/CNE/Social Work CE for completing the on-line module. The cost is $15 (or free for employees of University of Rochester Medical Center and its affiliates). This module was developed by the WNY Lead Poisoning Resource Center’s Rochester Office with funding, input, and approval from the NYSDOH Lead Poisoning Prevention Program. Find more information and to register go to:  https://bit.ly/NYSleadCE.

Here are a few testimonials about the CE module from those who have viewed it:

• “Great job- lots of useful information in a straightforward format.” Physician Pilot Tester
• “This is a great educational activity - plenty of resources about lead poisoning!” Senior Nurse Educator Pilot Tester
• “Increased my awareness of the importance of lead screening and follow up for children and pregnant women in the practice I work”
• “Reviewing this material made me better aware of why pregnant women are tested for lead, the level they are supposed to be under.”
• “Great update, graphics are good, loved links to the NYS sites”

If you have no need for CE credit, a video and slides are available free for anyone who wants to learn more:

by Fallon Beecroft, Buffalo
 
For office use, please reference NYSDOH Testing Guidelines for Pregnant and Lactating Women
 

Protecting children from exposure to lead is important for lifelong good health. No safe blood lead level has been identified. Even low levels of lead in blood have been shown to affect IQ, ability to pay attention, and academic achievement. The effects of lead exposure cannot be corrected.
How Might Lead Affect Breastfeeding Mothers and Infants?
Women who have been or are currently exposed to lead can expose their fetus or infant to lead during pregnancy and lactation through blood and breast milk, which can have long-term effects on the neurodevelopment of their child. During pregnancy and lactation, mothers can have lead in their blood or breast milk for two reasons:

1. They have been directly exposed to lead during pregnancy or lactation.
2. Lead that is stored in a woman’s bones and teeth from a prior exposure to lead can be released during pregnancy or lactation.

Can Mothers Breastfeed Their Children If They Have Blood Lead Levels (BLLs) of 5 μg/dL or Higher?
If a pregnant or lactating woman has blood lead levels (BLLs) ≥5 μg/dL, the health care provider should attempt to determine the source(s) of lead exposure, working with the local health department and occupational medicine specialists as needed for environmental assessment and case management.
It is recommended that mothers with BLLs <40 μg/dL should continue breastfeeding, but it is important to note:

• Infant BLLs should be monitored if the mother’s BLLs are between 5 and 39 μg/dL. Breastfeeding should continue for all infants with BLLs below 5 μg/dL.
• If infant BLLs are rising or failing to decline by 5 μg/dL or more, the healthcare provider should contact the local health department for environmental sampling. If no external source is identified, and maternal BLLs are ≥20 μg/dL and infant BLLs are ≥5 μg/dL, then breast milk may be the source of lead exposure. Mothers should consider temporarily pumping and discarding their breast milk until maternal BLLs are lower.

Mothers with BLLs ≥40 μg/dL are encouraged to pump and discard their milk until their BLLs drop below 40 µg/dL.

• Testing breast milk for lead is not recommended.

What Are Some Kinds of Lead Hazards Breastfeeding Women Might Be Exposed To? How Can They Protect Themselves and Their Infants?
Breastfeeding women should be aware of or avoid the following:

• Lead-based paint (typically found in homes built before 1978). Stay away from repair, repainting, renovation, and remodeling work. Test paint before starting home improvements that disturb paint. If hiring someone else to perform work, make sure they follow lead paint repair rules from the Environmental Protection Agency) and are RRP-certified.
• Pica. Never eat or mouth clay, soil, pottery, or paint chips because they may be contaminated with lead.
• Tainted food. Use caution when eating candies, spices, food additives, and other foods from abroad, especially if they appear to be noncommercial products of unknown safety. Limit eating game meat—such as deer—that have been hunted with lead ammunition.
• Tainted food ware. Avoid using imported lead-glazed ceramic pottery and pewter or brass containers or utensils to cook, serve, or store food. Avoid using leaded crystal to serve or store beverages. Do not use dishes that are chipped or cracked.
• Tainted medicine or personal care products. Avoid imported medicines and herbal remedies (azarcon, Ayurvedics); cosmetics and ceremonial powders (tiro, kohl, kajal, surma); and personal care products (litargirio) that may contain lead.
• Water with lead levels exceeding 15 parts per billion (ppb). If water lead levels exceed EPA’s action level of 15 ppb, use bottled water or water from a filtration system certified by an independent testing organization to reduce or eliminate lead for cooking and drinking. Run the cold water on your kitchen faucet for 2 minutes each morning before using it for cooking or drinking to flush out any lead that may have been released into the water from deteriorating lead pipes or lead solder.
• Some occupations or hobbies may involve lead exposure. These include construction or home renovation/repair in pre-1978 homes; use of firing ranges; work battery or electronics manufacturing or recycling; soldering or casting metal; oil field work; mining; and exposure to aviation fuel used in small planes. If a household member works with lead, take precautions to avoid bringing home lead dust in vehicles or on clothing, skin, hair, and shoes.
• Prior exposure. Prior significant exposure to lead such as childhood environmental exposure or previous occupational exposure could lead to large stores of lead in bone which can be released during pregnancy, particularly if the pregnant person has insufficient dietary calcium intake.
• Recent immigration. Recent immigration to the United States from countries where relatively high lead exposure is endemic, such as countries where leaded gasoline is still used or where use of consumer products containing lead is widespread.

Source: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/environmental-exposures/lead.html
 
Additional Resources:

• Lead - MotherToBaby
• Handout (pdf) - Lead (mothertobaby.org)
• Information for Pregnant People (ny.gov)

by Olivia Malvasi, Syracuse

U.S. EPA Proposes to Declare Aviation Lead Emissions Public Health Danger
https://www.usnews.com/news/us/articles/2022-10-07/u-s-epa-proposes-to-declare-aviation-lead-emissions-public-health-danger
Do your patients live near one of the many airports in NY State used by piston-engine aircraft?  Lead is not in the jet fuel used by commercial aircraft; however, according to this article, “emissions from the 190,000 U.S. general aviation airplanes operating on leaded fuel account for about 70% of the lead entering the atmosphere.”  It’s not on the recommended list of risk assessment questions, but families who live near airports may be at higher risk of lead exposure.
Experts warn of high levels of chemicals in clothes by some fast-fashion retailers.
https://www.cbc.ca/news/business/marketplace-fast-fashion-chemicals-1.6193385
We know there are many sources of lead exposure…but clothing too?!  A jacket for toddlers and a red purse for women have too much lead in them, according to this news article.
 
Special Issue of American Journal of Public Health Illuminates Lead Risks Throughout U.S., Prevention Steps - The dangers of lead are virtually everywhere in the United States.
https://www.newswise.com/articles/special-issue-of-ajph-illuminates-lead-risks-throughout-u-s-prevention-steps
 
Recent Lead Research Abstracts:
An Innovative Approach to Increase Lead Testing by Pediatricians in Children, United States, 2019–2021
Abstract: Opportunities for lead exposure are common in the United States. The American Academy of Pediatrics, in collaboration with the Centers for Disease Control and Prevention, launched the Increasing Capacity for Blood Lead Testing Extension for Community Healthcare Outcomes (ECHO) project to educate pediatricians on the importance of testing children for lead exposure and to assess practice behavior change. We found that two weeks to one month after receiving training, more than 80% of participants reported increased lead testing and practice changes. Our results support use of the ECHO model as a mechanism for practice change.(AmJPublicHealth.2022;112(S7):S647–S650. https://doi.org/10.2105/AJPH.2022.307084).
Pediatric lead exposures are common in the United States, and the adverse health effects of lead poisoning are wide ranging. Increasing lead screening and testing in pediatric patients is crucial to ensure the health and safety of children.
Evaluation of calcium-fortified municipal water as a public health intervention to mitigate lead burdens
Abstract: Lead has adverse effects on health, society, and the economy. Lead exposure results in increased blood lead levels and storage in bones. Calcium and lead are competitively absorbed and as such calcium can be used to mitigate the body lead burden. Twenty-eight quantitative research studies were reviewed that examined lead exposure (in blood, bone, or breastmilk) and calcium intake or serum calcium to evaluate the efficacy and safety of fortifying potable water supplies with calcium to mitigate lead absorption or resorption. Eighteen of the studies reported a significant inverse relationship between biomarker lead levels and calcium intake or serum calcium. The relationship was most evident with high calcium intake, suggesting a dose-dependent relationship. An intervention with calcium-fortified water could offer an accessible source of supplemental calcium to help meet the recommended dietary allowance (RDA) and mitigate lead absorption. A concentration of 60 mg-Ca/L can supply 22.0 and 16.3% of a 1,000 mg-Ca RDA for men and women, respectively, at the recommended daily water intake.
Tackling the Lead Gremlins: A Response to Take-Home Lead Exposure in a Minnesota Industrial Facility, 2019
Abstract: Lead exposure that occurs from contamination inadvertently brought home from a workplace is known as take-home exposure. Take-home exposures are a public health hazard that adversely affects health equity for families and communities. This article describes coordinated action by agencies in Minnesota to curb lead exposure among children of workers at a facility that produces fishing sinkers and battery terminals. (Am J Public Health. 2022;112(S7):S655–S657. https://doi.org/10.2105/AJPH.2022.306982) Because lead can cause permanent neurological damage, it is important to prevent lead exposure from all sources, including take-home lead.
Multi-Omics Reveals that Lead Exposure Disturbs Gut Microbiome Development, Key Metabolites and Metabolic Pathways
Abstract: Lead exposure remains a global public health issue, and the recent Flint water crisis has renewed public concern about lead toxicity. The toxicity of lead has been well established in a variety of systems and organs. The gut microbiome has been shown to be highly involved in many critical physiological processes, including food digestion, immune system development and metabolic homeostasis. However, despite the key role of the gut microbiome in human health, the functional impact of lead exposure on the gut microbiome has not been studied. The aim of this study is to define gut microbiome toxicity induced by lead exposure in C57BL/6 mice using multi-omics approaches, including 16S rRNA sequencing, whole genome metagenomics sequencing and gas chromatography-mass spectrometry (GC-MS) metabolomics. 16S rRNA sequencing revealed that lead exposure altered the gut microbiome trajectory and phylogenetic diversity. Metagenomics sequencing and metabolomics profiling showed that numerous metabolic pathways, including vitamin E, bile acids, nitrogen metabolism, energy metabolism, oxidative stress and the defense/detoxification mechanism, were significantly disturbed by lead exposure. These perturbed molecules and pathways may have important implications for lead toxicity in the host. Taken together, these results demonstrated that lead exposure not only altered gut microbiome community structures/diversity but also greatly affected metabolic functions, leading to gut microbiome toxicity.
 
Biting the Bullet: A Call for Action on Lead-Contaminated Meat in Food Banks
Abstract: Each year in the United States, food banks receive more than one million kilograms of donated hunted game meat. The National Rifle Association’s (NRA’s) Hunters for the Hungry initiative has established programs in more than 40 states for hunters to take their harvested game animal to a meat-processing facility and indicate intent to donate the resulting processed and packaged meat to a local food bank. Most donated game meat is ground deer meat (venison); other donated game includes wild hog and goose. Even though the presence of ammunition-derived metallic lead fragments in donated firearms-hunted meat has been recognized for more than a decade, the vast majority of donated hunted meat is not inspected to discard meat containing lead fragments.1 An underlying lack of food safety standards for adulterated donated food increases risks to low-income recipients, who are already disproportionately affected by elevated blood lead levels (BLLs).2 Primary prevention is needed for this overlooked source of lead exposure.
 
Health Remedies as a Source of Lead, Mercury, and Arsenic Exposure, New York City, 2010–2019
Abstract: The objective is to describe the types of health remedies collected during poisoning investigations in New York City over a 10-year period that were found to contain high levels of lead, mercury, or arsenic. Between 2010 and 2019, the New York City Department of Health and Mental Hygiene collected 584 samples of health remedies during poisoning investigations and store surveys for lead, mercury, or arsenic analysis. There was a significant association between blood lead levels and estimated cumulative daily lead exposures among adult users of rasa shastra Ayurvedic medications. Also, average blood lead levels among adult rasa shastra users were significantly higher than levels among those using other types of non-Ayurvedic health remedies. Rasa shastra Ayurvedic medications can contain very high levels of lead, mercury, and arsenic. This underscores the importance of screening for lead, mercury, and arsenic exposures within at-risk populations. Public Health Implications. The general ease of accessibility to rasa shastra medications raises concerns. There is a need for systemic change that results in primary prevention, that is, removal of the source through policy development and regulatory enforcement in the country of origin. (Am J Public Health. 2022;112(S7):S730–S740. https://doi.org/10.2105/AJPH.2022.306906)
 

Lead poisoning is a problem that crosses disciplines affecting health, education, the environment, housing, and the criminal justice system. New York State has many sources of lead including the oldest housing in the nation, and our families need many different sectors to work together to prevent lead exposure.  It is not someone else’s problem; it’s everyone’s problem.  Please contact your local coalition to get involved! 

Western Region
WNY LPPRC     Kaleida Health/Oishei Children’s Hospital   Buffalo – Niagara Office   716-768-7624	Allegany & Cattaraugus & Seneca Nation of Indians	Lead (Pb) Smart Partnership	Cattaraugus County DOH (716) 701-3438
	Chautauqua	Coalition for Healthy Housing	Jamestown Renaissance Corporation (716)708-6964
	Erie	Buffalo and Erie County Lead Safe Task Force	Community Foundation for Greater Buffalo (716) 852-2857
	Niagara	Niagara County Lead Poisoning Prevention Coalition	Niagara County DOH (716) 278-8596
	Genesee, Livingston, Orleans, & Wyoming	GLOW	Genesee County DOH (585) 344-2580
WNY LPPRC     University of Rochester Medical Center   Finger Lakes Office   585-276-3105	Rochester-based, consults state- and nation-wide	Coalition to Prevent Lead Poisoning	TheLeadCoalition.org
	Ontario, Yates, Wayne, Seneca, Livingston, Steuben, Schuyler, Chemung	Finger Lakes Coalition to STOP Lead Poisoning	bit.ly/FingerLakesLeadCoalition
	Chemung County	Chemung County Lead Coalition	Chemung County DOH (607) 737-2028