Upstate NY Regional Lead Resource Centers
Newsletter October 2022

A collaboration between the Upstate NY Regional Lead Resource Centers
for Lead Poisoning Prevention Week

Contact your Regional Lead Resource Center

The NYSDOH Lead Poisoning Prevention Program ( funds our centers to provide medical expertise and guidance to health care providers managing treatment of children and adults with high blood lead levels.  Please reach out to us with your questions, to arrange a consultation, or schedule a training for your staff.  Find our contact information at:

Contact Information Sheet for all Regional Lead Resource Centers
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National Lead Poisoning Prevention Week is Here! (Oct 23-29)



Federal agencies offer innovative outreach materials to help stakeholders prepare for National Lead Poisoning Prevention Week October 23-29
This year, National Lead Poisoning Prevention Week (NSPPW) is October 23-29. As in past years, the U.S. Department of Housing and Urban Development’s Office of Lead Hazard Control and Healthy Homes has worked closely with the U.S. Environmental Protection Agency and the Centers for Disease Control and Prevention in preparing for NLPPW. Please join us in helping to mobilize individuals and communities to act to reduce the risk of lead exposure!
The NLPPW ’22 messages are: Get the Facts, Get Your Child Tested, and Get Your Home Tested. Its hashtags: #LeadFreeKids, #NLPPW2022. OLHCHH and its agency partners are offering OLHCHH grantees, stakeholders, and other partners an expanded Information Kit and accompanying Social Media Package.

Free Patient Educational Material for Order or Download

by Lowry Nicsevic RN, Albany
As professionals, we are dedicated to helping our patients “live their best life,” and in ever changing health care, education has become even more important than ever! To be successful, the information must be tailored to the learner. We therefore must meet the learner on his/her level, taking any barriers to learning into consideration. These barriers may include: education level, language differences, and any social issues present for the learner. When not considered, the learner may be prevented from engaging fully into the process.
Recently, I had placed a rather large order for Lead Poisoning Prevention and Management materials from the New York State Department of Health web site. The offered materials were available in a variety of languages and pictures were an option as well as a variety of educational levels to target all learners.  Ordering these items consisted of completing an order form, after reviewing the options for the population at our office on an easy to access web site and emailing the form to OGS.SM.GDC@OGS.NY.GOV.  The order was filled and returned in under 1 week.  Another helpful web site for Lead Prevention/Poisoning is This site offers materials specific to home repairs, construction worker’s risk and much more.
The CDC also offers materials specific to lead cause, treatment and prevention. Many states have published data regarding the specific state information, as well.  There is plenty of information to be found and obtained based on the population that is your target to inform and minimize exposure to lead sources, and encourage proper treatment and monitoring.
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Requirements for NYS Healthcare Providers When a Child’s Lead Level is ≥5 µg/dL

NYS regulations regarding lead poisoning prevention changed in October 2019. 
Any blood lead levels of 5 µg/dL or greater must be followed up.  If it was a capillary/finger-stick level then the follow up must be a venous draw. 
For children with venous lead levels of 5 µg/dL or greater, the health care provider must complete a clinical lead exposure assessment on the patient and provide the local health departments with the following information:
  • Hemoglobin/hematocrit or CBC - it would be beneficial to automatically have these drawn with all initial or confirmatory venous lead levels. Local health department staff are often having to backtrack and wait 3 months or more for this for various reasons such as parents’ refusal or because it was never ordered.
  • Recent assessments - if not done recently (3-6 months for infants and toddlers; 6-12 months for over those 3 year old) another assessment needs to be done:
    • Physical with complete neuro exam
    • Nutritional assessment including an assessment of iron, calcium, and Vitamin C intake and consideration of checking labs for iron deficiency
    • Developmental assessment using a standardized tool
Please note and let parents know: The new guidelines require two venous lead test results less than 5 µg/dL obtained at least 3 months apart for discharge from case management by the local health department.
Complete Guidelines for Health Care Providers for the Prevention, Identification, and Management of Lead Exposure in Children are on the NYSDOH website at  Copies for your practice (either booklet or laminated wall chart format) can be ordered from:
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Requirements for Point of Care Testing (Lead Care II)

 A point of care blood lead testing machine such as Magellan’s Lead Care II allows for capillary testing in the office before the patient leaves.  If the result is 5 µg/dL or greater, then a confirmatory venous draw sent to a laboratory is required.
Before starting to use one of these machines, medical offices must do three things:
  1. Get a CLIA waiver from the NY State Wadsworth Center before starting to use a point of care blood lead testing machine
  2. Have at least one staff member watch a NYSDOH webinar training session on the proper use of the machine and how to report results.
  3. They must report all results to the NYS DOH in 14 business days according to New York Codes, Rules and Regulations. Contact the NYSDOH Lead Poisoning Prevention Program at to be approved and enrolled to report blood lead test results to NYSDOH.
Local Health Departments should be notified when a practice begins using a point of care analyzer, and they may be able to provide technical assistance as well.  More guidance on this topic can be found at this website address -

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Lead Poisoning in Children and Pregnant Women:
An interactive CE module for NYS Providers

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:

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:
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Pregnancy, Lactation and Lead

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.
Additional Resources:
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Lead News and Research

by Olivia Malvasi, Syracuse

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.
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.
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.
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. 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.
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Lead Coalitions

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
Kaleida Health/Oishei Children’s Hospital

Buffalo – Niagara Office
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, &

GLOW Genesee County DOH
(585) 344-2580
University of Rochester Medical Center
Finger Lakes Office
Rochester-based, consults state- and nation-wide Coalition to Prevent
Lead Poisoning
Ontario, Yates, Wayne, Seneca, Livingston, Steuben, Schuyler, Chemung
Finger Lakes Coalition to STOP Lead Poisoning
Chemung County Chemung County
Lead Coalition
Chemung County DOH
(607) 737-2028
The Rochester office of the Western NY Lead Poisoning Resource Center
is supported by the New York State Department of Health.

Copyright © 2022 Western NY Lead Poisoning Resource Center, Rochester Office, All rights reserved.

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