Childhood lead poisoning risks and new initiatives for blood lead screenings

Eric Frohmberg and Susan J. Lee

Maine Environmental and Occupational Health Program

Maine DHHS Public Health • Environmental and Occupational Health Program

Maine DHHS Public Health • Environmental and Occupational Health Program

Eliminating childhood lead poisoning

Maine DHHS Public Health • Environmental and Occupational Health Program

Focused efforts

Maine DHHS Public Health • Environmental and Occupational Health Program

Children with Blood Lead Levels > 20 ug/dL

0%

20%

40%

60%

80%

100%

2004

2005

2006

2007

2008

2009

2010

2011

year

Perc

ent >20 ug/dL Non-

MaineCare

> 20 ug/dL onMaineCare

MaineCare status as a risk factor

Maine DHHS Public Health • Environmental and Occupational Health Program

2004 2005 2006

2007 2008 2009

Trend of Cases of African Descent Lewiston

Not African African

Maine DHHS Public Health • Environmental and Occupational Health Program

High Blood Lead Levels often Chewers or Pickers

Maine DHHS Public Health • Environmental and Occupational Health Program

Children are poisoned by dust from lead paint

Maine DHHS Public Health • Environmental and Occupational Health Program

Children are poisoned by dust from lead paint

Maine DHHS Public Health • Environmental and Occupational Health Program

Maine DHHS Public Health • Environmental and Occupational Health Program

Rental vs. Homeowner

Percent Private Residence or Rental Property for EIs

0%10%20%30%40%50%60%70%80%90%

100%

2003 2004 2005 2006 2007 2008 2009 2010 2011

% rental

% private

Maine DHHS Public Health • Environmental and Occupational Health Program

Renovations causing poisoningsEBLL>15 ug/dL that report renovations in the last 6 months

0

10

20

30

40

50

60

2003

2004

2005

2006

2007

2008

2009

2010

2011

year

Per

cen

t

% EBLL>15 ug/dL

Maine DHHS Public Health • Environmental and Occupational Health Program

Next frequent category of exposures

• Soil

• Take Home Dust

Maine DHHS Public Health • Environmental and Occupational Health Program

Maine DHHS Public Health • Environmental and Occupational Health Program

CLPPP calculated MaineCare Screening Rates

0

10

20

30

40

50

60

70

80

90

100

2003 2004 2005 2006 2007 2008 2009 2010

Year of Test

Per

cent

12-23 months

24-35 months

Maine DHHS Public Health • Environmental and Occupational Health Program

Maine DHHS Public Health • Environmental and Occupational Health Program

Upcoming

• New Risk Groups

• Oral behavior

• New Mainers

Maine DHHS Public Health • Environmental and Occupational Health Program

Feedback

• How are you currently screening?

• Why are MC screening rates not 100%?

• Proposed changes via Medicaid

• Drop requirement for MaineCare universal screening?

Maine DHHS Public Health • Environmental and Occupational Health Program

Barriers to screenings and solutions

• Knowledge of screening?

• Loss from office to lab?

Maine DHHS Public Health • Environmental and Occupational Health Program

In office blood lead screening law

• Critical parts are data transfer and addressing barrier of losing patients

• Rulemaking: AG review; public comment, review and approval.

Maine DHHS Public Health • Environmental and Occupational Health Program

Rules

• Use of portable testing device is a capillary screen. Confirmatory venous still needs to go to the state lab.

• Must use IMMPACT to be approved

• Results to us w/in 48 hours

• Provide work flow and CLIA Waiver Certificate

Maine DHHS Public Health • Environmental and Occupational Health Program

In office portable testing devices: Plus

• Immediate results

• Removes barrier of testing at other location

• Families may be more motivated to get follow up venous

• PCP follow up easier

Maine DHHS Public Health • Environmental and Occupational Health Program

In office portable testing devices: Minus

• Staff time cost: Testing, recording, reporting

• Cost of machine – HETL will not provide supplies

• Reimbursement Rates

Maine DHHS Public Health • Environmental and Occupational Health Program

IMMPACT Lead Module

• Reporting

• Data and blood lead histories to users

• Data fields:

• Sample date

• Venous or Cap

• Results

• Name, Address when tested

• Ordering Phys

• Flag for follow up visits if needed

Maine DHHS Public Health • Environmental and Occupational Health Program

Questions? Thoughts? Comments?

Eric FrohmbergEric.frohmberg@maine.gov

287-8141

Susan LeeSusan.j.lee@maine.gov

287-8671

www.maine.gov/healthyhomes

tracking.publichealth.maine.gov