TY - JOUR AU - Hervey, Kaylee AU - Steward, Christine AU - Corimanya, Dante AU - Reichenberger, Sandra AU - Crager, Whitney AU - Byrne-Lutz, Adrienne PY - 2017/05/02 Y2 - 2024/03/28 TI - Lead Poisoning Surveillance: A Collaborative Effort between Epidemiology and WIC JF - Online Journal of Public Health Informatics JA - OJPHI VL - 9 IS - 1 SE - Communicable Disease Surveillance Use Cases for Human, Animal, and Zoonotic Diseases DO - 10.5210/ojphi.v9i1.7695 UR - https://ojphi.org/ojs/index.php/ojphi/article/view/7695 SP - AB - <div style="left: 78.2727px; top: 309.402px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.11884);" data-canvas-width="71.86668434343434">Introduction</div><div style="left: 91.3182px; top: 322.405px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.943578);" data-canvas-width="330.5510179292929">There is no safe level of lead in the body, and elevated lead in</div><div style="left: 78.2727px; top: 336.9px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02639);" data-canvas-width="345.22621212121214">children can lead to decreased Intelligence Quotients (IQ) and</div><div style="left: 78.2727px; top: 351.395px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.09344);" data-canvas-width="347.1864366161615">behavioral problems. The American Academy of Pediatrics</div><div style="left: 78.2727px; top: 365.89px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00716);" data-canvas-width="342.4663737373736">recommends lead testing of children with a positive risk assessment.</div><div style="left: 78.2727px; top: 380.384px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01258);" data-canvas-width="342.6055977272727">Children who live in low socioeconomic areas may be at higher risk</div><div style="left: 78.2727px; top: 394.879px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0206);" data-canvas-width="342.85324393939396">for lead exposure. As recent events have shown, having an elevated</div><div style="left: 78.2727px; top: 409.374px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.993948);" data-canvas-width="342.06718282828285">lead poisoning surveillance system can be critical to ensure that there</div><div style="left: 78.2727px; top: 423.869px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04371);" data-canvas-width="342.94441717171725">is not a community-wide lead exposure. To reach the children that</div><div style="left: 78.2727px; top: 438.364px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02267);" data-canvas-width="342.8852777777776">may not have been screened by a primary care physician, on March</div><div style="left: 78.2727px; top: 452.859px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0379);" data-canvas-width="343.008484848485">1, 2016 the Sedgwick County Health Department Women, Infants,</div><div style="left: 78.2727px; top: 467.354px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.955115);" data-canvas-width="343.25243484848477">and Children (WIC) program began offering lead screenings to all</div><div style="left: 78.2727px; top: 481.849px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.98362);" data-canvas-width="343.97196414141405">children in the WIC program and their mothers. Per Centers for</div><div style="left: 78.2727px; top: 496.344px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.992261);" data-canvas-width="344.23193106060603">Disease Control and Prevention (CDC) guidelines, the Sedgwick</div><div style="left: 78.2727px; top: 510.839px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.995843);" data-canvas-width="342.0055792929293">County Health Department Epidemiology program (Epi) investigates</div><div style="left: 78.2727px; top: 525.334px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.959218);" data-canvas-width="246.59895202020192">anyone who has an elevated blood lead test (5</div><div style="left: 324.793px; top: 527.674px; font-size: 12.3207px; font-family: sans-serif;">μ</div><div style="left: 331.999px; top: 525.334px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.964488);" data-canvas-width="90.00276515151516">g/dL or greater).</div><div style="left: 78.2727px; top: 539.829px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02596);" data-canvas-width="342.92840025252525">There are two types of lead tests – screening (capillary finger stick)</div><div style="left: 78.2727px; top: 554.324px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00489);" data-canvas-width="193.32421464646464">and confirmatory (venous blood draw).</div><div style="left: 78.2727px; top: 581.907px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.07424);" data-canvas-width="50.65042676767676">Methods</div><div style="left: 91.3182px; top: 594.91px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.03337);" data-canvas-width="329.97317676767693">Sedgwick County WIC clients are offered screening lead testing</div><div style="left: 78.2727px; top: 609.405px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.978302);" data-canvas-width="344.10133156565666">at their WIC appointments. Education to reduce lead exposure is</div><div style="left: 78.2727px; top: 623.9px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.971907);" data-canvas-width="341.80351969696966">provided at the time the test is performed. The filter papers used in this</div><div style="left: 78.2727px; top: 638.395px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.992786);" data-canvas-width="341.99818686868684">testing are sent to the Kansas Health and Environmental Laboratories</div><div style="left: 78.2727px; top: 652.89px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01702);" data-canvas-width="342.7004671717171">(KHEL) for analysis, and the results are reported to Epi. Epi reports</div><div style="left: 78.2727px; top: 667.384px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02133);" data-canvas-width="342.77439141414123">the lead testing results to WIC, who track the results in their patient</div><div style="left: 78.2727px; top: 681.879px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.948208);" data-canvas-width="209.80685656565655">charts. Epi receives KHEL results of &lt;5</div><div style="left: 288.207px; top: 684.22px; font-size: 12.3207px; font-family: sans-serif;">μ</div><div style="left: 295.385px; top: 681.879px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.936429);" data-canvas-width="126.13693484848483">g/dL via fax and results</div><div style="left: 78.2727px; top: 696.374px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.926958);" data-canvas-width="45.20467424242424">of &gt;= 5</div><div style="left: 123.467px; top: 698.715px; font-size: 12.3207px; font-family: sans-serif;">μ</div><div style="left: 130.69px; top: 696.374px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.984146);" data-canvas-width="291.56953282828283">g/dL via electronic laboratory reporting in the EpiTrax</div><div style="left: 78.2727px; top: 710.869px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00156);" data-canvas-width="342.2680103535353">disease investigation software maintained by the Kansas Department</div><div style="left: 78.2727px; top: 725.364px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.996981);" data-canvas-width="342.08073560606067">of Health and Environment. Epi notifies any WIC clients with results</div><div style="left: 78.2727px; top: 739.859px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.95711);" data-canvas-width="25.060318181818182">&gt;= 5</div><div style="left: 103.332px; top: 742.199px; font-size: 12.3207px; font-family: sans-serif;">μ</div><div style="left: 110.384px; top: 739.859px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.975819);" data-canvas-width="309.59472727272737">g/dL, while WIC staff notify all other clients about their results.</div><div style="left: 78.2727px; top: 754.354px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.01415);" data-canvas-width="342.5809563131313">Education is provided to the client a second time by Epi staff and/or</div><div style="left: 78.2727px; top: 768.849px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02607);" data-canvas-width="342.9468813131313">a WIC nurse or dietician. For clients with elevated blood lead tests,</div><div style="left: 78.2727px; top: 783.344px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.956522);" data-canvas-width="343.32759116161606">Epi interviews the case or guardian using an enhanced blood lead</div><div style="left: 78.2727px; top: 797.839px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.968663);" data-canvas-width="343.32635909090874">exposure questionnaire which asks about potential lead exposures,</div><div style="left: 78.2727px; top: 812.334px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.984591);" data-canvas-width="341.8663553030302">both in the home and at other locations (work, hobbies, etc.). If only a</div><div style="left: 78.2727px; top: 826.829px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00141);" data-canvas-width="342.1977823232323">screening test was performed, Epi recommends confirmatory testing.</div><div style="left: 78.2727px; top: 841.324px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.966798);" data-canvas-width="343.34237601010125">WIC lead testing program measures, including types of exposures</div><div style="left: 78.2727px; top: 855.819px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.989188);" data-canvas-width="339.2913275252526">identified, are monitored over time using data obtained from EpiTrax.</div><div style="left: 78.2727px; top: 883.402px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.08542);" data-canvas-width="44.50239393939395">Results</div><div style="left: 91.3182px; top: 896.405px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04365);" data-canvas-width="330.0705103535355">Between March 1 and July 21, of the 2,150 WIC clients offered</div><div style="left: 78.2727px; top: 910.9px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.986288);" data-canvas-width="344.21468207070694">lead testing, 89% self-reported never having received a lead test</div><div style="left: 78.2727px; top: 925.395px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.97598);" data-canvas-width="343.8216515151514">previously. Of the 1,427 clients with WIC lead screening results,</div><div style="left: 78.2727px; top: 939.89px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00121);" data-canvas-width="342.1620522727273">seven cases of elevated blood lead were identified. Of the seven, five</div><div style="left: 78.2727px; top: 954.384px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04557);" data-canvas-width="342.94811338383835">did not have a previous elevated lead test in EpiTrax. The average</div><div style="left: 78.2727px; top: 968.879px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02065);" data-canvas-width="144.4048472222222">screening test result was 8.6</div><div style="left: 222.668px; top: 971.22px; font-size: 12.3207px; font-family: sans-serif;">μ</div><div style="left: 229.767px; top: 968.879px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02168);" data-canvas-width="191.32702803030304">g/dL (range 6.8 to 13.4). The average</div><div style="left: 78.2727px; top: 983.374px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.941995);" data-canvas-width="343.2943252525251">age of the cases was 2 years (range 1-4). Of the seven cases, two</div><div style="left: 78.2727px; top: 997.869px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.990625);" data-canvas-width="194.88894444444443">(29%) were confirmed as 10.0 and 11.0</div><div style="left: 273.142px; top: 1000.21px; font-size: 12.3207px; font-family: sans-serif;">μ</div><div style="left: 280.241px; top: 997.869px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.988446);" data-canvas-width="139.84864974747475">g/dL through venous testing</div><div style="left: 78.2727px; top: 1012.36px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.997469);" data-canvas-width="342.0154358585857">at their primary care provider’s office. The remaining five cases have</div><div style="left: 78.2727px; top: 1026.86px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00031);" data-canvas-width="342.18792575757567">not received confirmatory testing. One of the three cases interviewed</div><div style="left: 78.2727px; top: 1041.35px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04425);" data-canvas-width="342.96782651515144">reported that their babysitter lived in an old home, which could be</div><div style="left: 78.2727px; top: 1055.85px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04021);" data-canvas-width="343.04544696969697">the source of lead exposure. While interviewing a child’s guardian</div><div style="left: 443.545px; top: 307.91px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.95187);" data-canvas-width="169.52800101010098">about an elevated 2016 test (7.9</div><div style="left: 613.208px; top: 310.25px; font-size: 12.3207px; font-family: sans-serif;">μ</div><div style="left: 620.398px; top: 307.91px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.960916);" data-canvas-width="166.52667676767672">g/dL), Epi discussed a previous</div><div style="left: 443.545px; top: 322.405px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.951888);" data-canvas-width="146.0989444444444">2015 elevated lead test (6.0</div><div style="left: 589.612px; top: 324.745px; font-size: 12.3207px; font-family: sans-serif;">μ</div><div style="left: 596.796px; top: 322.405px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.95935);" data-canvas-width="190.20707575757572">g/dL) of which the client’s guardian</div><div style="left: 443.545px; top: 336.9px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00123);" data-canvas-width="67.04928787878788">was unaware.</div><div style="left: 443.545px; top: 364.483px; font-size: 12.3207px; font-family: sans-serif; transform: scaleX(1.10408);" data-canvas-width="73.93656313131314">Conclusions</div><div style="left: 456.591px; top: 377.486px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.04787);" data-canvas-width="330.20110984848475">The ease of access to lead testing in the Sedgwick County WIC</div><div style="left: 443.545px; top: 391.98px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02438);" data-canvas-width="342.875421212121">program and the joint effort between WIC and Epi to implement an</div><div style="left: 443.545px; top: 406.475px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.02438);" data-canvas-width="343.063928030303">enhanced lead poisoning surveillance system identified six children</div><div style="left: 443.545px; top: 420.97px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.962607);" data-canvas-width="343.5382752525252">with elevated lead levels whose guardians did not know they had</div><div style="left: 443.545px; top: 435.465px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.0377);" data-canvas-width="343.27214797979764">elevated lead levels. This new surveillance program educates WIC</div><div style="left: 443.545px; top: 449.96px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.988546);" data-canvas-width="341.8885325757575">parents about lead, determines the lead levels in children for guardian</div><div style="left: 443.545px; top: 464.455px; font-size: 12.3207px; font-family: serif; transform: scaleX(0.971505);" data-canvas-width="343.6861237373738">knowledge (low level) and further follow-up (elevated level), and</div><div style="left: 443.545px; top: 478.95px; font-size: 12.3207px; font-family: serif; transform: scaleX(1.00339);" data-canvas-width="326.43713383838366">identifies lead exposures of WIC children with elevated lead tests.</div> ER -