CDC Report Finds Refugee Children at High Risk for Lead Exposure

Although blood lead levels (BLL) in children aged 1 to 5 years are decreasing in the United States, the risk for elevated BLL remains high for certain populations such as refugees, according to a new Centers for Disease Control and Prevention (CDC) report.

The report, Elevated Blood Lead Levels in Refugee Children – New Hampshire, 2004, found that of the 92 refugee children resettled in New Hampshire that were tested upon arriving in the United States and tested again 3 to 6 months after permanent placement, 37 children had BLL that were greater than 10 micrograms per deciliter (mcg/dL) -- the target level for lead poisoning elimination in U.S. children by the end of the decade.

Follow-up BLL had increased for 35 of these 37 children and the mean increases was 11 mcg/dl. Twenty seven children became elevated after resettlement in the United States. The children studied were predominantly from Africa.

Refugee children are at high risk for lead exposure as a result of exposure in their country of origin as well as health, social and economic factors. Iron deficiency, prevalent among refugee children, increases lead absorption in the gastrointestinal tract. Of the New Hampshire children, 37% were chronically malnourished and 25% had acute malnutrition.

The Manchester Health Department, New Hampshire Department of Health and Human Services, New Hampshire Lead Poisoning Prevention Program and the CDC conducted this investigation as part of follow-up routine screening examinations of refugee children placed in the state. While the cases described in this report were identified in New Hampshire, refugee children resettled in other areas of the country also may be at risk for lead poisoning.

Until federal standards for blood lead testing and lead risk assessment in refugee children are implemented, the following interim practices are recommended:

Providing pediatric multi-vitamin with iron for refugee children 6 to 59 months immediately upon arrival in the United States.

Blood lead testing, nutritional assessments and hemoglobin or hematocrit level testing for children younger than 6 years within 90 days of arrival in the United States, and a follow-up blood lead test 3-6 months after placement in a permanent residence.

Blood lead screening for children aged 6 years and older if lead hazards are evident.

The study appears in the Jan. 21 Morbidity and Mortality Weekly Report. For more information about refugee lead poisoning and prevention, please visit: http://www.cdc.gov/lead/.

For information of the New Hampshire Childhood Lead Poisoning Prevention Program: www.dhhs.nh.gov/dhhs/clppp/.