The Centers for Disease Control and Prevention (CDC) has issued a health advisory for clinicians and health departments to consider illness in children due to lead exposure from recalled cinnamon applesauce products and report cases to local health authorities.
The advisory was issued after the Food and Drug Administration (FDA) received 22 reports of high blood lead levels (BLLs) in children who consumed recalled fruit pouches that contain high levels of lead. The recall includes WanaBana brand apple cinnamon fruit puree pouches, Schnucks brand cinnamon applesauce pouches and Weis brand cinnamon applesauce pouches.
Tests of multiple lots of the products indicated they contain extremely high levels of lead, according to the CDC’s advisory. Lead exposure has been associated with health, learning and behavior problems, and there is no known safe level.
BLLs in the 22 children ranged from 4 to 29 micrograms per deciliter (µg/dL). They experienced signs and symptoms, including headache, nausea, vomiting, diarrhea, change in activity level and anemia. Cases were reported in Alabama, Arkansas, Louisiana, Maryland, Missouri, New Mexico, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Washington.
The FDA continues to evaluate incoming reports of illness and is investigating the source of the lead contamination.
A child who is exposed to large amounts of lead may develop acute lead poisoning, presenting with gastrointestinal, hematological and neurological effects, including one or more of the following signs and symptoms: anemia, abdominal pain, weakness and severe neurological sequelae (e.g., seizures, encephalopathy and coma), which may result in brain damage.
Even low levels of lead have been associated with learning, behavioral and cognitive deficits. Lead toxicity primarily targets the central nervous system. Children are more vulnerable to lead poisoning than adults because their nervous systems are still developing. Children also tend to absorb a higher fraction of ingested lead than adults.
The CDC recommends clinicians do the following:
- Counsel patients and families not to eat the recalled cinnamon-containing apple purée or applesauce products.
- Educate patients and families about the health effects of lead exposure in children and the importance of seeking medical care. Most children have no obvious symptoms, but appropriate screening can detect lead in blood.
- Test children who have consumed a recalled applesauce pouch for lead exposure. Refer to CDC guidance on testing children for lead exposure and AAP clinical guidance for managing lead exposure in children. Recommendations for obtaining BLLs may be available from your local health department or regional Pediatric Environmental Health Specialty Unit.
- Consider lead exposure in the differential diagnosis of patients presenting with clinical findings associated with lead poisoning.