This whole story really saddens me. I suspect most pediatricians have been following this in the lay press, but of course there wasn't much detail in those reports. In the past few months, a clearer picture is emerging.
Source: Kennedy C, Yard E, Dignam T, et al. Blood lead levels among children aged less than 6 years - Flint, Michigan, 2013-1016. MMWR. 2016;65(25):650-654; doi:10.15585/mmwr.mm6525e1.
The current publication provides a bit more detail of changes in percentages of Flint children under 6 years of age who had blood lead levels 5 mcg/mL and above, looking at 4 different time intervals grouped according to different changes in water supply to the city. It doesn't provide any startling new information compared to the earlier publication by the group at Michigan State who figured all this out. However, the CDC data provide further evidence of the association between an increased rate of high lead levels and the switch of the water supply that resulted in increased lead content in drinking water. Their logistic regression and multivariate regression analyses strongly suggest drinking the contaminated water was the cause of increased rates of blood levels of 5 mcg/dL and higher that were observed.
All of us should note that this problem was identified primarily because a few people were paying attention and noted that an unusually high number of Flint children were being identified with elevated blood lead levels. It shows the importance of thinking broadly, beyond just the individual patient in front of you, to look at the broader picture of population health that all clinicians should guard. Kudos to the folks at Michigan State for doggedly pursuing this. Their actions likely have prevented a terrible situation from becoming even more devastating.
Given the long lag time before adverse effects of lead exposure become manifest, this is a saga with several more chapters to come.
Just as a housekeeping aside, unusually keen readers may have noted the omission of the standard "PICO" listing after the article citation. This is a signal of some of the changes coming to AAP Grand Rounds next year. Of course, little glitches can accompany changes, such as the fact that I didn't realize I hadn't published 1 of my August posts until about 5 days past the usual Tuesday time. I apologize for that, and for any future dumb mistakes I'll likely make as we transition to the new system.
