Video Abstract
Preventing lead exposure in children has been a notable public health success. A half-century ago, nearly every child in the United States <6 years of age had a blood lead level of >5 micrograms per deciliter of blood. The decision to remove lead from gasoline and paint has drastically reduced lead exposure such that today, <2.5% of children <6 years of age have blood lead levels of >3.5 micrograms per deciliter. The benefits to our children’s brains and lifetime earnings are astonishing and have been valued in the hundreds of billions of dollars. Far less than one-tenth of that has been spent to achieve these gains. Such progress might easily afford complacency.
In June 2023, a seasoned team of North Carolina environmental public health professionals sleuthed their way to uncovering what led to a national lead exposure outbreak. The sentinel cases were, on the surface, typical: twins had repeat blood lead levels >10 ug/dL. North Carolina supports investigating such cases with a comprehensive assessment of the home environment. No or little lead was found by the state’s public health laboratory in dust, water, and soil samples from the home. Decades of experience among those working in the field and laboratory staff of North Carolina’s childhood lead prevention program quickly moved the search from these usual suspects to unusual ones. Here, too, the staff was well prepared. They kept a file of all atypical lead sources over the years, from imported ceramics to lead-painted toys to spices. Information provided by the affected family and a diet history pointed to cinnamon applesauce pouches as a possible source, and suspicion deepened when another child, just a few weeks later, and in a different part of the state, was found to have high blood lead levels and also ate cinnamon applesauce pouches.
Lead chromate, an orange-yellow pigment (the artist, Van Gogh used it to color sunflowers in paintings), may have been used to adulterate the cinnamon in the applesauce. Hundreds of children nationwide were exposed to lead as a result. In response, the US Food and Drug Administration recalled millions of pouches suspected to contain cinnamon tainted with lead and chromium. For reference, the average US toddler may eat several pouches each week.
Although lead paint remains the predominant source of lead in children’s bodies, the likelihood that other lead sources, like spices, has grown. Protecting children in the United States who may still have their futures compromised by lead requires steadfast vigilance and the kinds of people with expertise, tools, and resources that mobilized in North Carolina to forestall a potentially unprecedented national lead outbreak.
The capacity North Carolina possessed to quickly detect and address the lead outbreak did not appear overnight. The Centers for Disease Control and Prevention’s (CDC’s) Childhood Lead Poisoning Prevention Program (CLPPP) provides support to 62 state and local childhood lead poisoning prevention programs, including North Carolina. In many cases, the support the CDC provides is the primary funding for lead prevention in a jurisdiction. This foundational support enables the recruitment, training, and retention of highly qualified staff.
Lower average blood lead levels and a greater share of unusual lead sources make low-cost, reliable lead screening imperative. The CDC’s CLPPP launched the Lead Detect Prize to spark innovation to develop an affordable, point-of-care, and accurate lead screening device with the hope that it will enable more health care providers to effectively screen children for blood lead levels and prevent additional severe and widespread lead exposures.
Completing the last mile of the journey to end child lead exposure in the United States may not be as easy, but we at the CDC and our CLPPP intend to lend unwavering support to our partners as we move toward the finish line. The articles that follow represent a milestone in that journey as they capture where we are and the key needs for further progress.
Aaron Bernstein conceptualized and drafted the manuscript, accepted the final manuscript as submitted, and agrees to be accountable for all aspects of the work.
The findings and conclusions in this commentary are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Disease Registry.
Competing Interests
CONFLICT OF INTEREST DISCLOSURES: The author has indicated he has no potential conflicts of interest relevant to this article to disclose.
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