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DHMH Press Releases : Management of Childhood Lead Exposure

REQUEST FOR PUBLIC COMMENT: MANAGEMENT OF CHILDHOOD LEAD EXPOSURE

 

BALTIMORE, MD (September 11, 2012) –The Maryland Department of Health and Mental Hygiene is seeking public comments related to the management of childhood lead exposure in light of recent revisions by the U.S. Centers for Disease Control and Prevention (CDC) to guidelines for childhood lead poisoning.

In May, 2012, the CDC adopted the Advisory Committee on Childhood Lead Poisoning Prevention’s (ACCLPP) recommendation that eliminated the term “level of concern” (since there is no known safe blood lead level, or BLL) and the recommendation for a new BLL reference level of 5 mg/dL, based on the current lead levels in the population. The CDC also agreed in principle with ACCLPP recommendations that “no children in the U.S.[should] live or spend significant time in homes, buildings or other environments with lead-exposure hazards.”

An outstanding question is how the new CDC guidelines should influence current protocols for referral and case management.

The Department is considering two alternatives for case management under the new guidelines. These are: 

  • Continue current case management strategies with lower levels – Under this option, there would be no difference between the Local Health Department response to a child regardless of the lead level – as long as the level is 5 mg/dL or higher, the LHD would do the same thing (contact the family, arrange for follow up if necessary). Health Departments would be instructed to prioritize children with higher lead levels. Without substantial additional funding, this would likely contribute to a significant increase in workload, and could result in delays in processing cases.
  • Create an alternative case management strategy for children with lower blood lead levels – This option involves creation of a modified case management strategy, involving greater reliance on follow up by the primary care provider. Under this strategy, case managers at the LHD would notify the primary care provider, who would be expected to perform follow-up testing, screen family for risk factors, and refer for case management if indicated.  

The Department is seeking public comment on the pros and cons of these two strategies and whether other approaches are optimal.

The Department is also requesting comments and public input on the most appropriate management of children who have previously had blood lead levels between 5 – 9 mg/dL. The Department is considering working with MDE to notify parents of children who tested between 5 and 9 mg/dL in recent years of the new levels and recommending retesting as an initial step, to be followed up as appropriate. The Department seeks comment on the appropriate length of time for this “look-back,” given the fact that lead exposure peaks by the age of 3 years (36 months) and then starts to decline, particularly after 6 years (72 months) of age.

The Department requests comments by Friday, September 28, 2012, on these issues and any other recommendations related to the new CDC guidelines. The Department has also asked the Lead Poisoning Prevention Commission to review public comments and to make recommendations on whether the Department should take any additional action. In addition to reviewing written comments, the Commission will hold a hearing to solicit public input on the questions above on October 11, 2012. The Commission will then vote on recommendations to forward to the Secretary of Health and Mental Hygiene regarding the consent form and the consent and age verification procedures.

To read the full request for comments, visit http://dhmh.maryland.gov/SitePages/Request%20For%20Comment.aspx. Written comments should be submitted by Friday, September 28, 2012, at 5:00 PM. Comments may be submitted by mail to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 W. Preston St., Room 512, Baltimore, MD 21201 or call 410-767-6499, TTY: 800-735-2258, or by email to regs@dhmh.state.md.us, or by fax to 410-767-6483.

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