The Prevalence of Elevated Blood Lead Levels in Foreign-Born Refugee Children Upon Arrival to the U.S. and the Adequacy of Follow-up Treatment

  • Sarah SeifuEmail author
  • Kawai Tanabe
  • Fern R. Hauck
Original Paper


This study sought to evaluate the prevalence of blood lead levels (BLL) in refugee children upon arrival to the U.S. and determine whether they received BLL screening and follow-up according to CDC guidelines. 301 refugee children ages 6 months to 16 years were seen at the International Family Medicine Clinic from 2003 to 2016. Data were collected on BLL, treatment, age, gender, English proficiency, native language, anemia, malnutrition, and microcytosis. Bivariate analyses were conducted to determine the association between these variables and BLL. The prevalence of elevated blood lead levels (EBLL), defined as ≥ 10 µg/dL before June 2012 and ≥ 5 µg/dL from June 2012, was observed in 13% (n = 39). Male sex (p = 0.033), young age (p = 0.003), and microcytosis (p = 0.009) were significantly associated with EBLL. Follow-up and treatment for EBLL were lower than the recommended CDC guidelines for BLL and greater education of healthcare providers is needed.


Lead poisoning Elevated blood lead levels Refugee children Foreign-born Follow-up 



The authors would like to thank Marieke Jones, PhD and Data Services at the Health Sciences Library at the University of Virginia for expert advice on the statistical analyses.


  1. 1.
    Lidsky TI, Schneider JS. Adverse effects of childhood lead poisoning: the clinical neuropsychological perspective. Environ Res. 2006;100(2):284–93.CrossRefGoogle Scholar
  2. 2.
    Lidsky TI, Schneider JS. Lead neurotoxicity in children: basic mechanisms and clinical correlates. Brain. 2003;126(1):5–19.CrossRefGoogle Scholar
  3. 3.
    Cecil KM, Brubaker CJ, Adler CM, et al. Decreased brain volume in adults with childhood lead exposure. PLoS Med. 2008;5(5):e112.CrossRefGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention. Preventing lead poisoning in young children: a statement by the Centers for Disease Control. 1991. Accessed Feb 7 2019.
  5. 5.
    Centers for Disease Control and Prevention. Low level head exposure harms children: a renewed call for primary prevention: report of the. Advisory Committee on Childhood Lead Poisoning Prevention of the Centers for. Disease Control and Prevention”. 2012; 1–65. Accessed 23 July 2018.
  6. 6.
    Bellinger DC. Very low lead exposures and children’s neurodevelopment. Curr Opin Pediatr. 2008;20(2):172–7.CrossRefGoogle Scholar
  7. 7.
    Pirkle JL, Brody DJ, Gunter EW, et al. The decline in blood lead levels in the United States: The National Health and Nutrition Examination Surveys (NHANES). JAMA. 1994;272(4):284–91.CrossRefGoogle Scholar
  8. 8.
    Centers for Disease Control and Prevention. Blood lead levels in children aged 1–5 years—United States, 1999–2010. MMWR. 2013;62(13):245–8.Google Scholar
  9. 9.
    World Health Organization. Childhood Lead Poisoning. 2010;1–69. Accessed 23 July 2018.
  10. 10.
    Schmidt CW. Unsafe harbor? Elevated blood lead levels in refugee children. Environ Health Perspect. 2013;121(6):;190–5.CrossRefGoogle Scholar
  11. 11.
    Centers for Disease Control and Prevention. Infant lead poisoning associated with use of tiro, an eye cosmetic from Nigeria-Boston, Massachusetts, MMWR. 2011;61(30):574–6.Google Scholar
  12. 12.
    Al-Saleh I, Nester M, DeVol E, et al. Determinants of blood lead levels in Saudi Arabian schoolgirls. J Occup Environ Health. 1999;5(2):107–14.CrossRefGoogle Scholar
  13. 13.
    Wright RO. Neurotoxicology: what can context teach us? J Pediatr. 2008;152(2):155–7.CrossRefGoogle Scholar
  14. 14.
    Centers for Disease Control and Prevention. Lead Poisoning Prevention in Newly Arrived Refugee Children: Tool Kit. 2016. Accessed 26 July 2018.
  15. 15.
    Centers for Disease Control and Prevention. Recommended Actions Based on Blood Lead Level. 2018. Accessed 23 July 2018.
  16. 16.
    Virginia Department of Health. Elevated Blood Lead Levels in Children Fact Sheet. 2018. Accessed 17 Oct 2018.
  17. 17.
    Van Vranken M. Evaluation of Microcytosis. Am Fam Phys. 2010;82(9):1117–22.Google Scholar
  18. 18.
    Richardson M. Microcytic Anemia. Pediatr Rev. 2007;28(1):5–14.CrossRefGoogle Scholar
  19. 19.
    Centers for Disease Control and Prevention. Lead: topic home. Accessed 6 July 2018.
  20. 20.
    Raymond J, Brown MJ. Childhood blood lead levels in children aged < 5 years—United States, 2009–2014. MMWR Surveill Summ 2018. 2017;66(3):1.CrossRefGoogle Scholar
  21. 21.
    Mitchell T, Jentes E, Ortega L, et al. Elevated blood lead levels among children in refugee camps Mae La, Umpiem, and Nupo refugee camps, Talk Province, Thailand. Bridging Refugee Youth and Children’s Services. 2009:1–48.Google Scholar
  22. 22.
    Geltman PL, Brown MJ, Cochran J. Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999. Pediatrics 2001;108:158–162.Google Scholar
  23. 23.
    Goyer RA. Lead toxicity: current concerns. Environ Health Prespect. 1993;100:177–87.CrossRefGoogle Scholar
  24. 24.
    Singh G, Singh V, et al. Sex-dependent effects of developmental lead exposure on the brain. Front Genet. 2018;9:89.CrossRefGoogle Scholar
  25. 25.
    Hegazy AA, Zaher MM, Abd el-hafez MA, et al. Relation between anemia and blood levels of lead, copper, zinc and iron among children. BMC Res Notes. 2018;3(1):133.CrossRefGoogle Scholar
  26. 26.
    Sebahat T, Aziz P, Murat I, et al. Interaction between anemia and blood levels of iron, zinc, copper, cadmium and lead in children. Indian J Pediatr. 2007;74:827–30.CrossRefGoogle Scholar
  27. 27.
    US General Accounting Office. Medicaid. Elevated Blood Lead Levels in Children. Washington, DC: US General Accounting Office; 1998. GAO Publ. No. GAO/HEHS-98-78.Google Scholar
  28. 28.
    Binns HJ, Kim D, Campbell C. Targeted screening for elevated blood lead levels: populations at high risk. Pediatrics. 2001;108:1364–6.CrossRefGoogle Scholar
  29. 29.
    Roberts EM, Madrigal D, Valle J, King G, Kite L. Assessing child lead poisoning case ascertainment in the US, 1999–2010. Pediatrics. 2017;139(5):1–10.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University of Virginia School of MedicineCharlottesvilleUSA
  2. 2.Department of Family MedicineUniversity of VirginiaCharlottesvilleUSA

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