Case management follow-up protocols for lead elevated children

What is the Georgia Healthy Homes and Lead Poisoning Prevention Program (GHHLPPP)?
The Georgia Healthy Homes and Lead Poisoning Prevention Program (GHHLPPP) is a statewide prevention and surveillance program for lead sources in homes and other household public health hazards. GHHLPPP is the statewide childhood lead poisoning prevention and surveillance office for children with elevated blood lead levels (levels equal to or greater than 5 ug/dL). One of the goals of the GHHLPPP is to eliminate childhood lead poisoning under the Centers for Disease Control and Prevention's (CDC) national Healthy Homes Initiative.
Childhood Lead Poisoning Prevention
Lead poisoning remains a health hazard for nearly 250,000 children under the age of 6 years in the U.S. In Georgia, nearly 800 children age 6 years or younger have elevated levels of lead in their blood each year. Lead poisoning in children can cause permanent neurological damage resulting in behavioral and cognitive problems. As of 2012, the Advisory Committee on Childhood Lead Poisoning Prevention and CDC define "elevated blood lead level" (EBLL) as 5 ug/dL or greater. CDC defines a lead poisoned child as having a blood lead level (BLL) of 10 ug/dL or greater.
Preventing lead poisoning can save billions in health care treatment, IQ and lifetime earnings losses, special education costs, and crime. Screening a child's BLL identifies children who are exposed to lead and reduces the number of child lead poisoning cases. The goal of GHHLPPP case management is to provide timely and appropriate services to the medical community for management of child lead poisoning cases, including household environment inspection and lead hazard remediation.

Risk Factors Assessment Questionnaire
For children ages 6 months through 6 years, each child's risk factors need to be determined using the questions below.
1. Does your child live in or often visit a home or child care center that may have been built before 1978?
2. Does your child live in or often visit a pre-1978 home or child care center that is being remodeled or is having paint removed?
3. Does your child have a sibling or playmate who has or has had lead poisoning?
4. Does your child live with anyone that works at a job or has a hobby that uses lead (battery factory, steel smelter, stained glass)?
5. Does your child chew on or eat non-food items like paint chips or dirt?
6. Is your child a recent immigrant or, refugee, or a member of an minority group?
7. Does anyone in your family use ethnic or folk remedies or cosmetics such as greta, azarcon, kohl, or pay-loo-ah, or eat imported candies?
If the answer is YES or DON'T KNOW to any of the questions, a blood lead test is necessary!
FOR MORE INFORMATION
GEORGIA HEALTHY HOMES AND LEAD POISONING PREVENTION PROGRAM 2 Peachtree Street, NW. 13th Floor Atlanta, GA 30303 1-888-247-9054 Phone: (404) 463-3754 Fax: (404) 463-4039
PH/...

CASE MANAGEMENT FOLLOW-UP PROTOCOLS
for LEAD ELEVATED
CHILDREN
Healthy Homes and Lead Poisoning Prevention Program
Environmental Health Branch
GEORGIA DEPARTMENT OF PUBLIC HEALTH

Test all children at 12 and 24 months, (and children 3 to 6 years of age if never tested), regardless of their risk factors! It's a federal requirement.

Approved Medical and Case Management Actions

Blood Lead Levels (BLL)

Confirm* Blood Lead
Test

Hospitalization

< 10 ug/dL

No

No

10-191 ug/dL

within 1 day to 2 months

No

20-24

ug/dL 25-44

within 1 day to 1 week

No

ug/dL

45-50 ug/dL
60 ug/dL or Higher

within 24 hrs

No, if home is lead-safe
YESMEDICAL EMERGENCY

Chelation Therapy
(A) No No
No
YES
YES

Blood Lead Level Retest
Within 1 year if BLL 5 ug/dL

Referrals (B)
No

History and
Physical (C)
No

Lead Poisoning Education
(D)
YES

See Retest Chart

YES

YES

YES

See Retest Chart

YES

YES

YES

See Retest Chart
See Retest Chart

YES YES

YES YES

YES YES

Reduce Exposure
and Absorption
(E) YES
YES
YES
YES
YES

Retest Chart If the EBLLis confirmed, has BLL dropped at least 3 ug/dL over 3 months?

No

Yes

n/a

n/a

3 months 6 months

1 month 2 weeks

2 months 1 month

1 month after
chelation

1 month after
chelation

TTHHEERREE IISS NNOO SSAAFFEE LLEEVVEELL OOFF LLEEAADD IINN TTHHEE BBOODDYY DDAAMMAAGGEE CCAAUUSSEEDD BBYY LLEEAADD PPOOIISSOONNIINNGG IISS PPEERRMMEENNAANNTT AANNDD IIRRRREEVVEERRSSIIBBLLEE

Recommended Medical and Case Management Actions

(A) Chelation Therapy: if chelation therapy is

indicated, the child should be immediately removed

from

the

hazardous

environment

until the child's environment is made lead-safe;

however, if the home is already lead-safe, the child

may remain in the home unless

hospitalization is indicated

(B) Referrals: contact local health department and/or GHHLPPP to assist in case management and environmental investigations.

(C) History and physical: take medical, environmental, and nutritional history; test for anemia and iron deficiency; assess neurological,

psychosocial, and language development; screen all siblings age 6 and under; evaluate risk of other family members, especially pregnant women.
(D) Lead poisoning prevention education: discuss sources, effects of lead, and hazards associated with living in a pre-1978 and/or renovating a pre-1978 home, during prenatal care and well child care at 3, 6, and 12 months; explain what blood lead levels mean; contact GHHLPPP for materials.
(E) Reducing exposure and absorption: discuss damp cleaning to remove lead dust on surfaces; eliminating access to deteriorating. lead paint surfaces, and ensuring regular meals which are low in fat and rich in calcium and iron; contact GHHLPPP for materials.

RE-TESTING
* For confirmation blood lead tests and re-tests, capillary (fingerstick) method is acceptable, but venous testing is most accurate, and is strongly preferred.
Re-testing should occur until the blood lead level is less than 10ug/dL for 6 months, all lead hazards have been removed, housing is lead safe, and no new exposure exists.
1 A child with an elevated blood lead level (BLL) will most likely not have his or her BLL reduced to zero; however, this retesting schedule should be followed regardless of the BLL to ensure the BLL is decreasing rather than remaining the same or increasing, which would indicate continued exposure