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ISDS 2016 Conference Abstracts

Lead Poisoning Surveillance: A Collaborative Effort 
between Epidemiology and WIC
Kaylee Hervey*1, Christine Steward1, Dante Corimanya1, Sandra Reichenberger2, 
Whitney Crager1 and Adrienne Byrne-Lutz1
1Epidemiology, Sedgwick County Health Department, Wichita, KS, USA; 2Children and Family Health, Sedgwick County Health 
Department, Wichita, KS, USA

Introduction
There is no safe level of lead in the body, and elevated lead in 

children can lead to decreased Intelligence Quotients (IQ) and 
behavioral problems. The American Academy of Pediatrics 
recommends lead testing of children with a positive risk assessment. 
Children who live in low socioeconomic areas may be at higher risk 
for lead exposure. As recent events have shown, having an elevated 
lead poisoning surveillance system can be critical to ensure that there 
is not a community-wide lead exposure. To reach the children that 
may not have been screened by a primary care physician, on March 
1, 2016 the Sedgwick County Health Department Women, Infants, 
and Children (WIC) program began offering lead screenings to all 
children in the WIC program and their mothers. Per Centers for 
Disease Control and Prevention (CDC) guidelines, the Sedgwick 
County Health Department Epidemiology program (Epi) investigates 
anyone who has an elevated blood lead test (5 µg/dL or greater). 
There are two types of lead tests – screening (capillary finger stick) 
and confirmatory (venous blood draw).

Methods
Sedgwick County WIC clients are offered screening lead testing 

at their WIC appointments. Education to reduce lead exposure is 
provided at the time the test is performed. The filter papers used in this 
testing are sent to the Kansas Health and Environmental Laboratories 
(KHEL) for analysis, and the results are reported to Epi. Epi reports 
the lead testing results to WIC, who track the results in their patient 
charts. Epi receives KHEL results of <5 µg/dL via fax and results 
of >= 5 µg/dL via electronic laboratory reporting in the EpiTrax 
disease investigation software maintained by the Kansas Department 
of Health and Environment. Epi notifies any WIC clients with results 
>= 5 µg/dL, while WIC staff notify all other clients about their results. 
Education is provided to the client a second time by Epi staff and/or 
a WIC nurse or dietician. For clients with elevated blood lead tests, 
Epi interviews the case or guardian using an enhanced blood lead 
exposure questionnaire which asks about potential lead exposures, 
both in the home and at other locations (work, hobbies, etc.). If only a 
screening test was performed, Epi recommends confirmatory testing. 
WIC lead testing program measures, including types of exposures 
identified, are monitored over time using data obtained from EpiTrax.

Results
Between March 1 and July 21, of the 2,150 WIC clients offered 

lead testing, 89% self-reported never having received a lead test 
previously. Of the 1,427 clients with WIC lead screening results, 
seven cases of elevated blood lead were identified. Of the seven, five 
did not have a previous elevated lead test in EpiTrax. The average 
screening test result was 8.6 µg/dL (range 6.8 to 13.4). The average 
age of the cases was 2 years (range 1-4). Of the seven cases, two 
(29%) were confirmed as 10.0 and 11.0 µg/dL through venous testing 
at their primary care provider’s office. The remaining five cases have 
not received confirmatory testing. One of the three cases interviewed 
reported that their babysitter lived in an old home, which could be 
the source of lead exposure. While interviewing a child’s guardian 

about an elevated 2016 test (7.9 µg/dL), Epi discussed a previous 
2015 elevated lead test (6.0 µg/dL) of which the client’s guardian 
was unaware.

Conclusions
The ease of access to lead testing in the Sedgwick County WIC 

program and the joint effort between WIC and Epi to implement an 
enhanced lead poisoning surveillance system identified six children 
with elevated lead levels whose guardians did not know they had 
elevated lead levels. This new surveillance program educates WIC 
parents about lead, determines the lead levels in children for guardian 
knowledge (low level) and further follow-up (elevated level), and 
identifies lead exposures of WIC children with elevated lead tests.

Keywords
lead; surveillance system; WIC

*Kaylee Hervey
E-mail: Kaylee.Hervey@sedgwick.gov

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 9(1):e112, 2017