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An 'elevated' lead level isn't enough for Allegheny County to help some kids

Pittsburgh Tribune-Review - 3/27/2017

March 27--When testing revealed lead levels in 2-year-old Knylah Palmer's blood exceeded a federal threshold, the Rankin girl's mother wanted to know where the lead came from.

The answer has been elusive.

Knylah's December blood lead test result of 9 micrograms per deciliter was well above 5 mcg/dL -- the Centers for Disease Control and Prevention's threshold for an elevated level -- but below 10, the level at which the Allegheny County Health Department starts conducting home inspections.

"I just want to know why her level is high," said Kailynne Palmer, Knylah's mother. "I called the health department, and they said only if her levels were higher could they come out."

Palmer said she was worried lead could be to blame for her daughter's recent issues with balance and motor skills.

Roughly 800 children in the county had capillary blood test results in 2014 that showed lead levels between 5 and 9, according to state and county data.

County Council this year could pass legislation that would require all children to be tested for lead at ages 1 and 2. The bill does not lower the level that triggers a home investigation in which health department staff members test paint, soil, water, dust and wall coverings for lead.

A home lead investigation like the one the county performs is valued at more than $600, the department estimates. It's a cost that Palmer, a mother of three, says she can't afford for her more than century-old Section 8 home.

The CDC in 2012 lowered its threshold for what it deems an "elevated lead level" from 10 to 5. CDC research found children with levels between 5 and 9 had lower test scores in school and an increased likelihood of learning disabilities.

"In a prospective study conducted in Rochester, N.Y., a decline of more than 7 IQ points was observed from lifetime average blood lead concentration of 1 to 10," a 2012 CDC report stated. "The Rochester findings of effects on IQ have been replicated in several other studies of children with (blood lead levels) below 10."

The Allegheny County Health Department lowered its level for home inspections from 15 to 10 in November.

The department didn't drop the level to 5 because it can't afford to do that many inspections, said Dr. Karen Hacker, the department's executive director.

If the department had been doing home inspections for children with confirmed levels of 10 and above for all of 2016, it would have amounted to 70 inspections, according to health department data. If it had been doing inspections for children with confirmed levels 5 and above in the same year, it would have been 287 -- four times more.

"That would require a lot more inspectors," Hacker said. "We would love to, but we don't have the funding."

Dr. Robert Cicco, a retired West Penn Hospital neonatologist, said Allegheny County's aging housing stock creates a more pressing need for the health department to identify and remove lead sources here compared to other counties.

"I understand the quandary the health department is in," Cicco said. "But you do have to worry about kids (with lead levels) between 5 and 9. We need to identify where those sources of lead are coming from."

Pittsburgh Water and Sewer Authority samples exceed a federal threshold, but none of the county's home lead inspections have found water to be the primary source, Hacker said.

About 89 percent of houses in Allegheny County were built before 1978, the year lead paint was banned.

More work on the way

Even without lowering the inspection level to 5, the health department will face an increase in the number of homes it has to inspect if the universal lead testing legislation passes. The legislation would require all children in the county to get blood tests at ages 1 and 2.

The Board of Health will consider the measure in May. It then could go to County Council for final approval -- potentially making Allegheny County the first in the state to require lead testing.

Last year, 14,088 of the county's children younger than 6 received a lead test, Hacker said. Many received the test before turning 1, she said. That's less than half of the 39,374 residents who are 1 or 2, according to 2015 Census estimates.

Mandatory testing would detect more children with confirmed levels at 10 or higher, requiring more county inspections, Cicco said.

"We wouldn't have dropped it down to 10 if we didn't think we could handle it," Hacker said.

The department has changed several positions to inspectors and will add another inspector using part of a $3.4 million federal grant it received to help remove lead from low-income homes, Hacker said.

In 2014, the latest year state health department data are available, 1,010 children in the county under age 7 showed levels of 5 and above from a capillary test. Of those, 287 under age 6 showed a level of 5 and above after getting a venous test at an outside lab to "confirm" the capillary test -- a requirement for a county inspection -- according to county data.

The discrepancy means many parents don't subject their children to the more painful venous tests, or, in some cases, the capillary test was elevated but the venous test was not, Hacker said.

"It's really impossible to know," she said.

Palmer said she had to ask her pediatrician to give her daughter her first lead test at age 2, even though the American Academy of Pediatrics recommends testing at ages 1 and 2.

"I asked the doctor, and she said it wasn't necessary," Palmer said.

Pediatricians who do not encourage testing is a big part of the problem, Cicco said. He said Palmer's daughter's balance issue could be attributed to lead exposure.

"Only in the last few years are (pediatricians) paying more attention to lead, but it needs to get out to all providers," he said.

Some health departments do more

The Allegheny County Health Department does not offer services to parents whose children test between 5 and 9.

The Philadelphia Health Department also starts home inspections at 10 but performs outreach and education with the parents of children who test between 5 and 9.

"We'll set up an appointment with a health educator to visit the family and teach them about the dangers of lead poisoning and what steps they can take to reduce their child's risk," spokesman James Garrow said.

Michigan and Massachusetts state health departments conduct home inspections at 5 and up, according to their websites. In Michigan, the families also must be "low to moderate income" and live in a home built before 1978 to qualify.

Dane County in Wisconsin -- a county about half the size of Allegheny that includes the city of Madison -- performs home visits, including a visual assessment, qualitative lead test (color change kit) and water test for children with levels of 5 and above, said John Hausbeck, a spokesman. Like Allegheny and Philadelphia, the county does a full home investigation at 10 and above.

While getting more federal funding to address lead issues in Allegheny County doesn't seem likely, the health department is seeking funding from other sources for services for children with levels between 5 and 9, Hacker said.

The department applied for a $300,000 grant from the Hillman Family Foundation to start education and outreach initiatives for such children, she said. It also would purchase equipment for lead testing at health department buildings for children who don't have insurance. The grant recipient is announce in the spring.

"We would love to make ourselves more available to folks if we had the funding," Hacker said. "The federal government is likely where that would come from. But right now I'm more concerned about just keeping what we have."

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Theresa Clift is a Tribune-Review staff writer. Reach her at 412-380-5669 or tclift@tribweb.com.

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