The New Jersey Department of Health (NJDOH) released its latest annual Childhood Lead Exposure in New Jersey report, which illustrates how lead testing increased after a temporary disruption to testing in 2020 during the height of the pandemic and highlights the importance of continued screening.
The percent of children under age 6 years with elevated blood lead levels (BLLs) decreased between State Fiscal Years (SFY) 2018 and 2021. Just over 3,000 children (3,016 ) in this age group had elevated BLLs in SFY21.
While the state saw a decrease in elevated blood lead levels in SFY 2021 for blood lead levels of 5 ug/dL to 44 ug/dL, a significant increase in high elevated blood lead levels of 45 ug/dL and above was observed in this age group. Children with elevated blood lead levels of 45 ug/dL or greater require in-hospital chelation treatment to reduce their blood lead levels. Prior to the pandemic, New Jersey averaged three children per year requiring chelation. For the most recent year of data (SFY 2021), 15 children in this age group had a high BLL and required hospitalization for chelation multiple times throughout the year, averaging three hospital stays per child. As primary lead exposure for children is in the home, increased time spent at home during the COVID-19 pandemic likely led to this significant increase among children. The pandemic may have increased high risk behaviors such as hand-to-mouth-activity, and pica, a condition in which people eat non-food items, which would lead to higher exposure of lead.
“Lead is a neurotoxin, and no level of lead is acceptable,” said state Health Commissioner Judith Persichilli. “The Department continues to work with our local health partners and community organizations to step up testing, surveillance, and abatement to ensure the health and safety of our children.”
In New Jersey, N.J.A.C 8:51A requires healthcare providers to screen all children for lead at both ages 12 months and 24 months. Children ages 3 years and older must be tested at least once before turning 6 years if they have not already been screened at ages 1 and 2 years.
The number of lead screenings increased in SFY 2021 following a COVID-19 pandemic-related drop in SFY 2020. A total of 86,737 children between the ages of 6 months and 26 months were screened for lead in SFY 2021 (representing 40 percent of New Jerseyans in this age group), compared to 78,847 children in that age group screened in SFY 2020. Screening rates for childhood lead exposure worsened during COVID-19, likely due to pandemic-related limitations on in-person child health and wellness visits. There was also a nationwide recall of the point-of-care blood lead analyzer, LeadCare, during SFY 2021. Children may have missed the required blood lead screening at ages 1 and 2 years.
Between SFY 2018 and SFY 2021, the percentage of children less than 6 years of age with an elevated blood lead level dropped from 2.5 to 1.9 percent at 5 ug/dL. Among New Jersey-born children who turned age 3 years during SFY 2021, 72 percent had at least one blood test in their lifetime, which represents a lower percentage than in SFY 2020. Decreases in access to wellness visits, laboratory access and a nationwide recall of LeadCare analyzers had the greatest effect on blood lead screening of this population. Among children born in New Jersey who turned age 6 years during SFY 2021, 92 percent had at least one blood lead test in their lifetime, reflecting an increase from 88 percent in SFY 2020.
NJDOH continues to strengthen blood lead screening and surveillance by raising awareness of New Jersey’s universal blood lead screening law and supporting public health partners. In SFY 2021, NJDOH continued its #kNOwLEAD prevention campaign to increase awareness of all lead hazards in homes, schools and on the job, and to educate parents on what they can do to prevent exposure and encourage them to have their children tested. The Department continues to work with regional partners to provide education events and webinars, including American Academy of Pediatrics members, to increase screening. NJDOH’s Childhood Lead Program also has transitioned to a new database to allow for more robust data surveillance.
The findings of this report are guiding steps the Administration is taking to step up testing, surveillance, and abatement of childhood lead.
The five large municipalities with the highest percent of children less than 6 years of age with an elevated blood lead level at or above 5 ug/dL in SFY 2021 includes: Trenton (6.4 percent), East Orange (5.3 percent), Irvington (5.2 percent), Plainfield (4.0 percent) and Paterson (3.6 percent). While the percent of children with an elevated blood lead level is one metric that examines the burden of childhood lead in a geographic area, it does not account for factors that may vary from place-to-place such as population size, screening rates, and sources of exposure (e.g., age of housing). Earlier this year, the Lead Remediation and Abatement Grant Program was launched through the Department of Community Affairs to bolster activities in disproportionately impacted communities (https://nj.gov/dca/news/news/2023/approved/20230201.shtml).
The Murphy Administration works across state agencies to reduce and prevent the impacts of childhood lead exposure. Recently, NJDOH, the Department of Community Affairs (DCA), and the Department of Environmental Protection (DEP) launched the expanded version of the Potential Lead Exposure Mapping (PLEM) tool, which provides new publicly available data that indicate potential sources of lead exposure. The tool can be found here: Potential Lead Exposure Mapping (PLEM) – Housing in New Jersey (arcgis.com). NJDOH also distributes $17 million annually in grant funding to:
- Local health departments to support screening, environmental investigation and nurse case management;
- Childhood lead partners, including three regional coalitions, which focus on community based primary prevention education;
- Isles, to support the New Jersey Health Homes Training Center, which provides training courses for health and social services home visitors, housing inspectors, and weatherization/home performance staff in lead safe work practices and lead exposure reduction;
- Green and Healthy Homes Initiative to provide technical assistance to public health and community partners such as outreach and education, lead screening strategies, and funding opportunities.