Childhood lead poisoning in Maryland drops as state moves to respond to greater range of cases under more protective standard
Governor Larry Hogan proclaims Lead Poisoning Prevention Week in Maryland
BALTIMORE (October 26, 2020) – Childhood lead poisoning cases in Maryland decreased last year to the lowest levels since data has been collected in connection with the state’s 1994 lead law, according to the 2019 Childhood Blood Lead Surveillance report, released today by the Maryland Department of the Environment (MDE).
Historically low levels were reached in lead poisoning cases as defined by the benchmark used for many years by the state, including in 2019. Meanwhile, cases relating to a more protective standard that helps form the basis of Maryland’s current actions to reduce childhood lead poisoning also showed a steady and continuing decline. The new report also shows increased numbers of children tested for lead exposure under Maryland’s universal testing program.
“Lead poisoning is a preventable environmental injustice and we are making real progress in eradicating it,” said Maryland Environment Secretary Ben Grumbles. “Through universal testing, strong enforcement and a new emphasis on responding to lower levels of lead poisoning, we can continue to reduce childhood lead poisoning in Maryland.”
The report showed that just more than 0.2% of young children tested across the state in 2019 showed blood lead levels at or above 10 micrograms per deciliter, the level that state law defined as elevated for 14 years, including during 2019. The percentage is the lowest since the beginning of such data collection in1993 and represents a decrease of more than 99% from the earliest days of data collection. The number of Maryland children identified with blood lead levels of 10 micrograms per deciliter or above decreased from 390 in 2018 to 328 in 2019, a decrease of nearly 16% decrease.
The report showed that 0.7% of young children tested in Baltimore City in 2019 showed blood lead levels at or above 10 micrograms per deciliter — also the lowest comparable percentage since the beginning of such data collection in 1993.
The report also shows that the percentage of young children tested for lead and identified with a blood lead level of between 5 and 9 micrograms per deciliter has declined from about 18% in 2000 to less than 1% in 2019. The number of children identified with blood lead levels of 5 micrograms per deciliter or above decreased from 1,435 in 2018 to 1,198 in 2019, a 16.5% decrease.
The U.S Centers for Disease Control established 5 micrograms per deciliter as a “reference value” to identify children with blood lead levels that are higher than most children and require follow-up case management. In recent years, MDE has investigated properties for compliance with Maryland’s lead law upon receipt of referrals from the Baltimore City health department based on cases with blood lead levels of 5 micrograms per deciliter or above.
On July 1, 2020, the “Maryland Healthy Children Act” went into full effect. The law lowered the definition of an elevated blood lead level to the CDC reference level. It requires MDE or the local health department in Maryland jurisdictions to provide case management, including environmental investigations to identify lead sources, when a child is diagnosed with a blood lead level of 5 micrograms per deciliter or above. “Early intervention is a key component to ensure families with children exposed to lead are provided resources to mitigate the effects of lead exposure,” the report states.
If, during the environmental investigation, chipping, peeling, or flaking paint is observed by the inspector and the home is a property covered by Maryland’s lead law, a “Notice of Defect” will be issued by MDE or the local health department, triggering a requirement that the property owner take steps to ensure that risks of lead exposure are reduced.
The annual report also looks at the sources of childhood lead poisoning in Maryland, which in addition to lead-based paint in housing include certain cosmetics, spices, pottery and cookware and other consumer products. The report did not indicate any lead poisoning cases in 2019 caused by exposure to lead in drinking water. MDE enforces a state law that requires schools serving children pre kindergarten to grade 12 students to test for the presence of lead in all drinking water outlets.
Also effective July 1, 2020, MDE’s Land Restoration Program reduced the residential soil lead screening standard for brownfield redevelopment properties from 400 to 200 parts per million. This will further ensure that lead levels in soils are reduced to within acceptable levels.
As childhood lead poisoning cases in Maryland remain at their lowest recorded levels, blood lead testing rates have increased under the state’s universal testing initiative and the Maryland Department of Health initiative to endorse Point of Care testing for lead, which allows healthcare providers to test children and provide results in the same office visit. In 2019, 132,224 children age 6 and younger were tested for lead, a slight increase of about 0.5% compared to 2018.
October 25-31 is National Lead Poisoning Prevention Week. Governor Larry Hogan proclaimed this week as Lead Poisoning Prevention Week in Maryland.
Childhood lead poisoning is preventable
Exposure to lead is the most significant and widespread environmental hazard for children in Maryland. Children are at the greatest risk from birth to age 6 while their neurological systems are developing. Exposure to lead can cause long-term neurological damage that may be associated with learning and behavioral problems and with decreased intelligence.
MDE coordinates statewide efforts to eliminate childhood lead poisoning. Under the Maryland lead law, MDE: assures compliance with mandatory requirements for lead risk reduction in rental units built before 1978; maintains a statewide listing of registered and inspected units; and provides blood lead surveillance through a registry of test results of all children tested in Maryland. The lead program also: oversees case management follow-up by local health departments for children with elevated blood lead levels; certifies and enforces performance standards for inspectors and contractors conducting lead hazard reduction; and performs environmental investigations of lead-poisoned children. The lead program provides oversight for community education to parents, tenants, rental property owners, home owners and health care providers to enhance their roles in lead poisoning prevention. Maryland works in partnership with the U.S. Environmental Protection Agency, Baltimore City and other local governments and non-profit organizations such as the Green & Healthy Homes Initiative to prevent childhood lead poisoning.
Department of Housing and Community Development’s Lead Hazard Reduction Program
The Special Loans Program of the Maryland Department of Housing and Community Development (DHCD) continues to make a significant impact on the lead exposure from lead-based paint in pre-1978 housing stock statewide. The Lead Hazard Reduction Loan and Grant Program was established by the Maryland General Assembly in 1986 solely for the purpose to extend loans and grants to eligible individuals, child care centers and sponsors to finance the lead hazard reduction of residential housing units. In Fiscal Year 2020, the program helped abate lead in 35 homes for $2,562,115.
Maryland Department of Health: two programs
The Maryland Department of Health has two innovative programs, funded by Medicaid, to improve health outcomes and reduce exposures to lead for children who are lead-poisoned. The first, the MDH Childhood Lead Poisoning Prevention and Environmental Case Management Program, expands environmental case management capacity in local health departments that serve nine counties with the greatest pediatric lead poisoning and asthma burden. Community Health Workers (CHW) from the local health departments conduct home assessments to identify asthma triggers and conditions that contribute to lead poisoning. The CHW can conduct up to six home visits to address medication adherence, nutrition, and safe cleaning techniques in the child’s home. The CHW also will provide durable goods to assist with maintaining and meeting the health goals.
The second program, the Department’s Healthy Homes for Healthy Kids Program, provides federal and state funds to DHCD to remove lead hazards in homes throughout the state. Maryland families with a child exposed to lead may be eligible to have lead hazards removed at no cost. Eligibility requirements for the initiative are: a child who has a lead test result of 5 micrograms per deciliter or greater; under age 19; lives in or visits in the home or apartment for 10 hours or more a week; and is currently eligible or enrolled in Medicaid or Maryland’s Children’s Health Program.
For more information about either program, visit https://phpa.health.maryland.gov/OEHFP/EH/Pages/CHIPEnvCaseMgmt.aspx, or call 866-703-3266.
“Maryland has made significant progress in reducing lead levels statewide, but significant disparities in lead poisoning still exist. At the same time, new programs through Medicaid have made it easier for families to eliminate sources of lead in their environment. We strongly encourage all parents who have not done so already to make sure their children are tested for lead, as it is the only way to know that your child has not been exposed.”
– Robert R. Neall, Secretary, Maryland Department of Health
“The Department of Housing and Community Development strives to give all Marylanders an opportunity to live in a safe, healthy, and affordable home. A safe and healthy home includes preventing exposure to lead, and our Lead Hazard Reduction Loan and Grant Program and Healthy Homes for Healthy Kids plays a significant role in our partnership with the Department of the Environment and the Department of Health to reduce lead poisoning across the state.”
– Matthew Heckles, Assistant Secretary, Maryland Department of Housing and Community Development
“The toxic legacy of lead poisoning has undermined the health and opportunities of generations of Maryland’s children. To better advance the health and equity for all children in the State, we must eradicate lead poisoning. This Report shows important progress in increasing testing and lowering the rates of poisoning thanks in good part to the Administration’s commitment to Universal Blood Lead Testing. With the important passage of the Maryland Healthy Children’s Act sponsored by Delegates Robin Lewis and Marvin Holmes and supported by MDE, we can more readily zero in on our goal of protecting every child. To accomplish our mutual goal, we will need strong public and private commitments to invest, at scale, in eliminating lead hazards in every community.”
– Ruth Ann Norton, President and CEO, Green & Healthy Homes Initiative
2019 Maryland Childhood Lead Registry Annual Surveillance Report
Graphic: Childhood blood lead surveillance statewide 1993-2019
Graphic: Childhood blood lead surveillance Baltimore City 1993-2019
Graphic: Children tested and identified with blood lead level of 5-9 µg/dL
Lead Poisoning Prevention Week proclamation
Maryland Department of the Environment Lead Poisoning Prevention Program
Maryland Department of Health
Maryland Department of Housing and Community Development
Baltimore City Health Department
Green & Healthy Homes Initiative
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