Massachusetts

About the program

The State of Massachusetts received $565,000 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in the third funding year. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2023, to September 29, 2024.

The strategies focus on:

• Ensuring blood lead testing and reporting
• Enhancing blood lead surveillance
• Improving linkages to recommended services

To learn more about these efforts in Massachusetts, contact the program below.

Massachusetts Department of Public Health

Massachusetts Childhood Lead Poisoning Prevention Program

250 Washington Street

Boston, MA 02108

Phone: 617-624-5757

Success story: funding year 3

Massachusetts identifies and mitigates test tube contamination that led to falsely high blood lead test results

Challenge

For children with venous blood lead levels (BLLs) of ≥10 µg/dL, the Massachusetts Childhood Lead Poisoning Prevention Program (MA CLPPP) delivers the following services: 1) mandatory environmental investigation and abatement including owner-occupied homes, 2) home visiting, and 3) clinical care coordination with clinician's offices to monitor retesting compliance; communicate findings of the home visits, inspections, and abatement status; and to ensure the child's BLL improves. Through this regular communication, CLPPP staff received two complaints from pediatric groups concerned about an unusual number of children with high blood test results. Using surveillance data, MA CLPPP confirmed a statewide increase in reported lead levels ≥10 µg/dL from August through early November 2022. Upon investigation, MA CLPPP learned that supply chain shortages led to the use of non-certified trace-metal-free test tubes and likely false high lead test results in at least 13 Massachusetts children. MA CLPPP's challenge was to analyze near real-time data, modify case management services, and conduct outreach interventions to resolve these false cases of BLLs ≥10 µg/dL plus improve blood lead sampling practices to prevent future ones.

Intervention

To investigate the complaints and implement remedial measures to prevent medical interventions for children with falsely high BLLs, MA CLPPP analyzed data for 201 blood lead test results ≥10 µg/dL drawn between August 29 and November 5, 2022, that were received from concerned clinicians and analysis labs who also noted an unusual increase in high blood test results. By cross-referencing information from clinicians and laboratories, MA CLPPP identified 53 children whose blood samples were collected using potentially contaminated test tubes and identified the manufacturer and lot numbers of the suspect test tubes. MA CLPPP contacted the manufacturer, alerted CDC and other New England CLPPPs about the contamination, and filed a report with the Food and Drug Administration.

To prevent further falsely high BLLs, MA CLPPP issued a statewide Public Health and Homeland Alert Network notification to pediatricians, family practitioners, physicians assistants, and nurse practitioners alerting them of the problem and urging them to use the appropriate trace-metal-free test tubes for blood lead sample collection. For the 53 children mentioned above, MA CLPPP contacted each family and their child's primary care physician to explain the potential contamination and to promote follow-up testing and lead education.

Impact

MA CLPPP confirmed 18 cases of children under age 6 with falsely high BLLs due to contamination from non-certified trace-metal free test tubes between August 29 and November 5, 2022 (confirmatory test results were below the CDC blood lead reference value (BLRV) within 45 days). An additional 19 children may also have been impacted, but confirmatory testing resulted in BLLs between 3.5 and 10 µg/dL, making it difficult to confirm contamination versus a natural drop in BLLs over time. For these children, CLPPP offered services to families but did not mandate code enforcement inspections. One child moved out of state before follow-up testing was conducted, and 15 children were found to be truly lead poisoned, for whom mandatory inspections and full services were provided. Integrated service delivery, regular communication with clinicians, and robust and timely data reporting and analysis are critical to providing the best care for children and maximizing programmatic resources. Accurate blood lead test results are essential for appropriate public health interventions to prevent and mitigate childhood lead exposure.

Funding for this work was made possible in part by NUE2EH001456 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 2

Reducing lead exposure for Afghan refugees resettling in Massachusetts

Challenge

In 2021, approximately 2,000 Afghan refugees resettled in Massachusetts. The Massachusetts Childhood Lead Poisoning Prevention Program (MA CLPPP) needed to educate resettlement agencies, refugee families with children younger than age 6 years, healthcare providers, and other community groups about the harmful effects of lead exposure and ways to prevent it. MA CLPPP's challenge was to provide timely, easily understood, and culturally sensitive messaging to these groups. This was especially important for Afghan families who were already facing resettlement in a new country.

Intervention

In October 2021, MA CLPPP prioritized and adjusted case management and outreach practices for Afghan families. After learning about Afghan cultural and religious practices, MA CLPPP conducted the following activities:

• Met with experienced health advocates, such as the Western States Pediatric Environmental Specialty Unit and Alameda County Lead Poisoning Prevention Program, to learn about best practices for outreach to Afghan families
• Presented to the Massachusetts Office of Refugee and Immigrants, the Division of Global Populations, and community partners to teach them about lead exposure in high-risk populations and non-paint sources like surma
• Provided families with recommendations for alternate safe products to use in place of lead-tainted surma
• Connected with resettlement agencies and community health centers to improve communication and coordination of services
• Created new fact sheets in Arabic, Dari, Hindi, Pashto, and Urdu and published them on the MA CLPPP website

Impact

As of October 2022, MA CLPPP identified and provided case management services to 26 Afghan children who had blood lead levels (BLLs) ≥10 µg/dL. MA CLPPP triggered a mandatory home inspection for 20 children who were younger than 6 years. MA CLPPP action levels for blood lead levels range from 3.5 to 10 µg/dL, depending on guidelines.) Thirteen homes were inspected, which included three homes with exposed siblings. CLPPP code enforcement lead inspectors identified lead hazards in six homes and issued orders to conduct abatement. Seven homes were free from lead hazards. Four families moved out of state before CLPPPP could conduct an environmental investigation. For these cases, CLPPP staff contacted partner CLPPPs in each state to alert them that the families may need additional care upon arrival. The majority (90%) of the 20 younger children's BLLs decreased within 1–4 months of their initial blood lead test. The remaining six children who were older than 6 years were monitored for medical re-screening by MA CLPPP to ensure clinical consultation and care by their physicians.

MA CLPPP personnel created partnerships and a model to rapidly respond to future refugee resettlements through enhanced cultural sensitivity awareness, communication skills, and collaborations with federal, state, and community-based organizations.

Funding for this work was made possible in part by NUE2EH001456 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 1

Massachusetts uses new method to calculate accurate screening rates

Challenge

While U.S. Census data are useful, data are only collected every ten years. Therefore, lead screening rates based on census data may be inaccurate since populations can vary significantly over a decade. Conducting lead program activities based on data every collected every 10 years can result in programs making incorrect decisions that could leave children in need without services. Massachusetts was interested in identifying high-risk populations at a more localized level to help with outreach and prevention efforts and to develop more precise population estimates.

Intervention

Massachusetts state law requires that childhood blood lead test results be reported to the Department of Public Health, Bureau of Environmental Health’s Childhood Lead Poisoning Prevention Program (CLPPP), which allows the program to record the number of children screened accurately. Identifying the number of children eligible for lead screening compared to the number screened requires an accurate estimate of children’s total population and age distribution in a community. Population estimates in the intercensal years were previously based on data collected during the last U.S. Census in 2010. Because significant demographic shifts in populations can occur over a 10 period, the Bureau of Environmental Health partnered with the University of Massachusetts to use scientifically approved and validated methods to estimate population by age, sex, and race/ethnicity for every year, census tract, and community in Massachusetts during 2010‑2020 (U.S. Census years).

Impact

CLPPP applied the new population estimates to screening rates for 2017 and determined the following:

• 48 small to medium-sized communities (median population=10,765) decreased screening rates from above or near the state average to below the state average by at least 5%.
• The overall state screening rate decreased from 76% to 73%.

CLPPP is using this information to target new outreach efforts to medical care providers and local health practitioners:

• Prioritizing educational in-service training for pediatric practices within the 48 communities.
• Contacting providers regarding requirements and best practices for screening, reporting (including in-house, point-of-care device test results), and parent education.
• Updating and providing Childhood Lead Screening Community Progress Reports.
• Reminding providers to conduct venous follow-up testing for children with elevated capillary tests; and
• Providing services and education to reduce lead exposures and to increase screening.

Funding for this work was made possible in part by EH17-1701 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.