North Carolina

In May 2016, a North Carolina Childhood Lead Poisoning Prevention Program (NC CLPPP) epidemiologist noted clusters of elevated blood lead levels (BLL) among 16 children documented as take-home lead exposures in North Carolina’s lead surveillance system. Local lead investigators visited the homes of the children with confirmed BLLs greater than 5 micrograms per deciliter (µg/dL). They found lead dust on household members’ work boots, laundry areas, car upholstery, and children’s car seats. NC CLPPP partnered with North Carolina’s Occupational and Environmental Epidemiology Branch (OEEB), which houses the Adult Blood Lead Surveillance (ABLES) program. Through this partnership, NC CLPPP determined that the children’s exposures were linked to employees of two workplaces: a lead oxide manufacturer with 26 current employees and a battery manufacturer with over 400 employees. As the employees resided in multiple counties, the investigation crossed many jurisdictional boundaries. Concurrently, the North Carolina Occupational Safety and Health (NC OSH) Compliance Branch was investigating a complaint about the lead oxide manufactuer.

In July 2016, the  NC CLPPP worked with the local county health department to offer seminars to employees of each company on how to protect their household and themselves from lead exposure. The NC CLPPP team notified local health directors in employees’ home counties, coordinated with the State Laboratory of Public Health to provide free blood lead level testing to employees’ household members at local health departments, and urged private practices to retest affected patients. Few household members came to the health department for blood lead testing; however, private practices responded by testing many of the children at their next visit. OEEB industrial hygienists conducted site visits at the facilities, suggested improvements in engineering controls, and reviewed company policies for potential interventions. Due to the consistently elevated BLLs among the lead oxide manufactoring workers, OEEB epidemiologists and an occupational health nurses interviewed employees about their work procedures and personal hygiene.

Major successes of this investigation include enhanced coordination and stronger relationships between the NC CLPPP, ABLES, and external agencies including NC OSH, NC Division of Waste Management, and the county health department where these workplaces are located — each of which are crucial for navigating restrictions of jurisdictional boundaries. A written workflow was developed for improved coordination of future cases. New fields were created in North Carolina’s lead surveillance system (NCLEAD) for capturing company name and occupational exposures to alert NCLEAD data personnel of potential occupational clusters. NC CLPPP drafted questions for ABLES case investigation interviews to assist in linkage of family members. NC CLPPP now also coordinates with ABLES to provide counseling to families on exposure reduction. Since starting active surveillance in May 2016, NC CLPPP identified 19 more children exposed to lead through take-home exposure from the two companies, totaling 35 linked children with confirmed BLL ≥5 µg/dL during 2012–2018. NC CLPPP continues to monitor these children quarterly and matches employee rosters annually to identify new cases.