Washington

Washington State is one of the top 10 states for refugee arrivals. In 2015, approximately 3,100 refugees were resettled in Washington State, and nearly 45% were children 18 years of age or younger. Compared with the general Washington state population, refugee populations have significantly higher prevalence of blood lead levels greater than the CDC’s blood lead reference value potentially from exposures in their country of origin, including leaded gasoline, ammunition, traditional remedies and cultural items. During 2015-2017, refugees represented only 2.6% of all children tested in the state, and yet they represented 24% of the total elevated blood lead level (BLL) cases in Washington.

Using CDC funds, the Washington State Childhood Lead Poisoning Prevention Program (CLPPP) began a data linking project in 2012 to match refugee health records with CLPPP Blood Lead Registry records to determine testing rates among refugees. The testing rate among refugees was estimated to be 13%. The Refugee Health Program revised the guidelines to strongly recommend universal blood lead testing by refugee health screening clinics to address this low testing rate.

Additionally, CLPPP and Refugee Health Programs partnered to:

• Analyze data by blood lead level, country of origin, language, and jurisdiction to identify emerging populations at risk for elevated BLLs, language translation needs, and inadequacies in follow-up.
• Offer provider education through presentations at the North American Refugee Health Conference and the Washington State Public Health Association Conference and clinical management and Refugee Resettlement Webinars.  Additionally, a Grand Rounds presentation was provided by a Pediatric Environmental Health Specialty Unit (PEHSU) on lead prevention and medical management with emphasis on refugee populations was sponsored and promoted.
• Publish an issue of Epi-Trends dedicated to childhood lead prevention, testing, and treatment among refugee populations. The issue was distributed to all local health departments. In April 2019, the Refugee Health Program provided CLPPP data for the article “Blood Lead Levels Among Resettled Refugee Children,” published in the journal Pediatrics.
• Partnered with the Washington State Poison Center and local refugee communities to develop health education materials in Dari, Pashto, Arabic, and Somali.
• Provide health education, assistance on home investigations to identify continued or new domestic sources, and linkages to services for communities disproportionately affected by elevated BLLs. The refugee health screening clinics also refer families to primary care providers for medical case management and scheduled retesting for children identified with elevated BLLs.

Since starting the data linking project, the testing rate has increased significantly each year to a high of 98% in 2017. The recommendation for universal testing has drastically improved testing rates, allowing for more timely identification of pediatric refugees with elevated BLLs and enabling referral to clinical case management and public health interventions.