Identification of Infants with Elevated Blood Lead Levels living in
Homes built in Milwaukee before 1951 – Wisconsin 1995-2015
Background and Study Objective
In the city of Milwaukee, water delivery to dwellings built before 1951
occurs through pipes containing lead1,2. Lateral service lines (LSLs) are pipes
connecting the water main pipe to the homes and are considered the biggest
source of lead in drinking water3. In 1986, Amendments to the Environmental
Protection Agency’s (EPA) Safe Drinking Water Act prohibited the use of new
lead pipes in potable water delivery systems. Since pipes are rarely replaced,
there are many LSLs containing lead3. In Milwaukee, approximately 80,000
dwellings constructed before 1951 are known to have LSLs1.
In 1991 the EPA established the “Lead and Copper Rule” or LCR to
reduce lead and copper in drinking water4. The LCR is regularly revised based
on current scientific knowledge and has significantly decreased lead in
drinking water. Despite these efforts, children are still exposed to lead in
drinking water. Children are very susceptible to lead poisoning, which can
lead to delayed development, learning difficulties and behavioral
disturbances2.
Wisconsin’s Childhood Lead Poisoning Prevention Program (WCLPPP)
recommends blood lead screening of all children residing in Milwaukee,
especially those identified as high-risk. In addition, all children enrolled in
Medicaid receive regular screening tests. Screening is constituted of at least
three tests before their third birthday, at 12, 18, and 24 months, and some
infants are initially tested before one year of age1.
This is an exploratory study to identify homes in which children with
elevated BLLs reside. More specifically, the objective of this study is to
identify residential houses built prior to 1951 in which infants with an
elevated BLL live.
Methodology and Data Management
The address of infants living in Milwaukee between 1995 and 2015 with
elevated venous or capillary BLL test results under 7 months of age will be
identified through the statewide WCLPPP database. Infants under seven
months have limited mobility and are chosen in this study to minimize the
chances of lead exposure through routes other than municipal water (i.e.
paint chips). The addresses of qualifying infants will be cross-matched with
an address list of Milwaukee homes built prior to 1951. Resulting matches
will be examined and analyzed for patterns. An ArcGIS map will be used to
depict these patterns. The data and resulting analyses will be held on the
Wisconsin DHS secure server and will not be shared publicly.

 References
1. Department of Public Works, City of Milwaukee 2015. Lead Awareness
and Drinking Water Safety. Accessed on 02/29/16, available at
http://milwaukee.gov/water/about/LeadandWater.htm
2. Triantafyllidou S, Gallagher D, Edwards M. Assessing risk with
increasingly stringent public health goals: the case of water lead and
blood lead in children. Journal of Water and Health. March 2014; 12(1):
57-68
3. Del Toral MA, Porter A, Schock MR. Detection and Evaluation of
Elevated Lead Release from Service Lines: A Field Study. Sci. Technol.
2013;47:9300−9307
4. EPA 2016. Drinking Water Requirements for States and Public Water
Systems: Lead and Copper Rule. Accessed on 02/29/16, available at
http://www.epa.gov/dwreginfo/lead-and-copper-rule
5. Wisconsin Department of Health Services 2014. Wisconsin Childhood
Lead Poisoning Prevention and Control Handbook for Local Public
Health Departments. Wisconsin Childhood Lead Poisoning Prevention
Program. Accessed on 02/29/16, available at
https://www.dhs.wisconsin.gov/publications/p00660.pdf