Maine Department of Health and Human Services Maine Center for Disease Control and Prevention 11 State House Station 286 Water Street Augusta, Maine 04333-0011 Tel; (207) 287-8016; Fax (207) 287-9058 TTY: Dial 711 (Maine Relay) Janet T. Mills Governor Jeanne M. Lambrew, Ph.D. Commissioner To: Medical Practice Office Managers *Please distribute to all providers who see pediatric patients.* From: Nirav Shah, MD, JD, Director, Maine Center for Disease Control and Prevention Date: September 3, 2019 Re: New Blood Lead Testing Requirements As of June 27, 2019, Maine law requires blood lead tests for all children at 1 and 2 years of age. Please make certain that your practice is in compliance with this new state law. Blood lead testing rates are low. We need to do better. • Statewide, only 51% of 1-year-olds and 30% of 2-year-olds were tested for blood lead in 2018. • For children covered by MaineCare, only 52% of 1-year-olds and 37% of 2-year-olds received a mandatory blood lead test in 2018. Confirm capillary tests >5 µg/dL with venous tests. • The Maine Center for Disease Control and Prevention (Maine CDC) can only provide services to identify and remove lead hazards when providers confirm capillary tests with venous tests. • The sooner providers confirm capillary blood lead tests with venous specimens, the sooner children can receive services to eliminate the source of their lead exposure and make homes lead safe. • Children with blood lead levels as low as 5-9 µg/dL have been found to have lead hazards in the home nearly as often as children with blood lead levels > 10 µg/dL.1 New tools are in development to help improve testing and venous confirmation rates. Maine CDC is working to implement new tools to help improve your practice’s testing rates. • Testing Guidelines o Maine CDC is in the process of updating its testing guidelines to reflect the new law, and will send those to you in the coming weeks. • Blood Lead Module in ImmPact o In the coming months, Maine CDC will add a blood lead module in Maine’s immunization registry – ImmPact – making it easier for providers to identify children who need a blood lead test or confirmatory venous test. o Maine CDC will also be able to view blood lead testing rates for individual medical practices and prepare report cards on practice performance. Maine CDC will notify providers when the guidelines and module are available to use. For more information on blood lead testing, visit our website at http://go.usa.gov/xENdW or call 207-287-4311. 1 Cluett R, Fleisch A, Decker K, Frohmberg E, Smith AE. Findings of a Statewide Environmental Lead Inspection Program Targeting Homes of Children with Blood Lead Levels as Low as 5 µg/dL. Journal of Public Health Management and Practice. 2019;25(1 Supp):S76-S83. The percentage of 1- and 2-year-old children tested for blood lead varies greatly by county of residence. These results indicate that providers serving Washington and Franklin Counties are well on their way to meeting the new State mandate for universal blood lead testing of young children. Blood Lead Testing Rates by County and Age Group, Maine 2018 100% Age: 12-<24 Months Age: 24-<36 Months Percent Tested 80% 60% 40% 20% 0% Timely confirmation of capillary blood lead levels with a venous specimen remains low. Children with capillary blood lead tests >10 µg/dL are more likely to receive confirmation venous tests than children with test results between 5 and 10 µg/dL. As of 2016, Maine CDC inspects a dwelling for lead hazards upon identifying a child with a confirmed blood lead level of 5 µg/dL and higher. Percent Confirmed 100% Confirmation Rates by Initial Capillary Blood Lead Level (5-<10 µg/dL and 10-<15 µg/dL), 2015-2019 (*2019 data are through May) 80% 60% 40% 70% 78% 77% 70% 60% 28% 37% 41% 37% 37% 2018 2019* 20% 0% 2015 2016 5-<10 µg/dL Venous Confirmation Rate 2017 10-<15 µg/dL Venous Confirmation Rate