Childhood Lead Poisoning from Commercially Manufactured French Ceramic Dinnerware --- New York City, 2003
Lead poisoning adversely affects children worldwide. During 1999--2000, an estimated 434,000 children aged 1--5 years in the United States had elevated blood lead levels (BLLs) >10 µg/dL (1). Glazes found on ceramics, earthenware, bone china, and porcelain often contain lead and are a potential source of lead exposure. Children are especially vulnerable to the neurotoxic effects of lead. Exposures to lead in early childhood can have adverse effects on the developing nervous system, resulting in decreased intelligence and changes in behavior (1). In addition, certain behaviors (e.g., thumb sucking) place children at greater risk for exposure to lead. In 2003, the New York City Department of Health and Mental Hygiene's Lead Poisoning Prevention Program (LPPP), and the Mount Sinai Pediatric Environmental Health Specialty Unit (PEHSU) investigated a case of lead poisoning in a boy aged 20 months. This report summarizes that case investigation, which identified ceramic dinnerware imported from France as the source of lead exposure. This case underscores the susceptibility of children to a toxic exposure associated with 1) the high proportion of time spent in the home and 2) dietary habits that promote exposure to lead leached from ceramic ware.
In July 2002, the patient's lead exposure was first identified when a routine lead screening at age 12 months revealed a BLL of 15 µg/dL, which exceeds CDC's level of concern (>10 µg/dL). Follow-up at age 15 months documented a BLL of 18 µg/dL. The child's pediatrician provided guidance to the child's parents on lead hazards. A private environmental testing company confirmed the absence of lead-based paint in the family's home by using x-ray fluorescence. However, at age 18 months, the child's BLL increased to 23 µg/dL. In February 2003, LPPP completed a comprehensive investigation of the child's home and assessed the child's routine daily activities and physical environment and found no lead paint hazards, although concern was raised by an LPPP investigator about the ceramic dinnerware used regularly by the child. A home lead test (2) was conducted by the family and revealed that the ceramic dinnerware was positive for lead.
In March 2003, the child was referred to Mount Sinai PEHSU for a secondary evaluation. A plate from the dinnerware also was submitted for evaluation, and PEHSU requested assistance from the Food and Drug Administration (FDA) to test the plate. The sample plate appeared to be in good condition and had no visible cracks or signs of wear. The plate was tested for lead by using an FDA protocol, whereby lead is extracted from the food contact surface (3--5). In accordance with this standard protocol, the plate was leached in a 4% acetic acid solution for 24 hours at a temperature of 71.6º F (22.2º C). The amount of lead released was measured by flame atomic absorption spectroscopy. The ceramic plate released 29.6 µg/mL of lead into the leaching solution, a level exceeding the FDA compliance guideline of <3 µg/mL.
The child was home full time and consumed all meals and beverages using the dinnerware. Because of concerns about lead exposure to other family members, BLLs of the child's mother and grandmother also were assessed. Results for both were <5 µg/dL, substantially lower than the child's BLLs. The family was advised to discontinue use of the dinnerware. On follow-up at age 23 months, the child's BLL had decreased to 8 µg/dL.
The particular brand of dinnerware identified in this investigation is no longer sold in the United States. However, plates of this brand are available online and might still be available for sale in discount stores, flea markets, and online auctions. Additional tests will be conducted on plates from the same manufacturer to determine the extent of the problem. A complete listing of dinnerware that has been restricted for importation into the United States is available at http://www.fda.gov/ora/fiars/ora_import_ia5208.html.
Reported by: M Galvez, MD, L Vanable, JA Forman, MD, PJ Landrigan MD, Mount Sinai School of Medicine, New York City; E Akeredolu, MSc, J Leighton, PhD, D Nagin, MPH, New York City Dept of Health and Mental Hygiene Lead Poisoning Prevention Program, New York.
When investigating lead poisonings, examining the most common sources of lead exposure (e.g., occupational exposures or lead-based paint) is a critical first step; after these sources are ruled out, other sources should be investigated. Traditionally, more concern has been raised about the presence of lead glazes in homemade ceramics than in manufactured dinnerware. The case described in this report illustrates how imported, commercially manufactured dinnerware also should be considered as potential sources of lead exposure.
Lead can leach out of ceramic ware when the glaze is improperly fired or when the glaze has broken down because of wear from daily usage, particularly after repeated use in a microwave or dishwasher (6). Chips and cracks in ceramic ware also allow leaching of lead. When lead is released into food and drink from ceramics, hazardous levels can contaminate food substances and expose children and adults to toxic levels. Children's risk for such exposures is compounded by their diets, especially their frequent consumption of acidic juices (e.g., orange and apple juices) that promote leaching of lead from ceramics.
This report is based on data contributed by W Yip, K Simmonds, Northeast Regional Laboratory, Food Chemistry Br, Food and Drug Administration, Jamaica, New York.
- CDC. Surveillance for elevated blood lead levels among children---United States, 1997--2001. In: CDC Surveillance Summaries (September 12). MMWR 2003;52(No. SS-10).
- Sheets RW. Use of home test kits for detection of lead and cadmium in ceramic dinnerware. Sci Total Environ 1998;219:13--9.
- U.S. Food and Drug Administration. Flame Atomic Absorption Spectrometric Determination of Lead and Cadmium Extracted from Ceramic Food Ware. In: Capar SG, ed. FDA Elemental Analysis Manual for Food and Food Related Products. Rockville, Maryland: U.S. Department of Health and Human Services, 2000:1--18.
- American Society for Testing and Materials. Standard Test Method for Lead and Cadmium Extracted from Glazed Ceramic Surfaces. In: Annual Book of ASTM Standards, Volume 15.02, Glass, Ceramic Whitewares, Standard Designation C738-94. West Conshohocken, Pennsylvania: American Society for Testing and Materials, 1997.
- AOAC International. Lead and Cadmium Extracted from Ceramicware: Official Methods of Analysis of AOAC International, 16th ed., 3rd Revision, Method 973.32. Gaithersburg, Maryland: AOAC International, 1997.
- Wallace DM, Kalman DA. Hazardous lead release from glazed dinnerware: a cautionary note. Sci Total Environ 1985;44:289--92.
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