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Notes from the Field: Outbreak of Acute Lead Poisoning Among Children Aged <5 Years --- Zamfara, Nigeria, 2010

On May 8, 2010, the Nigerian Federal Ministry of Health assembled federal, state, and international organizations to investigate reports of death from lead poisoning in at least six villages in Zamfara, Nigeria. Participating organizations included CDC, the Nigerian Field Epidemiology and Laboratory Training Program, World Health Organization (WHO), and Medecins Sans Frontieres (MSF). Eight days later, on May 16, 2010, a multidisciplinary team began an investigation in two affected villages, including administering a house-to-house questionnaire, collecting blood from selected children aged <5 years, and analyzing blood and environmental samples for lead.

From May 23 to June 4, 2010, the team surveyed 119 family compounds. In the 12 months beginning May 2009, 118 of 463 (26%) children aged <5 years in the surveyed compounds died; 82% of deaths had occurred within the preceding 6 months. Parents reported that 82% of children who died had convulsions before death, a sign of severe lead poisoning (1). Blood samples collected from 205 living children aged <5 years all revealed lead poisoning (≥10 µg/dL), and 97% of children had levels above the threshold (≥45 µg/dL) for initiating chelation therapy (2). Blood lead concentrations ranged from 33.3 to 445 µg/dL. Two thirds of households reported processing gold ore rich in lead (breaking, grinding, and drying ore) inside family compounds; 76% of households had begun within the preceding 12 months. Lead concentrations in soil and dust ranged from 45 parts per million (ppm) to >100,000 ppm; 85% of family compounds exceeded the U.S. Environmental Protection Agency standard (400 ppm) for areas where children are present (3).

Control measures have included initiating chelation therapy when appropriate, identifying and remediating contaminated areas, developing public health messages, and controlling mining activities. As of July 13, MSF had provided oral chelation therapy to 166 children in a local hospital. Most children have responded well, with convulsions resolving within 1 day of initiating treatment. On June 8, environmental remediation (e.g., removal of contaminated soil) began in two villages. Active case identification in other villages, an assessment of animal health, and discussions about long-term monitoring and support of lead-poisoned children are ongoing.

Reported by

O Biya, MBBS, S Gidado, MBBS, S Haladu, DVM, T Geoffrey, MBBS, P Nguku, MBChB, Nigerian Field Epidemiology and Laboratory Training Program; J Durant, MSPH, Div of Toxicology and Environmental Medicine, Agency for Toxic Substances and Disease Registry; LB Davis, DVM, Div of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (proposed); MJ Brown, ScD, A Neri, MD, Div of Emergency and Environmental Health Svcs, National Center for Environmental Health; C Dooyema, MSN, MPH, YC Lo, MD, EIS officers, CDC.

References

  1. Henretig FM. Lead [Chapter 91]. In: Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, Nelson LS, eds. Goldfrank's toxicologic emergencies. 8th ed. New York, NY: McGraw-Hill; 2006:1308--24.
  2. CDC. Managing elevated blood lead levels among young children: recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention. Atlanta, GA: US Department of Health and Human Services, CDC; 2002. Available at http://www.cdc.gov/nceh/lead/casemanagement/casemanage_main.htm. Accessed July 8, 2010.
  3. Environmental Protection Agency. 73 CFR 745. Lead; renovation, repair, and painting program; lead hazard information pamphlet; notice of availability; final rule. Federal Register 2008;73:21692--769. Available at http://www.epa.gov/fedrgstr/epa-tox/2008/april/day-22/t8141.pdf. Accessed July 8, 2010.

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