Refugees and Other Newcomer Persons Resettled to the United States
Lead poisoning disproportionately impacts refugee and other newcomer children resettled in the United States. Refugee children arriving in the United States have higher blood lead levels (BLL) than U.S.-born children [1,8], though this varies among sub-populations.
Reports suggest that country of origin and country of last residence are strong predictors of BLLs among refugee children [7,8]. Furthermore, in some circumstances these children may experience a rise in BLLs after arriving and resettling in the United States.
Several risk factors put newcomer children who are resettled in the U.S. at a higher risk for lead exposure. These include
Environmental exposure. Newcomer children may be exposed to environmental lead hazards in their country of origin. These hazards include industrial emissions, lead-based paint, and the burning of waste containing lead.
Newcomer children may be exposed to environmental lead hazards from:
- Living near or working in mines, ammunition manufacturing, smelters, or battery recycling facilities.
- Lead-based paint and leaded gasoline have only been recently phased out in much of the world. Newcomer children may currently or have previously lived in areas where high lead levels remain in the soil even in areas where leaded gasoline is no longer widely used.
- Resettling in pre-1978 housing containing lead-based paint after arriving to the U.S.
Cultural practices, traditional medicines, and consumer products. Some cultural practices, traditional medicines, and household and personal use items are associated with increased BLLs, before and after U.S. arrival.
- Refugees and other newcomer populations may use or consume imported products contaminated with lead, such as traditional remedies, herbal supplements, spices, candies with lead in the wrappers, cosmetics, jewelry, and amulets.
- Car batteries used for household electricity outside the U.S., lead-glazed pottery, pewter or brass utensils or cooking pots, pressure cookers, leaded crystal, and chipped or cracked dishes may also be sources of lead exposure [1, 9-11].
Other risk factors. Parents of newcomer children may not know about the risks posed by lead exposure and may not recognize potential sources in their daily lives. Most children with lead in their blood may not have any obvious immediate symptoms. Newcomer children are also more likely to have compromised nutritional status. This includes chronic malnutrition and other moderate to severe health conditions that could increase lead absorption and possible neurological effects.
While some of the above information pertains specifically to refugees, many of these risk factors will be similar for all children arriving from the same countries or regions, regardless of visa type.
Refugees and eligible newcomers receive a range of benefits and services such as a comprehensive domestic medical examination within 90 days of arrival to the United States that screens for a wide range of infectious diseases and non-communicable conditions. As part of the domestic medical screening, healthcare providers might consider evaluating refugee and other eligible newcomer children and pregnant/lactating women for lead exposure, with follow-up testing for specific age groups.
For CDC’s lead screening recommendations for refugees and certain other newcomer infants, children, adolescents, and pregnant and lactating women and girls, refer to Screening for Lead during the Domestic Medical Examination for Newly Arrived Refugees. This guidance was developed by the Immigrant, Refugee, and Migrant Health Branch in collaboration with its Centers of Excellence in Newcomer Health, and external experts in refugee health.
- Pezzi C, Lee D, Kennedy L, Aguirre J, Titus M, Ford R, et. al. Blood Lead Levels Among Resettled Refugee Children in Select US States, 2010-2014. Pediatrics. 2019; 143(5):e20182591.
- CDC. Lead in Spices, Herbal Remedies, and Ceremonial Powders Sampled from Home Investigations for Children with Elevated Blood Lead Levels — North Carolina, [PDF – 131 KB] 2011- 2018. MMWR. 2018; 67(46):1290-1294.
- CDC. Infant Lead Poisoning Associated with Use of Tiro, an Eye Cosmetic from Nigeria – Boston, Massachusetts, 2011. MMWR. 2012; 61(30):574-576.CDC.
- Lead Poisoning in Pregnant Women Who Used Ayurvedic Medications from India — New York City, 2011–2012. MMWR. 2012; 61(33):641-646
- CDC. Death of a Child After Ingestion of a Metallic Charm—Minnesota, 2006. MMWR. 2006; 55(12):340-341.
- CDC. Lead Poisoning Associated with Use of Litargirio—Rhode Island, 2003. MMWR. 2005; 54(9):227-229.
- CDC. Elevated Blood Lead Levels in Refugee Children—New Hampshire, 2003–2004. MMWR. 2005; 54(2):42-46.
Erratum: Vol. 54, No. 2 MMWR. 2005; 54(3):76.
- CDC. Lead Poisoning Associated with Ayurvedic Medications—Five States, 2000–2003. MMWR. 2004; 53(26):582-584.
- CDC. Childhood Lead Poisoning Associated with Tamarind Candy and Folk Remedies—California, 1999–2000. MMWR. 2002; 51(31):684-686.
- CDC. Fatal Pediatric Lead Poisoning—New Hampshire, 2000. MMWR. 2001 50(22):457-459.
- CDC. Elevated Blood Lead Levels Among Internationally Adopted Children—United States, 1998. MMWR. 2000; 49(5):97-100.
- Lead Poisoning Associated with Use of Traditional Ethnic Remedies—United States. MMWR. 1993; 42(27):521-524.
- Screening for Lead during the Domestic Medical Examination for Newly Arrived Refugees – CDC’s lead screening recommendations for all newly arrived refugee infants, children, adolescents, and pregnant and lactating women and girls
- CDC’s Division of Global Migration and Quarantine (DGMQ) – The Division of Global Migration and Quarantine has statutory responsibility to make and enforce regulations necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the United States.
- Office of Global Health Affairs – Provides policy guidance and coordination on refugee health policy issues, in collaboration with Public Health Service operating divisions, the Office of Refugee Resettlement, the Department of State, and others.
- Office of Refugee Resettlement (ORR), Refugee Health Coordinators – ORR plans, develops, and directs implementation of a comprehensive program for domestic refugee and entrant resettlement assistance. The office monitors and evaluates the performance of state and other public and private agencies in administering these programs and supports actions to improve them. State refugee health coordinators in each state can assist with newcomer health issues.
- Office of Lead Hazard Control and Healthy Homes – U.S. Department of Housing and Urban Development (HUD)
- Office of Pollution and Prevention and Toxics – U.S. Environmental Protection Agency (EPA)
- Geltman PL, Brown MJ, and Cochran J. Lead poisoning among refugee children resettled in Massachusetts, 1995 to 1999. Pediatrics. 2001; 108(1):158-62.
- Ritchey MD, Scalia Sucosky M, Jefferies T, et al. Lead poisoning among Burmese refugee children–Indiana 2009. Clin Pediatr (Phila). 2011; 50(7):648-56.
- Eisenberg KW, van Wijngaarden E, Fisher SG, et al. Blood lead levels of refugee children resettled in Massachusetts, 2000 to 2007. Am J Public Health. 2011; 101(1):48-54.
- Raymond JS, Kennedy C, Brown MJ. Blood lead level analysis among refugee children resettled in New Hampshire and Rhode Island. Public Health Nurs. 2013; 30(1):70-9.
- Plotinsky RN, Straetemans M, Wong LY, et al. Risk factors for elevated blood lead levels among African refugee children in New Hampshire, 2004. Environ Res. 2008; 108(3):404-12.
- Hebbar S, Vanderslice R, Simon P, Vallejo ML. Blood levels in refugee children in Rhode Island. [PDF – 200 KB] Med Health R I. 2010; 93(8):254-5.
- Yun K, Matheson J, Payton C, et al. Health Profiles of Newly Arrived Refugee Children in the United States, 2006-2012. Am J Public Health. 2016; 106(1):128-35.
- Seifu S, Tanabe K, Hauck FR. The Prevalence of Elevated Blood Lead Levels in Foreign-Born Refugee Children Upon Arrival to the U.S. and the Adequacy of Follow-up Treatment. J Immigr Minor Health. 2019.
- Mitchell T, Jentes E, Ortega L, et al. Lead poisoning in United States-bound refugee children: Thailand-Burma border, 2009. Pediatrics. 2012; 129(2):e392-9.
- Minnesota Lead Poisoning Prevention Program. Biennial Report to the Legislature. [PDF – 4.16 MB] Minnesota Department of Health, Environmental Health Division; February 2007.
- Haefliger P, Mathieu-Nolf M, Lociciro S, et al. Mass lead intoxication from informal used lead-acid battery recycling in Dakar, Senegal. Environ Health Perspect. 2009; 117(10):1535-40.