Puerto Rico

Social determinants of health can play a key role in the risk of lead exposure. About 41% of Puerto Ricans live below the poverty line, and 55% of housing units were built before the 1978 ban on lead paint in residential housing. Puerto Rico (PR) faces extreme climate events, such as hurricanes and seasonal floods. These result in housing infrastructure deterioration that can increase the risk of lead exposure.

Before 2021, reports of blood lead tests in children were low. An average of 7,300 children with blood lead tests (5% of children under 6 years old) were reported in 2019 and 2021 in PR. Implementing a lead surveillance system in PR would help healthcare providers report cases of childhood lead poisoning. Outreach was also needed to educate the public, parents and caregivers, healthcare providers, and partners about lead exposure, prevention, and the importance of blood lead testing.

In September 2021, the PR Department of Health (PRDOH) established a comprehensive childhood lead poisoning prevention and surveillance program for children with a blood lead level above 3.5 µg/dL. PRDOH collaborated with 14 key partners, including the U.S. Environmental Protection Agency, the PR Women, Infants and Children Program, the PR Department of Housing and Urban Development, and the American Academy of Pediatrics’ PR Chapter. These partners formed a Lead Advisory Committee to ensure changes, sustainability, and action. Furthermore, parents and caregivers are being educated on lead poisoning prevention, potential sources of lead exposure (residence, hobbies, or occupations), and how to track a child’s developmental milestones. Also, the PRDOH system uses social media to share information about recalls of lead-contaminated products.

Following the implementation of the surveillance system in late 2021, blood lead tests among children had a two-fold increase resulting in 16,245 reports (11% of children younger than 6 years old) in 2022.