Elevated blood lead levels (EBLLs), or
blood lead levels (BLLs) $10 mg/dL
affect ∼1% of children in the United
States. Neurocognitive effects range
from subtle declines in IQ to clinically
evident lead poisoning, including encephalopathy,
coma, and death.1 Other
sequelae in children may include
delayed sexual maturation, behavioral
and dental problems, and cardiac
dysregulation.2 Because children ,6
years old are particularly vulnerable to
lead’s neurocognitive effects,3 prevention
efforts in the United States focus
on blood lead testing for at-risk
children aged ,6 years and removal of
environmental exposures (eg, deteriorating
leaded house paint). These and
other efforts, such as phasing out leaded
gasoline, have led to dramatic
declines in EBLL rates among US children.
However, higher EBLL rates are
seen in subpopulations, such as newly
arrived refugees.4 Refugee children
may be exposed to lead in camps or
other overseas locations, and placed in
older housing containing leaded paint
after arrival in the United States. Anemia
and malnutrition, both common
among refugee children,5 increase lead
absorption.6 In 2000, after the death of
a US-resettled refugee child from lead
poisoning,7 The Centers for Disease
Control and Prevention (CDC) recommended
that all refugee children aged
6 months to 16 years have BLL testing
#3 months after arrival, and that
children aged 6 months to 6 years be
retested 3 to 6 months after placement
in permanent housing, regardless of
the initial BLL.8 BLL testing is not typically
conducted in refugee camps;
therefore, the prevalence of and risk
factors for EBLLs among US-bound
children still living in camp settings
have not been described previously.
Since 2007, up to 15 000 Burmese refugees
per year have been resettled in the
United States from camps in Thailand.
In 2008, Refugee Health Coordinators in6 states alerted CDC to a high (13%)
prevalence of EBLLs (CDC, unpublished
data) among resettled Burmese refugee
children. Because these children were
from the same refugee camps, some
lead exposure was suspected to have
occurred before arrival in the United
States. We conducted an investigation
among US-bound children living in 3
refugee camps on the Thailand-Burma
border to identify the prevalence of and
risk factors for EBLLs