Lead in Spices, Herbal Remedies, and Ceremonial Powders Sampled from Home Investigations for Children with Elevated Blood Lead Levels - North Carolina, 2011-2018.

The number of pediatric cases of elevated blood lead levels (BLLs) are decreasing in North Carolina. However, one county reported an increase in the number of children with confirmed BLLs ≥5 µg/dL (CDC reference value, https://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm), from 27 in 2013 to 44 in 2017. Many children with elevated BLLs in this county lived in new housing, but samples of spices, herbal remedies, and ceremonial powders from their homes contained high levels of lead. Children with chronic lead exposure might suffer developmental delays and behavioral problems (https://www.cdc.gov/nceh/lead/). In 1978, lead was banned from house paint in the United States (1); however, children might consume spices and herbal remedies daily. To describe the problem of lead in spices, herbal remedies, and ceremonial powders, the North Carolina Childhood Lead Poisoning Prevention Program (NCCLPPP) retrospectively examined properties where spices, herbal remedies, and ceremonial powders were sampled that were investigated during January 2011-January 2018, in response to confirmed elevated BLLs among children. NCCLPPP identified 59 properties (6.0% of all 983 properties where home lead investigations had been conducted) that were investigated in response to elevated BLLs in 61 children. More than one fourth (28.8%) of the spices, herbal remedies, and ceremonial powders sampled from these homes contained ≥1 mg/kg lead. NCCLPPP developed a survey to measure child-specific consumption of these products and record product details for reporting to the Food and Drug Administration (FDA). Lead contamination of spices, herbal remedies, and ceremonial powders might represent an important route of childhood lead exposure, highlighting the need to increase product safety. Setting a national maximum allowable limit for lead in spices and herbal remedies might further reduce the risk for lead exposure from these substances.

Exploration of the effects of classroom humidity levels on teachers' respiratory symptoms.

PURPOSE: Previous studies indicate that teachers have higher asthma prevalence than other non-industrial worker groups. Schools frequently have trouble maintaining indoor relative humidity (RH) within the optimum range (30-50 %) for reducing allergens and irritants. However, the potential relationship between classroom humidity and teachers' health has not been explored. Thus, we examined the relationship between classroom humidity levels and respiratory symptoms among North Carolina teachers. METHODS: Teachers (n = 122) recorded daily symptoms, while data-logging hygrometers recorded classroom RH levels in ten North Carolina schools. We examined effects of indoor humidity on occurrence of symptoms using modified Poisson regression models for correlated binary data. RESULTS: The risk of asthma-like symptoms among teachers with classroom RH >50 % for 5 days was 1.27 (95 % Confidence Interval (CI) 0.81, 2.00) times the risk among the referent (teachers with classroom RH 30-50 %). The risk of cold/allergy symptoms among teachers with classroom RH >50 % for 5 days was 1.06 (95 % CI 0.82, 1.37) times the risk among the referent. Low RH (<30 %) for 5 days was associated with increased risk of asthma-like [risk ratio (RR) = 1.26 (95 % CI 0.73, 2.17)] and cold/allergy symptoms [RR = 1.11 (95 % CI 0.90, 1.37)]. CONCLUSIONS: Our findings suggest that prolonged exposure to high or low classroom RH was associated with modest (but not statistically significant) increases in the risk of respiratory symptoms among teachers.

Lead Levels in Spices From Market Basket and Home Lead Investigation Samples in North Carolina.

OBJECTIVES: Lead investigators in North Carolina found evidence that contaminated spices may contribute to children's elevated blood lead levels. We compared lead levels in samples of spices and other consumable products by country of purchase to inform consumer safety interventions and regulations. METHODS: From February 1, 2011, through October 22, 2020, North Carolina lead investigators sampled spices and other consumable products from 103 homes of children with confirmed elevated blood lead levels. In 2017, the study team purchased 50 products frequently sampled during lead investigations, as a "market basket" sample, from local stores in or near Raleigh, North Carolina. The State Laboratory of Public Health analyzed 423 product samples using mass spectrometry. We extracted environmental sample results from lead investigations from the North Carolina Electronic Lead Surveillance System. RESULTS: The median market basket lead result was 0.07 mg/kg (SD = 0.17); the maximum lead result was 0.88 mg/kg. The median home lead investigation sample result was 0.26 mg/kg (SD = 489.44); the maximum lead result was 6504.00 mg/kg in turmeric purchased in India. Among all samples, products purchased in India had more than triple the median lead levels (0.71 mg/kg) of those purchased in the United States (0.19 mg/kg). CONCLUSIONS: Purchasing spices in the United States is an action that consumers can take that may reduce their lead poisoning risk. Regulatory agencies should consider a lead limit of <1 mg/kg as attainable for spices sold in US stores and for ingredients of any foods that may be consumed by children.

COVID-19 Outbreaks Linked to Workplaces, 23 US Jurisdictions, August-October 2021.

OBJECTIVES: Early in the COVID-19 pandemic, several outbreaks were linked with facilities employing essential workers, such as long-term care facilities and meat and poultry processing facilities. However, timely national data on which workplace settings were experiencing COVID-19 outbreaks were unavailable through routine surveillance systems. We estimated the number of US workplace outbreaks of COVID-19 and identified the types of workplace settings in which they occurred during August-October 2021. METHODS: The Centers for Disease Control and Prevention collected data from health departments on workplace COVID-19 outbreaks from August through October 2021: the number of workplace outbreaks, by workplace setting, and the total number of cases among workers linked to these outbreaks. Health departments also reported the number of workplaces they assisted for outbreak response, COVID-19 testing, vaccine distribution, or consultation on mitigation strategies. RESULTS: Twenty-three health departments reported a total of 12 660 workplace COVID-19 outbreaks. Among the 12 470 workplace types that were documented, 35.9% (n = 4474) of outbreaks occurred in health care settings, 33.4% (n = 4170) in educational settings, and 30.7% (n = 3826) in other work settings, including non-food manufacturing, correctional facilities, social services, retail trade, and food and beverage stores. Eleven health departments that reported 3859 workplace outbreaks provided information about workplace assistance: 3090 (80.1%) instances of assistance involved consultation on COVID-19 mitigation strategies, 1912 (49.5%) involved outbreak response, 436 (11.3%) involved COVID-19 testing, and 185 (4.8%) involved COVID-19 vaccine distribution. CONCLUSIONS: These findings underscore the continued impact of COVID-19 among workers, the potential for work-related transmission, and the need to apply layered prevention strategies recommended by public health officials.

Occupational and Take-home Lead Exposure Among Lead Oxide Manufacturing Employees, North Carolina, 2016.

OBJECTIVE: In 2016, North Carolina blood lead level (BLL) surveillance activities identified elevated BLLs among 3 children exposed to take-home lead by household members employed at a lead oxide manufacturing facility. We characterized BLLs among employees and associated children and identified risk factors for occupational and take-home lead exposure. METHODS: We reviewed BLL surveillance data for 2012-2016 to identify facility employees and associated children. We considered a BLL ≥5 µg/dL elevated for adults and children and compared adult BLLs with regulatory limits and recommended health-based thresholds. We also conducted an environmental investigation and interviewed current employees about exposure controls and cleanup procedures. RESULTS: During 2012-2016, 5 children associated with facility employees had a confirmed BLL ≥5 µg/dL. Among 77 people employed during 2012-2016, median BLLs increased from 22 µg/dL (range, 4-45 µg/dL) in 2012 to 37 µg/dL (range, 16-54 µg/dL) in 2016. All employee BLLs were <60 µg/dL, the national regulatory threshold for immediate medical removal from lead exposure; however, 55 (71%) had a BLL ≥20 µg/dL, a recommended health-based threshold for removal from lead exposure. Because of inadequate controls in the facility, areas considered clean were visibly contaminated with lead dust. Employees reported bringing personal items to work and then into their cars and homes, resulting in take-home lead exposure. CONCLUSIONS: Integration of child and adult BLL surveillance activities identified an occupational source of lead exposure among workers and associated children. Our findings support recent recommendations that implementation of updated lead standards will support better control of lead in the workplace and prevent lead from being carried home.

Inequalities in the nuclear age: impact of race and gender on radiation exposure at the Savannah River Site (1951-1999).

Changes in the workforce during the civil rights movement may have impacted occupational exposures in the United States. We examined Savannah River Site (SRS) employee records (1951-1999) for changes in radiation doses and monitoring practices, by race and sex. Segregation of jobs by race and sex diminished but remained pronounced in recent years. Female workers were less likely than males to be monitored for occupational radiation exposure [odds of being unmonitored = 3.11; 95% CI: (2.79, 3.47)] even after controlling for job and decade of employment. Black workers were more likely than non-black workers to have a detectable radiation dose [OR = 1.36 (95% CI: 1.28, 1.43)]. Female workers have incomplete dose histories that would hinder compensation for illnesses related to occupational exposures. The persistence of job segregation and excess radiation exposures of black workers shows the need for further action to address disparities in occupational opportunities and hazardous exposures in the U. S. South.

NC CATCH: Advancing Public Health Analytics.

The North Carolina Comprehensive Assessment for Tracking Community Health (NC CATCH) is a Web-based analytical system deployed to local public health units and their community partners. The system has the following characteristics: flexible, powerful online analytic processing (OLAP) interface; multiple sources of multidimensional, event-level data fully conformed to common definitions in a data warehouse structure; enabled utilization of available decision support software tools; analytic capabilities distributed and optimized locally with centralized technical infrastructure; two levels of access differentiated by the user (anonymous versus registered) and by the analytical flexibility (Community Profile versus Design Phase); and, an emphasis on user training and feedback. The ability of local public health units to engage in outcomes-based performance measurement will be influenced by continuing access to event-level data, developments in evidence-based practice for improving population health, and the application of information technology-based analytic tools and methods.