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In 1997, the CDC recommended
that state health officials develop a statewide plan for childhood lead
poisoning screening by convening an inclusive planning committee. This
recommendation entailed a move away from the CDC's previous recommendation for
universal screening of all children to a risk-based approach to screening. CDC
suggested that targeted screening of high-risk children might be appropriate
under certain conditions. Nationally, blood lead levels continue to decline,
offering the hope that lead poisoning can be eliminated in the not too distant
future. Yet, some children continue to be exposed to this toxicant at an
unacceptable rate. The purpose of this state plan is to increase the screening
and follow-up care of children who most need these services and to ensure that
screening is appropriate for local conditions. In November 1998, the ADHS Office
of Environmental Health's Childhood Lead Poisoning Prevention Program formed a
coalition to develop a statewide lead poisoning screening policy. The coalition
is comprised of physicians, managed care organizations, members of the
community, county health departments, local, state, tribal, and federal
agencies, child advocacy groups, laboratories, and other health professionals.
After four meetings and extensive debate, the coalition recommended, in February
1999, the following universal screening policy for Arizona:
Arizona Childhood Lead Poisoning Screening
Policy
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All children in Arizona should receive
at
least one venous or capillary blood lead test between the ages of 12
and 24 months. Children 25-72 months of age should receive a blood lead
test, if not previously tested.
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Children covered by the Arizona Health
Care Cost Containment System (AHCCCS) and KidsCare should be screened according
to Health Care Financing Agency (HCFA) requirements, as follows: screen
all AHCCCS and KidsCare children at 12 and at 24 months of age;
screen children 36-72 months of age who have not been previously tested.
The policy is a recommendation for all Arizona
health care providers to follow. Unlike the HCFA lead poisoning screening
requirements, this policy does not mandate screening nor are funding resources
for screening provided.
The coalition selected a universal screening
policy, as opposed to a targeted screening policy, for two reasons. First,
there are a variety of lead sources in Arizona, including lead-based paint,
folk medicine and imported pottery. The ubiquitous nature of these sources
makes it difficult to define high risk target populations or geographic
areas. Second, only limited screening data are available for use in characterizing
risks. Only minimal screening of young children has occurred statewide,
mainly through the AHCCCS program. The most recently available data suggest
that only 4% of all young Arizona children have been screened. Further,
non-elevated results are not reportable by law, precluding the estimation
of prevalence rates and at-risk populations. Efforts are underway to change
reporting rules and increase screening compliance. Once lead-poisoning
risks and rates have been more fully characterized among Arizona's children,
the coalition will reconvene to discuss the possibility of amending the
screening policy.
The screening policy does not supplant
AHCCCS and KidsCare requirements that mandate the screening of children
at 12 months and another screen at 24 months. All other children should
be screened between the ages of 12 and 24 months, the ages when children
are most vulnerable to lead poisoning.
The policy calls for blood lead testing.
The coalition encourages the use of fingerstick testing because this type
of draw is less invasive than a venous draw. A venous draw, however, is
more reliable. It should be noted that a positive fingerstick test should
be confirmed with a venous test. The coalition did not recommend the use
of a verbal risk questionnaire in screening children. |
