Lead poisoning remains one of the most common and preventable pediatric environmental conditions even though the United States (US) has made great strides in reducing the number of children with elevated blood lead levels. One objective of Healthy People 2010 is to eliminate blood lead levels (BLLs) >10 g/ dL among the nation's children. US children living in poorly maintained housing built before 1978 are at greatest risk for elevated BLLs because of their frequent exposure to lead-based paint and lead-contaminated house dust and soil.
The prevalence of elevated blood lead levels (i.e., BLLs >10 g/dL) among newly resettled refugee children is substantially higher than the 2.2% prevalence for US children.

# Background:
New Hampshire requires blood lead screening of newly arrived refugee children aged 6 months to 16 years. Beginning in May 2004, 242 refugee children, predominately from Africa, were resettled to New Hampshire. Of these, 96 children were tested twice for BLLs. The first blood lead samples were collected within 90 days of the children's arrival, and the second samples were collected 3 to 6 months after their resettlement. Most of the children had initial capillary BLLs 10 g/dL; as did 5 other children who were siblings of cases (range: 11 to 73 g/dL). Eleven of the recently resettled families had at least one child with a BLL >20 g/dL. Environmental investigations revealed moderate lead hazards within the residences of the children as well as lead-contaminated soil in play areas frequented by the children. The children with elevated BLLs also showed evidence of extreme chronic malnutrition. Health examinations before arriving in the US indicated that 16 (37.2%) of the children had severe growth retardation (Height per Age Z-score <2; or approximately the second percentile on the standard pediatric growth curve) and, of the 40 children for whom weight was measured, 10 (25%) had evidence of failure to gain weight or of loss of weight (Weight per Height Z-score <2; or approximately the second percentile on the standard pediatric growth curve).

# Recommendations: Primary Prevention of Elevated Blood Lead Levels
Ideally all children would live in lead-safe housing, especially those whose nutritional status and lack of knowledge about the dangers of lead place them at great risk for lead poisoning. However, we recommend the following to reduce the risk of lead exposure in refugee children: 2. Repeat BLL testing of all refugee children 6 months to 6 years 3 to 6 months after refugee children are placed in permanent residences and older children, if warranted, regardless of initial test results.
- Children who mouth or eat non-food items, especially soil, which is common among certain refugee populations, are at risk for lead poisoning, regardless of the age of their housing. - The New Hampshire case study demonstrates that although some children had elevated BLLs when they arrived in the US, the majority of the children did not. The follow-up screening which was conducted on average 60 to 90 days after the placement of the children in the state and in their permanent residences, revealed elevated BLLs that ranged from 11 to 72 g/dL. - The refugee status for most of the children entitles them to Medicaid, WIC, and other social services for at least 8 months after their resettlement, regardless of family financial status.