GET AHEAD OF LEAD
Our Community Support Specialist will be in neighborhoods talking with home owners and residents about lead and to offer free assessments and a free swag bag full of information and gifts.
If you are interested in making an appointment for a free home assessment where the inspector will test the water line, check for chipped paint, and to take air samples please call our office at 800-618-8582 x 89 or ask for Michael Johnson.
Lead as a neurotoxin
Lead is a known neurotoxin and a serious threat to public health, particularly to young children and pregnant women. The
health effects of lead are well known. Lead impairs brain development and children under the age of six are particularly
vulnerable to its effects. At extremely high levels of lead exposure, which are rare in the United States and Allegheny
County, lead can cause seizures, coma, and even death.
There is no safe lead level in children, with even low levels of blood lead showing an effect on a child’s IQ, ability to pay
attention, academic achievement, and other behavioral issues. Lead exposure from any source contributes to the lead
burden for children. Blood lead levels, a measure of children’s exposure, have declined steadily, both nationally and
locally, as society has passed major legislation to reduce sources of exposure, including removing lead from gasoline, paint,
and plumbing fixtures. However, historical use of lead means that existing sources remain a threat. The greatest source
of lead exposure is lead-based paint in older houses that can chip, peel, flake, and become dust. Lead can also be found
in water pipes and solder, and in some toys, jewelry, cosmetics, imported candies and other imported consumer products.
Sources of Lead in Allegheny County
A recent Allegheny County Lead Task Force Report provided extensive information on sources of harmful lead exposure
in our County --
d-Task-Force-Report-Dec2017.pdf. Those sources of harmful lead exposure include:
Lead had been used in paint for many years. Adding lead created a highly durable and washable paint, which was desirable
for use as both an interior and exterior paint. It was banned from use in residential paint by the Consumer Product Safety
Commission in 1978. More than 80% of the Allegheny County homes were built before 1978 and 40% of homes were built
before 1950. In Pittsburgh, more than 60% of homes were built prior to 1950, and over 85% were built before 1978.
Peeling or flaking lead paint and household dust that contains lead accounts for up to 80% of elevated lead levels in US
children. Houses built before 1950 usually contain the most lead paint.
Lead can be present in water when it is transported from water treatment facilities to homes through pipes that contain
lead, or when it travels within the home through plumbing fixtures that contain lead. Historically, lead was commonly
used in plumbing pipes and fixtures. The federal government included language to the Safe Drinking Water Act in 1986 to
reduce the amount of lead used in residential and commercial plumbing.
a b Lead is no longer used in plumbing but lead
pipes and fixtures can still be found in older homes and many water systems still have lead water pipes.
Lead is a naturally occurring element. However, it may be present in soil at higher concentrations due to known sources
of contamination. Although the phase out of leaded gasoline began in 1975, it was not totally banned in the United
States until 1996. Emissions from vehicles powered by leaded gasoline would often settle in soil around garages, alleys,
and busy intersections. Runoff from these areas has transported lead to the edges of properties. Lead was also found in
emissions from some industrial sources.
Lead paint can also enter the soil through demolition debris which could be buried or left in abandoned properties. This
usually results in higher concentrations of lead-contaminated soil in the center of properties. Lead can also enter soil
around the edges of the house due to paint chips falling to the ground and years of unsafe scraping and sanding exterior
house paint when preparing to apply new coats of paint. The so-called “drip line” usually extends 2-3 feet out from the
foundation wall of the house.
Federal standards control air emissions of lead from industrial facilities. In the past they were less stringent than today,
resulting in areas with higher concentrations of lead in soil surrounding specific facilities. Due to the unique topography
of Allegheny County, both industrial emissions and gasoline emissions tended to settle near the points of emission,
rather than blowing further away. Industrial sources in valleys, for example, could be expected to have higher
concentrations of lead in the soil than sources in higher elevations and more open areas. Today, the Federal Clean Air
Standards include lead as one of the six criteria pollutants that is monitored by the ACHD Air Quality Program.
Some occupations and hobbies may increase a person’s risk to lead exposure. Lead dust can linger on clothing, hair, and
hands, so it is important for parents to use caution so that lead is not accidentally brought into the home. Home
contractors, painters, and people working on home remodeling projects are at an increased risk to encounter lead, as are
people repairing vehicles, performing metal work, and welding. Working on electronics repair and jewelry repair may also
expose a person to lead. Alternative sources such as candy, jewelry, ceramics, some herbs and medicinal remedies,
cosmetics, and other consumer products from foreign countries where lead content is not regulated can make their way
to the United States. These alternative sources are important to identify and report to the Consumer Product Safety
Venous Blood Test
Venous blood tests draw blood from the child’ vein to test for the presence of lead. The results for venous lead tests are
considered the most accurate method for confirming a child’s blood lead levels.
Capillary Blood Test
Capillary, or “finger prick”, tests are preliminary tests that can accurately identify if a child does not have an elevated blood
lead level. However, since capillary tests can include trace amounts of lead from the exterior surface of the child’s finger
in the results, this test may overestimate the amount of lead absorbed by the child. If a capillary test returns an elevated
level, the child must also have a follow-up venous blood test to confirm the result within 1 to 84 days of the capillary test.
Confirmed Blood Lead Level
The Allegheny County Health Department considers blood lead level results from all venous blood tests as confirmed and
considers blood lead level results less than 5 µg/dL from capillary blood tests as confirmed. Capillary blood tests can
register lead levels higher than, but not lower than, actual blood lead levels; therefore, capillary blood tests can be used
to confirm a low blood lead level.
Elevated Blood Lead Levels
The Allegheny County Health Department currently treats confirmed blood lead level tests with 5 µg/dL or more of lead
as elevated. This measurement is based on the Centers for Disease Control and Prevention’s reference level for public
health action, established in May 2012.
Population of Interest
Children under six years of age are both at the highest risk for absorbing lead from their environment and most
susceptible to the long-term harm caused by lead absorption.
Hand to mouth behavior
Young children explore their environments in ways that make them more susceptible to lead absorption. By
putting objects in their mouths, touching surfaces and then placing their fingers in the mouths, etc., young children
in environments with lead present are at risk for ingesting lead.
A person’s brain rapidly develops during childhood, with their brain reaching approximately 90% of adult size by
six years of age. Lead absorption effects cognitive development, putting children less than six years of age at risk
for permanent changes in their brain’s growth.
Allegheny County Testing
Number of children less than six years of age tested over time
The Allegheny County Council approved a regulation in July 2017 to require county-wide universal childhood blood lead
testing for children under six years of age. The regulation was publicly discussed in the summer and fall before going into
effect on January 1, 2018. This period coincided with a sizable increase in the number of children less than six years of age
being tested for blood lead in Allegheny County, surpassing 2016’s tested count by almost 3,000 children. The blood lead
testing rate for children under six years of age continued to increase in the first quarter of 2018 (5,848 children tested
between January 1 and March 31), putting the county on pace for more than 23,000 unique children being tested for the
Figure 1: The
number of unique Allegheny County children under six years of age tested for blood lead levels by year. Testing numbers did not fluctuate a lot
between 2011 and 2016 but increased by almost 3,000 between 2016 and 2017—the same time that the universal childhood blood lead testing
regulation came into effect and was publicly discussed. This growth in testing has continued through the first three months of 2018.
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 pace
Number of Children Tested
Year of Test
Allegheny County Children (< 72 months) Tested for Blood Lead by Year
Number of children between nine and 14 months of age tested over time
The universal childhood blood lead testing regulation required all county children to have their first blood lead test
between nine months of age and their first birthday (measured specifically between 270 days and 412 days of age
consistent with Early Periodic Screening Diagnosis and Treatment measurement standards). The proportion of children
born in Allegheny County that were tested in this age range increased each year since 2009, surpassing 50% of children
born in the year 2016. Most children born in 2016 reached this age range in 2017, which is when public discussion of
childhood lead exposure was a popular local topic and the universal childhood blood lead testing regulation was passed.
Allegheny County Health Department’s goal is to have as many children as possible tested by their first birthday, and then
tested again near the date of their second birthday.
Figure 2: The percent of Allegheny County children tested for blood lead between the ages of 270 days and 412 days (corresponding to 9 months and
12 months of age) by birth year. This period in a child’s life is the first blood lead testing requirement established in the County’s universal testing
Blood lead levels over time
The geometric mean blood lead level—which represents the average concentration of lead in blood, for children less than
6 years of age in Allegheny County decreased each year from 2009 to 2014 but then increased in 2015 and again in 2016.
However, coinciding with increased testing of children, 2017 saw a significant decrease in the geometric BLL for county
children and continued to decrease in the first quarter of 2018. The values used to compute the annual geometric means
were all venous and all confirmed capillary blood lead tests (either an unelevated capillary test or a capillary test
administered between 1 and 84 days following an elevated capillary test) for all Allegheny County children less than six
years old. Blood test results below detection limits were treated as having a result equal to one-half of the specified
detection limit. Most test reports for Allegheny County children with undetectable blood lead had a detection limit of 3
or 3.3 µg/dL.
The confirmed rate of elevated blood lead level for children under six in Allegheny County decreased from ≥ 6% in 2009 and
2010 to 2.1% in 2016 and 2017. This reflects the county trend for lower average childhood blood lead levels. Confirmed tests
are venous blood draws, capillary blood tests below the elevated level (5 µg/dL), or a second capillary blood test (elevated or
not) within 84 days of an elevated capillary blood test but not on the same day as the first test.
The Allegheny County regions with the highest rates of children tested with elevated blood lead levels between 2013
and 2017 were in the Northeast corner of the county, the Mon Valley, the Southern tip of the county, and
neighborhoods directly North, South, and West of downtown Pittsburgh.
Changes in unconfirmed capillary tests
A child with a capillary lead test ≥ 5 µg/dL must have their blood lead level confirmed with a venous blood test within 84
days but not on the same day as the elevated capillary test. The level of concern was previously 10 µg/dL but the CDC
changed this number in 2012. The proportion of Allegheny County children with capillary tests ≥ 5 µg/dL that did not have
a venous confirmation test in the specified time frame decreased from nearly 9% in 2009 to 2.4% in 2015, while it has
stabilized ever since. Until 2012, CDC considered 10 µg/dL the level of concern; those with blood lead levels between 5
and 9 in the years 2009 – 2011 reflect children that were not considered as having an unconfirmed elevated capillary test
at the time.
The regions with highest rates of unconfirmed elevated blood lead capillary tests were in the neighborhoods directly North
and South of Downtown Pittsburgh, the Mon Valley, and several isolated pockets throughout the county.
Prior to the Allegheny County regulation requiring childhood lead testing at ages 9-12 months and 24 months, elevated
capillary tests were considered confirmed with a venous test or a second capillary test in the aforementioned time frame
(1-84 days after the first test) according to the Council for State and Territorial Epidemiologist (CSTE) definition. Using 5
µg/dL as the elevated reference value and either a capillary or venous test as sufficient for confirmation yields a decline
from 8.6% unconfirmed in 2009 to 1.9% in 2017.
The rates of children with unconfirmed elevated capillary blood lead tests stayed relatively stable from 2010-2016. Since
2016, the number of elevated capillary blood lead tests that were confirmed has steadily increased. This indicates that there
has been a recent increase in awareness of childhood blood lead among both our medical providers and the community.
Validity of capillary tests
Capillary lead tests are a screening test for elevated blood lead. If the reported concentration is less than 5 ug/dL, the
child does not have an elevated level of lead in their blood. However, if the capillary test result is 5 and over, it may
indicate elevated lead. However, there is a good chance that it is falsely high, sometimes called a “false positive.”
Locally the Allegheny County Health Department compared the percentage of elevated capillary blood lead tests with
the percentage of elevated venous blood lead tests that were used as a confirmation. These venous tests occurred
between 1 and 84 days after the elevated capillary test and are required to confirm that a child’s actual blood lead level
is elevated. Venous confirmation tests only revealed an elevated blood lead level about 40% of the time; demonstrating
a 60% falsely elevated blood lead level with a capillary test. This rate is consistent with literature on the subject.
Table 1: Capillary versus venous testing
Year Initial Capillary
Tests ≥ 5 µg/dL
2012 812 166 81 48.8%
2013 750 167 70 41.9%
2014 680 179 79 44.1%
2015 521 153 76 49.7%
2016 524 125 52 41.6%
2017 652 186 74 39.8%
Number of investigations done, number of families that refused
For children identified with a confirmed elevated blood lead level and documented in the Pennsylvania National
Electronic Disease Surveillance System (PA-NEDSS) the ACHD Bureau of Environmental Health, Housing Division
performs outreach with a home investigation to find and help mitigate sources of lead. These investigations include the
use of X-ray fluorescence technology, dust and soil analysis, and water tests to determine sources of lead in the
environment during the inspection. The childhood lead level that triggers a home inspection has decreased over time, in
part due to resources and more recently to conform with CDC reference levels. Two new inspectors were added to the
Division in March 2018 which allowed home inspections to begin for children with blood lead levels of ≥ 5ug/dL. Owner
Occupants are educated to mitigate and eliminate the identified lead hazards. For tenant occupied properties, landlords
are required to eliminate hazards. A notice of violation with a specified compliance time to correct violations is sent to
the landlord. The number of home inspections conducted since 2010, and the threshold for inspection follows in Table 2.
Lead in Water
The Pennsylvania Department of Environmental Protection (DEP) is the regulatory authority for the federal lead and
copper rule (LCR), and only DEP has the authority to require corrective action or to issue penalties due to exceedance or
violations of the rule. The federal LCR rule requires the public water system itself to test water for lead every three years
by requesting that homeowners and tenants voluntarily obtain samples in their homes. If its results exceed the federal yestablished action level, the system must then implement measures to decrease those levels. These actions include
revisiting its corrosion control methodology, providing public education, increasing the lead testing intervals, and replacing
a percentage of lead services lines. Currently, that LCR action level is at 15 ppb. Some systems have also voluntarily taken
additional actions such as providing filters, ceasing partial line replacements and replacing the private side of the line
(owned by the homeowner).
Allegheny County has 42 public water suppliers. Since 2001, 5 water systems have exceeded the Lead and Copper Rule:
Reserve Township Water Department in 2017, Pittsburgh Water and Sewer Authority, East Deer Township Water
Department, and Braddock Borough Water Authority all in 2016, and West View Borough Municipal Authority in 2010.
Both Reserve and Pittsburgh Water and Sewer Authority are currently under corrective action requirements.
ACHD Lead Activities
Today, ACHD’s comprehensive lead strategy has three main parts: tracking information on lead exposure (surveillance),
education and primary prevention, and intervention. This is a brief review of actions taken to date. ACHD is committed
to expanding efforts for prevention and intervention as resources become available. Current lead activities include:
ACHD monitors children’s elevated blood lead levels (EBLLs) in real time by extracting data from the PA NEDSS system
directly. By linking data from birth certificates to data from the PA NEDSS system ACHD can examine exposure over time
and identify community patterns using ArcGIS mapping. It also allows ACHD to determine the percent of children who
received lead testing on time, what type they received, the number of unconfirmed capillary tests, and trends in all
Prevention and Education
ACHD launched its “Get Ahead of Lead Campaign” last year with information available to families in multiple languages.
Information such as the “lead prevention brochure” is also available for pediatric providers, parents, day care providers,
school nurses and others who interface with children and families. ACHD also funded ten community organizations to
help in this education effort especially in higher risk communities, including Circles of Greater Pittsburgh – Mon Valley,
Clairton Cares, Inc., Consumer Health Coalition, Environmental Occupational & Public Health Consultants Inc. – EOPHC,
Homewood Children’s Village, Perry Hilltop Citizens Council, Opening Doors for Youth & Families, United Somali Bantu
Community of Greater Pittsburgh, Women for a Healthy Environment and Youth Enrichment Services.
ACHD’s Safe and Healthy Homes Program (SHHP)is available to anyone who meets income requirements and has either
a child under 22 years of age or a pregnant woman residing in the home. The SHHP Program provides free in-home
health and safety assessments to qualified participants in Allegheny County as well as Beaver, Washington, and
Westmoreland counties, including a visual assessment of potential lead-based paint hazards.
For children under 6 years of age with a confirmed blood lead level of 5 µg/dl and above, ACHD offers a free home
inspection. The goal of this inspection, along with XRF readings, sampling of dust, soil, and water, is to help identify any
sources of lead exposure in the home. The inspection includes identifying possible alternative sources of lead exposure
from jewelry, toys, cosmetics, parent occupations and/or hobbies. Inspectors also educate the family about how good
nutrition can mitigate absorption of lead and immediate steps the family can take to reduce lead exposure in the home.
ACHD also offers free lead testing for the uninsured or under insured at its Immunization clinic site
https://alleghenycounty.us/Health-Department/Health-Services/Infectious-Disease-Immunization Program/Immunization-Clinic.aspx and its McKeesport WIC sites.
For homes built before 1978 and undergoing renovation work that will disturb painted surfaces, it is important that the
work be performed by an EPA-certified renovator to reduce the risk of exposing the occupants to lead dust.
The Allegheny Lead Safe Homes Program currently provides free home repairs to keep families safe from lead paint. This
program will test for lead-based paint in the home and will aid with repairs and prevention education to Allegheny
County homeowners or renters who meet income requirements and whose home is built before 1978. All work is done
in a lead-safe manner. Eligible residents must either have a child under 6 years or a pregnant woman in the household.
Community Support Specialist
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