Colorado

About the program

The State of Colorado received $500,000 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in FY 2022. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2022, to September 29, 2023.

The strategies focus on:

• Ensuring blood lead testing and reporting
• Enhancing blood lead surveillance
• Improving linkages to recommended services

To learn more about these efforts in Colorado, contact the program below.

Colorado Department of Public Health and Environment

4300 E Cherry Creek South Dr.

Denver, CO 80246

Phone: 303-692-2000

Success story: funding year 2

Colorado detects cluster of lead-poisoned children

Challenge

Being able to rapidly detect a cluster of children with blood lead levels (BLLs) higher than CDC's blood lead reference value (BLRV) of 3.5 μg/dL can help identify previously unknown sources of lead exposure and guide public health interventions at the local level. Prior to 2020, Colorado did not have the ability to detect clusters of increased rates of BLLs.

However, changes in BLL rates can be caused by random patterns in the data, seasonal variation, and trends over time. Under these circumstances, determining if an increase in the rate of higher BLLs is likely random or when it might indicate an unknown or emerging source of lead exposure is difficult. Furthermore, lead exposures are almost never uniform across a city.

Intervention

The Colorado Childhood Lead Poisoning Prevention Program (CCLPPP) developed a statistical tool in 2020 to detect changes in the rates of higher BLLs in children. The tool combines a statistical model of the number of BLLs at or above the BLRV (cases) in each census tract with a mathematical function that compares the observed and expected number of cases.

CCLPPP tested the statistical tool by measuring how quickly it could detect a simulated cluster of cases. The simulated clusters varied in where they were located, how big an area they affected, and how severe they were. The statistical tool developed by CCLPPP detected these clusters in an average of 9 months. Larger, more severe clusters were usually detected in less than 6 months.

The statistical tool was developed into a computer program that CCLPPP personnel can run as part of their routine work to automatically generate a report if a potential cluster of cases is identified.

Impact

CCLPPP has been running this tool quarterly since July 2020. On April 11, 2022, the tool detected a cluster for the first time. CCLPPP data analysts worked with the community care coordinator to analyze the results and found that the cluster was among populations of refugees/newcomers being resettled in Colorado. The cluster identified 38 children with BLLs at or above the BLRV. CCLPPP worked quickly to connect with the Refugee Health Program at the Colorado Department of Public Health and Environment to ensure the appropriate steps were taken for follow-up care. The cluster was identified based on temporary patient addresses, as all newcomers are initially housed at a hotel near the airport after they arrive in Denver.

CCLPPP is working with the Refugee Program to finalize a data sharing agreement that will allow the two programs to share data to ensure cases of lead poisoning in refugees/newcomers are identified and responded to quickly. Additionally, this cluster identified gaps in the cluster response protocol, and CCLPPP is working to address these gaps by developing updated guidance documents.

Funding for this work was made possible in part by NUE2EH001459 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 1

Colorado updates blood lead level screening guidelines and reporting requirements

Challenge

The Colorado Childhood Lead Program Prevention Program (CO CLPPP) sought to update lead screening recommendations to ensure providers were screening individuals at high risk for lead poisoning and reporting all blood lead test results to the state.

Intervention

In 2018, CO CLPPP developed a workgroup composed of Colorado healthcare providers and public health professionals to update lead screening recommendations. CO CLPPP personnel researched the efficacy of various lead screening guidelines throughout the United States and determined the best methods to target at-risk populations. CO CLPPP recommended targeted testing based on a risk-based questionnaire. If the questionnaire indicates a high risk, children should receive blood lead testing at 12 months and 24 months of age.

CO CLPPP prepared a proposal for the Colorado Board of Health to update the blood lead reporting level. For individuals up to 18 years of age, the timeframe for reporting blood lead levels (BLLs) ≥5 micrograms per deciliter (µg/dL) is 7 days and the timeframe for reporting BLLs <5 µg/dL is 30 days.

Impact

CO CLPPP presented the proposal at the May 2018 meeting of the Board of Health and it was passed unanimously.

CO CLPPP published three documents on the updated lead screening guidelines which were disseminated to 3,051 recipients including all local public health agencies and provider associations in the state. They also conducted 31 educational outreach activities reaching 8,681 individuals. CO CLPPP was able to refer 363 children with elevated BLLs for appropriate services.

Funding for this work was made possible in part by NUE2EH001373 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.