Florida

About the program

The State of Florida received $499,959 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 Florida, contact the program below.

Florida Department of Health

Lead Poisoning Prevention Program

4052 Bald Cypress Way

Tallahassee, FL 32399

Phone: 850-245-4401

Success story: funding year 3

Florida lead poisoning prevention program narrows the gap in testing children at higher risk of lead exposure

Challenge

Head Start students who are unable to get a blood lead testing at their local primary care provider's office often receive a test at their local Head Start program to meet the Centers for Medicare and Medicaid Services requirement. Some Head Start programs in Florida were unable to provide blood lead testing due to low resources following the COVID-19 pandemic. Head Start programs serve many children younger than age six years who live in ZIP codes where a larger proportion of homes were built before 1978, when the federal government banned lead in residential paint. Additionally, children in the program are predominantly African American and live with families who have lower incomes. For example, Hillsborough County has the second highest number of lead poisoning cases in Florida. Most of the county's Head Start programs are in or near ZIP Codes considered high risk for lead poisoning because of the proportion of people living in pre-1978 housing, living in poverty, and who are younger than age six years. A Florida Environmental Public Health Tracking Program (EPHT) analysis of 2022 lead poisoning case data found three ZIP Codes with the highest number of cases.

Intervention

The Lead Poisoning Prevention Program (LPPP) in Hillsborough County partnered with EPHT to buy point-of-care blood lead testing machines for 19 Head Start centers. LPPP organizers held weekly blood lead testing events from May through July 2023, to check Head Start-enrolled children outside of a clinical setting who might have otherwise missed testing.

Impact

The LPPP in Hillsborough County tested 156 children between May 19, 2023, and July 5, 2023. Although the program was able to test children and close the gaps, some children were still missed due to school absences during the summer or inability to get parental consent on time. On January 22, 2024, LPPP in Hillsborough County began testing children in high-risk ZIP codes where Head Start centers do not exist. They will also train other county health departments to implement a similar structure to test additional children who may not be able to receive a blood lead test at their health care provider's office.

Funding for this work was made possible in part by [CDC-RFA-EH21-2102] from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 2

Using an electronic lab reporting (ELR) web-based portal in Florida to increase blood lead test result reporting.

Challenge

Each year, the Florida Lead Poisoning Prevention Program (LPPP) receives an estimated 270,000 blood lead results from healthcare providers, hospitals, and laboratories. Blood lead level (BLL) results are received by electronic lab reporting (ELR), Excel files via secure email, and paper-based faxes. Data received via ELR are directly uploaded into Florida’s reportable disease and condition surveillance system, Merlin. Excel files are reformatted and uploaded into Merlin, whereas paper-based results are manually entered. Data in ELR are used to auto generate lead poisoning cases for BLLs ≥3.5 µg/dL. BLLs <3.5 µg/dL are classified as “not a case” and are stored and managed in Merlin. Due to limited funding, delays in reporting occur because results need to be manually entered. As a result, surveillance trends may not indicate the true burden of lead poisoning in Florida.

Intervention

To streamline data reporting and improve the quality, quantity, and efficiency of BLLs reported, LPPP implemented an ELR web portal in May 2021. The portal standardizes the reporting of blood lead data. This online reporting portal supports both manual data entry and batch data uploads via csv files. The objective of this portal is to transition LPPP away from paper-based data faxing and non-ELR. Reporting blood lead data via the ELR portal improves data quality and allows county health departments to quickly initiate case management services.

Impact

Since the launch of the ELR portal, 317 facilities have been onboarded. They have reported 18,531 blood lead results from 2021–2022. Their reports have triggered the detection of 41 cases of lead poisoning in 2021 and 847 cases in 2022. The portal has assisted in standardizing BLL results. State- and county-level personnel are tracking the number of providers transitioning to electronic reporting. LPPP continues to increase the numbers of providers reporting on the ELR portal in 2023.

Funding for this work was made possible in part by CDC-RFA-EH21-2102 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

Strengthening Florida's surveillance and improving data access to reduce gaps in lead screening

Challenge

All blood lead level (BLL) results are reportable in Florida; however, only results associated with lead poisoning levels meeting the state case definition (BLL ≥10 μg/dL) have been historically stored and managed within the state’s reportable disease surveillance application, called Merlin. Non-identifiable screening results that do not meet the surveillance case definition have been housed in a separate electronic laboratory reporting (ELR) database that few people are able to access. Analyzing and characterizing lead screening data has been extremely difficult due to the structure of the databases, the need to combine data from multiple databases (Merlin and ELR), and the inherent difficulties with de-duplicating records. This approach has made it challenging to access data at the county level to identify gaps in screening.

Intervention

In 2017, Florida implemented system enhancements in Merlin to automate processing and create records of all BLL results. All laboratory results received either create an identifiable record within Merlin or are associated with an existing person-centric record without user intervention. Sophisticated matching algorithms within Merlin that were developed and fine-tuned over years can now be used for person matching of all BLL results. When a person-centric record is created, the system assigns a case classification of “confirmed,” “suspect,” or “not a case” based on the laboratory results associated with the record. Any record determined to be “not a case” is automatically closed in the system without any end-user involvement. BLLs between 5 μg/dL and 10 μg/dL can be counted as a confirmed or suspect case, but the system closes the case without requiring end-user involvement. However, end users can access and view these cases if they choose to do additional follow-up.

Impact

Improvements to Merlin enable effective tracking of children over time, as well as increase the ability to estimate the number of children screened, rather than just the number of screening tests performed. These system enhancements have allowed for back-loading of previous years' data and the creation of 723,692 person-centric records with 1,068,564 laboratory results. Staff members are currently working on entering all previous data. Since any Merlin user can now access these records to better assess lead screening practices in their counties, the time to respond to data requests from the public has decreased from days to hours. Florida was able to use these data to characterize screening rates to identify and address gaps.

Funding for this work was made possible in part by NUE2EH001356 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.