Research and analysis

HPR volume 17 issue 1: news (30 January 2023)

Updated 28 December 2023

Lead exposure in children in England: annual report in summary

The UK Health Security Agency (UKHSA) has published the fifth annual report on lead exposure in children in England summarising data from the surveillance of cases of elevated blood lead concentrations reported between 1 January and 31 December 2021.

Early in 2021, a review of the harm of lead exposure in children carried out by Public Health England (1) had recommended a halving of the blood lead public health intervention level for England: from the then 0.48 μmol/L to 0.24μmol/L.

(Where cases of blood lead above the intervention level are identified, Health Protection Teams (HPTs) are required to initiate case management and public health interventions to identify and remove the source of lead.)

As a result, with effect from 5 July 2021, for the purposes of surveillance and public health intervention, a case has been defined as a child, resident in England:

• with a blood lead concentration ≥0.24μmol/L (equivalent to ≥5μg/dl), as detected in a UKAS-accredited biochemistry or toxicology laboratory
• reported to UKHSA for public health intervention
• aged under 16 years at the time of the first elevated blood lead concentration

As expected, the halving of the intervention level during the year resulted in a significant rise in cases being reported to the UKHSA’s Lead Exposure in Children Surveillance System (LEICSS) in 2021: 121 cases of high blood lead concentrations were reported, compared with 35 in 2020.

Nevertheless, in 2021 the main epidemiology trends were the same as in previous reports:

• most cases (86, 72%) were directly notified by participating laboratories; a minority (34, 28%) were notified through other routes
• 31 of the 121 cases reported were notified before the case definition was changed; 90 were reported post case definition change
• the median delay between a specimen being drawn and a case being processed by surveillance was 11 days; in 2020 this delay had been 18 days. This shorter delay suggests that much of the extended delay in 2020 was due to pressures on the health system from the coronavirus (COVID-19) pandemic
• cases were typically 1 to 4 years of age, male, and resident in more deprived areas

Main messages from the report

The key messages and recommendations of the latest annual report are that:

• lead is a persistent environmental contaminant that can have toxic effects even at low blood lead concentrations, although risk is reduced as levels drop
• children exhibiting pica (that is: persistent ingestion of non-nutritive substances at an age where this is developmentally inappropriate) in environments with lead hazards are at highest risk of exposure
• clinicians should be aware of important sources of lead exposure and should identify children most at risk or presenting symptoms or signs of exposure
• cases with a blood lead concentration above the public health intervention level for lead should be notified to HPTs for active public health case management

Reference

1. Public Health England (2021). ‘Evaluation of whether to lower the public health intervention concentration for lead exposure in children’.

Infection reports in this issue

Group A streptococcal infections: seventh update on seasonal activity in England.

Laboratory surveillance of paediatric bloodstream infections and AMR in England: 2017 to 2021.

Laboratory reports of Haemophilus influenzae by age group and serotype, England: annual report for 2021 (and 2020).

Laboratory surveillance of pyogenic and non-pyogenic streptococcal bacteraemia in England: 2021 update.

Chemical and environmental hazards

Lead Exposure in Children Surveillance System (LEICSS) annual report 2022 (summary of 2021 data).

New and updated guidance

Guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings.

UKHSA guidance on the management of scabies cases and outbreaks in long-term care facilities and other closed settings.