
Health care providers play an important role in preventing lead exposure by identifying children who are at risk for lead poisoning. Children who are at high risk for lead exposure should be screened at 12 and 24 months, in accordance with Virginia policy. Women who are pregnant should be educated about sources of lead, and screened if they are at an increased risk for lead exposure. VDH is committed to supporting health care providers with preventing lead poisoning in children across the Commonwealth.
Important Updates
Risk of False Positive Results with Certain Capillary Blood Collection Tubes Used with Magellan Diagnostics LeadCare Testing Systems
The U.S. Food and Drug Administration (FDA) is alerting health care providers and laboratory staff of reports that falsely elevated (false positive) results have occurred when using ASP Global’s RAM Scientific SAFE-T-FILL Micro Capillary Blood Collection tubes with the LeadCare Testing Systems. These tests may overestimate blood lead levels and give inaccurate results when processing capillary blood samples collected in these ASP Global’s RAM Scientific SAFE-T-FILL tubes. The root cause of these false results is not yet known. The FDA is recommending that ASP Global RAM Scientific SAFE-T-FILL tubes not be used with the LeadCare Testing Systems while this issue is being investigated.
Recommendations for Health Care Providers and Facilities, Laboratory Staff, and Patients and Caregivers
- Avoid using ASP Global’s RAM Scientific SAFE-T-FILL Micro Capillary Blood Collection tubes with the LeadCare Testing Systems.
- The capillary collection devices that are provided with the LeadCare Test Systems as well as other third-party capillary blood collection tubes, as described in the instructions for use of LeadCare Testing Systems, can still be used.
- If no alternate capillary blood collection devices are available other than the ASP Global’s RAM Scientific SAFE-T-FILL Micro Capillary Blood Collection tubes, interpret results with caution and consider retesting with a different method or specimen type.
- Follow CDC’s recommendations for confirmatory venous blood testing based on blood lead levels observed in capillary blood lead tests (https://www.cdc.gov/lead-prevention/testing/index.html).
Reporting Problems with Your Device
Health professionals and patients are encouraged to report adverse events or side effects related to the use of ASP Global’s RAM Scientific SAFE-T-FILL Micro Capillary Blood Collection tubes, Magellan Diagnostics LeadCare Testing Systems, or other devices to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:
- Complete and submit the report online.
- Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on form, or submit by fax to 1-800-FDA-0178.
- You can submit voluntary reports through MedWatch, the FDA Safety Information and Adverse Event Reporting program.
- Device manufacturers and user facilities must comply with the applicable Medical Device Reporting (MDR) regulations.
- Health care personnel and clinical laboratory staff employed by facilities that are subject to the FDA's user facility reporting requirements should follow the reporting procedures established by their facilities.
For more information, visit the FDA Safety Communication.
Reference: Food and Drug Administration
Policies
Blood Lead Testing Criteria:
Children in any of the following risk categories should have their blood tested at 12 and 24 months:
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- The child is eligible for or receiving benefits from Medicaid or the Special Supplemental Nutrition Program for Women, Infants and Children (WIC);
- The child is living in or regularly visiting a house, apartment, dwelling, structure, or child care facility built before 1960;
- The child is living in or regularly visiting a house, apartment, dwelling, structure, or child care facility built before 1978 that has (i) peeling or chipping paint or (ii) recent (within the last six months) ongoing or planned renovations;
- The child is living in or regularly visiting a house, apartment, dwelling, or other structure in which one or more persons have blood lead testing yielding evidence of lead exposure;
- The child is living with an adult whose job, hobby, or other activity involves exposure to lead;
- The child is living near an active lead smelter, battery recycling plant, or other industry likely to release lead;
- The child's parent, guardian, or other person standing in loco parentis requests the child's blood be tested due to any suspected exposure; or
- The child is a recent refugee or immigrant or is adopted from outside of the United States.
A child up to 72 months in those categories who hasn't previously been tested (or who has experienced a change that has resulted in an increased risk of exposure to lead), or the sibling of a child who has an elevated blood lead level should also be tested.
Virginia Blood Lead Testing Reporting Guidelines:
On October 20, 2016, the Virginia Department of Health modified its disease reporting requirements:
“Lead, reportable levels” means any detectable blood lead level in children 15 years of age and younger and levels greater than or equal to 5 μg/dL in persons older than 15 years of age.
There are two primary ways to report a blood lead level to the Department of Health:
- Visit Virginia’s Confidential Morbidity Report Portal
- Fax the report to 804-864-8102
Case Management and Follow-Up:
Both health care providers and Local Health Department staff should please refer to the guidance found in the Virginia Blood Lead Testing and Case Management Guidelines for recommended case management and follow-up actions.
Supplemental Information
Quick Links
CEUs for lead:
Pediatric Environmental Health Specialty Unit (PEHSU)
Professional Resources:
American Academy of Pediatrics
Pediatric Environmental Health Specialty Unit (PEHSU)
Agency for Toxic Substances and Disease Registry (ATSDR)
Centers for Disease Control and Prevention (CDC)
Guidelines for Collecting and Handling Blood Lead Samples

Guidance for Special Populations
Pregnant and Lactating People
Elevated lead levels in pregnancy have been associated with adverse outcomes for both maternal and fetal health. It can cause:
- Increased risk of stillbirth and miscarriage
- Increased risk of the baby being born preterm
- Increased risk of the baby having a low birthweight
- Damage to the baby’s brain, kidneys, and nervous system
- Future developmental and learning problems in the baby
Pregnant individuals who are at increased risk for lead exposure should be screened for lead.
Pregnant individuals are at an increased risk of being exposed to lead if they:
- Live in a home built before 1978.
- Are a recent immigrant or refugee.
- Use imported pottery or ceramics to prepare and store food.
- Have old plumbing and pipes in their home.
- Live with someone who has a job or hobby that may expose them to lead, such as welding, metalwork, building renovation, stained glass, casting, or soldering.
- Developed pica during their pregnancy.
- Use traditional folk remedies or cosmetics.
There are some simple steps pregnant individuals can take to protect themselves and their baby from the harmful effects of lead, such as:
- Wet-wipe and wet-mop around window sills and home entrances.
- Washing their hands often.
- Removing their shoes before entering their home.
- If a family member has a job or hobby that exposes them to lead, asking them to take off their shoes before coming inside and change their clothes immediately after coming home.
- Pregnant individuals should not remodel their home, sand paint, or remove paint with a heat gun.
Breastfeeding and Lead Exposure
Individuals who have been or are currently exposed to lead can expose their fetus or infant to lead during pregnancy and lactation through blood and breast milk, which can have long-term effects on the neurodevelopment of their child.
Please utilize the resources linked below for guidance on medical management of an elevated blood lead level during lactation.
Refugee and Newcomers
Refugees and recent immigrants to the United States are at high risk of having an elevated blood lead level or being exposed to lead. Lead exposure hazards are common in many countries, including those where refugees originate or seek asylum. These exposures can be environmental or occupational exposures, or come from household and/or personal items.
Environmental exposures include:
- Leaded gasoline
- Lead-based paint
- Burning waste that contains lead
Occupational exposures include working in:
- Mines
- Smelting
- Battery recycling facilities
- Ammunition manufacturing
Household and personal item exposures include:
- Lead-glazed pottery
- Cookware and dining utensils
- Spices
- Cosmetics (such as kajal or kohl)
- Traditional medicines and remedies (such as Ba-baw-san, Greta, Paylooah)
Please visit our Information for Parents page or the CDC Immigrant, Refugee, and Migrant Health page for more information on spices and cosmetics known to contain lead.
Exposure After Entering the United States & Federal Screening Guidelines
Refugees and asylum seekers in the United States are also at risk of exposure after entering the United States. Members of this population may be placed into older homes that are more likely to contain lead hazards, including lead-based paint, lead in the soil, and lead from old plumbing and water fixtures.
Because of their risk of exposure to lead both before and after entering the United States, it is critical that refugees and asylum seekers receive initial and follow up blood lead screens.
When completing blood lead screens for refugees or asylum seekers new to the United States, it is important to:
- Collect complete and accurate personal and contact information
- Establish a standardizable follow up plan
Without these two components, follow-up blood lead screening cannot be completed in compliance with federal guidelines for refugees and newcomers. Chronic or acute lead exposure after entering the United States cannot be adequately assessed without a follow-up blood lead test.
See the table below for CDC’s recommended screening measures for children and pregnant women after arrival in the United States.
Recommended Screening Measure | Population |
---|---|
Initial lead exposure screening with blood test |
|
Follow-up testing with blood test, 3-6 months after initial testing |
|
*All newly arrived pregnant or breastfeeding women should be prescribed a prenatal or multivitamin with adequate iron and calcium. Referral to a healthcare provider with expertise in high-risk lead exposure treatment and management may be indicated for EBLLs. |
Reference: CDC Lead Screening Guidelines: Domestic Guidelines
Additional Information
- For more information on the CDC Blood Lead Screening Guidelines in Refugee populations, click here.
- For more information and resources on newcomer health screening from the VDH Newcomer Health Program, click here.
- For CDC refugee and newcomer health education resources in languages other than English, click here.
The following states have additional information on blood lead screening guidelines for refugee children and pregnant women:
The following State Childhood Lead Poisoning Prevention Programs provide additional lead education and outreach materials in languages other than English: