Foreign-made jewelry is a potential source of lead exposure, according to public health officials.
A 1-year-old boy living in New York City had a rapid increase in blood lead levels, and the likely source of the exposure was traced to a Cambodian amulet made from knotted string and metallic beads, according to researchers from the NYC Department of Health and Mental Hygiene and the CDC.
Testing revealed that the beads contained 45 percent lead, the researchers reported in Jan. 28 issue of Morbidity and Mortality Weekly Report.
The boy had worn the amulet — "something to protect him," his father said — since he was 3 months old, and had been seen putting it in his mouth.
"Healthcare providers and public health workers should consider traditional customs when seeking sources of lead exposure in Southeast Asian populations," the authors wrote.
Healthcare professionals should ask parents — particularly from Southeast Asian families — about the use of amulets, they added, noting that educational efforts about the risk of lead poisoning from jewelry are needed for immigrant families.
An accompanying editorial note pointed out that the CDC recommends blood lead testing for internationally adopted and refugee children and that the New York City health department recommends testing all children with recent travel to foreign countries.
Although the most common source of lead exposure in young children is paint, other sources have been increasingly identified.
That is particularly true in immigrant communities because of the use of lead-containing products from their country of origin, such as spices, food, candy, cosmetics, health remedies, ceramics or pottery, and jewelry.
For the case of the 1-year-old boy, routine lead testing showed an elevated blood lead level of 10 micrograms/dL.
According to the National Institutes of Health lead concentrations in blood should be less than 10 micrograms/dL in children and less than 20 micrograms/dL in adults.
Because he lived in a household with a cousin who had had lead poisoning, he had also been tested at 6 months. His blood lead level was just 1 microgram/dL then.
A risk assessor from the Environmental Protection Agency visited the home to look for potential sources of the lead exposure. The boy's father denied using any imported products, and the assessor failed to find any potential sources of exposure.
Three months later, the boy's blood level doubled to 20 micrograms/dL.
The boy's father again denied that the child wore jewelry or charms, but eventually admitted that the child had worn an amulet acquired at a Cambodian market since he was 3 months old.
A second home inspection identified one area of paint with an elevated lead level, as well as imported spices and rice. Testing revealed that the food products did not have elevated lead content.
Within eight days of the amulet being removed from the home, the boy's blood lead level decreased to 14 micrograms/dL.
About five weeks later — after the lead paint was reported to be removed — the boy's blood lead level was 10 micrograms/dL, and five months after the amulet was removed, the level was down to 5 micrograms/dL.
"Although other factors might have contributed to the child's overall lead burden," the researchers wrote, "the most likely source identified was the amulet, based on its high lead content, statements that the child had been observed mouthing it, and the rapid decrease in the child's blood lead level after its removal."