Epidemiologic Notes and Reports Lead Poisoning Following Ingestion of Homemade Beverage Stored in a Ceramic Jug -- New York

In the summer of 1987, seven persons living in Westchester County, New York, developed lead poisoning after ingesting a homemade beverage stored in a ceramic bean jug. The six adults and one child were relatives and lived at or frequently visited the home where the jug was kept.

The 140-ounce brown ceramic jug had been obtained in Mexico and is of a type commonly used to cook beans. The first person to experience illness used the jug to store a beverage he prepared frequently from sugar, water, and mara, a grain imported from Colombia. After the beverage fermented, family members consumed it several times daily throughout the summer.

In October 1987, the first patient--a 67-year-old man--consulted a physician because of severe abdominal pain, fatigue, and weight loss. The physician initially suspected gastric carcinoma. However, because severe anemia (hemoglobin 8 gm) and red blood cells with basophilic stippling were detected, a blood-lead level was obtained. Both the blood-lead level (70 ug divided by L) and the erythrocyte protoporphyrin (EP) (382 ug divided by L) were markedly elevated. He received chelation treatment for lead during a 2-week hospitalization.

After the initial case was diagnosed, a public health sanitarian visited the home to search for the source of lead. Interviews and a search of the premises identified the bean jug, which was severely corroded on the inside. Analysis of the jug by the New York State Department of Health (NYSDH) detected a lead content of 730 ppm, 100 times the normal value for a hollow vessel of this size.

Other household members were tested for lead. Six persons, aged 8-90 years, had elevated blood-lead levels (range: 35-70 ug divided by L). An 8-year-old child had a lead level of 35 ug divided by L and an EP of 152 ug divided by L (CDC risk classification III (high risk)).* One of the five adults was also hospitalized.

Investigation by NYSDH revealed other earthenware with high lead contents in shops and bodegas in this town. The Westchester County Department of Health distributed bilingual fliers in ethnic communities in the county warning of the possible hazards from the use of ceramic ware.

No additional cases have been identified. All patients have been followed by their personal physician, and their blood values have returned to normal. Reported by: KA Raciti, MD, Child Health Svcs, G Haloukas, Bur of Public Health Protection, AS Curran, MD, G Argentina, R Morrisey, Westchester County Dept of Health; B Friedman, MD; P Parsons, PhD, DL Morse, MD, State Epidemiologist, New York State Dept of Health. Div of Environmental Hazards and Health Effects, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Because of industrialization, lead is ubiquitous in the human environment. Common sources of lead exposure include lead-based paints (present on the interior surfaces of an estimated 30-40 million U.S. homes), airborne lead from combusted lead additives in gasolines or from factories using lead, occupations such as the production or repair of lead-acid storage batteries or automobile radiators, and a variety of ethnic remedies, particularly those used by Asian and South American groups (1-3). Although lead-glazed pottery is not a widespread source of lead, it can release large amounts of lead into food and drink (1,4,5). Lead-glazed pottery has been responsible for outbreaks of serious poisoning; in several episodes similar to this one, imported pottery has been implicated (1,5). Homemade or craft pottery and porcelain-glazed vessels can release large quantities of lead, particularly if the glaze is chipped, cracked, or improperly applied. If the vessels are repeatedly washed, the glaze may deteriorate, and pottery previously tested as safe can become unsafe. Acidic foods, beverages, or even water can leach lead from the containers.

Excessive absorption of lead is one of the most prevalent and preventable childhood environmental health problems in the United States (1). Once thought to be a problem confined to poor urban children, lead poisoning is now known to involve children in all socioeconomic strata (1,6). Although the toxic properties of lead affect all age groups, attention is generally focused on the serious consequences of elevated lead exposure on the developing central nervous system of children less than 6 years of age (1,6-8). The level in children at which further diagnostic follow-up is recommended is 25 ug divided by L of lead in whole blood; however, recent studies have shown that blood-lead levels as low as 10 ug divided by L may adversely affect childhood neurobehavioral function and development (1,7).

References

1. CDC. Preventing lead poisoning in young children: a statement by the Centers for Disease Control, January 1985. Atlanta: US Department of Health and Human Services, Public Health Service, 1985:5-7; DHHS publication no. 99-2230.

2. Mahaffey KR. Sources of lead in the urban environment (Editorial). Am J Public Health 1983;73:1357-8.

3. Bose A, Vashistha K, O'Loughlin BJ. Azarcon por empacho--another cause of lead toxicity. Pediatrics 1983;72:106-8.

4. Molina-Ballesteros G, Zuniga-Charles MA, Cardenas Ortega A, et al. Lead concentrations in the blood of children from pottery-making families exposed to lead salts in a Mexican village. Bull Pan Am Health Organ 1983;17:35-41.

5. Klein M, Namer R, Harpur E, Corbin R. Earthenware containers as a source of fatal lead poisoning: case study and public health considerations. N Engl J Med 1970;283:669-72. 6. Thatcher RW, Lester ML, McAlaster R, Horst R, Ignasias SW. Intelligence and lead toxins in rural children. J Learn Disabil 1983;16:355-9.

6. Needleman HL. The neurobehavioral consequences of low lead exposure in childhood. Neurobehav Toxicol Teratol 1982;4:729-32.

7. Chisolm JJ Jr. The continuing hazard of lead exposure and its effects in children. Neurotoxicology 1984;5:23-42.

*CDC defines an elevated blood-lead level in children as a confirmed concentration of lead in whole blood of greater than or equal to 25 ug divided by L; lead toxicity is defined by an elevated blood level with an EP in whole blood of greater than or equal to 35 ug divided by L (1).

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