Early Detection in Childhood Lead Exposure Relies on Timely Testing—Reply

In Reply We appreciate the favorable response from Whitley et al regarding our study, which showed that half of the 1.1 million children tested across the US had detectable blood lead levels (BLL). We concluded, “To eliminate the effect of lead exposure on all children’s health, the US must focus efforts to prevent children from being exposed to lead, beginning in areas where risk is highest.” The Office of Inspector General of the US Department of Health and Human Services report cited by Whitley et al highlights a gap in required BLL screening tests among Medicaid-enrolled children in 5 states. Subsequently, the Centers for Medicare and Medicaid Services stated that it would monitor performance data for BLL screening tests in Medicaid-enrolled children nationally. It would then identify states in the lowest quartile of performance and request an action plan from those states. Although welcomed, this measure may result in fewer children being identified with lead exposure or poisoning than if the highest-risk areas were targeted because low-testing states may not have the highest prevalence of detectable or elevated BLL. Why not promote adherence by requesting action plans from all states that are not meeting the US Department of Health and Human Services targeted screening rates, given lead poisoning is prevalent in all states?