Health & Welfare | Daily Report

New York City Department of Health and Mental HygieneThis amulet has leaded beads similar to the ones that poisoned a boy in 2009.

Government health officials are warning of a newly identified source of lead poisoning, especially for Southeast Asians: amulets.

A healthy 1-year-old boy in New York City developed lead poisoning in 2009 after mouthing on an amulet around his neck, according to a report released yesterday by the U.S. Centers for Disease Control and Prevention.

The amulet's metal beads were 45 percent lead – far above the legal limit of 0.03 percent lead for children's products, including jewelry. Anecdotal information suggests that lead bullets are sometimes melted to make the beads of such amulets, the report said.

Typically made of black or white string with several knots, metal beads or both, the protective charms are commonly worn around the neck, wrist or waist in Cambodian, Vietnamese, Hmong and Laotian populations. California has the largest populations of these ethnic groups in the country, according to the U.S. Census Bureau.

Born in the United States to Cambodian immigrants, the boy had worn the amulet, custom made at a rural Cambodian market, since he was 3 months old. His blood lead level climbed to as high as 20 micrograms per deciliter of blood – double the level the CDC says is cause for concern. 

Long-term and high exposure to lead is toxic and potentially fatal. The heavy metal can damage the nervous system, brain, kidneys and reproductive system. Children are particularly vulnerable to lead.

The most common source of lead exposure is lead-based paint, usually found in older, deteriorating housing. But other sources of lead – including food, candy, spices, cosmetics, health remedies, ceramics, pottery and jewelry – are increasingly being identified as the cause of lead poisoning, particularly in immigrant communities, the report said.

In the case highlighted by the report, inspectors tested for lead in the amulet, as well as in paint and imported spices and rice at the home. The food tested safe, and the paint was fixed. 

Once the amulet was removed from the home, the boy's blood lead level began to drop – to 14 micrograms per deciliter of blood in eight days, 10 micrograms per deciliter in six weeks and 5 micrograms per deciliter in five months. The boy's 6-year-old cousin, who lived in the same home, also had a high blood lead level that dropped after he stopped wearing a similar amulet.

The case shows that healthcare providers and public health workers should be aware of cultural customs when trying to determine the source of lead exposure, the Centers for Disease Control and Prevention said. 

Questions may need to be rephrased, the report said, noting that the boy's father initially denied that his son wore jewelry. Questioned more closely, he said his son wore "something to protect him."

Greater educational efforts are needed to inform Southeast Asian immigrants of amulets' potential lead risks, the report said.

Outreach to these communities can be difficult, said Kathy Ouchi, lead program coordinator at Long Beach's Childhood Lead Poisoning Prevention Program. Census figures show that the city is home to more than 17,000 Cambodians – more than in any other city in the state.

Ouchi and her staff have struggled to gain trust in the Cambodian community. A Cambodian outreach worker made inroads visiting temples and community events, but with the worker out sick in recent months, "our outreach has dwindled down to nothing, pretty much, for that community," she said.

None of the cases Ouchi has dealt with involved amulets. But when New York City health officials contacted her last year about the case in the CDC report, she posted a flyer warning about amulets' potential lead threats.

"Does your child wear one of these?" the flyer read, with pictures of Cambodian amulets that had tested positive for lead. The flyer listed phone numbers, both for English and Khmer speakers, to call for lead testing. But the flyer, printed only in English, generated no response, Ouchi said.

The program had previously received a grant to translate brochures about lead into Khmer. But the program lacks the resources to translate additional information, such as the amulet flyers, she said.

"I was thinking, if they had more knowledge and a better understanding of what lead does or can do to their children, they wouldn't want that to happen, and they would get them screened," Ouchi said. "I feel like there's just a whole group of children out there that haven't been screened that need to be."

Healthcare providers in public health programs like Medi-Cal are required to screen young children for lead. But that does not always happen, she said.

Doctors must explain to parents "that it's not a choice – it's something that needs to be done," she said. "Parents say, oh no, I don't want you to poke my child, and they say, OK. … The only person that suffers from that is the child."