标题：Globalization, Binational Communities, and Imported Food Risks: Results of an Outbreak Investigation of Lead Poisoning in Monterey County, California
摘要：Objectives. Although the burden of lead poisoning has decreased across developed countries, it remains the most prevalent environmental poison worldwide. Our objective was to investigate the sources of an outbreak of lead poisoning in Monterey County, California. Methods. An investigation in 3 county health department clinics in Monterey County, California, was conducted between 2001 and 2003 to identify risk factors for elevated blood lead levels (≥ 10 μg/dL) among children and pregnant women. Results. The prevalence of elevated blood lead levels was significantly higher in 1 of the 3 clinics (6% among screened children and 13% among prenatal patients). Risk factors included eating imported foods (relative risk [RR]=3.4; 95% confidence interval [CI]=1.2, 9.5) and having originated from the Zimatlan area of Oaxaca, Mexico, compared with other areas of Oaxaca (RR=4.0; 95% CI=1.7, 9.5). Home-prepared dried grasshoppers ( chapulines ) sent from Oaxaca were found to contain significant amounts of lead. Conclusions. Consumption of foods imported from Oaxaca was identified as a risk factor for elevated blood lead levels in Monterey County, California. Lead-contaminated imported chapulines were identified as 1 source of lead poisoning, although other sources may also contribute to the observed findings. Food transport between binational communities presents a unique risk for the importation In the past 25 years, the United States and many other countries have witnessed dramatic decreases in environmental exposure to lead, largely resulting from environmental policies that mandated that lead be removed from gas, paint, and other manufactured products, and through the modification of mining and other extraction processes. 1 – 4 The success of these programs is evidenced by studies that have reported substantial declines in blood lead levels (BLLs) in population samples of children in the United States over the past 10 years. 5 Despite these gains, lead exposure continues to be one of the most prevalent and harmful sources of environmental poisoning in much of the world. Recent estimates by the World Health Organization indicate that the percentage of children aged younger than 6 years with elevated BLLs, defined as 10 or more micrograms of lead per deciliter of blood [μg/dL], 4 , 6 is well over 20% in several regions, including Latin America. 4 The World Health Organization emphasizes that the risk of lead toxicity remains as high as in previous centuries for children in many countries. The insidious attack of lead on the developing nervous system significantly limits the ability of children worldwide to climb out of the poverty in which so many grow up. Globalization and the regular transnational movement of capital, goods, and people allow migrants to maintain strong ties with their communities of origin. In California, thousands of migrants travel back and forth to small communities in Mexico and other parts of Latin America. This connectedness enables families to communicate regularly, eat and transport foods prepared in their hometowns, and preserve language and customs while living in separate countries, all of which creates binational communities. 7 – 8 Unfortunately, the same conditions that allow for strong cultural ties to be maintained over vast distances can also lead to the importation of environmental hazards. We investigated an outbreak of lead poisoning in Monterey County, California, in which a localized problem of lead poisoning was found to be associated with contaminated imported foods among community residents from the southern Mexican state of Oaxaca (Figure 1 ▶ ). Open in a separate window FIGURE 1— State of Oaxaca, Mexico, with Zimatlan District and State Capital (Oaxaca City) shaded. In 2000, one of the community doctors (E. S.) affiliated with the Department of Family and Community Medicine at the University of California, San Francisco, asked for help in investigating a large number of lead poisoning cases where he worked. The clinic, in Seaside, Calif, is one of Monterey County Health Department’s 3 community-based primary care clinics. There were no epidemiological data from the County or State Health Department that could answer the questions of the doctor and nurse at the Seaside clinic who were seeing “way too many cases of lead poisoning” among their patients who were from Oaxaca. Although there had been prior lead case investigations conducted by the Monterey County Health Department, the more common sources of lead exposure in California, such as lead-contaminated water from old pipes, peeling lead-based paint, lead-contaminated soil, occupational sources, lead-glazed ceramics, or home health remedies containing lead, had not been identified in the majority of these investigations (Donna Staunton, Public Health Nurse, written communication, May 2005).
