The Lead Law and screening requirements
The Massachusetts Lead Poisoning Prevention and Control Regulation (Lead Law) requires all children to be screened for lead poisoning multiple times through the age of three. A child must be screened once between the ages of 9-12 months, again at age 2, and again at age 3. Children must be screened once more at age 4 if they live in a high risk community or in a high risk environment (other lead poisoned children in the same home, or a home built prior to 1978 that is under renovation). To see if a child you treat lives in a high risk community, click here for the most recent high risk community list. Every child must have a lead screening test before they can enter daycare, Kindergarten, or preschool.
On December 1, 2017 the Massachusetts Department of Public Health Childhood Lead Poisoning Prevention Program (CLPPP) amended its Lead Law. It lowered the blood lead level in the regulatory definition of Lead Poisoning, established a new Blood Lead Level of Concern category, and instituted additional screening guidelines for these blood lead levels.
Changes to Regulatory Blood Lead Levels
- Lead Poisoning: Venous blood levels ≥ 10 μg/dL (reduced from 25 μg/dL)
- Blood Lead Level of Concern: Venous Blood Levels 5 to <10 μg/dL (new regulatory category)
Changes to Screening Thresholds
- Capillary tests ≥ 5 μg/dL now require venous confirmatory re-screening (recommended within 2 months)
- Provide parents/guardians with proof of screening for entry into daycare and pre-K programs in addition to kindergarten.
Data reporting requirements
Every single blood lead test result you analyze in your practice must be reported to CLPPP, even if the blood test result was <5 μg/dL. If you send a blood sample to a laboratory for testing, then that laboratory will report the result to CLPPP. Blood test results and accompanying mandatory address and demographic data, including race and ethnicity, must be reported to CLPPP electronically via a secure network called the Mass HIway in an approved file format. To get set up to report blood lead test results through the Mass Hiway, contact the CLPPP at (617) 624-5757. If you are already a HIway user and are having issues with the website or need to reset your password, please e-mail MassHIwaySupport@state.ma.us or call (855) 624-4929 (option #2).
Changes to Reporting Thresholds
- Continue to report all Blood Levels to CLPPP
- BLL 10 μg/dL or greater (reduced from 25 μg/dL): Report within 3 business days of testing
- BLL < 10 μg/dL: Report within 7 calendar days of testing
Information about capillary blood lead testing
If you use a LeadCare device in your practice, you can only use the device with capillary (fingerstick) blood. Click here to read the Centers for Disease Control and Prevention safety alert about using the LeadCare device. Capillary blood tests can be a useful tool for preliminary lead screening because they are easier to conduct than venous tests, especially on children. However, they are prone to environmental lead contamination, leading to false positive results (a high result that is not truly high). Proper preparation for a capillary test is vital to avoid a potential false positive result and the need to test the child once more. In order to remove any environmental lead contamination, the child’s hand must be washed with soap and water first. An alcohol swab alone does not remove lead on the skin. All testing equipment should also be kept clean.
If a capillary blood test result is ≥ 5 μg/dL, the child must get a venous sample follow-up test within 2 months. See more information about additional actions to be taken based on a child’s blood lead level.
If you have any other questions about screening, electronic reporting, or want to get set up to report blood lead data to CLPPP, please call (617) 624-5757.