title: Toxicants in folk remedies: implications of elevated blood lead in an American-born infant due to imported diaper powder.
abstract: Though most childhood lead exposure in the USA results from ingestion of lead-based paint dust, non-paint sources are increasingly implicated. We present interdisciplinary findings from and policy implications of a case of elevated blood lead (13-18 mcg/dL, reference level <5 mcg/dL) in a 9-month-old infant, linked to a non-commercial Malaysian folk diaper powder. Analyses showed the powder contains 62 % lead by weight (primarily lead oxide) and elevated antimony [1000 parts per million (ppm)], arsenic (55 ppm), bismuth (110 ppm), and thallium (31 ppm). These metals are highly bioaccessible in simulated gastric fluids, but only slightly bioaccessible in simulated lung fluids and simulated urine, suggesting that the primary lead exposure routes were ingestion via hand-mouth transmission and ingestion of inhaled dusts cleared from the respiratory tract. Four weeks after discontinuing use of the powder, the infant's venous blood lead level was 8 mcg/dL. Unregulated, imported folk remedies can be a source of toxicant exposure. Additional research on import policy, product regulation, public health surveillance, and culturally sensitive risk communication is needed to develop efficacious risk reduction strategies in the USA. The more widespread use of contaminated folk remedies in the countries from which they originate is a substantial concern.
authors.affiliation: Department of Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA. matt.karwowski@childrens.harvard.edu.|Pediatric Environmental Health Center, Boston Children's Hospital, 1295 Boylston St, Suite 100, Boston, MA, USA. matt.karwowski@childrens.harvard.edu.|Department of Pediatrics, Harvard Medical School, 22 Shattuck St, Boston, MA, USA. matt.karwowski@childrens.harvard.edu.
authors.forename: Mateusz P
authors.initials: MP
authors.lastname: Karwowski
authors.affiliation: U. S. Geological Survey, Denver, CO, USA.
authors.forename: Suzette A
authors.initials: SA
authors.lastname: Morman
authors.affiliation: U. S. Geological Survey, Denver, CO, USA.
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Plumlee
authors.affiliation: Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: Law
authors.affiliation: Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Kellogg
authors.affiliation: Department of Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.|Pediatric Environmental Health Center, Boston Children's Hospital, 1295 Boylston St, Suite 100, Boston, MA, USA.|Department of Pediatrics, Harvard Medical School, 22 Shattuck St, Boston, MA, USA.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Woolf
mesh_terms: D001900:Boston; D041381:Diapers, Infant; D004781:Environmental Exposure; D005260:Female; D015386:Hazardous Substances / Q000032:analysis / Q000097:blood; D006801:Humans; D007223:Infant; D007854:Lead / Q000032:analysis / Q000097:blood*; D008296:Malaysia; D008519:Medicine, Traditional / Q000009:adverse effects*; D010087:Oxides / Q000032:analysis; D011208:Powders
chemical_list: D015386:Hazardous Substances; D010087:Oxides; D011208:Powders; D007854:Lead; C047365:lead oxide
keywords: Baby powder; Childhood lead poisoning; Folk remedies; Lead contamination; Metals toxicity; Regulatory policy