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Childhood Lead Exposure Linked to Apple Cinnamon Fruit Puree Pouches - North Carolina, June 2023-January 2024
Insights
Routine childhood lead testing identified WanaBana apple cinnamon puree as a lead exposure source. This led to a nationwide recall and public health advisory, highlighting the importance of early detection and investigation.
Area of Science:
- Environmental Health
- Pediatric Toxicology
- Public Health Surveillance
Background:
- Lead exposure poses significant risks to children's lifelong development, even at low levels.
- North Carolina mandates lead testing for Medicaid-covered children and encourages it for all 1- and 2-year-olds, with investigations for blood lead levels (BLLs) ≥5 μg/dL.
Purpose of the Study:
- To report on the identification and investigation of childhood lead exposure linked to a specific food product.
- To describe the public health response to an emerging lead contamination source.
Main Methods:
- Routine lead testing of young children in North Carolina.
- Home investigations to identify exposure sources for children with elevated BLLs.
- Product sampling and analysis for lead content.
Main Results:
- Four asymptomatic children in North Carolina were found with BLLs ≥5 μg/dL in June-August 2023.
- WanaBana apple cinnamon fruit puree pouches were identified as the sole exposure source; samples contained 1.9-3.0 ppm lead.
- Nationwide investigation linked approximately 500 cases to these purees, including 22 in North Carolina, with 45% not covered by Medicaid.
Conclusions:
- Routine testing and environmental investigations are crucial for detecting emerging lead exposure sources.
- A coordinated multiagency response, including public advisories and recalls, effectively mitigated further harm.
- The incident underscores the need for vigilance in food product safety and lead exposure prevention in children.
Abstract:
Lead exposure is toxic even at low levels, resulting in impairments that can affect a child's lifelong success. In North Carolina, testing for lead is encouraged for all children at ages 1 and 2 years and required for children covered by Medicaid; investigations are performed to identify potential exposure sources for children with blood lead levels (BLLs) ≥5 μg/dL. During June-August 2023, routine lead testing identified four asymptomatic North Carolina children with BLLs ≥5 μg/dL. Home investigations identified only WanaBana brand apple cinnamon fruit puree pouches as a potential exposure source; product samples contained 1.9-3.0 ppm of lead. An expanded nationwide investigation led to identification of approximately 500 cases of childhood lead exposure believed to be linked to consumption of apple cinnamon purees, including 22 cases in North Carolina. Fewer than one half (45%) of the 22 North Carolina cases were among children covered by Medicaid. A coordinated multiagency communication strategy was implemented in North Carolina to notify consumers of the hazard and provide recommendations for preventing further exposure. The Food and Drug Administration issued a nationwide public health advisory on October 28, 2023; 2 days later, the manufacturer issued a voluntary recall. Routine testing of young children for lead exposure, combined with thorough environmental investigations, can identify emerging sources of lead exposure and limit further harm.
