One child in 2012, and four more family members over eleven years

Surma is a traditional eye cosmetic and a recognised source of lead
exposure in adults and children. It is banned in the United States, and is
often purchased abroad and hand-carried into the country.

What happened

**In 2012, a child in New York City was found to have a blood lead level above
the CDC's reference value**, associated with the use of surma.

**Over the following 11 years, four other family members were also affected —
the child's mother and three younger siblings.**

Three younger siblings. Children born after the first case was identified, and
exposed to the same product.

Why this is a communication failure rather than a detection one

The lead was found. The source was identified. The family was told. And the
exposure continued for more than a decade, reaching children who did not exist
when it was first diagnosed.

**Cultural practices often persist despite health warnings and can span
generations, highlighting challenges in risk communication and the
importance of comprehensive family follow-up once a family member at risk of
lead exposure is identified.**

Comprehensive family follow-up is the operative recommendation. A lead
case is usually handled as one child: test, identify the source, advise,
close. This family's record shows what that misses — the household, the
practice, and the children not yet born.

Surma is used because it is traditional, applied to babies' eyes as an act of
care. A warning that treats it as a product to be discarded is arguing with
something older and more meaningful than a shopping habit, which is precisely
why one conversation in 2012 did not settle it.

*Source: Hore P, Sedlar S, Ehrlich J. Lead Poisoning in a Mother and Her Four
Children Using a Traditional Eye Cosmetic — New York City, 2012–2023. MMWR,
Centers for Disease Control and Prevention.*