Lead Poisoning From Kansa and Pital Metalware: A New York City Family, 2024

At a glance

• Known before: traditional metalware can contain high levels of lead, which can leach into food and drinks.
• Found here: in July 2024, blood lead screening in New York City found a pregnant woman and two family members above CDC's blood lead reference value of 3.5 µg/dL. The source was kansa (bronze) and pital (brass) metalware from Nepal that the family used to cook and serve food and drinks.
• What follows: clinicians and public health workers should know that imported metalware used for food can expose a whole household to lead.

Why it matters

Lead harms people of every age, even at low levels. In New York City, exposure usually comes from lead-based paint — especially for young children who put their hands in their mouths — or from construction work. The city's Department of Health and Mental Hygiene (DOHMH) has also found lead in consumer products from around the world, including traditional ceramics and metalware used for food.

How New York finds lead

• Testing: state law requires testing of pregnant women judged at risk at their first prenatal visit, all children aged 1 and 2, and adults exposed at work. DOHMH receives every result.
• Follow-up starts at 3.5 μg/dL for children and pregnant women and 5 μg/dL for other adults, and DOHMH recommends testing household members too.
• Investigation: a questionnaire on possible sources, and testing of paint, dust, and products such as spices, cultural powders, remedies and cookware — paint and metalware with a handheld X-ray fluorescence (XRF) device, and metalware for leachable lead following FDA guidance.

What they found

In July 2024, prenatal testing found a blood lead level of 11.2 μg/dL in a woman aged 28, 11 weeks pregnant and without symptoms. Her spouse, aged 27, had 18.7 μg/dL and their child, aged 7, 6 μg/dL; neither had symptoms. The spouse had lived in the United States for 5 years; he traveled to Nepal in April 2024, and his wife and child came back with him.

• Home and school: none of 33 paint readings or six dust samples exceeded the guidelines, and the child's school had no lead-paint hazards.
• Spices and powders: six spice and two religious-powder samples were below reference limits.
• Metalware: four of the nine kansa and pital items the family bought in Nepal exceeded DOHMH's XRF limit of 0.4 mg/cm², and three leached lead far above FDA's guidance of 7 mg/L for similar products such as silver-plated hollowware.

The kansa and pital metalware used by the three family members. CDC, MMWR.

After: DOHMH told the family to stop using the items. By September 2024, the woman's level was 1.7 μg/dL and her spouse's 10.7 μg/dL; by October 2024, the spouse's was 8 μg/dL and the child's 3 μg/dL.

Why metalware

• Kansa is mainly copper and tin (bronze); pital mainly copper and zinc (brass). The names are often used interchangeably. Both are widely used in South Asian communities for food, drink and religious practice, and in Ayurveda, India's ancient medical system, kansa is believed to be healthful.
• Lead may be added to make the metal easier to shape or cheaper to make.
• A recent study of imported metalware sold in the United States found items — especially from Afghanistan and India, including a pital brass pot — leaching lead above recommended dietary limits under simulated cooking and storage. DOHMH checks of local stores in 2017–2022 also found bronze and brass metalware from South Asia leaching far more lead than reference limits allow.

Why rules aren't enough

• U.S. rules allow such products to be sold if labeled not for food use, and DOHMH has acted against stores that skip the label — but a label may not stop people using culturally ingrained items for food.
• Labels are often only in English.
• Rules cover only products sold in the United States, not items carried in from abroad, like this family's.
• These items are often handed down through generations and seen as safe, even beneficial, which makes warnings hard to deliver. Raising awareness in communities can help, and broader collaboration is needed to cut lead exposure from traditional products worldwide.

For clinicians

• Remember that imported metalware used for food can expose a whole household, especially in South Asian communities, already at risk from other traditional products.
• Counsel families on avoiding known lead sources, as trusted sources of health information.
• Where testing depends on a risk assessment — as for children over 2 and pregnant people in New York City — or isn't mandated, watch closely for risk factors and test those at risk.
• When one person has an elevated level, consider testing everyone in the home.

Sources

Based on "Elevated Blood Lead Levels in a Pregnant Woman and her Family from Traditional Kansa (Bronze) and Pital (Brass) Metalware — New York City, 2024," by Paromita Hore and colleagues of the New York City Department of Health and Mental Hygiene, Morbidity and Mortality Weekly Report, CDC, with its published correction; a work of the United States government in the public domain.