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Lead poisoning can do lasting harm, but it is largely preventable. The usual sources are contaminated soil, water, and lead paint in homes built before the 1978 ban. In 2023, a very different source turned up: applesauce pouches for young children.
How it was found
North Carolina encourages blood lead tests for all children at ages 1 and 2, and requires them for children on Medicaid. When a child under 6 has two blood lead levels of 5 μg/dL or more within a year, the state investigates the home for the source.
In October 2023, that routine testing turned up four children aged 1–3 with lead poisoning and no symptoms. All four had eaten the same brand of cinnamon applesauce. Pouches from their homes held 1.9–3.0 parts per million of lead — nearly 200–300 times the recommended action level for fruit purees and similar foods for babies and young children.
| Date | |
|---|---|
| October 28, 2023 | the FDA issues a public health alert |
| The next day | the distributor begins a voluntary recall |
| November 3 | the alert expands: the WanaBana product was also sold as Schnucks and Weis. The recall eventually covered 2,998,088 pouches. CDC notifies its funded Childhood Lead Poisoning Prevention Programs |
| November 13 | CDC alerts clinicians through its Health Alert Network |
| November 21 | CDC asks states to report all cases |
| December 5 | CDC launches a web page for the public and businesses, updated every two weeks |
| January 5, 2024 | the FDA reports high lead and chromium in recalled products and in cinnamon from the foreign manufacturer; CDC warns clinicians about possible chromium exposure |
| February 29, 2024 | the FDA reports the lead and chromium came from lead chromate |
Counting the cases
A case was a blood lead level of 3.5 μg/dL or more — CDC's reference value, higher than 97.5% of U.S. children aged 1–5 — in a sample taken within 3 months of eating a recalled product. States classed cases as suspected, probable or confirmed depending on the type of test, whether an environmental assessment was done, and whether other lead sources were found.
From November 22, 2023, to April 12, 2024, 44 states, DC and Puerto Rico reported 566 cases.
| Confirmed | 130 (23%) |
| Probable | 401 (71%) |
| Suspected | 35 (6%) |
| Most cases | New York (65), Missouri (50), Arizona (38) — together 27% |
| Children under 6 | 542 (96%) |
| Children under 2 | 311 (55%) |
| Median highest venous blood lead | 7.2 μg/dL (range 3.5–39.3; IQR 5.2–11.3); about a third were 10 or more |
| Hospitalizations | none reported |
People first ate a recalled product between about November 2022 and January 2024, and last ate one between December 2022 and March 2024.
Reported cases by jurisdiction, November 2023–April 2024 (566 in all). CDC
Symptoms were reported around the time of eating the product in 81 cases — 55 gastrointestinal and 35 developmental or behavioral, including stomach pain and lethargy. These are nonspecific, but consistent with lead poisoning. The long-term effects are unknown.
Why it matters
Lead can affect nearly every organ system; in children, the main concern is the brain and nervous system, with harm that may not show at once and may last for life. Lead in the blood is linked to declines in thinking, movement and sensory function, and there is no safe blood lead level in children.
Chromium (VI) — the hexavalent form in lead chromate — is less understood when eaten; most of what is known comes from long-term workplace breathing and skin exposure, which has caused lung disease, damaged mucous membranes and cancer. CDC did not recommend for or against chromium tests: chromium leaves the body quickly, results are hard to interpret, and they don't guide treatment. It did recommend blood lead tests for children who ate a recalled product, since the results guide prevention and treatment.
Where the lead came from
The FDA traced the contamination to cinnamon ground in Ecuador, and found lead chromate in it. The source of the lead chromate is unknown, but its presence points to economically motivated adulteration — food fraud designed to avoid detection. Spices such as paprika and turmeric have been adulterated with lead chromate and other lead compounds to add weight and color, and lead has turned up in imported candies, ceramics and glassware, cosmetics and traditional medicines.
Lessons
- Prevention comes first: stop toxic metals getting into food, with more product testing — especially as global supply chains make such outbreaks more likely.
- Routine childhood blood lead testing and follow-up are the safety net when prevention fails. North Carolina, with nearly three decades of CDC support for its lead program and an experienced staff, caught these cases fast.
- Look beyond paint, soil and water. Clinicians and public health workers should keep lesser-known sources, including food, in mind.
- Coordination among CDC, the FDA and state partners led to the recall of a nationally distributed product marketed mainly to young children.
Limits
Cases were almost certainly undercounted — especially among people who stopped eating the product before the recall, children 2 and older (who are tested less routinely), and states without universal testing. How much product people ate wasn't recorded consistently; symptoms and consumption dates were often left blank, so it couldn't always be checked that tests fell within 3 months; and other lead sources, such as paint, can't be fully ruled out.
Sources
Based on Troeschel AN, Buser MC, Winquist A, et al., "Investigation of Lead and Chromium Exposure After Consumption of Contaminated Cinnamon-Containing Applesauce — United States, November 2023–April 2024," MMWR volume 74, number 14, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report describes symptoms as reported in "approximately 20%" of cases, but the count it gives, 81 of 566, is not that share, so the count alone is used here.
Лицензия: CC0 1.0 (общественное достояние) · По материалам www.cdc.gov
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