Childhood Lead Exposure Linked to Apple Cinnamon Fruit Puree Pouches - North Carolina, June 2023-January 2024.

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.

Using Inundation Extents to Predict Microbial Contamination in Private Wells after Flooding Events.

Disaster recovery poses unique challenges for residents reliant on private wells. Flooding events are drivers of microbial contamination in well water, but the relationship observed between flooding and contamination varies substantially. Here, we investigate the performance of different flood boundaries─the FEMA 100 year flood hazard boundary, height above nearest drainage-derived inundation extents, and satellite-derived extents from the Dartmouth Flood Observatory─in their ability to identify well water contamination following Hurricane Florence. Using these flood boundaries, we estimated about 2600 wells to 108,400 private wells may have been inundated─over 2 orders of magnitude difference based on boundary used. Using state-generated routine and post-Florence testing data, we observed that microbial contamination rates were 7.1-10.5 times higher within the three flood boundaries compared to routine conditions. However, the ability of the flood boundaries to identify contaminated samples varied spatially depending on the type of flooding (e.g., riverine, overbank, coastal). While participation in testing increased after Florence, rates were overall still low. With <1% of wells tested, there is a critical need for enhanced well water testing efforts. This work provides an understanding of the strengths and limitations of inundation mapping techniques, which are critical for guiding postdisaster well water response and recovery.

Comparison of the Biolog OmniLog Identification System and 16S ribosomal RNA gene sequencing for accuracy in identification of atypical bacteria of clinical origin.

The Biolog OmniLog Identification System (Biolog) and the 16S ribosomal RNA (rRNA) gene sequencing methods were compared to conventional microbiological methods and evaluated for accuracy of bacterial identification. These methods were evaluated using 159 clinical isolates. Each isolate was initially identified by conventional biochemical tests and morphological characteristics and subsequently placed into one of seven categories: aerobic Actinomycetes, Bacillus, Coryneforms, fastidious Gram-negative rods (GNR), non-fermenting GNR, miscellaneous Gram-positive rods (GPR), and Vibrio/Aeromonas. After comparison to the conventional identification, the Biolog system and 16S rRNA gene sequence identifications were classified as follows: a) correct to the genus and species levels; b) correct to the genus level only; or c) neither (unacceptable) identification. Overall, 16S rRNA gene sequencing had the highest percent accuracy with 90.6% correct identifications, while the Biolog system identified 68.3% of the isolates correctly. For each category, 16S rRNA gene sequencing had a substantially higher percent accuracy compared to the conventional methods. It was determined that the Biolog system is deficient when identifying organisms in the fastidious GNR category (20.0%). The observed data suggest that 16S rRNA gene sequencing provides a more accurate identification of atypical bacteria than the Biolog system.