Childhood Lead Exposure Associated with the Use of Kajal, an Eye Cosmetic from Afghanistan — Albuquerque, New Mexico, 2013

Lead is a toxic metal that damages blood cells, the kidneys, the cardiovascular system, and the developing nervous system. The risk for lead exposure causing subsequent cognitive and neurobehavioral deficits is especially high among toddlers because of their hand-to-mouth activities and their higher absorption of ingested lead compared with adults. In January 2013, the New Mexico Department of Health (NMDOH) received a report from an Albuquerque clinic of a refugee child aged 20 months (patient 1) with an elevated blood lead level (BLL) of 27.0 µg/dL (CDC reference value = 5.0 µg/dL). Medical staff informed NMDOH that the child and family used kajal, a traditional eye cosmetic brought from Afghanistan, their country of origin. Further investigation revealed that patient 1's brother, aged 4 months (patient 2), also had an elevated BLL of 33.5 µg/dL. Laboratory analysis of kajal used by the family showed a lead content of 54%. These two cases highlight the potential for lead poisoning among refugee populations in the United States and call attention to contaminated consumer products as a source of lead exposure. Physicians who provide health services to refugee and immigrant children should be aware of this potential exposure. Health-care providers who routinely screen refugee and immigrant children for elevated BLLs should consider asking questions about the use of traditional eye cosmetics.