Inconsistent screening for lead endangers vulnerable children: policy lessons from South Bend and Saint Joseph County, Indiana, USA.

Lead exposure is a major health hazard affecting children and their growth and is a concern in many urban areas around the world. One such city in the United States (US), South Bend Indiana, gained attention for its high levels of lead in blood and relatively low testing rates for children. We assessed current lead screening practices in South Bend and the surrounding St. Joseph County (SJC). The 2005-2015 lead screening data included 18,526 unique children. Lead screening rates ranged from 4.7 to 16.7%. More than 75% of children had 'elevated blood lead levels' (EBLL) ≥ 1 micrograms per deciliter (µg/Dl) and 9.7% had an EBLL ≥ 5 μg/dL. Over 65% of the census tracts in SJC had mean EBLL ≥ 5 μg/dL, suggesting widespread risk. Inconsistent lead screening rates, coupled with environmental and societal risk factors, put children in SJC at greater risk for harmful lead exposure than children living in states with provisions for universal screening. Indiana and other states should adhere to the US Centers for Disease Control's guideline and use universal lead testing to protect vulnerable populations.