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Margaret A. Handley, PhD, MPH, Celeste Hall, RN, Eric Sanford, MD, Evie Diaz, Enrique Gonzalez-Mendez, MD, Kaitie Drace, BA, Robert Wilson, PhD, Mario Villalobos, PhD and Mary Croughan, PhD

At the time of the study, Margaret A. Handley, Kaitie Drace, Robert Wilson, and Mary Croughan were with the Department of Family Medicine and Community Medicine, University of California, San Francisco. Celeste Hall and Evie Diaz were with the Monterey County Health Department, Salinas, Calif, and the Department of Family and Community Medicine, University of California, San Francisco. Eric Sanford was with the Monterey County Health Department, Salinas, and the Department of Family Medicine Collaborative Research Network, University of California, San Francisco. Enrique Gonzalez-Mendez was with the Southwest Community Health Clinic in Sonoma County, Santa Rosa, Calif, and the Department of Family Medicine Collaborative Research Network, University of California, San Francisco. Mario Villalobos was with la Universidad Nacional Autonoma de Mexico, Mexico City.

Correspondence: Requests for reprints should be sent to Margaret A. Handley, PhD, Assistant Professor, Department of Family and Community Medicine, University of California, San Francisco, San Francisco General Hospital, 995 Potrero Ave, Ward 83, San Francisco, CA 94110 (e-mail: handleym{at}fcm.ucsf.edu).

Objectives. Although the burden of lead poisoning has decreased across developed countries, it remains the most prevalent environmental poison worldwide. Our objective was to investigate the sources of an outbreak of lead poisoning in Monterey County, California.

Methods. An investigation in 3 county health department clinics in Monterey County, California, was conducted between 2001 and 2003 to identify risk factors for elevated blood lead levels ( 10 µg/dL) among children and pregnant women.

Results. The prevalence of elevated blood lead levels was significantly higher in 1 of the 3 clinics (6% among screened children and 13% among prenatal patients). Risk factors included eating imported foods (relative risk [RR]=3.4; 95% confidence interval [CI]=1.2, 9.5) and having originated from the Zimatlan area of Oaxaca, Mexico, compared with other areas of Oaxaca (RR=4.0; 95% CI=1.7, 9.5). Home-prepared dried grasshoppers (chapulines) sent from Oaxaca were found to contain significant amounts of lead.

Conclusions. Consumption of foods imported from Oaxaca was identified as a risk factor for elevated blood lead levels in Monterey County, California. Lead-contaminated imported chapulines were identified as 1 source of lead poisoning, although other sources may also contribute to the observed findings. Food transport between binational communities presents a unique risk for the importation

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