Blood Lead Levels in Children 5 to 7 Years of Age from the Republic of Georgia: A Feasibility Study on Lead Surveillance Using Volumetric Absorptive Microsampling.

Background: For years, children in the Republic of Georgia, have experienced elevated blood lead levels (BLLs). From September 2023 to April 2024, the National Center for Disease Control and Public Health in Georgia piloted a national surveillance program for lead in children in two western regions of the country, using volumetric absorptive microsampling (VAMS) to measure BLLs.

Objectives: We monitored BLLs and assessed predictors of elevated BLLs in children 5-7 years of age from two regions in the Republic of Georgia. We also aimed to demonstrate the feasibility of VAMS for BLL surveillance.

Methods: Children 5-7 years of age were randomly selected from the regions of Adjara and Imereti, Georgia, and 1,635 children participated. A trained phlebotomist collected two capillary blood samples from the children's fingertips using $30\text{-}\mu L$ VAMS devices. The samples were analyzed using inductively coupled plasma tandem mass spectrometry. Guardians completed a questionnaire detailing demographics, household, and lifestyle characteristics. We employed multivariable logistic regression models to identify predictors of BLLs $\ge 3.5$ or $\ge 10.0\mu g/\text{dL}$ in Georgia.

Results: Approximately 39.8%, 20%, and 4% of the participants had BLLs $\ge 3.5$, $\ge 5.0$, and $\ge 10.0\mu g/\text{dL}$, respectively. In both regions, male sex and unpainted housing predicted BLLs $\ge 3.5\mu g/\text{dL}$ but not BLLs $\ge 10.0\mu g/\text{dL}$. In Imereti, urban living additionally predicted BLLs $\ge 3.5\mu g/\text{dL}$, while small household size and metal toys [metal vs. plastic toys: $\text{odds\hspace{0.17em}ratio\hspace{0.17em}}\left(\text{OR}\right)=3.58$; 95% confidence interval (CI): 1.66, 7.72] were associated with BLLs $\ge 10.0\mu g/\text{dL}$. In Adjara, age, housing type, use of certain spices (yes vs. no: $\text{OR}=1.47$; 95% CI: 1.11, 1.94), and household lead bullet production (yes vs. no: $\text{OR}=6.66$; 95% CI: 1.41, 31.6) predicted BLLs $\ge 3.5\mu g/\text{dL}$ but not BLLs $\ge 10.0\mu g/\text{dL}$.

Discussion: Our findings confirm that lead exposure remains a significant public health issue in two regions of the Republic of Georgia, despite a national decrease in BLLs over the past 5 years. To our knowledge, this research marks the first large-scale application of VAMS technology for national BLL surveillance, offering significant advantages as a less invasive lead testing method that is accurate and suitable for settings with limited resources to handle, store, and transport venous blood samples. https://doi.org/10.1289/EHP15788.