Explaining the HPV vaccine and cervical cancer; avoiding lead poisoning of children: Upstate Medical University's HealthLink on Air for Sunday, Feb. 27, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a pediatrician who specializes in infectious disease tells what you need to know about the HPV vaccine.

Manika Suryadevara, MD: "... We can prevent infection, and the best way to prevent infection is the HPV vaccine..." .

Host Amber Smith: A gynecologic oncologist explains how that HPV vaccine has dramatically reduced the incidence of cervical cancer.

Allison Roy, MD: "...There was a study that looked actually at a huge population of 1.7 million women that showed almost a 90% reduction in patients' cervical cancer frequency in those who were vaccinated before age 17."

Host Amber Smith: And a pediatrician discusses why the rates of lead poisoning in children are so high in Syracuse and the Northeast.

Travis Hobart, MD: "...The older your home is, the more likely it is that lead paint was used."

Host Amber Smith: All that, some advice on solving crossword puzzles, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, a pediatrician talks about lead poisoning and what to do if your home has lead paint. But first, a pediatrician tells how cervical cancer can be prevented, followed by a gynecologist who discusses how cervical cancer is diagnosed and treated

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." The human papillomavirus, or HPV, can cause genital warts and cervical cancer, but there is a vaccine available. Here with me to talk about HPV is Dr. Manika Suryadevara.

She's an associate professor of pediatrics at Upstate, where she specializes in infectious disease. Welcome to "HealthLink on Air," Dr. Suryadevara.

Manika Suryadevara, MD: Thank you for having me on to speak about this very important cancer prevention vaccine.

Host Amber Smith: Please tell us about HPV. What is this virus?

Manika Suryadevara, MD: HPV is the human papillomavirus, and it is a sexually transmitted infection that can go on to cause genital warts, or, even more severely, new, different types of cancers.

And it is the most frequent sexually transmitted infection in the United States. It's actually so common that almost every individual who is unimmunized will acquire this infection at some point during their life.

Host Amber Smith: I didn't realize that. So it's more common than herpes or gonorrhea?

Manika Suryadevara, MD: It is. So at any point in time, there are about 40 million people with an HPV infection. The next most common sexually transmitted infection would be herpes at 19 million infections, so you can see how frequent this virus infection really is.

Host Amber Smith: So how many different types of HPV are there, and is there only one that causes cervical cancer?

Manika Suryadevara, MD: So that's a great question. There are over a hundred different types of HPV and then over 40 of which can infect the genital area. And by infecting the genital area, that could mean multiple things. These viruses have been stratified based on their risk for developing into cancers. So you can have low-risk HPV, which more commonly causes the genital warts, or you can have the high-risk HPV.

And those are more likely to go on to cause cancers, not just cervical cancer, even though that's the association we make, but any sort of genitourinary cancers. So that includes penile cancer, anal cancer, and it also can cause a head and neck or a throat cancer.

Host Amber Smith: Do you see HPV infections in children, or is it mostly young adults, or is it older adults?

Manika Suryadevara, MD: There are about 13 million new HPV infections that occur each year in the United States. And more than half of these infections are occurring in our young adult population. So that's typically people between the ages of 15 to 24 years old. Now, most of HPV infections are asymptomatic.

So that means that most people in the United States who are infected with HPV don't even know that they have infection. This infection may or may not clear itself from the body without any intervention or even knowledge that there was an infection. The HPV infection that persists, however, can stay in the body for years and ultimately go on to develop cancer.

So while the infection can be acquired in the young adult period, it is most often manifested with these cancers later on in life.

Host Amber Smith: So there's no reliable symptom that people get,so most people wouldn't even necessarily know they're infected? Is that right?

Manika Suryadevara, MD: That is correct. So if someone were to develop genital warts, that would be an indication that they probably have an HPV infection.

For cervical disease, there is a screening method. So women who are getting their Pap smears, can be identified to have abnormal cells that may be due to HPV infection, but outside of that, HPV is often diagnosed at the time of cancer diagnosis, particularly for throat cancer and noncervical disease.

Host Amber Smith: Would a doctor diagnose HPV if there were genital warts, or is there a way to do that when you see genital warts?

Manika Suryadevara, MD: Genital warts is most often caused by HPV infection.

Host Amber Smith: So it's assumed that if you have the warts, that's probably why.

Manika Suryadevara, MD: Exactly.

Host Amber Smith: Now I think you kind of described this: Once a person's infected, does their body just fight it off and it goes away, or does it stay in the body?

Manika Suryadevara, MD: Most often when a person is infected with HPV, the body fights it off, and the infection gets cleared, and there's nobody even knows about it. However, there is a substantial proportion of infection that stays in the body, and it is the virus that stays in the body that leads to cancer development.

And when we're trying to just see how much disease burden that really means, you can look to see the data regarding HPV cancers, and each year HPV has been found to be responsible for 35,000 cancer cases in the United States. It is the major cause of cervical cancer, penile cancer, vaginal cancer, anal cancer and throat cancer.

And in fact, HPV causes 70% of mouth and throat cancers in the United States now, so where we used to associate mouth and throat cancers with smoking and alcohol, now HPV causes most of them.

Host Amber Smith: And is that through sexual contact usually?

Manika Suryadevara, MD: Correct. That is through sexual contact.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Manika Suryadevara. She's an associate professor of pediatrics at Upstate, specializing in pediatric infectious disease. And our subject today is HPV, the human papillomavirus.

So let's talk about treatment and prevention. Can HPV be cured if someone develops it?

Manika Suryadevara, MD: There's no antiviral treatment to get rid of the virus, so treatment of HPV really is based on the symptoms that are presenting. So individuals with HPV genital warts can see their doctor to see if there's any ways to reduce the warts, and those with HPV cancers should be followed by their providers and may need chemotherapy or surgery or radiation for treatment.

But there is no medicine to remove the HPV from the body. What we can do is we can prevent infection, and the best way to prevent infection is the HPV vaccine.

Host Amber Smith: So tell me more about the vaccine. How does it work?

Manika Suryadevara, MD: So the HPV vaccine, the one that we currently are using in the United States, is 9-valent, which covers for the majority of HPV types that are causing cancers today.

And essentially the vaccine is recommended to be given at the 11- to 12-year-old well-child check. And, you know, you hear 11- and 12-year-olds, and you think, oh, why are we giving them the vaccine this early? And there are multiple reasons for doing so. There is definitely rationale for doing that. The first reason is because at the 11- to 12-year-old well visit is when these teens are getting other adolescent vaccines, their tetanus shot for school, their meningitis shot, so it really fits into the adolescent vaccine platform. A second, very important reason to vaccinate at the 11- to 12-year-old visit is because we know that younger adolescents produce a much stronger antibody response to the vaccine, compared to older adolescents. And this is why when you get the vaccine, when you're a younger teen, so 11 or 12 years old, you only need two doses of the HPV vaccine series.

Whereas if you get the vaccine after your 15th birthday, you need three doses of the vaccine series to get the same response. So it's really recommended to start at the 11- to 12-year-old visit and can even be given down as young as 9 years of age to get these kids immunized and protected.

Host Amber Smith: Now you mentioned kids, boys and girls. Cervical cancer only affects women, though, so why are the boys being vaccinated?

Manika Suryadevara, MD: So again, while we consider HPV vaccine to really protect against cervical cancers, essentially it's protecting against all HPV-associated cancer. And if you look at mouth and throat cancer, men are at higher risk of acquiring HPV throat cancer than women.

And men can also develop penile cancer due to HPV. So by vaccinating boys and girls, you are protecting both genders from developing HPV-associated cancers later in life.

Host Amber Smith: I don't think a lot of people realize that a vaccine exists that can prevent cancer. Does this surprise people when you explain this to them?

Manika Suryadevara, MD: It does surprise people because when we think of HPV, we think of it being a sexually transmitted infection. But the whole goal of vaccine really is to prevent these cancers. You know, 4,000 women are dying each year from cervical ,cancer, and that's with screening and with treatments. And here we have a vaccine that can prevent infection and the subsequent development of cancers in our sons and our daughters.

So I think it's a very important message to send that we're really trying to prevent cancers in our teens by giving the HPV vaccine. Now the HPV vaccine, while it can be started around 11 to 12 years of age, is recommended all the way through 26 years of age for everybody. And then for adults who are between the ages of 27 and 45, if they are considered themselves to be at higher risk for acquiring HPV infection, they can talk to their provider and discuss whether they should also be vaccinated.

Host Amber Smith: I wondered because there's a lot of people who, you know, this vaccine wasn't available when they were adolescents. So in general, can people who are older than 21 get vaccinated?

Manika Suryadevara, MD: Recommendations for a routine vaccine or HPV series go all the way through 26 years old. So if you're an individual who's 24 years old and has not been immunized against HPV, definitely speak with the provider to get vaccinated. And then adults who are 27 through 45 can talk to their provider about risk factors and the benefits and risks of getting vaccinated.

Host Amber Smith: What about people in their 50s, 60s and older? Do they need HPV vaccines?

Manika Suryadevara, MD: Currently guidance goes up through 45 years of age, where there's universal routine recommendations for administration of vaccines as early as 9 years old, all the way through 26 years old. And then for adults 27 through 45, it's based on an individual case, discussing benefits of the vaccine.

Host Amber Smith: Is that because of the time it takes for the cervical cancer to develop?

Manika Suryadevara, MD: Correct. Any kind of HPV-associated cancer, the older you are in life, the less likely it is you are to be exposed to the virus, and the vaccine works best prior to exposure to the virus as opposed to once infected. So the recommendations really are to capture everybody who's younger and at risk of newly acquiring HPV infection. And that's where the focus is.

Host Amber Smith: If people got the vaccine as children, are they going to need boosters later on in life?

Manika Suryadevara, MD: As of right now, no boosters are recommended or needed. We have over 10, 15 years' worth of data showing significant antibody response and significant reduction in HPV disease. We're talking about genital warts and cervical precancers as well as cancers associated with HPV in the vaccinated population. So no booster doses are needed, and we have a lot of safety and efficacy data showing that even 10, 15 years later, the vaccine is working very well.

Host Amber Smith: If someone has already been infected with HPV before they're vaccinated, is the vaccine going to have any protection for them?

Manika Suryadevara, MD: Yes, so it is very important if someone has been already infected with HPV to get the HPV vaccine, because it is likely that they were infected with only one type of HPV, and the HPV vaccine prevents against nine types of the virus. So to ensure that they stay protected from future infections, it is very important that even if an individual has been infected in the past, that they do go and get the HPV vaccine.

Host Amber Smith: What if you have a couple -- partners -- that are never with anyone else; are they at risk for HPV in other ways?

Manika Suryadevara, MD: The risk factors for developing HPV-associated disease, as you mentioned, earlier onset of sexual activity, multiple partners, I would say, to be fully protected even though you are solely with one other partner, my recommendation for everybody, because we know it is a safe and effective vaccine that does prevent cancer, my recommendation to everybody is to get vaccinated.

Host Amber Smith: Has the vaccine been in use long enough to have an impact on reducing the number of cervical cancers or genital wart cases?

Manika Suryadevara, MD: Yeah. So we have over 15 years' worth of data on vaccine safety and efficacy, and there are multiple studies coming out, showing significant reduction in HPV infection, genital warts, precancers and cancers in the U.S. and in other countries around the world with robust HPV vaccination programs.

Host Amber Smith: Are there other vaccines that are designed to protect against other cancers?

Manika Suryadevara, MD: Yes. So the main one that comes to mind is the hepatitis B vaccine. Hepatitis B virus can be acquired, again, through sexual transmission or through contaminated blood exposure. And we know that chronic hepatitis B virus also leads to liver cancer. Now we have a hepatitis B vaccine that's been in use for quite a while, currently given to infants in the first 6 months of life, but then can be administered to, any unimmunized individual at any age to prevent the acquisition of hepatitis B virus, and the subsequent development of liver cancers.

It's a very similar purpose of, here we have a vaccine that prevents liver cancers, and we routinely vaccinate all our newborns with it, and anyone who's older who has not been unimmunized again for the sole purpose of cancer prevention.

Host Amber Smith: Well, thank you. I really appreciate you making time for this interview.

Manika Suryadevara, MD: Well, thank you for having me.

Host Amber Smith: My guest has been Dr. Manika Suryadevara, an associate professor of pediatrics at Upstate, specializing in pediatric infectious disease. I'm Amber Smith for "Upstate's HealthLink on Air."

More about the vaccine that prevents cancer -- next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." The human papilloma virus, or HPV, is the most frequent sexually transmitted infection in the United States. Some types of this virus caused genital warts. Other types cause head and neck or throat cancers and genitourinary cancers, including cervical cancer. My guest today is gynecologic oncologist, Allison Roy, who's an assistant professor at Upstate. Welcome back to "HealthLink on Air," Dr. Roy,

Allison Roy, MD: Thank you. It's great to be here again.

Host Amber Smith: I know that the HPV vaccine protects against genitourinary cancers. And from what I understand, the vaccine is recommended for 9- to 12-year old boys and girls. But it's a relatively new vaccine, so I imagine there are a lot of adults who were not vaccinated when they were children. Among the patients that you see with cervical cancer, are they mostly women who were not vaccinated as children?

Allison Roy, MD: Yes. I would say the vast majority of my patients with cervical cancer are patients that weren't vaccinated. Additionally, they may also not be up to date with regular screening.

Host Amber Smith: So, do you recommend your adult patients get the HPV vaccine if they did not get it when they were younger?

Allison Roy, MD: As you mentioned before, the HPV vaccine is recommended for everyone ages nine through 26, although it's recommended between 9 and 12. And the reason for that is because you want to have the vaccine prior to any kind of sexual exposure where you may be at risk for HIV. The decision to vaccinate beyond age 26, really depends on risk factors. And it's an individualized decision between the patient and their physician.

Host Amber Smith: So someone, say, between 27 and 45, how would you go about assessing their risk factors? What should they consider?

Allison Roy, MD: Most patients between 27 and 45 will have been exposed to HPV at some point. And it's important to understand that the vaccine itself doesn't cure HPV or treat HPV that one already has. However, the HPV vaccine does cover multiple different strains or types of HPV virus. And you may not have been exposed to all of those types. Therefore there's still some benefit from getting the vaccine at an older age. And so when I talk to patients about getting it as an adult, I think about who's at risk for more HPV transmission. So, patients who have multiple sexual partners or maybe have new sexual partners, or if they work in a profession like gynecology or dermatology, where they may be occupationally exposed to HPV, actually through treatment procedures. Another important factor that is a consideration is cost. And so unfortunately, although the vaccine is FDA approved from 27 to 45, a lot of insurance companies don't yet cover it. And so that can also be a factor in terms of patients getting vaccine.

Host Amber Smith: I didn't realize that. So it could be expensive to pay out of pocket?

Allison Roy, MD: It can be expensive to pay out of pocket for the vaccine, and insurance companies are starting to come around and cover it, but it's not quite there yet.

Host Amber Smith: So, what about people who are over age 45? Are they not considered to be at high risk for cervical cancer or throat cancer?

Allison Roy, MD: So risk for HPV-related cancers doesn't just suddenly disappear after age 45, but when you're considering the vaccine benefit, it starts to decrease a little bit in that age group, again, because of prior HPV exposure. Or patients that are potentially in more monogamous or committed relationships where they don't necessarily have multiple sexual partners or new partners, although we do know that people in those age groups still do. But it's just in terms of kind of risk-benefit. Right now, the vaccine isn't approved for that age group. It may be in the future.

Host Amber Smith: So someone, say a woman in her twenties or thirties, if she has developed genital warts, or cervical cancer for that matter, is it too late for her to be vaccinated?

Allison Roy, MD: It's not too late for her to be vaccinated. And as I kind of previously alluded to, while the vaccine doesn't treat or cure HPV that one has already been exposed to, it does cover multiple different types of HPV. And so the vaccine could still help protect them against the types that they haven't been exposed to.

Host Amber Smith: If you have a patient who has developed genital warts, is she at greater risk for developing cervical cancer?

Allison Roy, MD: Not necessarily, although risk of exposure to one type of HPV probably means that they're engaging in behaviors that are a little bit higher risk for exposure to other types of HPV. But in general, the HPV strains that cause genital warts don't typically cause cancer. They're more of a low-grade strain. But again, because you have that potential for exposure, you know, your risk is a little bit higher based just off of that.

Host Amber Smith: This is Upstate's HealthLink on Air, with your host Amber Smith. I'm talking with gynecologic oncologist, Dr. Allison Roy. She's an assistant professor at Upstate, and we're discussing cervical cancer, which can be largely prevented by the HPV vaccine.

Aside from the HPV vaccine, what else has done to protect women from cervical cancer?

Allison Roy, MD: An important part of cervical cancer is actually that we do have screening for it. And so routine pap smears are also performed, in addition to HPV vaccination to help prevent against cervical cancer.

Host Amber Smith: Can you walk me through what happens if a woman's Pap smear or Pap test, or the cervical exam is abnormal?

Allison Roy, MD: Pap tests are a screening tool. And so typically if a Pap test comes back abnormal, you're going to do a more specific test. And usually this is something called a colposcopy, which may or may not, depending on what's found, include biopsies of the cervix. And a colposcopy is similar to a Pap in that it's an exam where you're up in stirrups and you have a speculum and you actually are looking at the cervix with a microscope, as opposed to just with the naked eye to help identify abnormal cells.

Host Amber Smith: Are you able to visualize the cancer cells that way, with the naked eye?

Allison Roy, MD: So it depends. Sometimes depending on the lesion, you can see something that looks abnormal. If it's very small and microscopic, the microscope can actually help us to see that a little bit better. We also use something called acetic acid, which is actually just a solution that you can put on top of the cervix that helps turn some of those abnormal cells a whitish color to allow us to see it better.

Host Amber Smith: Now I've heard the term cervical dysplasia. Is that related to cervical cancer?

Allison Roy, MD: So, cervical dysplasia is a general term for pre-cancer of the cervix. So these are abnormal cells, but they're not yet cancer. And there's three different grades of dysplasia, depending on how abnormal those cells look.

Host Amber Smith: You mentioned the colposcopy. Is that like a biopsy, or is it a type of biopsy, technically?

Allison Roy, MD: The colposcopy part of it is just the act of using that acetic acid solution and looking at the cervix with a microscope. Most often, when you have a colposcopy, if there's abnormal areas that are seen, biopsies will also be done.

Host Amber Smith: I see. And then once you get the results of those biopsies back, is that how you diagnose whether she has cervical cancer?

Allison Roy, MD: Cervical cancer is a diagnosis based off of the tissue. So based off of the biopsy sample that we get.

Host Amber Smith: What are a woman's options if she's diagnosed with cervical cancer?

Allison Roy, MD: So, it really depends on the stage at diagnosis. The stage of diagnosis is based on physical exam, as well as, typically, imaging that's done to kind of get a sense if the cancer spread anywhere else beyond the cervix. And so it's a combination of looking physically at the cervix and doing a physical exam, along with imaging to help decide what the treatment recommendation is going to be.

Host Amber Smith: Is surgery an option, or radiation, chemotherapy? Are they all options?

Allison Roy, MD: So again, depending on the stage. Surgery is an option in earlier stage cervical cancers. As we get into later stages, we actually move more toward treatment with a combination of radiation and chemotherapy, and not actually treating it with surgery at all.

Host Amber Smith: What are the survival rates like for cervical cancer?

Allison Roy, MD: Early stage cervical cancer, or cancers that are confined to the cervix, have a good overall survival rate. The statistics from the American Cancer Society give about a 90% survival at five years. And a lot of cancers are reported based on five-year survival, which is the amount of patients with that diagnosis that are still alive at five years from their diagnosis. So greater than 90% is great for early cervical cancer.

Unfortunately, once that disease starts to spread regionally, meaning within the pelvic area, that survival decreases to around 66%. And then when you start to have diagnosis of distant disease -- either a disease that spread to the abdomen, the chest, or actually locally invading into the bladder, into the rectum -- that drops down to about 15 to 20%.

Host Amber Smith: Do you know if the HPV vaccine has been in use long enough to have an impact and reduce the incidence of cervical cancer? Are we seeing less of it now?

Allison Roy, MD: Yes. There's actually been several studies that have shown a dramatic decrease in cervical cancer in young patients who have been vaccinated. There was a study that looked actually at a huge population of 1.7 million women that showed almost a 90% reduction in patients' cervical cancer frequency in those who were vaccinated before age 17. So these are huge decreases in numbers, based off of the vaccine.

Host Amber Smith: Does the woman who developed cervical cancer need to be concerned about throat cancer or other HPV-related cancers, as well as the cervical cancer?

Allison Roy, MD: Yeah. So cervical cancer and other HPV-related cancers are all kind of linked to that exposure risk to HPV. And so, unfortunately, someone who has a diagnosis of cervical cancer, or even someone who has a diagnosis of HPV, is potentially at risk for HPV in other sites. Unfortunately there's no standard screening for other HPV-related cancers the way there is for cervical cancer with the Pap smears. And I also have to add here just with HPV-related cancers, smoking is another major modifiable risk factor that is increased in all HPV-related cancers.

Host Amber Smith: At the beginning I said genitourinary cancers, and we've talked mostly about cervical cancer. Do you see many cases of vaginal or vulvar or anal cancers in women that are tied to HPV?

Allison Roy, MD: Vaginal and vulvar cancers are a little bit less common, but I certainly do see those in my patients. And most of them are tied to the HPV virus, a lot of vaginal/vulvar cancers. I don't see as many in terms of anal cancers, mostly because those end up going to my colorectal colleagues.

Host Amber Smith: So the vaginal or vulvar would not be diagnosed with a cervical test or a pap smear. How would those cancers be discovered?

Allison Roy, MD: Typically they're either based on a patient developing some sort of symptoms that comes to present, so things like itching, burning, maybe a bump that they feel, just general kind of irritation in the vaginal or vulvar area. Or they might be discovered just on a routine annual GYN (gynecologic) exam. You know, as providers, we're always looking at the external as well as the internal parts of the vulva, vagina, cervix, everything to look for any abnormal areas.

Host Amber Smith: So a woman who's listening to this interview, if she doesn't remember getting the HPV vaccine in childhood, should she talk with her gynecologist? Any gynecologist can help give a vaccination for HPV?

Allison Roy, MD: Absolutely. Yeah. Any OB/GYN (obstetrician/gynecologist) physician is able to talk about risk factors for the HPV vaccine and whether you should get it or not, depending on your individualized circumstances.

Host Amber Smith: Well, thank you so much for making time for this interview, Dr. Roy.

Allison Roy, MD: Thank you so much for having me. It's always a pleasure.

Host Amber Smith: My guest has been Dr. Alison Roy, a gynecologic oncologist at Upstate Medical University. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air" -- what you can do to protect your children if your home has lead paint.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." One of the worst lead poisoning crises in America is here in Syracuse, where the Onondaga County Health Department reports up to one in five children in some of the lowest income neighborhoods have elevated levels of lead in their blood. Here with me to talk about this problem is a pediatrician who cares for many of the children who are lead poisoned. Dr. Travis Hobart is an assistant professor of pediatrics and of public health and preventative medicine at Upstate. And he's also the medical director of the Central and Eastern New York Lead Poisoning Resource Center. Welcome back to "HealthLink on Air," Dr. Hobart.

Travis Hobart, MD: Thank you so much for having me. I'm glad to be here.

Host Amber Smith: I'd like to start by asking you to explain why lead is dangerous.

Travis Hobart, MD: Lead is dangerous because it has multiple effects on the body. Most importantly, it affects the brain and the nervous system, and that is particularly true for children who are more likely to be exposed and adults, for a number of reasons. And in children when they are exposed, it has permanent effects on their on their brain and development. It can lower their IQ. It can affect their behavior and attention, which gives them trouble in school as they go forward, as they grow older. And it affects their executive function. So it affects people's ability to make good decisions, which is obviously crucial to succeeding in life.

Host Amber Smith: Is it inhaled, or is it ingested?

Travis Hobart, MD: So it can be, it can be either. Most typically for kids, they are ingesting it in their mouth. And the way that that happens is usually that -- most often, anyway, the way that it happens is that -- the paint in older homes may still have lead in it, and as the paint deteriorates, dust from the paint falls onto the floor. And as we all know, children crawl around on the floor, and children often put objects in their mouth that may have that dust on them. And so they usually get it that way, by putting objects or putting their hands in their mouth that have leaded paint dust on them, and they ingest it that way. That said, it can also be inhaled into the lungs and absorbed that way. For instance, we sometimes will see that happen where somebody is doing home renovations, and they're sanding down old paint. And that sanding process, puts a lot of lead dust into the air, and people then walk through the cloud of lead dust, or children are in the room and they inhale it that way. Or adults are in the room, for that matter, and inhale it that way.

Unfortunately we sometimes see that when people are pregnant and they're renovating a room for a new child, or re painting, or something like that. And so then not only does the older child might get exposed, but also the mother, the pregnant mother can be exposed too.

Host Amber Smith: So if the pregnant mother is exposed, can she pass that onto the developing baby?

Travis Hobart, MD: She can. Yes, unfortunately, the lead does pass through the placenta into the developing baby. And usually the fetus doesn't have quite as high a level as the mother does, but it's usually 85 or 90% of what the mother's level is. So definitely. And that can have effects on the pregnancy, that can lead to miscarriage and hypertension, high blood pressure during the pregnancy. And then it also can,when the baby is born, the baby can have a high lead level then, as well.

Host Amber Smith: You talked about the long-term effects and the permanent damage that lead poisoning can do. Are there immediate effects? Are there symptoms that a parent would look for to tell whether their child has been exposed?

Travis Hobart, MD: Sometimes, but I would say most of the time, what we see most kids who have an elevated lead level don't have symptoms at the time that we see them, because if you get a high enough level, it can cause things as bad as seizures and what we call encephalopathy, which is brain swelling and brain problems, along with those seizures, and it even can cause death in some cases. But that's very rare. Most of the time, at lower levels, the most common symptoms that it can cause would be things like constipation or abdominal pain, things which, while maybe a problem, are not exclusive to lead poisoning. And many children that we see in everyday practice have abdominal pain or constipation. And so, it's really hard to pick out a child who has lead poisoning based on symptoms alone. And for that reason, and maybe I'm getting ahead of, to another question you're going to ask, but for that reason we would recommend that everybody get tested, all the kids get tested at age one and two. And that's what the state requirements are, in New York state, that all kids, age one and two, get tested, and that pediatricians are asking these questions when kids are from six months to six years old, asking the questions, "Hey, do you live in an old home? Do you have paint that's breaking down or flaking off?" and other questions that might be a warning sign for a kid that might get exposed.

Host Amber Smith: So it sounds like you generally discover this through the blood test, the routine blood tests?

Travis Hobart, MD: Yeah, that's correct. Yeah. Most of the time we don't know until we do the blood test.

Host Amber Smith: Okay. Why is the lead poisoning such a problem in Syracuse?

Travis Hobart, MD: So the main reason that it's a problem in Syracuse, and I don't want it to be exclusive to Syracuse. Unfortunately it's a problem in many, many cities in the Northeast and the Midwest. And the reason for that is that our housing is very old as a whole. If you look at the housing in the city of Syracuse, about 90% of it is built before 1980. And the reason that that timeframe is important is because lead paint used to be used regularly inside homes in residential for residential use, but that was banned in 1978. So if your house was built from 1978 onwards, then it was not, lead paint was never used inside your home. But if your house was built before then, which as I said, about 90% of the houses in Syracuse were there may well have been lead paint in there. It doesn't guarantee it, but, it makes it more likely. And the older your home is, the more likely it is that lead paint was used.

Host Amber Smith: So if you live in an old home, it's probably been painted since then, probably many times, but maybe the lead paint, the original lead paint, maybe wasn't removed. So would it still potentially pose problems?

Travis Hobart, MD: So we know that a painting over the lead paint does contain it in the wall. And so fortunately, if you live in an old home and the paint on your walls is in good shape, and it's not flaking off or breaking down, then you're in good shape. But the problem is, is that we know that that's not always the case, that sometimes the paint is breaking down. And in particular, we know that when people are renting homes, they often don't have the control over the paint that the landlord does. And unfortunately there are landlords out there that aren't responsive to tenants' needs. So, if they're not painting regularly and keeping the paint in good shape, then that old paint comes through, and we end up with kids being exposed. And then another place that sometimes we see the paint breakdown, more often, I should say, is in doors and windows. And that's because they have moving parts. And so as the doors are opened and closed, as the windows are opened and closed, the paint gradually breaks down, the layers get worn away, and you get to some of that older paint. And windows in particular, if you have a very old window, it usually has a storm window, the old sort of I think -- I forget what they're called -- but the old windows that have a storm window and then a main window. And that in-between area, while people may paint the inside of the window and people made the outside of the window, they aren't always painting that in-between area. And so, that's okay as long as the window's closed. But if it's a hot summer day and you open the window, then that paint that might've deteriorated in there might come into the home.

If you're living in a home that might have old lead paint, couple of things that you can do for your family and for your children: One thing is making sure your child is getting good nutrition, because if they have enough iron and enough calcium and enough vitamin C in their system, then they will absorb less lead from their environment. So I think it's important to make sure they're getting good nutrition. If you're afraid that they're not eating well or something like that, certainly talk to their doctor, or maybe consider using a multivitamin with your doctor's advice and approval. So I think that's an important aspect of prevention.

And then the other thing that I would recommend for families to do is: if you think that there's lead paint in your home, it's important when you're cleaning to do it with a mop or a wet wipe rather than a broom, because if you sweep up the lead dust, it just kicks it up into the air, and then it resettles down on the floor. And so the important thing is to mop it up or wipe it with a wet wipe so that you're getting it out of the environment and keeping your kids from being exposed.

Host Amber Smith: And we've talked about Syracuse and cities, but is this the problem in rural or suburban areas as well, or potentially?

Travis Hobart, MD: It is. Yeah. And we do have children every year that are exposed in suburban and rural areas as well. So anywhere where there's an old house, it's true. Now typically, the suburban areas have usually a lower percentage of older housing because they've been built up in the last 50 years or 40 years, but that's not to say there's none. I live in a suburban area, and my home has even old windows that have lead in it that I know for a fact. The rural areas, in particular, when we do sometimes see kids that come that live in a farmhouse or something like that, that's been around for a hundred and 150 years, and they often will have lead paint in those places too. I think the difference is, is that, of course, in the city, more people live in the city, so we often see higher numbers there, and also more people usually rent homes in the city where, again, they have that lack of ability to make the repairs that are needed to keep the house up to date.

Host Amber Smith: What can you tell us about the lead abatement and control ordinance that the city of Syracuse passed a couple of years ago? Has it been helpful?

Travis Hobart, MD: So, yes. I'm very hopeful about that lead ordinance. I think it's on route to being helpful, let's say. What the ordinance does, is it requires that homes are inspected, I believe it's every three years, that rental homes are inspected every three years and that they're on the rental registry, so that we are sure that if there's a lead issue that comes up, that that gets identified in that three-year period, and the landlords are then responsible for fixing it. And so that's great. And that's the kind of model that has been done in other cities as well, a similar models to that of making sure that these houses, these rental homes get inspected regularly to protect the children that might live there. And why I say it's en route to becoming effective is, it was passed during the pandemic, of course. And so the city is still in the process of operationalizing it and enforcing it. And so that required that they hired more inspectors, and it required that they had money to do it. And certainly early in the pandemic, they were very low on money. And then in the last year they got some money from the federal government. So very recently I've heard that they are moving forward with getting that ordinance done and operationalized so that they can enforce it and really make it work for the families in the city.

Host Amber Smith: Is there any way, right now, for a potential tenant to know ahead of time if the apartment that they're thinking about moving into is a lead hazard?

Travis Hobart, MD: There are a couple of ways that it might come up. When you're buying a house, the previous owner is supposed to disclose if there are any lead hazards in the home. So that's at least something. It usually isn't the greatest because some people don't always know that there are lead hazards in the home, even though there are. Now if you're renting a house, you can, I believe you can ask for an inspection, but I don't know the exact rules on whether the landlord has to get the inspection done, or not, before they give it to you. I mean, now this new ordinance says that they would have had to have one within the past three years. But again, I'm not sure. It may be that they haven't because it's yet to be really enforced. But you can certainly ask for them to do an inspection and look for lead.

And then, if you live in a home where let's say you're already renting a home, if you have a child or you're pregnant, you can call the health department, and the health department can do an inspection for looking for lead, specifically. And now I should say that they will do the inspection for people that ask, but they have to prioritize the places where people have been exposed already. And for a number of reasons, including the pandemic, obviously, there's a pretty good backlog of people needing inspections, for that reason, that already have lead poisoning, and the health department has to prioritize those. So if you call out of the blue, they may not be able to come right away to do the inspection.

And then finally, what I would say is that, I wish there were an easier way to find out if your house had lead in it then than that, and we're headed in that direction. So that's encouraging. And the other thing that I would say is that you can do it yourself, to some degree. So there are lead testing kits that are available at Home Depot or Lowe's or whatever hardware stores that are little pieces, like little cylinders that have fluid in them and you pop it and then you rub it on the area that you think there might be lead, and it will turn red if there's lead. And those are pretty accurate ways of determining if there's lead in certain places.

Host Amber Smith: Well, let me ask you as a practicing pediatrician who cares for children who have been lead poisoned, what is the treatment? What are you able to offer for medical treatment?

Travis Hobart, MD: I think maybe another unfortunate thing about it is that there are not treatment options for kids at low levels of lead. The medications that we use for lead poisoning are only really effective when the level is 45 or above, and so that's obviously way higher than what is unhealthy. And any level above zero is unhealthy. But the medications just don't work unless, the medications that we have, I should say, don't work unless it's 45 or above, and unfortunately I don't know of any pharmaceutical companies making medicines that would work. So the main therapy that we would do is fixing the hazard. That's the main thing that we can do is fixing the hazard in the home, and / or removing the child from the home so that they're no longer exposed. And so that, in some cases, might mean that they move to a relative's house or for a period of time, or in some cases it might mean that the whole family gets new housingthrough housing assistance or their own other way.

The key, sort of, treatment, quote, unquote, treatment of lead poisoning is not treating the kids after they become exposed. It's treating the homes before the kids are living there to be exposed in the first place. And so I think that's why part of my job is to talk to the health department regularly and talk to the city inspectors and, be a voice between the medical community and these public health organizations and public health agencies that are doing the work to keep kids out of these homes. That's what we call primary prevention. We'd rather keep the kid from being exposed to begin with because once we find it in the office, it's too late. They've already been exposed. Some of that damage has already been done. Now, we can prevent further damage, but we can't go back and erase the damage that's already been.

Host Amber Smith: Well, Dr. Hobart, thank you so much for making time for this interview.

Travis Hobart, MD: Yeah, no, it's my pleasure. I'm happy to do it. And thank you for inviting me.

Host Amber Smith: My guest has been Dr. Travis Hobart, a pediatrician at Upstate and also the medical director of the Central and Eastern New York Lead Poisoning Resource Center. I'm Amber Smith for Upstate's HealthLink on Air.

And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Jane Schapiro's latest book of poetry is called "Let the Wind Push Us Across." It's published by Antrim House. She asks us to reconsider our use of the expression "status quo," which grows in this short poem to dramatic heights.

"Prayer for the Status Quo"

Bless the state in which

we find ourselves

as we are.

Praise the are,

the in out in

of breath.

Behold the breath,

the you, the me,

the IV drip

drip drip drip

and fear.

Seek grace in the fear,

the state in which

we find ourselves here

as things are

as we are

inside this wreckage

of now.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air": treatment options for bunions. If you missed any of today's show or for more information on a variety of health, science and medical topics, visit our website at www.healthlinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.