Napier et al. 2023 — Lead and chromium contamination in apple cinnamon fruit puree pouches
Between June and August 2023, routine blood lead testing in North Carolina identified four young children in three unrelated households with blood lead levels ≥5 µg/dL. Environmental investigations traced the exposure to WanaBana brand apple cinnamon fruit puree pouches, which contained 1.9–3.0 ppm lead. An expanded nationwide investigation ultimately identified approximately 500 cases of childhood lead exposure linked to the contaminated products. FDA investigation determined that the cinnamon used in these products, sourced from Ecuador, contained lead chromate (PbCrO₄).
Key numbers
| Metric | Value |
|---|---|
| North Carolina cases confirmed | 22 |
| Nationwide cases reported (by March 2024) | ~500 |
| Product lead concentration range | 1.9–5.8 ppm |
| Product lead concentration mean (NC confirmed cases) | 3.0 ppm |
| Initial blood lead level mean (NC) | 11.7 µg/dL (range 4.8–23.0) |
| Confirmatory blood lead level mean (NC) | 10.8 µg/dL (range 5.2–23.5) |
| FDA draft action level for fruits | 10 ppb (0.01 ppm) |
| North Carolina food reportable limit | ≥1.0 ppm |
| Cases among Medicaid-enrolled children | 10 of 22 (45%) |
Methods
Product samples were analyzed for lead using inductively coupled plasma mass spectrometry (ICP-MS) following EPA method 6020B. Blood lead levels were measured by capillary or venous blood sampling in children identified through routine screening at ages 1–2 years. Environmental investigations by county health department staff collected samples from homes and assessed potential exposure sources.
Implications
This outbreak demonstrates both the effectiveness of routine childhood lead screening and the emergence of unexpected contamination sources in processed foods. Fruit-based purees for young children warrant supplier verification and heavy metals testing, particularly when imported spices or spice-containing products are components. The contamination with lead chromate specifically highlights the need for source-country quality controls and import testing programs. For HMT&C certification, this case supports extending surveillance to finished fruit products and implementing spice supplier verification protocols.
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