By Rose Hoban
Quick work from a North Carolina pediatrician and Catawba County public health authorities helped detect mass lead poisoning that has affected more than 500 children in at least 44 states.
Their action helped get the word out quickly to unsuspecting parents across the country about tainted applesauce.
In a new publication from the Centers for Disease Control and Prevention, public health officials from the North Carolina Department of Health and Human Services detail how a couple from Hickory learned from their pediatrician that their two toddlers had lead poisoning.
The pediatrician notified county health officials, who checked the home of Nicole Peterson and Thomas Duong for lead in their water, the paint, dust and soil in and near their home without finding the culprit.
Then the pediatrician suggested that the couple check what the children were eating. By process of elimination, they determined that pouches of WanaBana brand applesauce flavored with cinnamon purchased at Dollar Tree were the only foods the children were consuming that the parents were not.
The cinnamon in the applesauce was tainted with lead chromate, a chemical known to be added to cinnamon to increase its weight and volume to fetch a higher price on the market.
Since the winter, the CDC and the U.S. Food and Drug Administration have been investigating the incident and a chain of food manufacturers and distributors stretching from Sri Lanka to Ecuador to Florida-based distributor WanaBana to the national retail chain Dollar Tree.
In October 2023, WanaBana USA issued a voluntary recall of all WanaBana Apple Cinnamon Fruit Puree pouches, and Dollar Tree was notified in writing on Oct. 29 to remove the products from their store shelves, according to the FDA. The recall also extends to two other private label brands distributed by the same company under the names Schnucks Apple Sauce pouches with cinnamon, and Weis Cinnamon Apple Sauce.
Some Dollar Tree stores continued to sell the tainted applesauce, according to the FDA, prompting the agency to send a warning letter on June 11 alerting the retailer that over the previous six months the product had been found on its shelves by state and local inspectors.
“You continued to offer the recalled WanaBana Apple Cinnamon Fruit Puree pouches on store shelves well after the recall was initiated, despite FDA’s numerous attempts to bring this serious issue to your attention,” the agency told the retailer.
While the incident has demonstrated the effectiveness of local public health officials at finding the culprit behind the poisoning, the episode has also shown that federal regulators can’t always address the whole problem.
Lead exposure symptoms and complications in children
Exposure to lead can seriously harm a child’s health and cause well-documented adverse effects such as:
- Damage to the brain and nervous system
- Slowed growth and development
- Learning and behavior problems
- Hearing and speech problems
This can cause:
- Lower IQ
- Decreased ability to pay attention
- Underperformance in school
There is also evidence that childhood exposure to lead can cause long-term harm.
Lead exposure in children is often difficult to see. Most children have no obvious immediate symptoms. If parents believe their children have been exposed to lead, they should talk to their child’s healthcare provider. They may need to get a blood lead test.
Healthcare providers and most local health departments can test for lead in the blood. Many private insurance policies cover the cost of testing for lead in the blood. The cost of blood lead testing for children enrolled in Medicaid is covered by the Centers for Medicare and Medicaid Services.
Lead effects
Peterson and Duong’s children were 3 years old and 1 year old at the time of the lead poisoning. They had been eating one or two of the WanaBana applesauce pouches each day. The products were marketed as “kosher,” “additive free” and “organic.”
When the children were first diagnosed with lead poisoning in June 2023, their blood lead levels were 12.4 micrograms/deciliter of blood for the older child and 10.2 mcg/dl for the younger child. By the time the source of their poisoning was discovered, those levels had risen to 24.1 mcg/dl for the older child and to 20.8 mcg/dl for the younger one.
Lead was more prevalent in the environment and in many consumer products in decades past. It was believed then that children could withstand some small amounts of lead in their blood, but even then, a blood lead level higher than 10 mcg/dl was cause for alarm. Since the 1990s, the science has evolved. Health researchers now believe that no level of lead in humans is safe.
The heavy metal is known to cause widespread neurological effects in people who have been exposed to it, especially over time. Those effects include irreversible damage to the brain and central nervous system. Lead poisoning can leave children with behavioral issues and decreased intellectual capacity.
“Any child that has a [blood lead] test in North Carolina, their results are required to be reported to the lead poisoning prevention program,” Melanie Napier, an epidemiologist from the state Division of Public Health, explained to NC Health News. “And then we have a case definition that we use, anything over 5 micrograms per deciliter, that’s what would trigger an environmental investigation.”
All children enrolled in the state’s Medicaid program — more than 1.4 million — are required to have lead testing of their blood when they’re 1 and 2 years old. Lead testing is not required for everyone, though, so it is not as common for children who do not receive Medicaid.
From October 2023 to early 2024, a total of 22 North Carolina children were either suspected of or confirmed as having lead poisoning from eating the applesauce.
“Fewer than one half of the North Carolina cases were among children enrolled in Medicaid, and no typical potential sources of lead exposure were identified as the likely cause for one half of the children, including those from households,” the state health officials said in the CDC report. “This finding suggests that the recommendation for routine lead testing of all young children in North Carolina at ages 1 and 2 years might have led to detection of cases that would not otherwise have been identified and resulted in earlier identification and removal of a novel exposure source.”
Tangled supply chain
Cinnamon, a spice that comes from the bark of a tree, is widely produced in the tropical world. The cinnamon in question was grown in Sri Lanka, and the cinnamon sticks were shipped to a manufacturer in Ecuador.
According to the FDA, the original sticks have not tested positive for lead, but the ground cinnamon sold by a now-shuttered spice manufacturing company in Ecuador — Carlos Aguilera — tested positive for high levels of lead. Often there are trace amounts of lead in manufactured foods, perhaps 1 or 2 parts per million, but some samples from the Aguilera facility tested as high as 2,000 parts per million.
Another company, Negasmart, bought the ground cinnamon and provided it to a manufacturer, Austrofoods, that actually made the applesauce with cinnamon and exported it to the U.S. — where WanaBana packaged and distributed it, according to a lawsuit filed against the company by Peterson and Duong.
The FDA has noted that because the Carlos Aguilera company and Negasmart did not ship directly to the U.S., the agency does not have the authority to inspect the food manufacturers’ facilities. The FDA does have the ability to inspect Austrofoods, since it ships to the U.S., but the agency had not carried out an inspection for five years.
“The pandemic was one of the reasons we weren’t sending our folks into the field,” said Conrad Choiniere of the FDA’s Center for Food Safety and Applied Nutrition. He also cited a dearth of inspectors.
“We can always use more resources to do our job,” he told NC Health News.” The food system is large. It’s complex. There are thousands of manufacturers of food and facilities, tens of thousands of facilities within the U.S. and and then again, that much and more outside of the U.S. that we would be responsible for.”
Choiniere said the agency is looking to “use the resources that we have in a much more effective manner by focusing on high-risk areas,” and that the FDA is also looking for “additional authorities” as well as using more remote technology to access business records and manufacturing logs of distant companies.
There also is fallout from the incident already playing out in the courts.
Peterson and Duong filed a lawsuit against WanaBana and Dollar Tree in Florida state court in January.
They have accused the companies of gross negligence and deceptive and unfair trade practices, among other things. The couple is seeking unspecified compensatory damages, medical expenses and legal fees.
“At all pertinent times, the WanaBana Defendants had a duty to reasonably and properly design, manufacture, test, inspect, package, label, distribute, market, examine, maintain, supply, provide proper warnings and prepare for use the Products, as a reasonably prudent and careful manufacturer,” the lawsuit reads.
The lawsuit also notes that on WanaBana’s Facebook page, the company states that their products are held to “EXTRAORDINARY STANDARDS – Recognized both at the national and international level, while also striving for innovation and contributing to the development of agriculture and agroindustry.”
Groups of parents of other affected children from across the country, including those of other North Carolina couples, have also filed suit against some or all of the companies involved in the mass poisoning.
In May, WanaBana filed for bankruptcy, listing dozens of lawsuits for damages that have been filed against it, and listing only $566,160 in assets.
