In the Fall of 2023, three brands of cinnamon-flavored apple sauce pouches being sold on Amazon and in Dollar Tree stores in the US were found to contain high levels of lead and chromium. Hundreds of cases of lead exposure from these products have been reported across the US, including 19 cases from Louisiana. Because new cases are still emerging, it’s crucial for pediatricians to be aware of the issue and the actions they can take to help protect their patients.
In late October 2023, the FDA was notified about an investigation in North Carolina regarding children with blood lead levels (BLL) above the reference value. North Carolina officials identified WanaBana Apple Cinnamon Fruit Puree Pouches as a shared source of exposure between the cases and found high concentrations of lead in multiple lots of the product. The FDA reviewed and supported the findings, issuing a safety alert reporting their investigation and advising parents and caregivers not to purchase or feed the contaminated product to children. By November 9th, WanaBana, Schnucks, and Weis cinnamon-flavored applesauce pouches were voluntarily recalled. As of January 26, CDC had received reports of 404 cases across 43 states. CDC recommends that clinicians counsel patients and caregivers not to eat the recalled products, to test the BLLs for all patients who have consumed the recalled products, and to educate patients and caregivers on the effects of lead exposure in children.
The Louisiana Department of Health (LDH) issued a health alert message via the Health Advisory Network and responded to its first case on October 30th. LDH’s Childhood Lead Poisoning Prevention Program (LCLPPP) coordinated with the FDA and CDC to identify children who may have consumed these products and provide follow-up services. LCLPPP is providing environmental assessments to rule out other sources of lead exposure for these cases. As of February 16, there had been 19 cases in Louisiana, with the reported BLLs ranging from 3.5 mcg/dL to 11.5 mcg/dL. These cases came from 14 parishes (Acadia, Ascension, Caddo, Calcasieu, East Baton Rouge, Jefferson, Lafourche, Livingston, Orleans, Point Coupee, Rapides, St. Bernard, Washington, and Webster) and ranged in age from 10 months to 2 years.
The lead-contaminated pouches were also linked to chromium exposure early this year when FDA product testing found high levels of chromium in the recalled product. The FDA cannot confirm which form of chromium is in the recalled pouches, and the effects of ingesting chromium (VI) are not well understood. To access clinical guidance for lead and chromium exposure, visit the CDC’s Clinician Outreach and Communication Activity (COCA). Should healthcare providers have additional questions, please visit ldh.la.gov/lead-poisoning-prevention or contact the LCLPPP at 888-293-7020 by phone or Leadinfo@la.gov by email.
More information can be found at the links below.
FDA Investigation Report: https://www.fda.gov/food/outbreaks-foodborne-illness/investigation-elevated-lead-chromium-levels-cinnamon-applesauce-pouches-november-2023
LDH’s Health Advisory Network message: https://ldh.la.gov/assets/oph/Center-CP/HANs/2023/HAN-23-20.pdf