Public Health in Action: Discovery of a toxic eczema treatment in Multnomah County leads to government recall in U.S. and Vietnam

March 6, 2023

Perry Cabot of the County's Lead Poisoning Prevention Program

It is rare for public health at the local county level to have far-reaching impacts across the globe, but that is exactly what happened last month when Multnomah County’s Lead Poisoning Prevention Program discovered toxic levels of lead in a popular Vietnamese eczema cream.

When Perry Cabot, Senior Program Specialist with the Public Health Division’s Lead Poisoning Prevention Program, was informed by an Oregon Health Authority (OHA) colleague about a lead exposure in neighboring Washington County, he took note but did not expect to use the information. The father in this case had proactively narrowed down his infant’s lead exposure to either an Amazon shoe rack or a Vietnamese cream used to treat eczema, but the source was still unknown.

Shortly after learning of this case, Cabot had a home visit for another infant who had been diagnosed with lead poisoning, this time in Multnomah County. He followed his regular protocol, looking for possible exposures throughout the house. In the baby’s room, he took photos of potential sources, including a small tube of cream that had Vietnamese text across the label. There were no other clear sources of lead in the family’s newly built home.

Curious, Cabot used Google Lens to translate the text on the tube and saw that it was intended to treat eczema. He realized this could not be a coincidence and sent a photo of the cream to his colleague at OHA. He responded with his own photo of the same Vietnamese eczema cream, Diep Bao, taken the day before at the home of the Washington County case. The two sprung into action: They submitted the cream for lead testing, gathered Vietnamese community leaders and Public Health staff to help get the word out, and filed a report with the federal Food and Drug Administration (FDA).

Diep Bao

When the lab results came back, they were shocked. One of the bottles of Diep Bao had 9,670 parts per million (ppm) of lead and the other 7,370 ppm, making the solution about 1% lead. That’s 1,000 times the amount of lead that’s considered safe. The FDA limit for lead in cosmetics is 10 ppm.

The FDA ultimately issued a formal recall and advisory of Diep Bao eczema cream. Word traveled and the Vietnamese government began investigating the company that manufactures the cream in Hanoi. They too eventually decided to recall Diep Bao, undoubtedly preventing lead poisoning in many other children.

“This is a great example of public health in action,” Cabot says, reflecting on the many systems in place that resulted in this amazing win:

  • First, one of the clinics that tested the children for lead followed a universal testing policy for infants. This was incredibly important for identifying the lead poisoning, as neither of the children showed any visible signs or symptoms and the standard screening questionnaire wouldn’t have led to these children being tested. Cabot supports a universal testing policy, but many clinics don’t have the resources or capacity to ensure it takes place. 
  • Second, the parents of the children were extremely vigilant and involved in their children’s health. Had the father in the first case not purchased his own at-home lead testing kit, the cream would not have been identified as a potential lead source. The mother of the Multnomah County case, featured in this video, was also very engaged in working with the Public Health Division. 
  • Third, the system in place between OHA, Multnomah County, and Washington County, as well as internal processes, allowed staff at the respective agencies to quickly work together to investigate potential sources of lead. They were then able to communicate swiftly with impacted communities about the source once it was identified. This collaboration between Environmental Health Services and Community Partnerships and Capacity Building (CPCB) in the Public Health Division, and staff with the Health Department Communications and Marketing team and County Communications, made it possible to get the word out promptly. 

It was the quick translation and outreach efforts by CPCB staff, along with support from other Public Health staff who were able to translate materials, that helped get the word out as quickly as it did. Chi Bui and Water Berry, from CPCB, and a staff person from the Women, Infants, and Children (WIC) program, quickly sprung into action when the need to communicate with Vietnamese communities arose. 

“I appreciate that we acted very quickly,” Bui said. “Right away I wanted to step in and do as much as I could to help spread the word.” As a member of the Vietnamese community and CPCB team, Chi was uniquely positioned to help with the translation and outreach efforts. She knew that the most effective ways to reach families that needed to hear this information was through schools and Facebook. She worked closely with CPCB’s Water Berry, who liaises with Multnomah County’s Asian communities. Together, they shared the translated messages with Vietnamese community health workers (CHWs), community partners, and schools. Chi also worked with Cabot to organize a learning session for CHWs on lead poisoning prevention and connect CHWs to resources.

Public Health is often touted as a model that, when working well, is invisible to the public. In this case, the quick work of Public Health stopped the continued use and production of a toxic product and saved innumerable children and families from lead poisoning. This is a massive win for communities in Multnomah County, across the United States, and even across the globe.