A meeting on the high rate of the rare birth defect anencephaly in Benton, Franklin and Yakima counties drew about two dozen people Wednesday night.
They peppered officials with questions -- from whether they'd considered lead and arsenic in the soil to why there isn't a better system in place to monitor occurrences -- during the session at the Benton-Franklin Health District.
One person asked if there was a link between maternal age and the neural tube defect. Another asked if the women with affected pregnancies had previously given birth.
Candelaria Murillo asked whether health officials had analyzed the occupation and economic status of the women and also whether they had other health problems.
Health officials - primarily Juliet VanEenwyk, a state epidemiologist - answered the questions they could, gave details on their investigation into the birth defect cluster and talked about plans moving forward.
Murillo, who grew up in Sunnyside and now works in the Tri-Cities for the nonprofit Columbia Legal Services, said she's glad the public session was put together.
"I think it's definitely a good first step -- getting the community involved, taking time to listen to us," she said.
But "obviously, the big question hasn't been answered - what's causing this. Causation is the puzzle that as a community we can't answer on our own."
Health officials have spent months looking into the high anencephaly rate in the three counties, but so far they haven't been able to identify a clear cause. They examined medical records, comparing affected pregnancies to healthy ones, and also considered possible effects from the Hanford site, pesticides and nitrate exposure.
They aren't done looking into the cluster, officials said during Wednesday's meeting in Kennewick.
An advisory group of community members, health care providers, public health officials and experts on birth defects and cluster investigations is forming.
One of the goals is to "help us decide how we might go forward exploring this further to try to find a cause. Do we interview women? Do we sample wells? What might be something that would help us figure this out?" VanEenwyk said.
Public input from the Kennewick session -- as well as from a similar meeting held Tuesday in Sunnyside -- will be passed onto the advisory group, officials said.
Anencephaly is a fatal neural tube defect; babies with it are missing parts of their skull and brain and die in utero or shortly after birth. Seven cases were found in Benton, Franklin and Yakima counties last year. The rate of 8.7 per 10,000 births was more than four times the national rate.
The local rate for 2010-12 also was high.
While officials continue to investigate, they're urging women of childbearing age to take steps to lower their risk, namely taking a daily multivitamin with folic acid.
Not getting enough folic acid before and during the early stages of pregnancy is known to be a risk factor. The Centers for Disease Control and Prevention recommends a vitamin with 400 micrograms of folic acid.
Officials also have said women who use private wells for drinking water should have the wells checked regularly for nitrates. High nitrates have been linked to birth defects.
Rosie Tobias, who works in the Women, Infants and Children program for the local health district, said she came to Wednesday's session in part so she can help educate her clients. Like Murillo, she said it was a good first step - and she wants to see the work continue.
"It's a starting point to build on," she said.
-- Sara Schilling: 582-1529; firstname.lastname@example.org; Twitter: @saraTCHerald