Transcript Health Hazards of Pesticides - AOEC

Pesticide Illness
Part I:
Background, Epidemiology,
Recognition, Diagnosis, Management
Prepared by:
Rupali Das, MD, MPH, California Department of Health Services,
Michael O’Malley, MD, MPH, University of California, Davis,
Laura Styles, MPH, Public Health Institute
Pesticide Toxicology
 Many
toxin
categories
 Affect
various
organs
 Varied
effects
health
Diagram illustrating various pesticide-related health effects.
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Definition of Pesticide
“Any substance or mixture of
substances intended for preventing,
destroying, repelling, or mitigating
any insects, rodents, nematodes,
fungi, or weeds, or any other forms
of life declared to be pests; any
substance or mixture of substances
intended for use as a plant
regulator, defoliant, or desiccant.”
--Federal Insecticide, Fungicide, and
Rodenticide Act (US EPA, 1947)
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US Pesticide Use
 4.5
billion pounds
chemicals per year
– 890 active
ingredients, 30,000
formulations
– Uses
 75%
agricultural
 25% home, garden,
structural
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Agricultural Pesticide Use
 High
volume:
– Hand labor (Western states)
 Vineyards
 Orchard,
 Low
row vegetables, nursery
volume:
– Mechanized (Midwest states)
 Livestock
insecticide dipping
 Grain agriculture
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Pesticide Exposure:
Occupational Settings
 Multiple
–
–
–
–
Agriculture
Emergency response
Maintenance
Transportation
 Variety
–
–
–
–
industries
of workers
Applicators, fieldworkers
Firefighters
Medical personnel
Flight attendants
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NEETF 2002
Pesticide Exposure:
Environmental-Occupational Interface
 Drift
– Off-target physical
movement of pesticide
through air
 Take-home
– Contaminated clothing
– Pesticide containers
brought home
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 Use
Pesticide Exposure:
Environmental Settings
in schools
 Lawn,
garden use
 Household
cleaning
 Home
pesticide
use
 Residues
in food
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Human Exposure to Pesticides
 Second
National Report on Human
Exposure to Environmental
Chemicals
– http://www.cdc.gov/exposurereport/
 Pesticides
or metabolites detected in
general population, 1999-2000
– Organophosphates
– Organochlorines
– Carbamates
– Herbicides
– Pest Repellents & Disinfectants
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Pesticide Exposure:
Accidental Ingestion
Prescription
pesticides
resembling oral
medications
California Poison Control Center

Photo: John P. Lamb, Pharm D.,
Improper storage
or mislabeling of
containers
Source: EPA Australia

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Pesticide Exposure:
Suicide/Homicide
 Unknown
substance
 Secondary
exposure
San Francisco Chronicle
Monday, January 17, 2000
Coroner Identifies Man Who Swallowed Pesticide
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Unintentional Pesticide Illness, USA
Number of Illnesses, Log
scale
Toxic Exposure Surveillance System 1993-1996
100000
10000
1000
100
Minor
Moderate
Major
Fatal
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In
R
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Illness severity
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Surveillance of Pesticide Illness

States with ongoing
surveillance
– Arizona, California,
Florida, Louisiana,
New York, Oregon,
Texas, Washington

States with previous
pilot or periodic
surveillance
programs
– Iowa, South Carolina,
Wisconsin
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Methods, Results of Surveillance
Surveillance-based
illness detection:


Reporting required
Reporting not required

Emergency
department treatment
of organophospate
toxicity
Automatic insecticide
dispenser units
Occupational use of
flea-control products
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Pesticide Illness
Rates Vary by Occupation
Organophosphate pesticide poisoning rates by agricultural sector
California, 1982--1990
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Source: HS-1688, Cal EPA
Pesticide Illness Around the World
Annual rates of intentional and unintentional pesticiderelated fatalities and hospitalizations in several countries
1000
800
600
400
200
0
Hospi tal izati ons
Costa
Rica
Sri
Lanka
Sweden
Fatali ties
U.K.
U.S.A.
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US EPA Toxicity Classification
(Systemic toxicity, eye irritation, skin irritation)

Class I: “Danger”
– Fatal if ingested; corneal opacity; corrosive to
skin

Class II: “Warning”
– May be fatal if ingested; reversible corneal
opacity; severe skin irritation

Class III: “Caution”
– Harmful if ingested; no corneal opacity;
moderate skin irritation

Class IV: “Caution”
– May be harmful if ingested; no eye irritation;
mild/no skin irritation
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Common Components of
Pesticide Formulations

Technical grade chemical
(active ingredient)

Adjuvants/synergists

“Inert” ingredients
– e.g., formaldehyde, sulfuric
acid, benzene, toluene, other
organic solvents
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Diagnosis of Pesticide Illness
 Exposure
history most important
– Occupational and environmental history
– Duration, dose, route of potential
exposure
 Symptom
review
 Physical exam & lab findings
 Health effects may be due to any
component of pesticide formulations
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Aspects of History that
Suggest Pesticide Illness
 Multiple
cases
– Similar symptoms, exposure history
 History
of chemical application
– Home or office
 Accidental
ingestion, esp. children
 Suicide, homicide attempts
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Pesticide Illness
Nonspecific Symptoms & Signs
 Rash
 Flu-like
symptoms
– Dizziness, malaise, respiratory tract
irritation
 Gastrointestinal
symptoms
 Seizures
 Odor-related
effects
– Not toxicological effects of active
ingredient
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Pesticide Illness May Mimic
Common Medical Conditions
 Mild:
–
–
–
–
Upper respiratory tract infection/influenza
Food-borne illness
Asthma
Plant-induced irritant or allergic dermatitis
 Severe:
– Cerebrovascular accident
– Psychiatric dysfunction
– Heat stroke
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How to Identify Pesticides
 Application
records
 Label
 Material
Safety Data Sheet

www.msdsonline.com

http://www.ilpi.com/msds/index.html
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Sources of Pesticide Information

Internet
– EXTOXNET: http://ace.orst.edu/info/extoxnet/
– California Department of Pesticide Regulation:
http://www.cdpr.ca.gov/docs/label/labelque.htm
– Pesticide Action Network: http://www/pesticideinfo.org/index.html

Textbooks
– US EPA. Recognition and Management of Pesticide Poisonings. 1999; 5th
ed. http://www.epa.gov/pesticides/safety/healthcare
– R Krieger (ed). Handbook of Pesticide Toxicology. 2001; 2nd ed.


Poison Control Centers: 1-800-222-1222
National Pesticide Information Center (NPIC):
1-800-858-7378 or [email protected]
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Treatment of Pesticide Illness
Decontamination

Shower, shampoo
– Scrub under fingernails

Contain contaminated
clothing, body fluids
– Save for residue analysis

Protect treating staff
– Body fluid precautions
– Personal protective
equipment if appropriate
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Pesticide Illness
Medical Treatment
 Symptomatic
treatment
– Respiratory distress
 Maintain
airway, breathing, circulation
 Oxygen, bronchodilators if indicated
– Ingestion
 Gastric
 Specific
lavage, charcoal if indicated
antidotes where applicable
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Poison Control Centers
 Toxicity
 Decontamination
 Management
 Reporting
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Case
Applicator with Gastrointestinal Illness



27 year-old pesticide applicator with
dizziness, headache, body ache, nausea
and vomiting. Sprayed Carzol yesterday.
Exam: Weak (not flaccid), oriented;
orthostatic hypotension; exam
otherwise normal.
Cholinesterase normal compared to
laboratory reference range
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Applicator with Gastrointestinal Illness
Discussion
 Differential
etiology of
gastroenteritis
 Pesticide-related
 Food-borne
 Viral
 Test
results confirm clinical
suspicions
– Normal results do not rule out
exposure
– Treatment based on symptoms
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Pesticide Illness: Summary (I)
 Varied
populations at risk
 Environmental,
 Keys
occupational exposure
to reducing illness
– Physician diagnosis
– Reporting to surveillance system
– Advice on preventing exposure
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Pesticide Illness: Summary (II)
 Occupational,
 Clinical
 Tests
environmental history
suspicion
supplement clinical diagnosis
 Treatment
symptomatic, few
exceptions
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