Pesticide%20Illness

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Pesticide Illness

• Part I
• Background, Epidemiology,
• Recognition, Diagnosis, Management

Prepared by Rupali Das, MD, MPH, California
Department of Health Services, Michael OMalley,
MD, MPH, University of California, Davis,
Laura Styles, MPH, Public Health Institute
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Pesticide Toxicology

• Many toxin categories
• Affect various organs
• Varied health effects

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, row vegetables, nursery
• Low volume
• Mechanized (Midwest states)
• Livestock insecticide dipping
• Grain agriculture

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Pesticide ExposureOccupational Settings

• Multiple industries
• Agriculture
• Emergency response
• Maintenance
• Transportation
• Variety of workers
• Applicators, fieldworkers
• Firefighters
• Medical personnel
• Flight attendants

NEETF 2002
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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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Pesticide ExposureEnvironmental Settings

• Use 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

• Improper storage or mislabeling of containers

• Prescription pesticides resembling oral
  medications

Photo John P. Lamb, Pharm D., California Poison
Control Center
Source EPA Australia
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Pesticide Exposure Suicide/Homicide

• Unknown substance
• Secondary exposure

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Unintentional Pesticide Illness, USA Toxic
Exposure Surveillance System 1993-1996
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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
• Emergency department treatment of organophospate
  toxicity
• Automatic insecticide dispenser units
• Occupational use of flea-control products

Reporting required Reporting not required
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Pesticide Illness Rates Vary by Occupation
Organophosphate pesticide poisoning rates by
agricultural sector California, 1982--1990
Source HS-1688, Cal EPA
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Pesticide Illness Around the World
Annual rates of intentional and unintentional
pesticide-related fatalities and hospitalizations
in several countries
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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/pesti
  cides/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 npic_at_ace.orst.edu

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Treatment of Pesticide IllnessDecontamination

• 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 IllnessMedical Treatment

• Symptomatic treatment
• Respiratory distress
• Maintain airway, breathing, circulation
• Oxygen, bronchodilators if indicated
• Ingestion
• Gastric lavage, charcoal if indicated
• Specific 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, occupational exposure
• Keys to reducing illness
• Physician diagnosis
• Reporting to surveillance system
• Advice on preventing exposure

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Pesticide Illness Summary (II)

• Occupational, environmental history
• Clinical suspicion
• Tests supplement clinical diagnosis
• Treatment symptomatic, few exceptions