Pesticide Illness

1. 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

2. 2
Pesticide Toxicology
 Many toxin
categories
 Affect various
organs
 Varied health
effects
Diagram illustrating various pesticide-related health effects.

3. 3
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)

4. 4
US Pesticide Use
 4.5 billion pounds
chemicals per year
– 890 active
ingredients, 30,000
formulations
– Uses
75% agricultural
25% home, garden,
structural

5. 5
Agricultural Pesticide Use
 High volume:
– Hand labor (Western states)
Vineyards
Orchard, row vegetables, nursery
 Low volume:
– Mechanized (Midwest states)
Livestock insecticide dipping
Grain agriculture

6. 6
Pesticide Exposure:
Occupational Settings
 Multiple industries
– Agriculture
– Emergency response
– Maintenance
– Transportation
 Variety of workers
– Applicators, fieldworkers
– Firefighters
– Medical personnel
– Flight attendants
NEETF 2002

7. 7
Pesticide Exposure:
Environmental-Occupational Interface
 Drift
– Off-target physical
movement of pesticide
through air
 Take-home
– Contaminated clothing
– Pesticide containers
brought home

8. 8
Pesticide Exposure:
Environmental Settings
 Use in schools
 Lawn, garden use
 Household
cleaning
 Home pesticide
use
 Residues in food

9. 9
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

10. 10
Pesticide Exposure:
Accidental Ingestion
 Improper storage
or mislabeling of
containers
 Prescription
pesticides
resembling oral
medications
Photo:JohnP.Lamb,PharmD.,
CaliforniaPoisonControlCenter
Source:EPAAustralia

11. 11
Pesticide Exposure:
Suicide/Homicide
San Francisco Chronicle Monday, January 17, 2000
Coroner Identifies Man Who Swallowed Pesticide
 Unknown substance
 Secondary exposure

12. 12
Unintentional Pesticide Illness, USA
Toxic Exposure Surveillance System 1993-1996
1
10
100
1000
10000
100000
D
isinfectantsFum
igantsFungicidesH
erbicidesInsecticides
R
odenticides
Minor
Moderate
Major
Fatal
NumberofIllnesses,Log
scale
Illness severity

13. 13
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

14. 14
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

15. 15
Pesticide Illness
Rates Vary by Occupation
Source: HS-1688, Cal EPA
Organophosphate pesticide poisoning rates by agricultural sector
California, 1982--1990

16. 16
Pesticide Illness Around the World
Costa
Rica
Sri
Lanka
Sweden
U.K.
U.S.A.
Fatalities
Hospitalizations0
200
400
600
800
1000
Annual rates of intentional and unintentional pesticide-
related fatalities and hospitalizations in several countries

17. 17
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

18. 18
Common Components of
Pesticide Formulations
 Technical grade chemical
(active ingredient)
 Adjuvants/synergists
 “Inert” ingredients
– e.g., formaldehyde, sulfuric
acid, benzene, toluene, other
organic solvents

19. 19
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

20. 20
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

21. 21
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

22. 22
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

23. 23
 Application records
 Label
 Material Safety Data Sheet
 www.msdsonline.com
 http://www.ilpi.com/msds/index.html
How to Identify Pesticides

24. 24
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 npic@ace.orst.edu

25. 25
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

26. 26
 Symptomatic treatment
– Respiratory distress
Maintain airway, breathing, circulation
Oxygen, bronchodilators if indicated
– Ingestion
Gastric lavage, charcoal if indicated
 Specific antidotes where applicable
Pesticide Illness
Medical Treatment

27. 27
Poison Control Centers
 Toxicity
 Decontamination
 Management
 Reporting

28. 28
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

29. 29
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

30. 30
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

31. 31
Pesticide Illness: Summary (II)
 Occupational, environmental history
 Clinical suspicion
 Tests supplement clinical diagnosis
 Treatment symptomatic, few
exceptions