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
 Manytoxin
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) 3
 US Pesticide Use

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

4
 Agricultural Pesticide Use

 High volume:
– Hand labor (Western states)
 Vineyards

 Orchard, row vegetables, nursery

 Low volume:
– Mechanized (Midwest states)
 Livestock insecticide dipping
 Grain agriculture

5
 Pesticide Exposure:
Occupational Settings
 Multiple industries
– Agriculture
– Emergency response
– Maintenance
– Transportation
 Variety 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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 Pesticide Exposure:
Environmental Settings
 Use in schools
 Lawn, garden use
 Household
cleaning
 Home pesticide
use
 Residues in food

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Human Exposure to Pesticides
 SecondNational 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 9
 Pesticide Exposure:
Accidental Ingestion
 Improper storage  Prescription
or mislabeling of pesticides
containers resembling oral
medications

California Poison Control Center

Photo: John P. Lamb, Pharm D.,
Source: EPA Australia

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 Pesticide Exposure:
Suicide/Homicide
 Unknown substance

 Secondary exposure

San Francisco Chronicle M onday, January 17, 2000

Coroner Identifies Man Who Swallowed Pesticide

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Unintentional Pesticide Illness, USA
Toxic Exposure Surveillance System 1993-1996
scale
Number of Illnesses, Log

100000
10000
1000
100 Minor
Moderate
10 Major
Fatal
1
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:
 Emergency
department treatment
of organophospate
toxicity
 Automatic insecticide
Reporting required dispenser units
Reporting not required
 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 pesticide-
related fatalities and hospitalizations in several countries

10 00

80 0

60 0

40 0

20 0

0 Hosp ital izatio ns

Costa Fa tali ties
Sri
Rica Swede n
La nka 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 npic@ace.orst.edu

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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
 Maintainairway, 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

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