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Endrin Poisoning Associated with Taquito Ingestion -- California

In mid-March 1988, three family members in Orange County, California, became dizzy and nauseated within 1 hour of eating taquitos, a snack consisting of a corn tortilla wrapped around a meat filling. Two of the three subsequently had multiple grand mal seizures. The taquitos, a commercial product sold frozen in sealed plastic bags of 48, had been purchased 5 days earlier.

After receiving the reports of illness, the County of Orange Health Care Agency (COHCA) requested that the product be removed from the shelves of the store where the implicated bag was purchased. Several remaining taquitos from the implicated bag were tested by the U.S. Department of Agriculture (USDA), Food Safety and Inspection Service, and found to contain endrin, a pesticide known to cause seizures. Samples of taquitos removed from the store and tested in USDA laboratories were negative for pesticides. The USDA reviewed the operations of the plant where the taquitos were produced, but no evidence of the pesticide was found. However, 90 cases of taquitos were destroyed by the plant owner as a precautionary measure. The USDA concluded that the poisonings were an isolated incident and closed the case April 20, 1988.

Subsequently, in September 1988, COHCA was informed of a 17-year-old boy who, in mid-March, had four seizures 30 minutes after eating taquitos purchased from the same store. After the seizures in March, he had been diagnosed as epileptic and begun on long-term anticonvulsants. At a hearing to determine the 17-year-old's continued eligibility for a driver's license, the hearing officer remarked that he had presided at a similar case (that of the father of the index family) the week before. (In California, seizures and loss of consciousness are reportable conditions for the purpose of determining eligibility for a driver's license.) This new information implicated a second bag of taquitos and indicated that other illnesses may have been misdiagnosed, resulting in serious medical and social consequences. Therefore, the investigation was reopened by the COHCA and the State of California. A state-issued press release and a mailing by the store to over 40,000 customers generated 100 calls to the local health department. As a result of this publicity, two additional persons who had suffered seizures less than or equal to 12 hours after eating taquitos were identified. All five seizure patients had eaten taquitos purchased from the same discount store within a 5-day period in March. Families other than the index family had no remaining taquitos.

California Department of Food and Agriculture laboratories confirmed the presence of endrin in leftover taquitos from the index family. Endrin was present in the tortillas but not in the meat filling. The store, the manufacturing plant, and the manufacturer's suppliers were thoroughly inspected, but no source of endrin was found.

Because of the limited nature of the outbreak and failure to find evidence of contamination in the plant inspections, the California Department of Health Services suspects deliberate tampering as the cause of the outbreak. Reported by: T Prendergast, MD, B Peck, Public Health, County of Orange Health Care Agency, Santa Ana; staff, California Dept of Food and Agriculture Laboratories; RJ Jackson, MD, T Slagle, PhD, KW Kizer, MD, DO Lyman, MD, State Epidemiologist, California Dept of Health Svcs. Food Safety and Inspection Svc, US Dept of Agriculture. Div of Field Svcs, Epidemiology Program Office; Div of Environmental Hazards and Health Effects, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Endrin is an extremely toxic chlorinated hydrocarbon pesticide in the family of pesticides that includes DDT, heptachlor, aldrin, and dieldrin. Symptoms of endrin poisoning include dizziness, nausea, tremors, leg weakness, disorientation, and tonic-clonic seizures (1). Endrin has been responsible for more than 1200 cases of illness and 45 deaths during outbreaks of foodborne poisonings in Wales (2), Qatar and Saudi Arabia (3), and Pakistan (4).

The Orange County episode is the first reported outbreak of endrin poisoning in humans in the United States. The registration of endrin for agricultural purposes in the United States was withdrawn in 1984 (5), and it has not been manufactured in this country since that time. Nevertheless, supplies of endrin remain in this country, and other countries continue to use and manufacture the chemical.

Pesticides can cause serious illness even among nonoccupationally exposed persons. Pesticide-related illness from a commercial product should prompt a rapid and aggressive investigation to identify cases, sources, and appropriate control measures including, if necessary, a product recall.

References

1.Hayes WJ Jr. Pesticides studied in man. Baltimore: Williams and Wilkins, 1982. 2.Davies GM, Lewis I. Outbreak of food-poisoning from bread made of chemically contaminated flour. Br Med J 1956;2:393-8. 3.Weeks DE. Endrin food-poisoning: a report on four outbreaks caused by two separate shipments of endrin-contaminated flour. Bull WHO 1967;37:499-512. 4.CDC. Acute convulsions associated with endrin poisoning--Pakistan. MMWR 1984;33: 687-8,693. 5.Environmental Protection Agency. Notice: EPA lists firms requesting voluntary cancellation of pesticide products registrations under FIFRA. Federal Register 1984;49:42792.

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