Abstract for Poster 14

Occupational and consumer exposure to pesticide products – Findings of a telephone survey of the Finnish Poison Information Centre contacts

M. Mäkinen*¹, M. Seuri¹, T. Lampinen², K. Hoppu²
¹Kuopio Regional Institute of Occupational Health, Kuopio, Finland
²Poison Information Centre, Helsinki, Finland

Background and objective

Both adults and children may be exposed to pesticides accidentally at home or in home gardening as well as in occupational situations. Due to poor personal protection, bad hygiene or inappropriate use habits of the products these exposures may lead to acute poisonings or symptoms (1). The most evident group of suspected poisonings are small children, who tend to put things into their mouth (2). For adults, the dermal route is considered dominant. These cases are not usually severe, and pesticides caused only 0,11% of all poisonings leading to hospitalisation in the latest study performed in Finland (3). Calls to the Finnish Poison Information Centre (FPIC) concerning pesticides were regarded as a signal of potential exposure, and followed up. The aim of this study was to get more information on the circumstances leading to (suspected) acute pesticide poisonings. An important goal was to analyse the cases and use the conclusions to improve the safety of both consumers and professional users.

Methods

All calls related to a true or suspected human acute pesticide poisoning to the FPIC were eligible for the study during the summer months of the year 2002. The subjects were contacted by telephone within one week of the original call and a structured interview was made by one physician.

Results

Approximately one hundred interviews were made, from which about half of the cases related to children. Furthermore, 75% of the exposed children were under the age of two. Most commonly a child sprayed an insect repellent on the skin, in the eyes or the mouth or tasted an ant bite. Eleven children had mild or moderate symptoms but only in two cases the symptoms were positively related to the pesticide exposure. Hence, most children did not get any symptoms at all, but the parents wanted to assure that they had acted correctly in the situation. The first aid had indeed been excellent. The exposed body parts had been washed thoroughly in all cases except one.

Adults had 33 non-occupational exposures, most commonly with herbicides and insecticides splashed on the face (eyes) or on the skin or clothes. Clinical symptoms were reported by 22 of adults exposed. Over 50 % of adults with symptoms visited a physician, but no one's symptoms were related to the incident with the pesticide by the doctor. Fourteen adults were exposed in their occupation. These cases were mostly skin exposures. Thirteen of them had symptoms which they complained to a physician, but only in three cases the symptoms were regarded as pesticide related. It was striking, that the adults did not self-evidently wash themselves after the exposure, even though they called to the FPIC. The cases of occupational exposure are presented in detail in Table 1.

Table 1. Suspected pesticide poisonings, occupational cases. Exposure scenarios (and exposure time if relevant), active ingredients, personal protective equipment (PPE) or respiratory protective equipment (RPE) used, experienced symptoms, and the possible period of disability.
Exposure scenario	Active ingredient	Personal protection used	Symptoms, period of disability
Emptying treated seeds from a seeding machine	Triadimenol + imazalil	No PPE	Diarrhoea, stomach cramps, nausea, headache
Planting pine tree seedlings
Case 1, 1 week	Deltamethrin	Permeable gloves	Vesicular, tingling and itching in backs of hands and neck
Case 2, 1.5 months	Permethrin	Permeable gloves	Dizziness, shortness of breath, muscular cramps, 2 days disability period
Tractor spraying
Case 1	Deltamethrin	Rubber boots and gloves	Chills, sweating, headache, dysphoria
Case 2	Thifensulfuron-methyl	Coverall, rubber boots, gloves, headgear, face shield	Headache, irritation of throat
Case 3	MCPA	No PPE	Dysphoria, nausea, shortness of breath, 10 days disability period
Case 4	Dimethoate	Gloves	Itching of cheek
Lawn treatment with pressurized hand-held sprayer	Glyphosate	No PPE	Dumb lower lip, strange overall feeling
Spraying of flies in a cow-house	Pyrethrins + piperonyl butoxide	No PPE	Strange sensation in tongue and throat
Mixing/loading of products
Case 1	MCPA	No PPE	Drying and irritation of eyes
Case 2	MCPA	Coverall, rubber boots, gloves, headgear, RPE (P2), face shield	Drying of eyes
Case 3, 2 weeks	Imazalil	Gloves, RPE	Nausea, palpitation, chills, general weakness
Repair of spraying equipment
Case 1	Dimethomorph + mancozeb	Coverall, gloves, headgear, RPE	Watering and redness of eyes
Case 2	Imazalil	Gloves	No symptoms

Conclusions

The sample size of the study was relatively small, but it probably gives a good impression of the overall situation in Finland. The obtained data are also more specific in a telephone interview compared to a survey by mail. However, some selection may occur, because in a case of a severe poisoning, people may not call a poison centre but seek their way straight to health care. It also seemed that the educational level and socioeconomic status of the callers was higher than expected. They might be more aware of the risks related to pesticides.

The exposures, or suspected exposures, of the children were usually related to situations, when for some reason an insect repellent was not kept in its usual place, left unattended for a moment, or used exceptionally in another place but home. None of the cases happened in a farm. Safety caps in household products would in most cases have prevented the exposures of children, which has been already seen in a study in U.S. (4). The normal, traditional caps in aerosol cans did not in some cases prevent even children under two years to get in touch with the content. Especially for the household products, it is important to carefully assess the exposure by all possible routes, including dermal, when placing them into the market.

In adult suspected exposures, instructions given on protective clothing or other equipment were not in most cases followed. In over 50 % of non-occupational and in 36 % of occupational exposures protective clothing was not used at all. Common reasons for exposures in non-occupational settings were improper use of gloves. Gloves were not used at all, they were made of unsuitable material, or they did not cover the wrists properly. Many of the callers complained about the difficulties experienced in understanding the instructions in the labels of the products. It had been difficult for many to find out the right glove material. The quality and intelligibility of the labels is crucial, as no one reported to have ever read a material safety data sheet of a pesticide product.

Suspected or real pesticide exposures of children, and the non-occupational exposures of adults were mild or moderate. In occupational exposures symptoms were more severe. The impression given by this study is that pesticide poisonings may remain undiagnosed in health care, and therefore, they are not added register of occupational diseases. This finding is parallel with the conclusions made in the U.S., where it was estimated, that only 10% of the health effects of the pesticides are reported (5,6). The false sense of security given by the apparently low numbers of poisonings does not promote safer handling. Education on correct pesticide storage and working practices both to the public and the workers has to be continued.

References

1. Chester G. Worker exposure: methods and techniques. Kirjassa: Krieger R toim. Handbook of pesticide toxicology, Vol 1. Principles. 2. painos. San Diego, Kalifornia: Academic Press 2001;425–33.

2. Adgate JL, Sexton K. Emerging issues: children’s exposure to pesticides in residential settings. Kirjassa: Krieger R toim. Handbook of pesticide toxicology, Vol 1. Principles. 2. painos. San Diego, Kalifornia: Academic Press 2001;887–904.

3. Lamminpää A, Riihimäki V. Pesticide-related incidents treated in Finnish hospitals – a review of cases registered over a 5-year period. Human Experim Toxicol 1992;11:473–9.

4. Sumner D, Langley R. Pediatric pesticide poisoning in the Carolinas: an evaluation of the trends and proposal to reduce the incidence. Vet Hum Toxicol 2000;42:101–3.

5. Lichtenberg E, Zimmerman R. Adverse health experiences, environmental attitudes, and pesticide usage behavior of farm operators. Risk Anal 1999;19:283–93.

6. Schnitzer PG, Shannon J. Development of surveillance program for occupational pesticide poisoning: lessons learned and future directions. Publ Health Rep 1999;114:242–8.

Content last modified: 15 May 2005