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Epidemiologic Notes and Reports Acute Effect of Indoor Exposure to Paint Containing Bis(tributyltin) Oxide -- Wisconsin, 1991

In January 1991, a woman in Wisconsin contacted her local public health department to report that she and her two children had become ill after her landlord painted the walls and ceilings of two rooms of her apartment. Reported symptoms included a burning sensation in the nose and forehead, headache, nose bleed, cough, loss of appetite, nausea, and vomiting. The woman, who was in the third trimester of pregnancy, also complained of a persistent odor from the paint and provided an empty bottle of a paint additive used for mildew control. The label indicated that this product contained 25% bis(tributyltin) oxide (TBTO) as its only active ingredient.

The family vacated the unit 1 week after the apartment was painted. Two days after the move, the Wisconsin Department of Health and Social Services collected an air sample in the painted apartment. Some areas of the apartment had been repainted, and the doorway to one of the two bedrooms had been sealed off by a sheet of particle board. The air sample from the second bedroom contained 0.002 mg/m3 of TBTO as tin.*

One day after moving out of the apartment, one of the children was treated at an emergency room for persistent vomiting. The other child developed a cough but did not require medical attention. Eight days after moving out of the apartment, the woman gave birth to a reportedly healthy infant. However, during a follow-up telephone call 12 weeks later, the woman reported having taken the baby to a pediatrician several times for evaluation of persistent vomiting, rashes, and respiratory difficulties. The woman had recurrent burning pain in her nose and forehead for at least 3 months after exposure. Both of the older children reportedly recovered without persistent symptoms. Reported by: L Knobeloch, PhD, HA Anderson, MD, State Environmental Epidemiologist, Div of Health, Wisconsin Dept of Health and Social Svcs. L Baum, MS, Pesticide Section, Washington Dept of Health. Air Pollution and Respiratory Health Activity, Div of Environmental Hazards and Health Effects, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note:

TBTO is a fungicide manufactured for use in exterior paints and is the active biocide in at least two widely available commercial paint fungicides. The U.S. Environmental Protection Agency registrations for these commercial products permit their use in interior paints.

In animal studies, a variety of toxic responses have been associated with exposure to TBTO. Dietary exposure of experimental animals to the chemical has resulted in weight loss, immunosuppression, and microcytic anemia (2,3). A dose-related increase in the incidence of cleft palate occurred after exposure of pregnant mice (4). Inhalation exposure produced hemorrhagic and edematous lesions in the lungs of mice and guinea pigs (5).

In humans, dermal exposure produces irritant effects, including erythema, follicular inflammation, and pruritus (6). Industrial exposure to vapors or fumes of organotin compounds causes eye and throat irritation; workers so exposed have developed sore throats and coughs within several hours of exposure (7). Except for nose bleeds and persistent pain in the forehead, the acute symptoms reported by the family in Wisconsin are consistent with the acute effects associated with exposure to TBTO. However, because the air sample was collected following partial remediation, the actual level of exposure may have been underestimated. The effect of prenatal exposure to TBTO on the infant's health is unknown.

The label on the empty paint additive bottle from the family's apartment did not specify whether the product was appropriate for use in interior paints. According to its manufacturer, this bottle was produced before 1988, when the consumer product label was voluntarily changed to include the words "for exterior use only." The material safety data sheet (MSDS) for this product states that the product is toxic and not for interior use. The consumer product label on a second fungicide, which also contained 25% TBTO, indicated that the product could be used in interior and exterior paints; the MSDS for this product states that it is safe for use in indoor paints if mixed according to directions.

In February 1988, the Washington Department of Health issued a health advisory against using TBTO in interior paint, based on its investigation of six incidents of illness among persons who painted one or more walls with interior paint to which this fungicide had been added (Washington Department of Health, unpublished data). Complaints and reported symptoms included respiratory problems, sore throat, weakness, headache, and swollen glands. In July 1988, the Washington Department of Agriculture established regulations banning the sale of this product in the state for use in interior paint.

The investigation in Wisconsin suggests that the use of this product as an additive for interior paints represents a source of toxic, short-term exposure. The health effects of chronic, low-level exposure are unknown.


  1. Office of the Federal Register. Code of federal regulations: occupational safety and health standards. Washington, DC: National Archives and Records Administration, Office of the Federal Register, 1989. (29 CFR ***1910.1000).

  2. Funahashi H, Iwasake I, Ide G. Effects of bis(tributyltin) oxide on endocrine and lymphoid organs of male rats. Acta Pathol Jpn 1980;30:955.

  3. Krajnc EI, Wester PW, Loeber JG, et al. Toxicity of bis(tri-n-butyltin) oxide in the rat: I. Shortterm effects on general parameters and on the endocrine and lymphoid systems. Toxicol Appl Pharmacol 1984;75:363.

  4. Davis A, Barale R, Brun G, et al. Evaluation of the genetic and embryotoxic effects of bis(tri-n-butyltin) oxide (TBTO), a broad-spectrum pesticide, in multiple in vivo and in vitro short-term tests. Mutat Res 1987;188:65.

  5. Truhaut R, Anger JP, Anger F, et al. Thermal degradation of tributyltin oxide and pulmonary toxicity of its combustion products in mice and guinea pigs (French). Toxicol Eur Res 1981;3:35.

  6. Lyle W. Lesions of the skin in process workers caused by contact with tributyl tin compounds. Br J Ind Med 1958;15:193.

  7. NIOSH. Criteria for a recommended standard--occupational exposure to organotin compounds. Cincinnati, Ohio: US Department of Health, Education, and Welfare, Public Health Service, 1976:34-5. *The Occupational Safety and Health Administration's permissible exposure limit for organic tin compounds is 0.1 mg/m3 as an 8-hour, time-weighted average exposure for workers (1).

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