All Americans are exposed to pesticides. Among approximately 1,900 subjects selected in 1999 and 2000 from the National Health and Nutrition Examination Survey (NHANES) to represent the United States population six to 59 years of age, at least 90 percent of these persons had detectable serum levels of dichlorodiphenyltrichloroethane (DDT) metabolites.1 In addition, detectable levels of five of the six measured urinary organophosphate insecticide metabolites were found in at least 50 percent of the subjects, with those six to 11 years of age having the highest metabolite concentrations.1 The sources of these pesticide exposures include diet,2 indoor pesticide exposures (indoor pesticide applications to control pests3 and tracking-in of pesticides used outdoors),4 other environmental exposures (drift of pesticides from their intended target),5 and occupational exposures (exposures on farms and in pest-control occupations).6 There are approximately 16,000 different pesticide products currently used in the United States, and each of them contains one or more of approximately 600 approved pesticide active ingredients. According to the U.S. Environmental Protection Agency, 1.23 billion lb of conventional pesticides (excluding disinfectants and wood preservatives) are used annually in this country, a figure that accounts for more than one fifth of global pesticide use.7 Despite the pervasiveness of pesticides, relatively few acute poisonings are identified annually. The Toxic Exposure Surveillance System (TESS), which collects poisoning reports submitted by poison control centers in the United States, identified 20,110 acute pesticide poisoning cases in 2001.8 However, this number should be considered a minimal estimate of the true magnitude of the problem because reporting to poison control centers is voluntary, and poison control centers appear to capture only a minority of acute pesticide poisoning cases.9 Unfortunately, no better national estimate of acute pesticide poisoning exists.
National Institute for Occupational Safety and Health, 4676 Columbia Parkway, MS R-17, Cincinnati, OH 45226