Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U60-OH-008349, 2007 Jan; :1-191
Background: Given Texas' mild climate and the resultant nuisance and destructive pests, farmers, commercial exterminators, golf course managers, parks and recreation departments, schools, highway departments, public health agencies, utility companies, and others often use pesticides. The public health impact of occupational related pesticide exposures has largely been unknown since occupational pesticide poisoning cases had historically been under-ascertained. This purpose of this project was to enhance a systematic occupational pesticide exposure surveillance system to collect, analyze, interpret, and disseminate occupational pesticide exposure data. The timely collection and dissemination of such data are vital to preventing occupational pesticide exposure-related illness. Methods: From 2002 to 2006, the Texas Department of State Health Services (DSHS) Pesticide Exposure Surveillance in Texas (PEST) Program, as part of the Sentinel Event Notification System for Occupational Risks (SENSOR) program collected data on occupationally related pesticide exposures. Occupations at-risk and associated risk factors for occupational pesticide exposure were identified and outreach efforts ensued; relationships with appropriate partners were made and data were collected and analyzed in a standardized manner. As of January 1, 2004, the PEST Program added disinfectants to its case definition. In addition to the pesticide surveillance activities a survey of Texas Farmworkers was conducted to assess whether they had received Worker Protection Standards (WPS) training and whether those who received the training understood the pesticide training objectives. Results: During the 4-year funding period, fiscal years 2002-2006, the Pesticide Exposure and Surveillance in Texas (PEST) Program processed 1,501 reports of suspected pesticide exposure; 76% of which were work-related. The majority of reports (79%) were obtained from the Texas Poison Center Network (TPCN). From 2002-2005 there were 524 confirmed (acute pesticide exposures classified as definite, probable, possible or suspected) work-related exposures. Three-fourths of the exposures were classified as low-severity and severity was high in 1.5% (8) of the exposures; three of the eight high-severity cases involved pyrethroids. The agricultural industry had the most exposures (18%) with Farmworker as the occupation with the most pesticide-related illnesses (n=38). With respect to pesticide-related illness, Janitors/Cleaners (n=36) and Pest Control Occupations (n=36) both were a close second. Disinfectants were associated with 29% of confirmed work-related exposures. Eighty-six percent of pesticide exposures involved exposure to 1 chemical class. Of these, the chemical class Other accounted for 131 exposures, followed by Pyrethroids and pyrethrins, which together accounted for the 94 single-chemical class exposures, but were involved in the highest number of illnesses associated with 2 or more chemical classes (28%). Inorganic Compounds and Organophosphates each were associated with 14% of all pesticide exposures. Reports of confirmed acute occupational pesticide exposures that occurred in calendar years 2002-2005 increased from 106 in 2002 to 157 in 2005. This increase was attributable to improved ties with the Texas Poison Center Network (TPCN) which also enabled the capture of disinfectant related exposures. Conducting surveillance on disinfectant related exposures also captured exposure information on an entirely different worker population, the Service Occupations - primarily cleaning (16%) and food preparation workers (11 %). Further, the number of females identified in occupational pesticide exposures increased; 71 % of the people exposed to disinfectants in the Professional and Related Service industry were female. Improved coordination with the TPCN also reduced the median latency between when an event took place and the report was received. The median latency was reduced from 202 days in 2002 to 3 days in 2005. With respect to the Farmworker survey, 29% of the workers interviewed reported that they had received safety training in pesticide use with 23% indicating that they had received Worker Protection Standard training. Only 17% of the Farmworkers interviewed reported that they had been trained in pesticide use or safety in the last five years. Conclusions: Incorporating data from Poison Centers can enhance the ability to capture cases of occupational pesticide exposure. Improved reporting can reduce the time interval from when the exposure occurred until the report is received; thereby, improving the ability to triage cases in a timely manner. Timely triage - which improves the capacity to conduct follow-up interviews, obtain medical records, and conduct field investigations - is critical to identifying the causes of exposure so effective prevention strategies can be developed and implemented. The involvement of pyrethroids and pyrethrins in a large number of exposures and in 37% of the exposures classified as high-severity is concerning. These pesticides often are marketed as a "safe" alternative. Precautions may be ignored when dealing with a pesticide considered "safe" compared to other "less safe" alternatives. The inclusion of disinfectants exposures revealed an entirely different worker population that was being exposed to pesticides; many disinfectants are classified by EPA in the highest toxicity class-I. The ubiquitousness and familiarity of disinfectant products likely serves to increase the potential for misuse; familiarity may lead to a perception of "safe" which in turn results in a general lapse in the taking of precautions. Surveillance findings from disinfectant exposures underscore the need for education regarding the health risks associated with the improper use of bleach and chlorine products. Funds used to support this project enabled the identification of emerging pesticide problems such as pesticide poisoning in retail establishments, unintentional lindane ingestions, and pesticide poisonings among working youth. The data collected under this cooperative agreement were used to generate numerous bilingual educational materials for targeted workers as well as a brochure to assist healthcare providers recognize and identify acute pesticide-related illness. Data collected under this cooperative agreement also contributed to the publication of 8 articles, and 1 in-press, over the 4-year funding period. Pesticide exposures that met the criteria for field investigation lead to interventions to change pesticide use practices and/or modify regulation.
John Villanacci, Ph. D., Texas Department of State Health Services, Environmental & Injury Epidemiology and Toxicology Branch, pesticide Exposure Surveillance in Texas (PEST) Program, 1100 W. 49th Street, Austin, TX 78756-3199