Cholinesterase Testing: Reporting Requirements and the Role of the WA State Department of Health (DOH) Cheryl J. Hanks, RN WA State Pesticide Surveillance Program

Objectives: 1.Describe PIRT and PIMs 2 Review reporting pesticide exposures Notifiable Conditions WAC Duties of the health care provider

1970 WA State legislature required DOH to investigate suspected pesticide poisonings 1990 pesticide exposures became a notifiable condition for public health surveillance purposes

Statewide Surveillance Program KNOWN OR SUSPECTED CASES OF PESTICIDE RELATED ILLNESS NOTIFIABLE by licensed health provider hospitalized, fatal, or cluster—immediately; others- within 3 days Requirement is fulfilled by calling the Poison Control Center

PIRT, the Pesticide Incident Reporting and Tracking Review Panel Includes representatives of 6 state agencies and a public member.  The agencies conduct pesticide investigation and collect data in accordance with their respective statutory responsibility.  PIRT analyzes the data and makes recommendations made for public health and safety.

PIMS-Pesticide Incident Monitoring System established by DOH to investigate and track all suspected cases.

DOH Classification of Cases  Pesticide related may be Definite, Probable, Possible (DPP)  National criteria based on signs and symptoms, findings characteristic for the pesticide, the temporal relationship and/or consistent with exposure health effect relationship for known toxicology

Others classified as Suspicious Insufficient Information Unrelated Unlikely and Asymptomatic

Trends in Pesticide Injuries in Washington State An analysis of 5 years of occupational illness and injury data

Case Classifications , 246 cases over 5 years with 1,011 (45%) classified as Definite 176 Probable 322 Possible % occurred among workers in agricultural settings primarily men 18–50 years of age

How did the agricultural exposure occur? ( ) Occupationalyes no Applicator/mixer/loader Drift Residue 74 7 Cleaning/fixing 10 0 Accident 14 3 Other 10 7 Total376 74

5-year Data Summary of DPPs* 84% of Ag cases were work-related 97% reported mild/moderate symptoms Most common exposures: applying, drift, field residues Most common location: tree fruit *Cases classified as definitely, probably and possibly related to pesticides,

In Year 2000 DOH responded to 302 incidents involving 388 individuals  In 2000 pesticide related incidents reported to DOH increased by 11% from 271 in 1999 to 302  Following investigation of the 388 total cases 203 or (52%) were classified as DPPs  Occupational exposures accounted for 115 of the 203 cases, a 25% increase from 1999.

 87 of the 115 occupational cases were agricultural  In 1998 the number of agricultural cases dropped in 1999 to 48  In 2000 the number of agricultural cases returned to the 1998 level (88).  47 (54%) of the occupational agricultural cases occurred in the tree fruit industry.  The remaining cases occurred in vegetable crops, grain crops, hops, nurseries, greenhouses, and livestock industries Agricultural Occupational Cases

National Data: Insecticide Type Acute occupational pesticide- related illnesses Preliminary data from NIOSH SENSOR states, Jan 2002 n = 466

Conclusions: Illness due to pesticide poisoning is a serious public health problem. Exposures occur where pesticides are used. PPE is not always reliable. Primary prevention message: education

Recognition and Management of Pesticide Poisonings

The Recognition and Management of Pesticide Poisonings is made an excellent text on pesticides and pesticide treatment. It is made available by the U.S. EPA. It is available on-line at healthcare/handbook/handbook.htm healthcare/handbook/handbook.htm

DOH Sources of Pesticide Exposure Reports You—by calling the Poison Control Center Or directly to us Mon-Fri Department of Agriculture notifies us of human case and provides spray records Department of Labor and Industry provide us with copes of claims which may involve pesticides

Questions? Washington State Department of Health--Pesticide Surveillance Program Dorothy Tibbetts, Manager (360) Cheryl J. Hanks, RN (360)