1. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Pesticide Basics Uses, Exposures, Types and Acute Effects

2. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Did you know?  5 million at risk population (U.S. EPA, 1992)  250-500 physician-diagnosed cases occur per 100,000 agricultural workers (Blondell, 1997).  Migrant and seasonal farmworkers are especially at high risk  84% of American households used pesticides, most commonly insecticides (Whitmore et al, 1992)  Homeowners use 5-10 lbs/ acre/yr on their lawns and gardens, many x greater than farmers apply to corn and soybean fields (Robinson et al, 1994).

3. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Did you know?  Non -agricultural pesticide exposure as disinfectants widespread: (e.g., pine oil cleaners, bathroom cleaning products, and cleaning materials for swimming pools).  Non-Ag Sector a concern = pest control, nurseries, greenhouses, and landscaping.  The medical profession uses disinfectants to sanitize and sterilize surfaces and instruments.  Organophosphate and pyrethroid insecticides most implicated for poisonings.  Water chlorination is one of the largest (by tonnage) uses of pesticides.

4. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Where Are Pesticides Used? Forests to control insects and under-story vegetation; Landscapes, parks, and recreational areas to control weeds, insects, and disease pests; Rights-of-way along railroads and under electric wires to control vegetation; Houses, schools, and commercial and office buildings to control insects, rodents, and fungi; Boat hulls to control fouling organisms;

5. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Where Are Pesticides Used? Aquatic sites to control mosquitoes and weeds Wood products to control wood-destroying organisms Food preparation areas to control insects and rodents Human skin to kill or repel insects Household pets to control fleas and ticks Livestock to control insects and other pests.

6. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Non Occupational Pesticide Encounters Accidental or intentional ingestion Food and water residues Contaminated clothing Treated wood/structures Residues on animals/carpets Garden residues Termite control Hazardous waste sites/spills

7. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Agriculture Pesticide Applications Aerial Air blast sprayer Enclosed cab Backpack wand Boom sprayer

8. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Agriculture Jobs Orchard thinner Mixer loader Flagger Picker

9. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Professions Exposed to Pesticides Aerial equipment maintenanceAerial equipment maintenance AgronomistsAgronomists Building maintenance workBuilding maintenance work Emergency respondersEmergency responders EntomologistsEntomologists FirefightersFirefighters Forestry workersForestry workers Formulating end productFormulating end product Greenhouse- nursery workersGreenhouse- nursery workers Hazardous waste workersHazardous waste workers LandscapersLandscapers Livestock dippers and veterinariansLivestock dippers and veterinarians Marina workersMarina workers Medical personnelMedical personnel Park workersPark workers Plant pathologistsPlant pathologists Research chemistryResearch chemistry Sewer workSewer work Storage/warehouse workStorage/warehouse work Structural applicationStructural application Transporting pesticidesTransporting pesticides Treating contaminated workersTreating contaminated workers Vector control workersVector control workers Wood treatment workersWood treatment workers Work on highway or railroad rights of wayWork on highway or railroad rights of way

10. Pesticide Health Effects Medical Education Database (PHEMED) 2010

11. Key Household Safety Points 1.Proximity 2.Take home 3.Garden 4.Animals 5.Recycle 6.Decant 7.Storage 8.Disposal 9.Child play/daycare “ Partly Trained Gorillas Always Run Down Streets Doing Cartwheels”

12. Pesticide Health Effects Medical Education Database (PHEMED) 2010 ROUTES OF EXPOSURE Source: EPA Protect Yourself from Pesticides-Guide of Agricultural Workers OP’s are readily absorbed: Across the SKIN with skin contact In the lungs with INHALATION of pesticide contaminated air/dust In the gut by INGESTION of pesticide residue on food/dirt/dust

13. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Risk Factors for Occupational Pesticide Exposures  Concentration of commercial preparations > than diluted final product = greater risk  AG workers highest exposure risk in mixing, loading, applying, and flagging. Source: H Murphy - Cambodia

14. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Occupational Risk Factors Pregnant Women: 1 st trimester Field workers entering sprayed field before re- entry interval [REI] Residuals on skin and clothes –How to remove PPE –How to clean PPE –Showering after use

15. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Evidence? Agriculture Risk Factors Indonesia: –Cocktail mixture of multiple products –Spray frequency –Skin contact > wet clothing – Use of toxic products (1a/Ib, II) Washington state: –Protective: Chemically resistant boots –Protective: Full face respirators –Risk: Mixing and loading pesticides –Risk: Cleaning equipment –Protective: Using a workplace locker for PPE Source: H Murphy - Indonesia

16. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Preventing Pesticide Illness Non-chemical Alternatives Engineering Controls Personal Protective Equipment [PPE] Primary Secondary Tertiary It’s the law

17. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Risk factors for pesticide exposures at home Migrant families > risk Children ’ s vulnerability Location near fields Take home pathway Pesticide storage and use in homes Multiple chemical sensitivities (MCS)

18. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Migrant Families Living conditions: quality and location Communication: language and literacy Immigration status Access to health care Diet

19. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Unintentional (Accidental) GI absorption from accidental ingestion = acute poisonings Respiratory and dermal absorption from surrounding environment Hand to mouth activity in children

20. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Occupational Dermal is most important Inhalation is a common pathway Ingestion less common but can occur if not use gloves or poor hygiene

21. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Intentional (Suicide/Homicide/Abuse) Ingestion is primary pathway Inhalation is another pathway, although primary agents of abuse in this manner are non- pesticide chemicals (aromatic solvents).

22. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Washington State Source of Case Reports 2002 and 2003 Combined Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report Poison Control Workman’s Comp Dept of AG

23. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report 67% Washington State Pesticide Events - 2003

24. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Agricultural vs. Non-Agricultural Cases of Poisonings Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

25. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Occupational versus Non-Occupational Cases of Pesticide Poisoning Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

26. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Proportion of Poisonings Ranked 8 th Cause of Poisonings = 102,754 cases in 2005 (4.2%) Source: Watson WA. 2004 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System Children Adults

27. Pesticide Health Effects Medical Education Database (PHEMED) 2010 US: Intentional vs. Accidental 6 suicide attempts used pesticides out of 196,164 8% 84% Accidental Suicide

28. Pesticide Health Effects Medical Education Database (PHEMED) 2010 WHO Sentinel Surveillance

29. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Pesticide Types of Pesticides InsecticidesHerbicidesFungicidesRodenticides ‘cide = to kill Disinfectants Fumigants

30. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Pesticide Chemical Families - grouping based on similarities- 1.Similar chemically (similar structure) 2.Attacks pests in a similar way (toxicity) 3.Common treatment + antidote Organophosphate OP Carbamate C Pyrethroid PY Organochlorine OC Chlorophenoxy Paraquat Diquat

31. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Pesticide Sample Label Type of pesticide (used for?) Company name Brand name Common/generic name (active ingredient) Chemical family (? atropine under 1 st aid) Signal word (hazard level)

32. Pesticide Health Effects Medical Education Database (PHEMED) 2010

33. Pesticide Classification Table #TypeCompany Name Brand Name Common Name Chemical Family Signal Class 1.Insecticide Gowen Supracide methidathion OP (Organophosphate) Danger- Poison Ib

34. Pesticide Health Effects Medical Education Database (PHEMED) 2010 COMPANYBRANDCOMMONTYPEFAMILYSIGNALWho 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Pesticide Labels BayerTemikAldicarbInsecticideCarbamateDanger-poisonla VerdiconSevinCarbarylInsecticideCarbamateCautionll UCP AllianceThiodanEndosulfanInsecticideOrganochlorineWarningll BayerGuthionAzinophos methylInsecticideOrganophospateDanger-poisonlb DowDursbanChlorpyrifosInsecticideWarningll SyngentaGramoxoneParaquatHerbicideParaquatDanger-poisonll HelenaWeed Rhap2, 4-DHerbicideChlorophenoxyDanger-poisonll DuPontAsanaEsfenverlateInsecticidePyrethroidWarninglV BayerCaptan FungicideDanger-poison MaxRoundupGlyphosateHerbicideCautionU-IV II Dow Dithane Mancozeb Fungicide Caution U-IV Cerexagri-Nisso Ziram Fungicide Danger III Exercise: Classifying Pesticides Organophospate

35. Pesticide Health Effects Medical Education Database (PHEMED) 2010 How toxic is it? Source: Richards, Kerry Penn State University Extension Service

36. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Source: Richards, Kerry Penn State University Extension Service

37. Pesticide Health Effects Medical Education Database (PHEMED) 2010 LD 50 Lethal dose = Amount of chemical it takes to kill 50% of an experimental population

38. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Source: Richards, Kerry Penn State University Extension Service

39. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Adapted from Richards, Kerry Penn State University Extension Service DANGER/POISON = extremely toxic by ingestion DANGER = extremely toxic high potential for skin and eye irritation * *

40. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Source: Richards, Kerry Penn State University Extension Service

41. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Insecticides ChE Inhibitors: –Organophosphates –n-methyl carbamates Pyrethroids –Pyrethrins (ocloresin extract of chrysanthemum) –Pyrethroids (the synthetic derivative) Organochlorines (e.g. DDT) DEET Boric Acid Fluorides Nicotine Arsenicals

42. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Herbicides Chlorophenoxy herbicides (e.g. 2-4D) Paraquat and diquat Pentachlorophenol and dinitrocresol (wood preservatives) Copper chromium arsenate ( decks, fences, and children ’ s wood playground sets – d/c 2003 )

43. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Fungicides Hexachlorobenzene Thiram Maneb Methylmercury compounds

44. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Fumigants Cyanide, 1, 3-dichloropropane Metam sodium Methyl bromide Naphthalene Phosphine gas (from aluminum phosphide)

45. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Rodenticides Warfarin-related compounds: –Warfarin –Coumarins –Brodifacoum –Difenacoum (so-called “ super warfarins ” ) Others: –Thallium –Zinc phosphide –Sodium fluoroacetate

46. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Disinfectants Agents used for sanitization and sterilization in the home and hospital Registered as pesticides by the U.S. EPA Examples include –Alcohols –Chlorhexidine –Hypochlorites –Iodines –Phenols –Pine oil

47. Pesticide Health Effects Medical Education Database (PHEMED) 2010

48. General central nervous system Fatigue Dizziness Headache Tremors Ataxia Convulsions (uncommon w/carbamate) LOC (uncommon w/carbamate) Coma (uncommon w/carbamate) From muscle over stimulation: Muscle weakness Muscle cramps Muscle fasciculations From gland over stimulation: Salivary gland- excessive salivation Sweat gland- excessive sweating Lachrymal gland-excessive eye tearing From organ over-stimulation: Eyes Gastrointestinal Pulmonary Blurred vision (constricted pupils) Stomach cramps Nausea Vomiting Diarrhea Chest tightness Wheezing Cough Runny nose Organophosphates: 30”-24 0 & Carbamates: 15”-3 0

49. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Pyrethroids Pyrethroids: are irritants to the eyes, skin and respiratory tract. The symptoms last from 1-2 hours. Systemic toxicity from inhalation or dermal absorption is low. Normal use: * Paresthesias (cyno pyrethroids) * Shortness of breath (wheezing) * Mucous membrane irritation (throat nose) * Skin itching If ingested: Loss of consciousness/coma Seizures (cyno-pyrethroids) High doses: Vomiting Diarrhea Excessive saliva Muscle fasciculation Ataxia Irritability : to sound ~ touch Cyno-pyrethroids: fenverlate, flucythrinate, fluvalinate cypermethrine, deltapermethrin,

50. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Organochlorines: 1 0 - 48 0 lipophylic The nerves stimulating glands are not affected so you will NOT see: excessive salivation excessive sweating excessive eye tearing (or over-stimulation of small muscles like) twitching eyelids CNS Effects Muscle Weakness Dizziness Headache Numbness Nausea/vomiting LOC Seizures Tremors Ataxia Anxiety/restlessness Confusion

51. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Paraquat Paraquat is very toxic to the skin and mucous membranes. Particles are too large to get deep into the lungs*, but once in the blood it collects in the lungs. If ingested high case fatality rate. Skin: dryness, cracks erythema blistering ulcerations Nails: discoloration splitting nails loss of nails Respiratory tract: cough nosebleeds sore throat Eyes: conjunctivitis ulceration, scarring, blindness Ingestion: lung fibrosis (stiff lungs) multi-system organ failure, specifically respiratory failure kidney failure

52. Pesticide Health Effects Medical Education Database (PHEMED) 2010 DEET DIETHYLTOLUAMIDE Few toxic cases - given the widespread use Toxic if ingested Children: toxic encephalopathy w/ heavy use on large surface area on kids (+ ETOH - isopropyl or ethyl) Dermal problems: tingling, irritation, desquamination, contact dermatitis, exacerbate pre-existing skin dz Kids: use 5-6.5% formulations

53. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Boric Acid Ants, Cockroaches in Residences “broiled lobster appearance”

54. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Boric Acid Respiratory tract irritant Moderate skin irritant Historic antibacterial: poisonings from burn compresses, diaper powder, irrigation solutions Targets: GI tract, skin, vasculature, brain Chronic ingestion more toxic than acute (13  ½ life) Absorption: via gut and abraded skin

55. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Fluorides Transformed in stomach to corrosive hydrofluoric acid:  thirst, nausea-vomiting, diarrhea, abdominal pain Fluoride ion reduces extra-cellular fluid concentrations of Ca + and Mg  hypocalcemic tetany Cardiac arrythmias- shock  2ndary to fluid/electrolyte imbalances, hypokalemia and the fluoride itself CNS  H.A. muscle weakness, stupor, seizures and coma

56. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Focus on OP ’ s  Children at risk for neurodevelopmental problems  Most commonly used insecticide in agriculture  Common cause of poisoning

57. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Normal Electrical Nerve Impulse Transmission nerve cell muscle cell Once acetylcholine is broken, it can no longer transmit electrical nerve impulses. Electrical nerve impulses stop and the muscles and glands are quiet Electrical nerve impulse coming from nerve cell stimulates the body to produce acetylcholine. Acetylcholine acts as a bridge transmitting the electrical charge to the muscle cell. Muscles and glands contract. After electrical nerve impulse transmission is completed, the body produces cholinesterase. Cholinesterase breaks up acetylcholine into acetate and choline. acetate choline

58. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Organophosphate-Carbamate Disruption of Electrical Nerve Impulse Transmission Therapeutic Effect of Atropine nerve cell Atropine relieves the over stimulation of the muscles and glands by reducing the amounts of acetylcholine. The effect only lasts 15 minutes. Therefore the dose must be repeated until the organophosphate binding effect has worn off. If an organophosphate (Op) or carbamate is present, they bind with cholinesterase. [This is an irreversible effect with an Op but not with a carbamate] The bound cholinesterase cannot penetrate acetylcholine to break it up. The body continues to produce acetylcholine unimpeded. This results in a build up of acetylcholine with continuous electrical nerve impulse transmission and over stimulation of muscle and glands. muscle cell Electrical nerve impulse acetate choline cholinesterase organophosphate atropine

59. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Signs and Symptoms in Adults Miosis Blurring EyeCNSLungs GI GlandsMuscle Heart Exercise: Body Mapping Fatigue Dizziness Headache Tremors Ataxia Seizures LOC Coma Insomnia Mental Δ Tightness Wheezing Cough Rhinorrhea Abd. cramps Nausea Vomiting Diarrhea Drooling Sweating Tearing Weakness Cramps Fasciculations Tachy Brady  BP ↓ BP

60. Pesticide Health Effects Medical Education Database (PHEMED) 2010 Signs of Pesticide Poisoning in Children Lethargic sleepy Seizures Coma Can be confused with the flu