American Journal of Industrial Medicine 18:307-312 (1990)

Pesticide Illness Surveillance: Review of the National Pesticide Hazard Assessment Program

Sheldon L. Wagner, MD

Regarding consultations on pesticide exposures by Oregon State University, the follow- ing information is summarized: 1) source of queries; 2 ) locations of' exposure; 3 ) types of chemicals; and 4) nature of the illnesses. The majority of queries involve nonagri- cultural exposures in the home and workplace. Principal sources of referral are from the National Pesticide Telecommunications Network (toll-free number), state departments of agriculture, and state extension services. In addition to illnesses, the system also responds to press releases such as those that occurred after the withdrawal of chlordanc. Previously unsuspected clinical problems have been reported (suggesting new areas of research need). including cases associated with long-acting organophosphates, such as chlorpyrifos, and with the pyrethroids.

Key words: organophosphates, pyrethroids, agricultural chemicals, pesticides, EPA, poison con- trol centers

INTRODUCTION A program at Oregon State University provides an information service whereby

members of the public may receive direct consultation, written information, or lab- oratory services when concerns arise regarding possible pesticide intoxication (Tele- phone number: 503-757-5086). The program is funded by the Environmental Pro- tection Agency. This report deals with the results of the first 20 months of that program.

RESULTS AND DISCUSSION Access to this service comes from a variety of sources. The principal source is

the National Pesticide Telecommunications Network hotline in Lubbock, Texas (see Fig. 1) (Telephone number: 1-800-858-7378). People who call that hotline are then referred to this service, providing that the problems are not of an emergency nature. In the latter case, they are referred to poison control centers or to other specific reference centers whose responsibilities are to deal with the emergency care of pa- tients. Other important sources of referral to this monitoring program are state de- partments of agriculture, offices of the Environmental Protection Agency, poison control centers, and health departments throughout the country.

Department of Agricultural Chemistry, Oregon State University, Corvallis. Address reprint requests to Dr. Sheldon Wagner, Department of Agricultural Chemistry, Oregon State University, Corvallis, OR 97331. Accepted for publication March 30, 1990.

0 1990 Wiley-Liss, Inc.

308 Wagner I

NPTh 177

DEPTS OF FIG 23

POISON CONTROL

HERLTH DEPTS 27

0 50 100 150 200

Fig. 1 . NPTN. National Pesticide Telecommunications Hotline.

Sources of referrals to Oregon State University Pesticide Information Program (funded by EPA).

3c r I

1 , , , , , , , , , , , 1 1986-87 0 OCT nEC FEB RPR JUN RUG

NOV J FlN MAR MAY JUL SEP

Fig. 2. gram.

Monthly distribution of inquiries made to Oregon State University Pesticide Information Pro-

Referrals vary by season, with most referrals starting in late February and the majority of them having occurred by about August each year (see Fig. 2). In the first 20 months of this program, over 300 referrals were handled. Surprisingly, the ma- jority of concerns do not come from the farm or workplace but arise from exposures in the home (see Fig. 3). The common route of exposure is inhalation, rather than dermal contact, as expected in farm worker exposures (Fig. 4). Of the total cases, 254 have concerned adults and 52 concerned children. Also, 146 have been related to

Pesticide Illness Monitoring 309

C 50 100 150 200

Fig. 3. mation Program.

Distribution by site of exposure of inquirics made to Oregon State University Pesticide Infor-

. ..

I RESP 130

DERM

URH L

I

0 50 100 150

Fig. 4. Information Program.

Distribution by route of exposure of inquiries made to Oregon State University Pesticide

chronic problems, whereas only 106 have been related to acute or subacute illnesses. Of these cases, 255 were seen first by physicians, with only 70 cases not being previously seen.

The cases can be divided into four different types (Fig. 5 ) . A type I illness does not necessarily mean that there is clearly cause and effect but simply that there is reason to believe that the illness could be related because of the temporal association and because of the nature of the symptoms, which are either compatible with or at

310 Wagner

44-7% TYPE 1

TYPE 2 17.

TYPE

8%

3 -YPE 4

Fig. 5. Distribution by type of case of inquiries made to Oregon State University Pesticide Information Program. Type 1 is an illness together with a pesticide exposure; type 2 is no illness but pesticide exposure has occurred; type 3 is illness but no pesticide exposure has occurred; and type 4 is neither illness nor exposure.

COMMUNICATION I

L I T 92

LETTER

I

CONSUL T 37

0 25 50 75 100

Fig. 6. mation Program.

Distribution by type of responses to inquiries made to Oregon State University Pesticide Infor-

least suspicious of being related to pesticides. The type 4 classification represents principally informational questions about the toxicology of pesticides in human be- ings. In this surveillance program, only questions specifically relating to human beings are addressed.

Pesticide Illness Monitoring 311

TABLE 1. Pesticide Classification and Numbers of Referrals

Carbamates Methylcarbamate Carbaryl Bendiocarb Methomyl Carbofuran F'ropoxur Thirain

Fertilizers Nitrate

Fumigants Aluminum phosphide Methyl bromide Ethylene dibromide DCP DBCP

Fungicides Methalax yl PCP Tributyltin Benomyl Dodemorph Ziram Eptam Chlorothalonil

Herbicides Diclofop-methyl Prometon

Paraquat Piclorani Triclopyr MCPA GI yphosate Chlorpropham Tributhiuron Alachlor Dicamba

2,4-D

2,4,5-T

Insecticides DDT Heptachlor Chlordane lron sulfate Aldrin Lindane Sulfur Endrin Toxaphene Dieldrin B.T.

19 1 3 7 2 I 3 2

I 1

11 5 2 2 1 1

14 1 6 2 1 1 I I 1

44 I 2

16 5 3 2 2 3 1 1 I 4 3

120 10 8

78 1 6

10 1 1 2 2 I

Miscellaneous DEET Ammonia Arsenic

lnerts Turpentine Methyl pentanc

Organophosphates D i a z i n o n Malathion Propetamphos Chlorpyrifos Parathion Difonate Acephate Dimethoate Sulfotepp Isofenphos Mcthoxychlor Phorate DDVP Metasystox-R Ethion Fenthion

Pyrethrums Pyrethrin-NOS Cypermethrin Fenvalerate Permethrin F'yrcthroid-NOS Allethrin

Rodenticides Warfarin Thallium Fluoroacetate Brodifacoum Not identificd

Cacodylic acid Silvicides

4 2 1 1

2 1 1

20 8 4

34 6 3 3 2 1 2 2 2 5 1 1 1

95

26 13 3 5 2 2 1

5 1 1 1 1 1

1 1

312 Wagner

In responding to these inquiries, literature searches have been made in 92 cases and formal letters, often quite detailed and some including reprints of literature, have been forwarded in 74 instances (see Fig. 6 ) . Consultation with other faculty members at Oregon State University has been required in 37 cases.

A wide variety of pesticide inquiries related to possible human illness are encountered, as noted in Table I. Three of these seem to occur most frequently and raise some interesting clinical questions. First are questions related to chlordane. The most common problem is to determine whether the exposed individual has an organic brain syndrome and/or peripheral neuropathy as a result of chlordane exposure. Next, 95 cases of organophosphate-associated inquiries were made. The most difficult problem has been encountered with chlorpyrifos. There have been 34 inquiries about this insecticide. The clinical problems most commonly raised have been complaints of long-term illness following acute exposure and/or intoxication. Finally, the pyre- thrums, pyrethrins, and pyrethroids are also associated with many complaints. Sur- prisingly, a number of complaints are developing with the pyrethroids, such as cypermethrin, fenvalerate, and permethrin. These complaints most commonly in- volve chronic respiratory problems, suggesting that the chemicals have the same propensity as an allergen as does pyrethrum.