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The Health of Farmworkers-Pt. 2. Marc Schenker M.D., M.P.H. Dept. Public Health Sciences, University of California at Davis Director, Western Center for Agricultural Health and Safety. Part II ****. Acute Injuries and Fatalities of Farmworkers. Outline. The hazardous passage - PowerPoint PPT Presentation
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The Health of Farmworkers-Pt. 2
Marc Schenker M.D., M.P.H.• Dept. Public Health Sciences, University of California
at Davis
• Director, Western Center for Agricultural Health and Safety
Part II
****
Acute Injuries
and Fatalities
of Farmworkers
Outline
• The hazardous passage
• Occupational fatalities among agricultural workers
– Animal
– Machine/tractor
– Transportation
• Fatalities of children
• Pesticides
Causes of Death Among Latin Immigrants Crossing US Border
• During the crossing– Exposure– Drowning– Accidents– Murder
• After the crossing– Disease– Injury (occupational)
U.S.-Mexico Border: The Season of Death
“The deaths trickle in over the cooler months. A couple here from a rollover. Four dead there during a cold snap. They begin in
earnest once the temperature spikes over 100 degrees sometime in May.”
PBS Frontline, June 27, 2006
Occupational Fatalities
in
Agriculture
SOURCE: U.S. Bureau of Labor Statistics, U.S. Department of Labor, 2007
Occupational fatality rates by age group for farming, 1992-2004*
* Excludes New York City. Rates calculated by NIOSH and may differ from BLS.* Excludes New York City. Rates calculated by NIOSH and may differ from BLS.
Agriculture Fatality Rate vs. Private Sector, US, 1992 - 2002
Children : The Forgotten
Farmworkers
“Farmers and Labor
Contractors say they allow
children to perform field work
because the grower needs to
get the crop in, parents need
the money or children would
learn the value of working.”
Fresno Bee, 12/14/92
José (22) and Angelica Alatorre and son Guillermo. Jose
died while working in a manure pit at Aguiar-Faria & Sons
Dairy, Gustine, CA. February 22, 2001
Pesticide Toxicology
• Many toxin categories
• Affect various organs
• Varied health effects
Diagram illustrating various pesticide-related health effects.
Definition of Pesticide
“Any substance or mixture of substances intended for preventing, destroying, repelling, or mitigating any insects, rodents, nematodes, fungi, or weeds, or any other forms of life declared to be pests; any substance or mixture of substances intended for use as a plant regulator, defoliant, or desiccant.”--Federal Insecticide, Fungicide, and Rodenticide Act (US EPA, 1947)
US Pesticide Use
• 4.5 billion pounds chemicals per year– 890 active ingredients,
30,000 formulations– Uses
• 75% agricultural • 25% home, garden,
structural
Agricultural Pesticide Use
• High volume:– Hand labor (Western states)
• Vineyards• Orchard, row vegetables, nursery
• Low volume: – Mechanized (Midwest states)
• Livestock insecticide dipping• Grain agriculture
Pesticide Exposure:Occupational Settings
• Multiple industries – Agriculture– Emergency response– Maintenance– Transportation
• Variety of workers– Applicators, fieldworkers– Firefighters – Medical personnel– Flight attendants
NEETF 2002
Pesticide Exposure: Environmental-Occupational Interface
• Drift
– Off-target physical movement of pesticide through air
• Take-home – Contaminated clothing– Pesticide containers brought
home
Pesticide Exposure:Environmental Settings
• Use in schools
• Lawn, garden use
• Household cleaning
• Home pesticide use
• Residues in food
Pesticide Exposure: Accidental Ingestion
• Improper storage or mislabeling of containers
• Prescription pesticides resembling oral medications
Pho
to:
John
P.
Lam
b, P
harm
D.,
Cal
iforn
ia P
oiso
n C
ontr
ol C
ente
r
Sou
rce:
EP
A A
ustr
alia
Pesticide Exposure: Suicide/Homicide
San Francisco Chronicle Monday, January 17, 2000
Coroner Identifies Man Who Swallowed Pesticide
• Unknown substance
• Secondary exposure
Unintentional Pesticide Illness, USA Toxic Exposure Surveillance System 1993-1996
1
10
100
1000
10000
100000
MinorModerate
MajorFatal
Nu
mb
er
of
Illn
esse
s,
Lo
g
sca
le
Illness severity
Pesticide Illness Rates Vary by Occupation
Source: HS-1688, Cal EPA
Organophosphate pesticide poisoning rates by agricultural sector California, 1982--1990
Pesticide Illness Around the World
CostaRica
SriLanka
Sweden U.K.U.S.A.
Fatalities
Hospitalizations0
200
400
600
800
1000
Annual rates of intentional and unintentional pesticide-related fatalities and hospitalizations in several countries
US EPA Toxicity Classification(Systemic toxicity, eye irritation, skin irritation)
• Class I: “Danger” – Fatal if ingested; corneal opacity; corrosive to skin
• Class II: “Warning”– May be fatal if ingested; reversible corneal opacity; severe
skin irritation• Class III: “Caution”
– Harmful if ingested; no corneal opacity; moderate skin irritation
• Class IV: “Caution”– May be harmful if ingested; no eye irritation; mild/no skin
irritation
Common Components of Pesticide Formulations
• Technical grade chemical (active ingredient)
• Adjuvants/synergists
• “Inert” ingredients– e.g., formaldehyde, sulfuric acid,
benzene, toluene, other organic solvents
Diagnosis of Pesticide Illness• Exposure history most important
– Occupational and environmental history– Duration, dose, route of potential exposure
• Symptom review• Physical exam & lab findings • Health effects may be due to any component of
pesticide formulations
41
Commonly-used Acronyms for Cholinesterase Inhibition Syndromes
• Salivation
• Lacrimation
• Urination
• Diarrhea
• Diarrhea
• Urination
• Miosis
• Bronchorrhea
• Emesis
• Lacrimation
• Salivation
42
Cholinesterase Inhibitors Clinical Presentations Vary
• Some signs & symptoms may be absent– Bronchorrhea more likely with high-dose
exposures (ingestion)• Common presentations
– Nausea, vomiting– Miosis – Sweating, urinary frequency
– Non-specific constitutional symptoms
Aspects of History that Suggest Pesticide Illness
• Multiple cases– Similar symptoms, exposure history
• History of chemical application– Home or office
• Accidental ingestion, esp. children• Suicide, homicide attempts
Pesticide Illness Nonspecific Symptoms & Signs
• Rash • Flu-like symptoms
– Dizziness, malaise, respiratory tract irritation• Gastrointestinal symptoms• Seizures• Odor-related effects
– Not toxicological effects of active ingredient
Pesticide Illness May Mimic Common Medical Conditions
• Mild:
– Upper respiratory tract infection/influenza– Food-borne illness– Asthma – Plant-induced irritant or allergic dermatitis
• Severe:
– Cerebrovascular accident– Psychiatric dysfunction – Heat stroke
• Application records• Label • Material Safety Data Sheet
• www.msdsonline.com• http://www.ilpi.com/msds/index.html
How to Identify Pesticides
Sources of Pesticide Information• Internet
– EXTOXNET: http://ace.orst.edu/info/extoxnet/– California Department of Pesticide Regulation:
http://www.cdpr.ca.gov/docs/label/labelque.htm– Pesticide Action Network: http://www/pesticideinfo.org/index.html
• Textbooks– US EPA. Recognition and Management of Pesticide Poisonings. 1999; 5th ed.
http://www.epa.gov/pesticides/safety/healthcare– R Krieger (ed). Handbook of Pesticide Toxicology. 2001; 2nd ed.
• Poison Control Centers: 1-800-222-1222
• National Pesticide Information Center (NPIC): 1-800-858-7378 or npic@ace.orst.edu
Treatment of Pesticide IllnessDecontamination
• Shower, shampoo
– Scrub under fingernails
• Contain contaminated clothing, body fluids
– Save for residue analysis
• Protect treating staff
– Body fluid precautions
– Personal protective equipment if appropriate
• Symptomatic treatment– Respiratory distress
• Maintain airway, breathing, circulation• Oxygen, bronchodilators if indicated
– Ingestion• Gastric lavage, charcoal if indicated
• Specific antidotes where applicable
Pesticide IllnessMedical Treatment
Poison Control Centers
• Toxicity
• Decontamination
• Management
• Reporting
Case
Applicator with Gastrointestinal Illness
• 27 year-old pesticide applicator with dizziness, headache, body ache, nausea and vomiting. Sprayed Carzol yesterday.
• Exam: Weak (not flaccid), oriented; orthostatic hypotension; exam otherwise normal.
• Cholinesterase normal compared to laboratory reference range
Applicator with Gastrointestinal Illness
Discussion
• Differential etiology of gastroenteritis• Pesticide-related• Food-borne• Viral
• Test results confirm clinical suspicions– Normal results do not rule out exposure– Treatment based on symptoms
53
• 66 year-old male with eye irritation, abdominal pain, nausea, vomiting, headache, dizziness, frequent urination, muscle shaking. Symptoms began after weeding a cotton field for 4 hours.
• Occasional palpitations but no other symptoms over the past 6 months
• 33 other crew members complain of similar symptoms
Case
Farmworker with Multiple Symptoms
54
Farmworker with Multiple Symptoms
Exposure History• 4:00 am: Aerial application of
– Carbofuran (N-methyl carbamate)
– Abamectin (macrolytic lactone)
– Mepiquat chloride (growth regulator)
• 6:00 am: Workers entered field
• 10:00 am: Symptoms
55
Farmworker with Multiple Symptoms
Physical Exam
• Nausea & abdominal pain
• Conjunctival injection
• Irregularly irregular pulse; rate 106-155,
• Lungs clear, no murmurs; neurological exam normal
This warning sign was posted after the workers entered
the field and became ill.
56
Pyrethroid Insecticides
• Use increasing• Examples of use
– Structural & agricultural– Pet flea control– Pediculicide
• Vector control– West Nile virus– Aircraft “disinsection”
Source: CDC
57
Pyrethroids: Health Effects Skin
Paresthesia, dermatitis Respiratory
Rhinitis Systemic
Dizziness, headache Fasciculations, seizures, Hormonal disruption in vitro
58
Pyrethrin & Pyrethroid Illness: Treatment
• Decontamination• Vitamin E cream • Symptomatic therapy • Remove from further
exposure if needed
59
Case
Woman Exposed to Flea Bomb• 35 year-old non-pregnant female with skin burning,
itching and chest tightness after putting on clothes from closet.
• Physical exam
– Arms and face bright red
– Vital signs normal
– Lungs clear
60
Woman Exposed to Flea Bomb
Ingredients
• Label– 0.435% permethrin – 0.05% pyrethrins – 0.4% piperonyl butoxide– 99.115% inert ingredients
• Recommended no entry for 4 hours after fogging
61
Fumigants
• Halogenated hydrocarbons– Methyl bromide– Ethylene dibromide, DBCP
• Inorganic compounds– Sulfuryl fluoride
• Pro-fumigants – Metam sodium
• Metal phosphides– Aluminum, Zinc, Magnesium
US
DO
T
62
Fumigants Methyl Bromide
• High vapor pressure• Heavier than air• Odorless
– Chloropicrin added• Toxic mechanism
– Tissue methylation
C
H
H
Br H
Pesticide Availability in Mexico
Pesticide Illness: Summary
• Occupational, environmental history
• Clinical suspicion
• Tests supplement clinical diagnosis
• Treatment symptomatic, few exceptions
Thank you!
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