Louisiana Guestworker Health and Safety a Necessary Component of Health Equity: Lessons From the COVID-19 Pandemic.

Guestworkers are a critical labor component of many industries considered essential to U.S. infrastructure. Despite their essential role in the U.S. labor force, guestworkers are vulnerable to exploitative labor practices. The COVID-19 pandemic compounded guestworkers' vulnerability to include a lack of public health protective measures in addition to longstanding labor abuses. The pandemic has created greater public health awareness about structural determinants of health inequities, such as unsafe and exploitative working conditions. As public health increases its focus on social and structural determinants of health, it can contribute to improved labor conditions for guestworkers. This article highlights guestworkers' experiences in Louisiana's crawfish industry to demonstrate the marginalized role of guestworker labor in a major Louisiana industry. This article also examines local public health approaches that can bring attention and resources to labor issues.

Association Between Work-Related Hyperthermia Emergency Department Visits and Ambient Heat in Five Southeastern States, 2010-2012-A Case-Crossover Study.

The objective of this study is to assess ambient temperatures' and extreme heat events' contribution to work-related emergency department (ED) visits for hyperthermia in the southeastern United States to inform prevention. Through a collaborative network and established data framework, work-related ED hyperthermia visits in five participating southeastern U.S. states were analyzed using a time stratified case-crossover design. For exposure metrics, day- and location-specific measures of ambient temperatures and county-specific identification of extreme heat events were used. From 2010 to 2012, 5,017 work-related hyperthermia ED visits were seen; 2,298 (~46%) of these visits occurred on days when the daily maximum heat index was at temperatures the Occupational Safety and Health Administration designates as having "lower" or "moderate" heat risk. A 14% increase in risk of ED visit was seen for a 1°F increase in average daily mean temperature, modeled as linear predictor across all temperatures. A 54% increase in risk was seen for work-related hyperthermia ED visits during extreme heat events (two or more consecutive days of unusually high temperatures) when controlling for average daily mean temperature. Despite ambient heat being a well-known risk to workers' health, this study's findings indicate ambient heat contributed to work-related ED hyperthermia visits in these five states. Used alone, existing OSHA heat-risk levels for ambient temperatures did not appear to successfully communicate workers' risk for hyperthermia in this study. Findings should inform future heat-alert communications and policies, heat prevention efforts, and heat-illness prevention research for workers in the southeastern United States.

Acute Occupational Pesticide-Related Illness and Injury -United States, 2007-2011.

CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on acute pesticide-related illness and injury reported by 12 states (California, Florida, Iowa, Louisiana, Michigan, Nebraska, North Carolina, New Mexico, New York, Oregon, Texas, and Washington). This report summarizes the data on illnesses and injuries arising from occupational exposure to conventional pesticides from 2007 through 2011. This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016 (1). The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases (2). In a separate report, data on illnesses and injuries from nonoccupational exposure to pesticides during 2007-2011 are summarized (3).

Acute Nonoccupational Pesticide-Related Illness and Injury - United States, 2007-2011.

CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on acute pesticide-related illness and injury reported by 12 states (California, Florida, Iowa, Louisiana, Michigan, North Carolina, Nebraska, New Mexico, New York, Oregon, Texas, and Washington). This report summarizes the data on illnesses and injuries arising from nonoccupational exposure to conventional pesticides that were reported during 2007-2011. Conventional pesticides include insecticides, herbicides, fungicides, and fumigants. They exclude disinfectants (e.g., chlorine and hypochlorites) and biological pesticides (1). This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016 (2). The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases (3). In a separate report, data on illnesses and injuries from occupational exposure to conventional pesticides during 2007-2011 are summarized (4).

Magnitude and characteristics of acute paraquat- and diquat-related illnesses in the US: 1998-2013.

BACKGROUND: Paraquat and diquat are among the most commonly used herbicides in the world. OBJECTIVES: Determine the magnitude, characteristics, and root causes for acute paraquat- and diquat-related illnesses in the US METHODS: Illnesses associated with paraquat or diquat exposure occurring from 1998 through 2011 were identified from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program, the California Department of Pesticide Regulation (CDPR) Pesticide Illness Surveillance Program (PISP), and the Incident Data System (IDS). Cases identified by the National Poison Data System (NPDS) were reviewed for the years 1998-2003 and 2006-2013. RESULTS: A total of 300 paraquat- and 144 diquat-related acute illnesses were identified by SENSOR, PISP, and IDS. NPDS identified 693 paraquat- and 2128 diquat-related acute illnesses. In SENSOR/PISP/IDS, illnesses were commonly low severity (paraquat=41%; diquat=81%); however, SENSOR/PISP/IDS identified 24 deaths caused by paraquat and 5 deaths associated with diquat. Nineteen paraquat-related deaths were due to ingestion, seven of which were unintentional, often due to improper storage in beverage bottles. In SENSOR/PISP/IDS, paraquat and diquat-related acute illnesses were work-related in 68% (n=203) and 29% (n=42) of cases, respectively. When herbicide application site was known, the vast majority of acute paraquat-related illnesses (81%) arose from agricultural applications. Common root causes of illness were failure to use adequate personal protective equipment (PPE), application equipment failure, and spill/splash of herbicide. CONCLUSIONS: Although the magnitude of acute paraquat/diquat-related illnesses was relatively low, several fatalities were identified. Many illnesses could be prevented through stricter compliance with label requirements (e.g. ensuring proper herbicide storage and PPE use), and through enhanced training of certified applicators.

Fatal Work-Related Injuries: Southeastern United States, 2008-2011.

In 2008, the work-related injury fatality rate was 3.8 per 100,000 workers in the United States but was 5.2 per 100,000 workers for the southeast region. Work-related fatalities in the southeast were examined for the period 2008 to 2011. Median work-related injury fatality rates are reported for the southeast region, each of the 12 states, and the United States. The percentages of employees in high fatality industries and work-related fatalities by cause were calculated. Finally, the Occupational Safety and Health Administration's database was searched for fatality reports. States with the highest rates (per 100,000 workers) included Arkansas (7.2), Louisiana (6.8), and West Virginia (6.6). Arkansas, Louisiana, Mississippi, and West Virginia each had more than 20% of their employees in high fatality industries. Forty percent of work-related injury fatalities were from transportation incidents in the southeast and the United States. Future analyses should include work-related injury fatality rates by industry and compare rates with other U.S. regions.

A review of adult asthma hospitalizations in Louisiana, 2006-2011.

This paper examines asthma inpatient hospitalizations for Louisiana residents ages 15 years and older from 2006 to 2011. There were 21,398 asthma hospitalizations, with 14,401 unique cases. Approximately 22 percent of cases had more than one asthma hospitalization. The case rate of adults hospitalized for asthma decreased significantly during the six-year period. However, the rate of all adult hospitalizations for asthma did not significantly change. Black women had the highest age-adjusted case rate, followed by white women. Days hospitalized averaged from 2.8 to 4.9 among the youngest to the oldest age groups, respectively. Differences between black and white patients were observed in type of payment and admit source. Parish rates varied significantly: Caldwell, Jefferson Davis, and LaSalle had rates that were at least twice the mean state rate. Rural parishes had a significantly higher rate than non-rural parishes. The information in this review can be used to target outreach and prevention activities.

Evaluation of available data sources to prioritize parishes for arsenic monitoring and outreach related to private well drinking water.

OBJECTIVE: The objective of this assessment was to identify and evaluate data sets for use in the surveillance of arsenic hazards and private well drinking water use in Louisiana. DESIGN: Features, strengths, and limitations of the data sets are described, and prioritization criteria are applied to identify areas in need of further monitoring or outreach. SETTING: Recent efforts have been made by the Environmental Public Health Tracking Network to evaluate the quality of private well water data for the purpose of supporting state and national surveillance activities. Like most states, Louisiana does not collect or mandate reporting of private well water quality data. Therefore, responding to public concerns about private well water quality requires an identification and evaluation of existing data. MAIN OUTCOME MEASURES: Data evaluated include measures of arsenic in groundwater and soil, private well water use, and biomonitoring results. RESULTS: The Environmental Protection Agency's Safe Drinking Water Information System and the US Geological Survey's Water Use data set were the most informative, nationally available data sets for conducting private well water arsenic surveillance. Three priority parishes were identified on the basis of a selection criteria, although all parishes require more private well sampling data. CONCLUSION: While the data reviewed enabled preliminary identification of parishes in need of monitoring and outreach, data limitations (particularly, a lack of statewide well water quality data) prevent a comprehensive evaluation of well water arsenic hazards and private well water use. A large number of unregistered wells further impede risk determination. Reliance on existing data sources is necessary, but development of metadata documentation is essential to prevent data misinterpretation. Increased outreach and policies to promote or mandate private well testing and reporting are needed to enable a comprehensive private well water tracking system.

Characteristics and magnitude of acute pesticide-related illnesses and injuries associated with pyrethrin and pyrethroid exposures--11 states, 2000-2008.

BACKGROUND: Excluding disinfectants, pyrethrins and pyrethroids are the pesticides used most commonly in and around homes. Respiratory effects and paresthesia are among the concerns about pyrethrin/pyrethroid exposures. METHODS: Acute pesticide-related illness/injury cases were identified from the Sentinel Event Notification System for Occupational Risks-Pesticides Program and the California Department of Pesticide Regulation from 2000-2008. Characteristics and incidence rates were determined for acute pyrethrin/pyrethroid-related illness/injury cases. Logistic regression analyses were performed to determine odds of respiratory and dermal symptoms in persons with illness/injury following pyrethrin/pyrethroid exposure compared to persons with illness/injury following exposure to other pesticides. RESULTS: A total of 4,974 cases of acute pyrethrin/pyrethroid-related illness were identified. Incidence rates increased over time, reaching 8 cases/million population in 2008. The majority of cases were low severity (85%) and 34% were work-related. Respiratory effects were the most common symptoms reported (48%). Risk of acute respiratory effects were significantly elevated among persons exposed only to pyrethrins (adjusted odds ratio [aOR] 1.79; 95% confidence interval [95% CI]: 1.49-2.16), only to pyrethroids (aOR 1.99 95% CI: 1.77-2.24), to a mixture of pyrethroids (aOR 2.36; 95% CI: 1.99-2.81) or to a mixture containing both pyrethrins and pyrethroids (aOR 2.99; 95% CI: 2.33-3.84) compared to those with illness arising from exposure to other pesticides. The most common factors contributing to pyrethrin/pyrethroid-related illness included exposure from spills/splashes, improper storage, and failure to evacuate during pesticide application. CONCLUSIONS: The magnitude of acute pyrethrin/pyrethroid-related illness/injury is relatively low but is increasing. As such, additional measures to prevent them are needed.

Gender differences in acute pesticide-related illnesses and injuries among farmworkers in the United States, 1998-2007.

BACKGROUND: Farmworkers have a high risk for acute pesticide-related illness and injury, and the rate among female farmworkers is approximately twice as high as that among males. Surveillance data were used to identify reasons for this gender difference. METHODS: We identified acute pesticide-related illness and injury cases among farmworkers from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program and the California Department of Pesticide Regulation. Gender-specific associations with acute pesticide-related illness and injury were assessed using chi-square tests. National Agricultural Workers Survey data were also examined. RESULTS: The over-representation of females among farmworker illness and injury cases was confined to females who did not handle pesticides (non-handlers). Female non-handler farmworkers who were affected were more likely to be working on fruit and nut crops, to be exposed to off-target pesticide drift, and to be exposed to fungicides and fumigants compared to males. CONCLUSIONS: Although there is an increased risk for acute pesticide-related illness and injury among female farmworkers, the absolute number of farmworkers with acute pesticide-related illness and injury is far higher among males than females. Furthermore, farmworkers have little or no control over many of the identified contributing factors that led to illness and injury. Stringent enforcement of existing regulations and enhanced regulatory efforts to protect against off-target drift exposures may have the highest impact in reducing acute pesticide-related illness and injury among farmworkers.

Acute pesticide illnesses associated with off-target pesticide drift from agricultural applications: 11 States, 1998-2006.

BACKGROUND: Pesticides are widely used in agriculture, and off-target pesticide drift exposes workers and the public to harmful chemicals. OBJECTIVE: We estimated the incidence of acute illnesses from pesticide drift from outdoor agricultural applications and characterized drift exposure and illnesses. METHODS: Data were obtained from the National Institute for Occupational Safety and Health's Sentinel Event Notification System for Occupational Risks-Pesticides program and the California Department of Pesticide Regulation. Drift included off-target movement of pesticide spray, volatiles, and contaminated dust. Acute illness cases were characterized by demographics, pesticide and application variables, health effects, and contributing factors. RESULTS: From 1998 through 2006, we identified 2,945 cases associated with agricultural pesticide drift from 11 states. Our findings indicate that 47% were exposed at work, 92% experienced low-severity illness, and 14% were children (< 15 years). The annual incidence ranged from 1.39 to 5.32 per million persons over the 9-year period. The overall incidence (in million person-years) was 114.3 for agricultural workers, 0.79 for other workers, 1.56 for nonoccupational cases, and 42.2 for residents in five agriculture-intensive counties in California. Soil applications with fumigants were responsible for the largest percentage (45%) of cases. Aerial applications accounted for 24% of cases. Common factors contributing to drift cases included weather conditions, improper seal of the fumigation site, and applicator carelessness near nontarget areas. CONCLUSIONS: Agricultural workers and residents in agricultural regions had the highest rate of pesticide poisoning from drift exposure, and soil fumigations were a major hazard, causing large drift incidents. Our findings highlight areas where interventions to reduce off-target drift could be focused.

Asbestosis in Louisiana: a descriptive review and demographic analysis of hospitalizations for abestosis, 1999-2009.

Asbestosis is a debilitating, chronic, lung disease with no known treatment and most commonly occurs among workers in certain occupational settings. As a condition highly associated with occupational exposure, its incidence has been affected by changes in industry standards. In particular, the bans on both production and new uses of asbestos fibers put in place during the past 20 to 30 years have significantly reduced occupational exposures. Despite these restrictions, asbestos can still be found in many products. Louisiana has more facilities that produce, process, or use asbestos than any other state in the US. Health outcomes associated with asbestos exposure include asbestosis, mesothelioma, and lung cancer. To evaluate the impact of asbestos exposure on Louisiana residents, Louisiana Hospital Inpatient Discharge Data (LAHIDD) from 1999-2009 was analyzed. Results indicate that asbestosis hospitalizations have remained steady over the 11-year period with approximately 295 cases per year. White males have the highest rates, and cases are clustered geographically. Overall, Louisiana's rate is significantly greater than the US rate (p < 0.0001).

Acute illnesses associated with exposure to fipronil--surveillance data from 11 states in the United States, 2001-2007.

INTRODUCTION: Fipronil is a broad-spectrum phenylpyrazole insecticide widely used to control residential pests and is also commonly used for flea and tick treatment on pets. It is a relatively new insecticide and few human toxicity data exist on fipronil. OBJECTIVE: This paper describes the magnitude and characteristics of acute illnesses associated with fipronil exposure. METHODS: Illness cases associated with exposure to fipronil-containing products from 2001 to 2007 were identified from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program and the California Department of Pesticide Regulation. RESULTS: A total of 103 cases were identified in 11 states. Annual case counts increased from 5 in 2001 to 30 in 2007. Of the cases, 55% were female, the median age was 37 years, and 11% were <15 years old. The majority (76%) had exposure in a private residence, 37% involved the use of pet-care products, and 26% had work-related exposures. Most cases (89%) had mild, temporary health effects. Neurological symptoms (50%) such as headache, dizziness, and paresthesia were the most common, followed by ocular (44%), gastrointestinal (28%), respiratory (27%), and dermal (21%) symptoms/signs. Exposures usually occurred from inadvertent spray/splash/spill of products or inadequate ventilation of the treated area before re-entry. CONCLUSIONS: Our findings indicate that exposure to fipronil can pose a risk for mild, temporary health effects in various body systems. Precautionary actions should be reinforced to prevent fipronil exposure to product users.

Characteristics of pesticide-related hospitalizations, Louisiana, 1998-2007.

OBJECTIVE: Pesticides are widely used on agricultural crops and in homes, workplaces, and public spaces. Exposure to pesticides can cause acute and chronic health effects. We analyzed data from the Louisiana Hospital Inpatient Discharge Database from 1998 through 2007 to characterize hospitalizations involving pesticides. METHODS: Data for the study period consisted of 384 pesticide-related hospitalizations. We used demographic information and diagnosis codes for analysis. RESULTS: Males consistently had higher hospitalization rates than females (p=0.0073). Children aged 0-4 years had the highest pesticide-related hospitalization rate of all age groups (2.69 hospitalizations per 100,000); children aged 5-9 years had the lowest rate (0.36 hospitalizations per 100,000). Compared with adults, children had a higher rate of disinfectant exposure (15% vs. 5%; odds ratio [OR] = 3.41, 95% confidence interval [CI] 1.61, 7.21; p=0.0008) and rodenticide exposure (14% vs. 2%; OR=8.55, 95% CI 3.07, 23.78; p<0.0001). Rural parishes (counties) were more likely than urban parishes to have higher pesticide hospitalization rates (OR=4.72, 95% CI 2.34, 9.54; p<0.0001). Intentional poisonings accounted for 27% of cases. Only eight cases were coded as work-related. CONCLUSIONS: Analyzing pesticide-related hospitalization data provides important information about some of the most severe pesticide poisoning cases. Significant findings include the elevated rate of hospitalizations among young children and men, and the large proportion of self-inflicted poisonings. Health departments and health-care providers may use these findings to target outreach and prevention activities.

Metal fume fever: a review of the literature and cases reported to the Louisiana Poison Control Center.

Metal fume fever (MFF) is an important occupational-related illness resulting from inhalation of volatile metal oxides, especially zinc, that are produced during welding or cutting of metal materials. Onset of MFF is rapid, occurring within a few hours after inhalation of the fumes. Symptoms include fever, chills, cough, dyspnea, headache, myalgia, and malaise. Symptoms are self-limiting and typically resolve within 24 hours with a subsequent short-lived tolerance to zinc oxide fumes that disappears after one to two days of avoidance. In this report, we present an overview of MFF's history, pathogenesis, clinical presentation, regulatory guidelines, and prevention recommendations. This review is followed by a description of MFF cases reported by the Louisiana Poison Control Center to the Louisiana Office of Public Health's Section of Environmental Epidemiology and Toxicology during a two-year period.

Acute pesticide poisoning among agricultural workers in the United States, 1998-2005.

BACKGROUND: Approximately 75% of pesticide usage in the United States occurs in agriculture. As such, agricultural workers are at greater risk of pesticide exposure than non-agricultural workers. However, the magnitude, characteristics and trend of acute pesticide poisoning among agricultural workers are unknown. METHODS: We identified acute pesticide poisoning cases in agricultural workers between the ages of 15 and 64 years that occurred from 1998 to 2005. The California Department of Pesticide Regulation and the SENSOR-Pesticides program provided the cases. Acute occupational pesticide poisoning incidence rates (IR) for those employed in agriculture were calculated, as were incidence rate ratios (IRR) among agricultural workers relative to non-agricultural workers. RESULTS: Of the 3,271 cases included in the analysis, 2,334 (71%) were employed as farmworkers. The remaining cases were employed as processing/packing plant workers (12%), farmers (3%), and other miscellaneous agricultural workers (19%). The majority of cases had low severity illness (N = 2,848, 87%), while 402 (12%) were of medium severity and 20 (0.6%) were of high severity. One case was fatal. Rates of illness among various agricultural worker categories were highly variable but all, except farmers, showed risk for agricultural workers greater than risk for non-agricultural workers by an order of magnitude or more. Also, the rate among female agricultural workers was almost twofold higher compared to males. CONCLUSION: The findings from this study suggest that acute pesticide poisoning in the agricultural industry continues to be an important problem. These findings reinforce the need for heightened efforts to better protect farmworkers from pesticide exposure.

Acute pesticide poisoning in the U.S. retail industry, 1998-2004.

OBJECTIVE: This study was conducted to describe the national magnitude and characteristics of acute pesticide poisoning among workers and customers in retail establishments. METHODS: Analyses included retail employees 15-64 years of age and customers with acute pesticide poisoning identified from the Sentinel Event Notification System for Occupational Risks-Pesticides (SENSOR-Pesticides) and California Department of Pesticide Regulation from 1998 to 2004. Pesticide poisoning incidence rates and incidence rate ratios (IRR) were calculated. RESULTS: A total of 325 cases of acute pesticide poisoning were identified. Of these cases, 287 (88%) were retail employees and 38 (12%) were customers. Overall, retail employees had a significantly lower acute pesticide poisoning incidence rate compared with non-agricultural, non-retail employees (IRR=0.53; 95% confidence interval 0.47, 0.59). However, significantly elevated pesticide poisoning incidence rates were observed for four retail occupations (janitors, stock handlers/baggers, bakery/deli clerks, and shipping/receiving handlers). In addition, workers employed in two retail industry sectors (farm supply stores and hardware stores) had significantly elevated acute pesticide poisoning incidence rates. Incidence rates among the retail employees demonstrated a quadratic trend, monotonically decreasing from 1998 to 2000 and monotonically increasing from 2000 to 2003. The rates appear to have leveled off in 2003 and 2004. CONCLUSIONS: Preventive measures to decrease acute pesticide poisoning incidence in the retail sector include adoption of unbreakable and tear-resistant container requirements, increased utilization of integrated pest management strategies, and advisement to store managers, employees, and customers about poisoning prevention.

Acute illnesses associated with pesticide exposure at schools.

CONTEXT: Pesticides continue to be used on school property, and some schools are at risk of pesticide drift exposure from neighboring farms, which leads to pesticide exposure among students and school employees. However, information on the magnitude of illnesses and risk factors associated with these pesticide exposures is not available. OBJECTIVE: To estimate the magnitude of and associated risk factors for pesticide-related illnesses at schools. DESIGN, SETTING, AND PARTICIPANTS: Analysis of surveillance data from 1998 to 2002 of 2593 persons with acute pesticide-related illnesses associated with exposure at schools. Nationwide information on pesticide-related illnesses is routinely collected by 3 national pesticide surveillance systems: the National Institute for Occupational Safety and Health's Sentinel Event Notification System for Occupational Risks pesticides program, the California Department of Pesticide Regulation, and the Toxic Exposure Surveillance System. MAIN OUTCOME MEASURES: Incidence rates and severity of acute pesticide-related illnesses. RESULTS: Incidence rates for 1998-2002 were 7.4 cases per million children and 27.3 cases per million school employee full-time equivalents. The incidence rates among children increased significantly from 1998 to 2002. Illness of high severity was found in 3 cases (0.1%), moderate severity in 275 cases (11%), and low severity in 2315 cases (89%). Most illnesses were associated with insecticides (n = 895, 35%), disinfectants (n = 830, 32%), repellents (n = 335, 13%), or herbicides (n = 279, 11%). Among 406 cases with detailed information on the source of pesticide exposure, 281 (69%) were associated with pesticides used at schools and 125 (31%) were associated with pesticide drift exposure from farmland. CONCLUSIONS: Pesticide exposure at schools produces acute illnesses among school employees and students. To prevent pesticide-related illnesses at schools, implementation of integrated pest management programs in schools, practices to reduce pesticide drift, and adoption of pesticide spray buffer zones around schools are recommended.

Acute occupational pesticide-related illness in the US, 1998-1999: surveillance findings from the SENSOR-pesticides program.

BACKGROUND: Concern about the adverse public health and environmental effects of pesticide use is persistent. Recognizing the importance of surveillance for acute occupational pesticide-related illness, we report on surveillance for this condition across multiple states. METHODS: Survey data collected between 1998 and 1999 were obtained from the seven states that conduct acute occupational pesticide-related illness surveillance as part of the Sentinel Event Notification System for Occupational Risks (SENSOR) program. Data were collected by these state programs in a standardized manner and analyzed. Acute occupational pesticide-related illness incidence rates for those employed in agriculture and those employed in non-agricultural industries were also calculated. RESULTS: Between 1998 and 1999, a total of 1,009 individuals with acute occupational pesticide-related illness were identified by states participating in the SENSOR-pesticides program. The mean age was 36 years, and incidence rates peaked among 20-24 year-old workers. The overall incidence rate was 1.17 per 100,000 full time equivalents (FTEs). The incidence rate among those employed in agriculture was higher (18.2/100,000 FTEs) compared to those employed in non-agricultural industries (0.53/100,000 FTEs). Most of the illnesses were of low severity (69.7%). Severity was moderate in 29.6% of the cases, and high in four cases (0.4%). Three fatalities were identified. Insecticides were responsible for 49% of all illnesses. CONCLUSIONS: Surveillance is an important tool to assess acute pesticide-related illness, and to identify associated risk factors. Our findings suggest that these illnesses continue to be an important occupational health problem, especially in agriculture. As such, greater efforts are needed to prevent acute occupational pesticide-related illness.