Acute Illnesses and Injuries Related to Total Release Foggers - 10 States, 2007-2015.

Total release foggers (TRFs) (also known as "bug bombs") are pesticide products often used indoors to kill insects. After an earlier report found that TRFs pose a risk for acute illness (1), the Environmental Protection Agency required improved labels on TRFs manufactured after September 2012 (2). To examine the early impact of relabeling, the magnitude and characteristics of acute TRF-related illness were evaluated for the period 2007-2015. A total of 3,222 TRF-related illnesses were identified in 10 participating states, based on three data sources: Sentinel Event Notification System for Occupational Risk-Pesticides (SENSOR) programs, the California Department of Pesticide Regulation (CDPR) program, and poison control centers (PCCs) in Florida, Texas, and Washington. No statistically significant decline in the overall TRF-illness incidence rate was found. Failure to vacate treated premises during application was the most commonly reported cause of exposure. To reduce TRF-related illness, integrated pest management strategies (3) need to be adopted, as well as better communication about the hazards and proper uses of TRFs. Redesigning TRFs to prevent sudden, unexpected activation might also be useful.

Descriptive review of asbestosis and silicosis hospitalization trends in North Carolina, 2002-2011.

BACKGROUND: Asbestosis and silicosis are debilitating pulmonary conditions resulting from inhalation of asbestos fibers or silica dust. PURPOSE: We provide a descriptive analysis of asbestosis and silicosis hospitalizations in North Carolina to assess trends over a 10-year period. METHODS: Events were defined as inpatient hospital discharges during the period 2002-2011 with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 501 or 502. Using statewide discharge data for 2002-2011, we calculated asbestosis and silicosis hospitalization rates in North Carolina (by demographics, hospital length of stay, cost, and payment type) and compared them with national rates. RESULTS: In North Carolina, average annual age-standardized hospitalization rates for asbestosis and silicosis were 71.2 hospitalizations per 1 million residents and 6.2 hospitalizations per 1 million residents, respectively. Rates for asbestosis and silicosis decreased significantly (less than .01 for both conditions) between 2002 and 2011, by 46% and 67%, respectively. Men had significantly higher rates than women (less than .01), more than half of hospitalizations were among persons aged 65-84 years, and Medicare was the predominant payment source. The highest silicosis rates by county were clustered in Western North Carolina; no geographic patterns were observed for asbestosis. The estimated average annual cost statewide for these hospitalizations was $10,170,417 for asbestosis and $886,143 for silicosis. LIMITATIONS: ICD-9-CM misclassification and duplicate hospitalization records may have biased the observed rates of asbestosis and silicosis. CONCLUSIONS: Decreases in hospitalization rates in North Carolina may be due to misdiagnosis, underreporting, or the declining use of asbestos in industries. Obtaining complete exposure histories at diagnosis is useful for continued public health surveillance.

Using surveillance data to promote occupational health and safety policies and practice at the state level: a case study.

BACKGROUND: Following the investigation of a birth defects cluster involving migrant farmworkers employed in North Carolina and Florida, it became clear that greater efforts were needed to protect agricultural workers from pesticide exposure. METHODS: Documentation is drawn from peer-reviewed published articles, government reports and news accounts. RESULTS: The birth defects cluster was identified and investigated by state and federal pesticide poisoning surveillance system staff. Following the investigation, efforts were initiated to highlight pesticides as an important public health issue needing more attention. A series of subsequent events led to the creation and passage of important legislation recently enacted in North Carolina. The legislation resulted in funding to promote various activities to prevent harm from pesticides including strengthening surveillance, improving the quality of pesticide compliance inspections, and increasing and improving pesticide safety training. The legislation also broadened the coverage of anti-retaliation rules to include agricultural workers, and increased recordkeeping requirements pertaining to pesticide applications. CONCLUSION: The important and positive impacts that can occur through surveillance activities are highlighted. As such, it is important to continue to support and improve occupational illness and injury surveillance programs.

The Opioid Epidemic and the Role of the Occupational Health Nurse.

The opioid epidemic is a national public health crisis. It began with the misuse of commonly used prescription opioid pain relievers and has led to the increased use of heroin and illicit fentanyl. Large-scale initiatives have begun on the federal and state level and place an emphasis on improved opioid prescribing, which have important implications for the workplace. Treatment of work injury may initiate the use of prescription opioids and result in misuse and possible overdose. Prescription drug abuse affects all aspects of society so potentially any workplace could be affected. A multifaceted approach is needed to reduce opioid morbidity and mortality and the occupational health nurse should be actively involved. The intent of this article is to provide an overview of the epidemic and its impact on health, the challenges for the workplace, and recommended strategies for the occupational health nurse to impact the problem.

Aldicarb: a case series of watermelon-borne carbamate toxicity.

Improper use of pesticides on food plants can result in significant toxicity. In spite of regulations, enforcement, and prior episodes of poisonings, poisonings from misapplication of pesticides continues to occur. The objective of this study was to present a case series of toxicity resulting from ingestion of watermelon inappropriately treated with the carbamate insecticide aldicarb. A restrospective review of medical records, impounding the suspected watermelons, and chemical analysis of the watermelon samples using liquid chromatography and mass spectroscopy were carried out. Seven farm workers shared a watermelon and presented to a rural emergency department with symptoms of cholinergic poisoning. They were treated empirically with atropine and pralidoxime. The farmer denied use of insecticides other than rat poison on the watermelon patch. Chemical analyst verified aldicarb in the watermelon samples from the field, but none in control samples. Despite government regulations, application of restricted pesticides such as aldicarb continues to occur and cause significant poisonings.

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.