PANNA: PAN Online Pesticide Poisoning Diagnostic Tool

PAN Online Pesticide Poisoning Diagnostic Tool
New Help for Treating Pesticide Poisonings

by Margaret Reeves

In October 2003, PANNA launched an important new tool for the diagnosis, treatment and reporting of pesticide related illness -- an online database with a set of search capabilities that link pesticides with both symptoms of exposure and information on how and where pesticides are used within the U.S. This online tool is a critical resource for health care professionals in the speedy diagnosis, reporting and treatment of pesticide poisoning, and is now available on the PAN Pesticide Database website at http://www.pesticideinfo.org.

Pesticide poisonings are undercounted

Agricultural workers are at the greatest risk for pesticide related illness. Unfortunately, worldwide estimates of the number of workers affected are grossly inaccurate. In 1990 the United Nations estimated three million farmworkers were poisoned yearly, based on hospital reports. However, hospital records do not reveal the true magnitude of the problem for a number of reasons. To begin with, much of the world's population and most of the world's poor do not have access to hospitals. Also, mild or moderate poisoning cases rarely result in hospitalization, and doctors often do not recognize or report pesticide related illness.

Public health workers surveying agricultural workers in Asia and Latin America have estimated that between 2% to 10% of agricultural workers are sickened annually by pesticides.(1) The International Labor Organization estimates 1.6 billion workers worldwide are engaged in agriculture.(2) Based on these surveys, somewhere between 32 and 160 million workers are likely to be poisoned by pesticides each year. However detailed field observations by public health workers have noted an even higher incidence of pesticide related illness in Indonesia, where 21% of pesticide applications were found to result in significant poisoning symptoms.(3) If similar conditions exist in other countries and regions, this finding would raise the annual estimate of agricultural workers poisoned to 320 million each year, a truly staggering public health problem.

In the U.S., 90,000 pesticide exposure incidents were reported in 2001 through the Toxic Exposure Surveillance System, a voluntary reporting system of poison control centers.(4) Of these, 52% involved children under six years old. More complete data do not exist for occupational pesticide poisonings, or for the chemicals involved in acute pesticide poisonings. One state, California, requires doctors to report occupational pesticide poisonings and therefore is better able to characterize poisoning circumstances and outcomes, but studies repeatedly indicate that many poisonings go unreported because agricultural workers do not have access to medical care, may avoid treatment for fear of employer retaliation, and because doctors fail to recognize and/or report cases. Among U.S. doctors, this failure to recognize and report results often arises from lack of training, U.S. medical school curricula devote only about seven hours to environmental medicine overall, a topic which may or may not include pesticide toxicology.(5)

Pesticide identification is a problem

When a poisoning incident occurs identification of the chemical agent involved is the foremost concern, yet can be quite difficult. The victim may have only partial information, or not know the chemical or mix of chemicals involved in his or her exposure. Many poisoning symptoms mimic common diseases or conditions, which can further complicate the diagnosis.

For all of these reasons, the new on-line pesticide poisoning diagnostic tool developed by PAN North America is an important resource. Using a reliable search mechanism, the PAN Online Pesticide Poisoning Diagnostic Tool assists health care providers and others to identify poisoning symptoms of a known chemical, or find the pesticide involved in a poisoning by entering a crop, type of use, (e.g., insecticide, herbicide, etc.) or (U.S.) geographic location. A user can also view use and toxicity information on a specific pesticide or product.

The Diagnostic Tool contains diagnostic, treatment and related information for 1,900 pesticides, and provides reporting requirements, instructions and contacts for all states in the U.S. (and county-specific information for California and Florida). Because the new tool incorporates extensive U.S. data on registration and use, the search function is more precise for locations within the U.S. However, international registration information is also incorporated, and together with the poisoning symptom and treatment information, is valuable anywhere pesticide exposures occur.

In addition to providing crucial information to doctors when they need it, the diagnostic tool can be an important resource for documenting the risks agricultural workers encounter with pesticides. As explained by Marcia Miller, of the Northwest Regional Primary Care Association, one of the sponsors of the Diagnostic Tool, "Our ability to advocate for better pesticide regulation is only as good as our data on pesticide poisoning, which are incomplete because we, and this includes health care providers, have limited access to information on diagnosis and an inconsistent system of tracking."

Margaret Reeves is Senior Scientist at PANNA.

Note: The PAN Pesticide Poisoning Diagnostic Tool addresses the symptoms of acute pesticide poisoning only, and therefore does not provide complete information on illness or health problems associated with chronic and longer term exposures to pesticides. Visit the PAN Online Pesticide Poisoning Diagnostic Tool at: http://www.pesticideinfo.org.

Resources: National Pesticide Information Center, Oregon State University, http://npic.orst.edu/mcapro/index.html provides Medical Cases and Topics for Health Care Providers with information and scenarios of pesticides exposures.

For Illness related to chronic pesticide exposure see: Agricultural Health Study (AHS) National Cancer Institute, U.S. http://www.cancer.gov/newscenter/press

Environmental Justice Foundation, London, UK. 2003.What's Your Poison? Health Threats Posed by Pesticides in Developing Countries; Recognition and Management of Pesticide Poisonings, U.S. Environmental Protection Agency handbook, 5th edition available in English and Spanish; http://www.eap.gov/pesticides/safety/healthcare/handbook/handbook.htm.

Sources: The Public Health Impact of Pesticide Use in Agriculture, World Health Organization and United Nations Environmental Program, Geneva, Switzerland, 1990; Kishi, M, Hilrschorn N, Djadjadisastra M, Satterlee, L, Strowman S, Dilts, R, Relationship of pesticide spraying to signs and symptoms in Indonesian farmers. Scandinavian Journal Work Environ Health, 1995.

Notes

1. Jeyaratnam, J, et al, Survey of acute pesticide poisoning among agricultural workers in four Asian countries, WHO Bulletin 1987; 65: 525-527; Condara G, et al. Pesticide poisonings among agricultural workers in Bolivia, Impact of Pesticide Use on Health in Developing Countries, Proceedings of a Symposium Held in Ottawa, ON, Canada, September 17-20, 1990, International Development Research Centre, Ottawa, ON, Canada, 1993: 76-84; Wesseling C, et al. Agricultural pesticide use in developing countries: health effects and research needs. International Journal of Health Serv. 1997; 27: 273-308.
2. Forastiera Valentina, "Safe Work: The ILO Programme on Occupational Safety and Health in Agriculture" International Labor Office, Geneva, Oct. 1999, on ILO website: http://www.ilo.org.
3. Kishi, M, et al. Relationship of pesticide spraying to signs and symptoms in Indonesian farmers, Scand Journal of Work Envir Health, 1995: 21:124-33.
4. In 2002 a similar number of calls for poisoning incidents were reported through the TES System, (96,112 not counting exposures to disinfectants), follow up of 41% of these reports determined as many as 17,516 cases with clear poisoning symptoms or signs, and 24,082 with possible poisoning symptoms, totaling potentially 41,544 cases, Watson WA, et al, 2002 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. American Journal of Emergency Medicine, 2003, 21:353-421.
5. According to the National Environmental Education and Training Foundation (2003), too often providers are not prepared to respond effectively to pesticide exposure or illness. A survey of environmental medicine content in U.S. medical schools found that 75% require only about seven hours of study over four years (Schenk, et al., 1996)."