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).

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.

Trends in non-fatal agricultural injuries requiring trauma care.

BACKGROUND: Efforts to control agricultural injuries have been underway for years. Yet, very little is known about their trends over time. We examined trends in non-fatal agricultural injuries through analyzing injuries reported in a state trauma registry. METHODS: Using Iowa Trauma Registry data collected by the Iowa Department of Public Health, we examined trends in non-fatal agricultural injuries reported by acute care hospitals accredited as Level I, II, and III Trauma Care Facilities from 2005 to 2013. Rate ratios and corresponding 95 % confidence intervals were used to examine the burden of non-fatal agricultural injuries across this period. Negative binomial regression was used to calculate the average annual change in agricultural injury rates over time. Joinpoint regression analysis was used to examine the average annual change in the number of injuries over time. RESULTS: Between 2005 and 2013, a total of 1238 agricultural injuries were reported to the trauma registry by Level I, II and III trauma facilities. From 2005 to 2013, the rate of agricultural injuries per 100,000 hired workers, ranchers, and farm operators increased by 11 % for every unit increase in year and had nearly tripled over this time period. From 2005 to 2008 there was a significant annual increase of 31.74 % in the number of agricultural injuries whereas from 2008 to 2013 there was a non-significant annual increase of 3.70 %. The number of moderate and severe/critical injuries increased steadily and significantly over the study period, with annual percent increases of 13 and 20 %, respectively. CONCLUSION: Non-fatal agricultural injuries are rising, although the documented increases could be influenced in some part by treatment patterns in the trauma system, reporting bias or increases in farm work exposure. However, these issues do not likely account for all of the increase found, and this calls for an increase in priority of agricultural safety programs. Since the majority of research involves fatal injuries, information about non-fatal injuries may help inform new intervention approaches.

Notes from the Field: Acute Mercury Poisoning After Home Gold and Silver Smelting--Iowa, 2014.

In March 2014, a man, aged 59 years, who lived alone and had been using different smelting techniques viewed on the Internet to recover gold and silver from computer components, was evaluated at a local emergency department for shortness of breath, tremors, anorexia, and generalized weakness. During the smelting processes, he had used hydrogen peroxide, nitric acid, muriatic acid, and sulfuric acid purchased from local stores or Internet retailers. For protection, he wore a military gas mask of unknown type. The mask was used with filter cartridges, but their effectiveness against chemical fumes was not known.

Characteristics of Work- and Non-work-Related Farm Injuries.

PURPOSE: Farm-related injuries are an important public health problem in agriculture because of their impact on individuals, families, and farm operations. While surveillance programs such as the Census of Fatal Occupational Injuries is available to track fatal agricultural injuries, more work is needed to examine the burden of nonfatal agricultural injuries. METHODS: Data involving agricultural injuries were collected from the Iowa Trauma Registry from January 1, 2005, through December 31, 2011. A total of 2,490 trauma patients were found to have been classified as having a farm-related injury. These nonfatal farm-related injuries were compared by work-relatedness, injury severity score, length of hospital stay, and hospital discharge status. Also reported are the age and gender of the trauma patients, as well as the population of the county in which the injury occurred. RESULTS: In our analysis, we found that work- versus nonwork-relatedness had little effect on injury severity, but that work-related injuries did result in longer average hospital stays. Injuries occurring in counties of lower population size tended to be slightly more severe and be more likely to have nonroutine discharges. CONCLUSIONS: Farm environments pose hazards which are persistent for those working and living on the farm, regardless of whether or not they are engaged in work-related activities. Public health prevention approaches that consider work and nonwork farm environments may be helpful in designing interventions to reduce injury.

Nonfatal tractor-related injuries presenting to a state trauma system.

PURPOSE: To identify tractor-related injuries using data from a statewide trauma system, to characterize the mechanisms of nonfatal tractor-related injury, and to determine which injuries are associated with higher severity injury. METHODS: A retrospective observational study was conducted using the Iowa State Trauma Registry to identify cases of nonfatal tractor-related injuries over an 11-year period from 2002 to 2012. Frequency of injury was reported by age, sex, severity, and nature. Injuries were classified by mechanism and a polytomous regression model was used to predict injury severity adjusting for sex and age. RESULTS: Five-hundred thirteen nonfatal tractor-related injuries were identified with 18% classified as severe. Injuries were most frequent among males and among those ≥45years of age. Rollovers were the most frequent mechanism of both total (25%) and severe injury (38%), although the frequency of injury mechanism varied by age. Falls were the next most frequent mechanism of injury (20%) but resulted in fewer high-severity injuries. Collision (adjOR=1.89, 95% CI=1.01-3.51), rollover (adjOR=2.03, 95% CI=1.21-3.40), and run over/rolled on (adjOR=2.06, 95% CI=1.17-3.62) injuries were significantly associated with higher injury severity. Advanced age was also a significant predictor of higher severity injury (adjOR=1.82, 95% CI=1.06-3.12). SUMMARY: Mechanisms of nonfatal tractor-related injuries are heterogeneous, differ by age, and are associated with varying level of severity. PRACTICAL APPLICATIONS: This work shows the burden of nonfatal tractor injuries on a rural state trauma system. These findings also demonstrate the heterogeneous nature of nonfatal tractor injuries and underscore the need for a multi-level approaches to injury prevention.

A cluster of lead poisoning among consumers of Ayurvedic medicine.

BACKGROUND: Use of alternative medications and herbal remedies is widespread in the United States and across the globe. These traditional medications can be contaminated with toxic metals. Despite several case reports of poisoning from such contamination, the epidemiological data are still limited. OBJECTIVES: To report on a cluster of lead and mercury toxicity cases in 2011 among a community of adherents of traditional medical practice of Ayurveda. METHODS: Adherents of Ayurveda were offered heavy metals screening following the identification of the index case. RESULTS: Forty-six of 115 participants (40%) had elevated blood lead levels (BLLs) of 10 µg/dl or above, with 9.6% of BLLs at or above 50 µg/dl. CONCLUSIONS: This is the largest cluster of lead and mercury toxicity following use of Ayurvedic supplements described in the literature in the US. Contamination of herbal products is a public health issue of global significance. There are few regulations addressing contamination of "natural" products or supplements.