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===Total release foggers===
===Total release foggers===
An article published by SENSOR-Pesticides in the CDC’s Morbidity and Mortality Weekly Report in October 2008 called attention to the high number of injuries and illnesses resulting from consumer use of total release [[fogger]]s, also known as “bug bombs”.<ref name=mmwr>{{cite journal
An article published in CDC’s Morbidity and Mortality Weekly Report&mdash;investigated in part by state health departments that participate in SENSOR-Pesticides&mdash;called attention to the number of injuries and illnesses resulting from consumer use of total release [[fogger]]s, also known as “bug bombs”.<ref name=mmwr>{{cite journal
| title = Illnesses and Injuries Related to Total Release Foggers &mdash; Eight States, 2001&ndash;2006
| title = Illnesses and Injuries Related to Total Release Foggers &mdash; Eight States, 2001&ndash;2006
| journal = Morbidity and Mortality Weekly Report
| journal = Morbidity and Mortality Weekly Report

Revision as of 02:09, 30 September 2009

Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides is a state-based surveillance program that monitors pesticide-related illness and injury. It is administered by the National Institute for Occupational Safety and Health (NIOSH), which collaborates with several state health agencies. NIOSH supports these surveillance activities by providing funding and technical support to state health departments. The SENSOR-pesticides program is also partially funded by the US Environmental Protection Agency.

Importance of pesticide poisoning surveillance

Pesticides are used extensively in several industries. They are particularly useful for agriculture, because they increase crop yields and decrease the need for manual labor.[1] They are used to control pests in other areas as well.[2][3] However, this extensive use of pesticides puts workers in many different occupations at risk for pesticide exposure and illness, and so surveillance is needed to assess the magnitude and severity of occupational pesticide poisonings. Surveillance of pesticide-related injuries and illnesses is critical and is recommended by several national agencies,[4] including the American Medical Association,[5] the Council of State and Territorial Epidemiologists,[6] and the Government Accountability Office.[7][8][9]

Overview of the SENSOR-Pesticides program

History

Beginning in 1987, NIOSH supported the implementation of the Sentinel Event Notification System for Occupational Risks program in ten state health departments.[10] The objectives of the program were to assist state health departments in developing and/or refining reporting systems for selected occupational disorders so that they could direct appropriate intervention and prevention efforts and evaluate the effectiveness of such efforts. The primary areas of focus were silicosis, occupational asthma, carpal tunnel syndrome, lead poisoning, and pesticide poisoning. While each of the participating state health departments had previously performed surveillance and/or interventions for occupational illnesses, SENSOR clearly assisted the states to develop and refine reporting systems and to direct effective intervention and prevention efforts.

Before 1998, the individual state pesticide-poisoning surveillance systems used different methods for collecting and categorizing data, which did not allow for routine pooling and analysis.[11] In response to this issue, NIOSH, along with other federal agencies (EPA, National Center for Environmental Health), non-federal agencies (CSTE, Association of Occupational and Environmental Clinics), and state health departments, developed a standard case definition[12] and a set of standardized variables,[13] which were finalized in 1998. Three states (California, Oregon, and Texas) joined the program that year, and more states joined the program in the years that followed. As of 2008, SENSOR-Pesticides has 12 participating states.[14]

Participating states

As of 2008, twelve states contribute occupational pesticide-related injury and illness data to the program.[14] Health departments in seven states receive federal funding to aid in surveillance:

Five additional states are unfunded SENSOR-Pesticides program partners:

Case definition

A standard case definition and a standardized set of variables are used by all participating SENSOR-pesticides states. A case is characterized by an acute onset of symptoms that are dependent on the formulation of the pesticide and involve systemic signs or symptoms (e.g. respiratory, gastrointestinal, allergic, and/or neurological), skin lesions, and/or ocular lesions. Cases are classified as occupational if exposure occurs while the patient is at work, with the exception of suicides and attempted suicides.

Cases are reportable to the national surveillance system when:

  • there is documentation of new adverse health effects temporally related to a documented pesticide exposure AND
  • consistent evidence of a causal relationship between the pesticide and the health effects based on known toxicology of the pesticide OR
  • insufficient information to determine whether a causal relationship exists between the exposure and the health effects.

Cases investigated by state programs are rated and reported as definite, probable, possible or suspicious based on the strength of evidence that a pesticide exposure occurred, whether adverse health effects were observed by a healthcare professional versus being self-reported, and the presence of sufficient evidence that the known toxicology of the agent was consistent with the observed health effects. Illness severity was assigned to all cases as either low, moderate, severe, or fatal using standardized criteria which were based on signs and symptoms, medical care received, and lost time from work.[15]

Data collection

The original SENSOR model was based on physician reporting, with several states using a system of sentinel health care professionals who were contacted on a regular basis.[11] However, this system was labor-intensive and did not yield many cases, and was thus discontinued.[16] All states currently participating in the program require physician reporting of pesticide-related injuries and illnesses; however, the principal sources of reporting for most states come from workers’ compensation claims, poison control centers, and/or state agencies with jurisdiction over pesticide use, such as state departments of agriculture.[11] Data sources may differ between states, depending on the state’s reporting requirements and the existence of cooperative agreements between poison control centers and state health departments. Other sources include emergency medical services, medical laboratories, hospital emergency rooms and discharge data, Migrant Legal Aid, and death certificates, and some states accept self reports. Data submitted annually to NIOSH by each SENSOR-Pesticides state program is aggregated to produce a national database consisting of acute pesticide-related illness and injury cases.

When a report is received, SENSOR-Pesticides states review the information to determine whether the patient was symptomatic and whether the chemical involved was a pesticide. If so, medical records are requested (if available) and attempts are made to interview the patient (or a proxy) and anyone else involved in the incident (e.g. supervisors, applicators, and/or witnesses). Information collected for each case include demographics, whether the exposure was occupational, type of exposure (e.g. drift, spill, direct spray), activity during exposure, biological monitoring information (i.e. laboratory tests), factors that contributed to exposure (e.g. lack of notification, equipment failure), and use of personal protective equipment.

In addition to identifying, classifying, and tabulating pesticide poisoning cases, the states periodically perform in-depth investigations of pesticide-related events and develop interventions aimed at particular industries or pesticide hazards.[17][18][19][20]

Impact

Pesticide use in schools

SENSOR data was used in part for a 2005 article in the Journal of the American Medical Association (JAMA). The article described illnesses in students and school employees that were associated with school pesticide exposures.[21] The article generated media coverage.[22][23][24] Officials in the pesticide industry reacted strongly to the report, calling it “alarmist” and “incomplete” in its health reporting.[24] Critics claimed that the report was “written without context about the proper use of pesticides in schools and [did] not mention the positive public health protections they provide to [children].” The increased awareness of pesticide use in schools resulting from the article influenced several school districts to adopt integrated pest management programs.

Total release foggers

An article published in CDC’s Morbidity and Mortality Weekly Report—investigated in part by state health departments that participate in SENSOR-Pesticides—called attention to the number of injuries and illnesses resulting from consumer use of total release foggers, also known as “bug bombs”.[25] In response to this report, the New York State Department of Environmental Conservation (DEC) published a press release stating that the state would restrict the use of total release foggers.[26] DEC Commissioner Pete Granis announced that the department would move to classify foggers as a restricted-use product in New York State, meaning that only certified pesticide applicators would be able to obtain them.

References

  1. ^ Litchfield MH. 2005. Estimates of acute pesticide poisoning in agricultural workers in less developed countries. Toxicol Rev 24(4): 271-278.
  2. ^ Calvert GM, Petersen AM, Sievert J, Ball C, Mehler LN, Das R, Harter LC, Romoli C, Becker A, Ball C, Male D, Schwartz A, Lackovic M. Acute pesticide poisoning in the US retail industry, 1998-2004. Public Health Rep 2007; 122:232-244.
  3. ^ Calvert GM, Barnett M, Mehler LN, Becker A, Das R, Beckman J, Male D, Sievert J, Thomsen C, Morrissey B. Acute pesticide-related illness among emergency responders, 1993-2002. Am J Ind Med 2006; 49:383-393.
  4. ^ Centers for Disease Control and Prevention. 2006. Pesticide-Related Illness and Injury Surveillance (DHHS Publication No. 2006-102). Cincinnati, OH: National Institute for Occupational Safety and Health.
  5. ^ American Medical Association. 1997. Educational and information strategies to reduce pesticide risks. Prev Med 26:191-200.
  6. ^ Council of State and Territorial Epidemiologists. 1996. CSTE position statement 1996-15: adding acute pesticide poisoning/injuries (APP/I) as a condition reportable to the National Public Health Surveillance System (NPHSS). Atlanta, GA: Council of State and Territorial Epidemiologists.
  7. ^ Government Accountability Office. 1994. Pesticides on farms. Limited capability exists to monitor occupational illnesses and injuries. Washington, DC: U.S. General Accounting Office, GAO/PEMD–94–6.
  8. ^ Government Accountability Office. 1999. Pesticides. Use, effects, and alternatives to pesticides in schools. Washington, DC: U.S. General Accounting Office, GAO/RCED–00–17.
  9. ^ Government Accountability Office. 2000. Pesticides: improvements needed to ensure the safety of farmworkers and their children. Washington, DC: U.S. General Accounting Office, GAO/RCED–00–40.
  10. ^ Levy B, Johnson A, Rest K. 1992 September 28. Evaluation of the Sentinel Event Notification System for Occupational Risks (SENSOR). Final Report.
  11. ^ a b c Calvert GM, Mehler LN, Alsop J, De Vries AL, Besbelli N. 2009. Surveillance of pesticide-related illness and injury in humans. In: Krieger R, editor. Handbook of pesticide toxicology 3rd edition. San Diego, CA: Academic Press (in press).
  12. ^ Centers for Disease Control and Prevention. 2005. Case Definition for Acute Pesticide-Related Illness and Injury Cases Reportable to the National Public Health Surveillance System. Cincinnati, OH: Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health.
  13. ^ Centers for Disease Control and Prevention. 2009. Standardized Variables for State Surveillance of Pesticide-Related Illness and Injury. Cincinnati, OH: Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health.
  14. ^ a b Calvert, GM. 2008. "An Overview of SENSOR-Pesticides". Retrieved on March 10, 2009
  15. ^ CDC. 2001. Severity index for use in state-based surveillance of acute pesticide related illness and injury. Cincinnati, OH: Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health.
  16. ^ Schnitzer PG, Shannon J. 1999. Development of a surveillance program for occupational pesticide poisoning: lessons learned and future directions. Public Health Reports 114:242-248.
  17. ^ "California Occupational Health Surveillance and Evaluation Program (OHSEP)." Retrieved on March 10, 2009.
  18. ^ "Program Q&A ." Florida Department of Health/Pesticide Exposure Surveillance Program (DOH/PESP). Retrieved on March 10, 2009.
  19. ^ "Pesticide Surveillance Program". Louisiana Center for Environmental Health. Retrieved on March 10, 2009.
  20. ^ "Pesticide Program. Washington State Department of Health" Retrieved on March 10, 2009
  21. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1001.2Fjama.294.4.455, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1001.2Fjama.294.4.455 instead.
  22. ^ Osterweil, Neil. July 27, 2005. School Kids and Teachers Bugged by Pesticide Exposure. Accessed September 29,2009.
  23. ^ PANNA. September 15, 2005. PANNA: JAMA Study of Pesticide Risks in Schools. Accessed September 29,2009.
  24. ^ a b U.S. Newswire. July 26, 2005. Industry Responds to JAMA Report on Incidence of Pesticide Exposure at Schools. Accessed September 29,2009.
  25. ^ "Illnesses and Injuries Related to Total Release Foggers — Eight States, 2001–2006". Morbidity and Mortality Weekly Report. 57 (41). Atlanta, GA: Centers for Disease Control and Prevention: 1125–1129. October 17, 2008.
  26. ^ New York Department of Environmental Conservation. October 17, 2008. State to Restict Use of “Bug Bombs”. Accessed September 29,2009.

External Links

SENSOR-Pesticides Program

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