1. Pesticide Effects: Integration into Health Care Provider Curricula Faculty and Student Champion Training: Part I
Helen Murphy-FNP/MHS
Director of Outreach
Pacific Northwest Agricultural Safety and Health Center
University of Washington
May 31, 2006

2. Agenda Part I: Nurse Murf Part II – Dr. Matt Rationale
Exposure Pathways
The Chemicals
Health Effects
Risk Communication
Part II – Dr. Matt
Environmental/public health context
Diagnosis and treatment
Referrals and Reporting

3. Did you know?
5 million AG workers at risk for pesticide exposure (U.S. EPA, 1992)
physician-diagnosed cases occur per 100,000 agricultural workers (Blondell, 1997).
Migrant and seasonal farmworkers are especially at high risk
84% of American households used pesticides, most commonly insecticides (Whitmore et al, 1992)
Homeowners use 5-10 lbs/ acre/yr on their lawns and gardens, many times greater than farmers apply to corn and soybean fields (Robinson et al, 1994).

4. Did you know?
Widespread pesticide exposure through non -agricultural sources with use of disinfectants: (e.g., pine oil cleaners, bathroom cleaning products, and cleaning materials for swimming pools).
Non-Ag Sector a concern = pest control, nurseries, greenhouses, and landscaping.
The medical profession uses disinfectants to sanitize and sterilize surfaces and instruments.
Organophosphate and pyrethroid insecticides most implicated for poisonings.
Water chlorination is one of the largest (by tonnage) uses of pesticides.

5. Where Are Pesticides Used?
Forests to control insects and under-story vegetation.
Landscapes, parks, and recreational areas to control weeds, insects, and disease pests
Rights-of-way along railroads and under electric wires to control vegetation
Houses, schools, and commercial and office buildings to control insects, rodents, and fungi
Boat hulls to control fouling organisms;

7. Washington State Pesticide Events - 2003
67%
Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

8. Washington State Source of Case Reports
2002 and 2003 Combined
Workman’s Comp
Dept of AG
Poison Control
Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

9. Agricultural vs. Non-Agricultural Cases of Poisonings
Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

10. Occupational versus Non-Occupational Cases of Pesticide Poisoning
Source: 2004 Pesticide Incident Reporting and Tracking (PIRT) Annual Report

11. Proportion of Poisonings
Ranked 8th Cause of Poisonings = 102,754 cases in 2005 (4.2%)
Adults
Children
Source: Watson WA Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

12. US: Intentional vs. Unintentional
Accidental
84%
Suicide 8%
Out of 196,164 suicide fatalities 7 used pesticides

13. WHO Sentinel Surveillance

14. ROUTES OF EXPOSURE OP’s are readily absorbed:
Across the SKIN with skin contact
In the lungs with INHALATION of pesticide contaminated air/dust
In the gut by INGESTION of pesticide residue on food/dirt/dust
Source: EPA Protect Yourself from Pesticides-Guide of Agricultural Workers

15. Where Are Pesticides Used?
Aquatic sites
Wood products
Food preparation areas
Human skin
Household pets
Livestock

16. Non Occupational Pesticide Encounters
Accidental or intentional ingestion
Food and water residues
Contaminated clothing
Treated wood/structures
Residues on animals/carpets
Garden residues
Termite control
Hazardous waste sites/spills

17. Professions Exposed to Pesticides
Aerial equipment maintenance
Agronomists
Building maintenance work
Emergency responders
Entomologists
Firefighters
Forestry workers
Formulating end product
Greenhouse- nursery workers
Hazardous waste workers
Landscapers
Livestock dippers and veterinarians
Marina workers
Medical personnel
Park workers
Plant pathologists
Research chemistry
Sewer work
Storage/warehouse work
Structural application
Transporting pesticides
Treating contaminated workers
Vector control workers
Wood treatment workers
Work on highway or railroad rights of way

18. Agriculture Pesticide Applications
aerial
Boom sprayer
enclosed cab
back pack-wand
air blast sprayer

19. Agriculture Jobs
orchard thinner
mixer loader
flagger
picker

20. Agriculture Worker Risk Factors
Indonesia:
Cocktail mixture of multiple products
Spray frequency
Skin contact > wet clothing
Use of toxic products (1a/Ib, II)
Washington state:
Baseball caps?
Facial exposure – poor fitting masks?
Contaminated hands: urinating/eating?
Improper decontamination?

21. Children Are More Vulnerable To Pesticides
GREATER EXPOSURE
Hand to mouth behaviors
SKIN contact with floors and lawns
Lighter less clothing
Eat and drink more per weight
GREATER ABSORPTION
 Breathing rates
 Heart rates
 Skin surface/weight
GREATER SENSITIVITY
Sensitive developing organs
Less ability to detoxify

22. Children’s Exposure
Children have twice the amount of pesticide by-products in their urine as adults.
What behaviors in young children that would explain this?

23. Behaviors Hand to mouth: Taste their environment
Near the ground: Spend more time on the ground
Outdoors: Spend more time outside
Diet: consume more per weight (water and fruits)

24. Behavior: soil ingestion
2.5 year old
Adult
Soil ingestion
Indoor
50mg
20mg
Outdoor
60mg
0.4mg
G. Selevan. EHP 2000;108 Suppl 3:

25. Diet
Drinks 2 x more water per their weight than an adult
Eats 12x more apples per their weight than an adult

26. Biology: dermal & dietary dose
Newborn
Young Child
Older Child
Adult
Surface area: body mass ratio (m2/kg)
0.067
0.047
0.033
0.025
< 1 year
1-10 years
11-19 years
20-64 years
Drinking water (tap) mean intake (ml/kg/day)
43.5
35.5
18.2
19.9
3-5 years
12-19 years
40-69 years
Fruit consumption (g/kg/day)
Citrus
1.9
2.6
1.1
0.9
Apples
5.0
3.8
0.4
G. Selevan. EHP 2000;108 Suppl 3:

27. Pesticides in Urine of 22 Children Before, During, and After Organic Diet Intervention
Conventional diet
Organic
diet
Conventional
diet
Lu et al Environ Health Perspect on-line

28. Children’s Biologic Vulnerability
Maria’s husband is an applicator but his blood test (cholinesterase monitoring program) is normal. She likes to take her baby with her when she picks him up from work but was advised against this. She cannot understand why being around pesticides would be a problem for her baby when her husband who had direct contact is fine.
What is it about a child’s body that would make it more vulnerable than an adult?

29. Child’s Biological Factors
Higher metabolic rate
More skin per body weight
Developing organs

30. Biology- Higher Dose By:
Skin
More permeable: highest at birth
2.7 x more skin surface/weight than adults
Lungs
Inhales more per day (1.7x) than adult

31. Biology: inhalation dose
Age (years)
Weight (kg)
Inhalation Rate (m3/day)
“dose”
(m3 per kg per day)
<1
7.6
4.5
0.592
1-2 13
6.8
0.523
3-5 18
8.3
0.461
6-8 26 10
0.385
9-11 36 14
0.389
12-14 50 15
0.300
15-17 66 17
0.258

32. Vulnerability to Health Effects: Organs Still Developing
Nervous System
Sex organs
Lungs
Kidneys
Bones
Immune
Metabolism
Digestive system
“A little kid goes from a single cell to a laughing, sociable, intelligent, friendly human being over the course of two years. That’s dramatic growth and development!”
Kenneth Olden, PhD, former Director, National Institute of Environmental Health Sciences

33. Parent Activities
Ramon and Rosa’s 3 year old has small amounts of OP’s in his urine (he was recruited for a PNASH study). They are asking you how this could occur. The family live 5 miles from the closest orchard.
Why is this? What things are the parents doing that would account for this? What questions will you ask and what things will you look for in the household

34. Sources – Child-Pesticide Encounters

35. Proximity Data from Agricultural Washington State PNASH Center Research

36. Parental Take-Home

37. Parent Activity Questions
Source of food and water
Parent occupation?
Shower after working before holding children?
Work clothes and shoes in the house?
Laundry practices ?
Use household pesticides ?
Garden pesticides ?
House and car cleaning ?
Pesticide storage?
Location of day care?
House near fields?

38. Key Household Safety Points
“ Partly Trained Gorillas Always Run Down Streets Doing Cartwheels”
Proximity
Take home
Garden
Animals
Recycle
Decant
Storage
Disposal
Child play/daycare
pesticide

39. Pesticide
‘cide = to kill
Disinfectants
Fumigants

40. Pesticide Chemical Families -grouping based on similarities-
Similar chemically (similar structure)
Attacks pests in a similar way (toxicity)
Common treatment + antidote
Pyrethroid PY
Organophosphate OP
Carbamate C
Organochlorine OC
Chlorophenoxy
Paraquat
Diquat

41. Pesticide Sample Label
Type of pesticide (used for?)
Company name
Brand name
Common/generic name (active ingredient)
Chemical family (? atropine under 1st aid)
Signal word (hazard level)

43. Pesticide Classification Table#
Type
Company
Name
Brand
Common
Chemical Family
Signal
Class 1.
insecticide
Gowen
Supracide
methidathion OP
organophosphate
Danger-Poison Ib

44. Exercise: Classifying Pesticides
Pesticide Labels
COMPANY
BRAND
COMMON
TYPE
FAMILY
SIGNAL
Who 1. 2. 3. 4. 5. 6. 7. 8. 9.
10.
11.
12.
Bayer
Temik
Aldicarb
Insecticide
Carbamate
Danger-poison la
Verdicon
Sevin
Carbaryl
Insecticide
Carbamate
Caution ll
UCP Alliance
Thiodan
Endosulfan
Insecticide
Organochlorine
Warning ll
Bayer
Guthion
Azinophos methyl
Insecticide
Organophospate
Danger-poison lb
Dow
Dursban
Chlorpyrifos
Insecticide
Organophospate
Warning ll
Syngenta
Gramoxone
Paraquat
Herbicide
Paraquat
Danger-poison ll
Helena
Weed Rhap
2, 4-D
Herbicide
Chlorophenoxy
Danger ll
DuPont
Asana
Esfenverlate
Insecticide
Pyrethroid
Warning lV
Bayer
Captan
Captan
Fungicide
Danger-poison II
Max
Roundup
Glyphosate
Herbicide
Caution
U-IV
Dow
Mancozeb
Fungicide
Dithane
Caution
U-IV
Cerexagri-Nisso
Ziram
Ziram
Fungicide
III
Danger

45. How toxic is it?
Source: Richards, Kerry Penn State University Extension Service

46. Source: Richards, Kerry Penn State University Extension Service

47. LD50
Lethal dose = Amount of chemical it takes to kill 50% of an experimental population

48. Source: Richards, Kerry Penn State University Extension Service

49. * * DANGER/POISON = extremely toxic by ingestion
DANGER = extremely toxic high potential for skin and eye irritation
Adapted from Richards, Kerry Penn State University Extension Service

50. Source: Richards, Kerry Penn State University Extension Service

51. Insecticides ChE Inhibitors: Pyrethroids Organochlorines (e.g. DDT)
Organophosphates
n-methyl carbamates
Pyrethroids
Pyrethrins (ocloresin extract of chrysanthemum)
Pyrethroids (the synthetic derivative)
Organochlorines (e.g. DDT)
DEET
Boric Acid
Fluorides
Nicotine
Arsenicals

52. Herbicides Chlorophenoxy herbicides (e.g. 2-4D) Paraquat and diquat
Pentachlorophenol and dinitrocresol (wood preservatives)
Copper chromium arsenate ( decks, fences, and children’s wood playground sets – d/c 2003)

53. Fungicides
Hexachlorobenzene
Thiram
Maneb
Methylmercury compounds

54. Fumigants Cyanide, 1, 3-dichloropropane Metam sodium Methyl bromide
Naphthalene
Phosphine gas (from aluminum phosphide)

55. Rodenticides Warfarin-related compounds: Others: Warfarin Coumarins
Brodifacoum
Difenacoum (so-called “super warfarins”)
Others:
Thallium
Zinc phosphide
Sodium fluoroacetate

56. Disinfectants
Agents used for sanitization and sterilization in the home and hospital
Registered as pesticides by the U.S. EPA
Examples include
Alcohols
Chlorhexidine
Hypochlorites
Iodines
Phenols
Pine oil

57. Organophosphates: 30”-240 Carbamates: 15”-30
General central nervous system
Fatigue
Dizziness
Headache
Tremors
Ataxia
Convulsions (uncommon w/carbamate)
LOC (uncommon w/carbamate)
Coma (uncommon w/carbamate)
From muscle over stimulation:
Muscle weakness
Muscle cramps
Muscle fasciculations
From gland over stimulation:
Salivary gland- excessive salivation
Sweat gland- excessive sweating
Lachrymal gland-excessive eye tearing
From organ over-stimulation:
Eyes
Gastrointestinal
Pulmonary
Blurred vision (constricted pupils)
Stomach cramps
Nausea
Vomiting
Diarrhea
Chest tightness
Wheezing
Cough
Runny nose

58. Pyrethroids Normal use: If ingested: High doses:
Pyrethroids: are irritants to the eyes, skin and respiratory tract. The symptoms last from 1-2 hours. Systemic toxicity from inhalation or dermal absorption is low.
Normal use:
Paresthesias (cyno pyrethroids)
Shortness of breath (wheezing)
Mucous membrane irritation (throat nose)
Skin itching
If ingested:
Loss of consciousness/coma
Seizures (cyno-pyrethroids)
High doses:
Vomiting
Diarrhea
Excessive saliva
Muscle fasciculation
Ataxia
Irritability: to sound ~ touch
Cyno-pyrethroids: fenverlate, flucythrinate, fluvalinate cypermethrine, deltapermethrin,

59. Organochlorines: 10 - 480 lipophylic
CNS Effects
Muscle Weakness
Dizziness
Headache
Numbness
Nausea/vomiting
LOC
Seizures
Tremors
Ataxia
Anxiety/restlessness
Confusion
The nerves stimulating glands are not affected so you will NOT see:
excessive salivation
excessive sweating
excessive eye tearing
(or over-stimulation of small muscles like)
twitching eyelids

60. Paraquat
Paraquat is very toxic to the skin and mucous membranes. Particles are too large to get deep into the lungs*, but once in the blood it collects in the lungs. If ingested high case fatality rate.
Skin:
dryness, cracks
erythema
blistering
ulcerations
Nails:
discoloration
splitting nails
loss of nails
Respiratory tract:
cough
nosebleeds
sore throat
Eyes:
conjunctivitis
ulceration, scarring, blindness
Ingestion:
lung fibrosis (stiff lungs)
multi-system organ failure, specifically
respiratory failure
kidney failure

61. DEET DIETHYLTOLUAMIDE
Few toxic cases - given the widespread use
Toxic if ingested
Children: toxic encephalopathy w/ heavy use on large surface area on kids (+ ETOH - isopropyl or ethyl)
Dermal problems: tingling, irritation, desquamination, contact dermatitis, exacerbate pre-existing skin dz
Kids: use 5-6.5% formulations

62. Boric Acid Ants, Cockroaches in Residences
“broiled lobster appearance”

63. Boric Acid Respiratory tract irritant Moderate skin irritant
Historic antibacterial: poisonings from burn compresses, diaper powder, irrigation solutions
Targets: GI tract, skin, vasculature, brain
Chronic ingestion more toxic than acute (13 ½ life)
Absorption: via gut and abraded skin

64. Fluorides
Transformed in stomach to corrosive hydrofluoric acid:  thirst, nausea-vomiting, diarrhea, abdominal pain
Fluoride ion reduces extra-cellular fluid concentrations of Ca+ and Mg  hypocalcemic tetany
Cardiac arrythmias- shock  2ndary to fluid/electrolyte imbalances, hypokalemia and the fluoride itself
CNS  H.A. muscle weakness, stupor, seizures and coma