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Pyrethroid Pesticides: Hidden Hazard Rupali Das, MD, MPH, FACOEM Chief, Exposure Assessment Section California Department of Public Health Environmental.

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Presentation on theme: "Pyrethroid Pesticides: Hidden Hazard Rupali Das, MD, MPH, FACOEM Chief, Exposure Assessment Section California Department of Public Health Environmental."— Presentation transcript:

1 Pyrethroid Pesticides: Hidden Hazard Rupali Das, MD, MPH, FACOEM Chief, Exposure Assessment Section California Department of Public Health Environmental Health Investigations Branch and Associate Clinical Professor UCSF Division of Occupational and Environmental Medicine Faculty Disclosure: Rupali Das, MD, MPH, has no conflict of interest to disclose. Western Occupational and Environmental Medical Association Webinar December 10, 2009 Begin slide show to hear audio:

2 2 Learning Objectives Understand why illness due to pyrethroids is a concern Recognize settings where pyrethroid pesticides are used Identify potential health effects of pyrethroid pesticides Manage illnesses due to pyrethroid pesticides Learn how to report pesticide illness

3 3 Pesticides: Defined by Law Substances that prevent or destroy pests US Environmental Protection Agency ▪ Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) 1947

4 4 Pesticide Classes: Examples Functional ClassChemical ClassTarget Organisms Insecticide Organophosphates, Pyrethroids Aphids, fleas, beetles HerbicideGlyphosateInvasive grasses RodenticideCoumarinsMice, rats Disinfectant Hypochlorite, Glutaraldehyde Microbes

5 5 Many Pesticides Associated with Worker Illnesses Occupational Pesticide Illness in California 1998 – 2007

6 6 Pyrethroids: Use Widespread Agriculture Structures Pet flea control, pediculocide Vector control

7 7 Vector Control: Aircraft “Disinsection” Source: CDC From DDT to Pyrethroids Sutton P. Pesticide Illness Among Flight Attendants Due to Aircraft Disinsection. Am J Indust Med. 2007; 50:345–356.

8 8 Pyrethroid Products ALLETHRIN (Bansect Flea Shampoo) BIFENTHRIN (Speckoz Termiticide) CYFLUTHRIN (Intruder) CYPERMETHRIN (Raid, Sweep) DELTAMETHRIN (Deltox) ESFENVALERATE (CB Total Release Fogger) FENVALERATE (Tricomin) PERMETHRIN (Elimite, Nix, Off!, Raid) PHENOTHRIN (Seargant’s Flea Soap) RESMETHRIN (Scourge Inecticide) S-BIOALLETHRIN (Off! Mosquito Coil) TETRAMETHRIN (Petscription Aerosol Flying Insect Spray) TRALOMETHRIN (Chemisco Flea Killer) Some products listed here may no longer be registered for use

9 9 Increasing Use Pyrethroid Use in CA Organophosphate Use in CA Pesticide use data: and CDPR, personal communication 11/10/09. Pounds of Reported Use

10 10 Increasing Exposure % of all US Insecticide Exposures Due to Pyrethroids/Pyrethrins and Organophosphates From Power 2007. Source of data: American Association of Poison Control Centers Toxic Exposure Surveillance System annual reports Power L. Pyrethrin and pyrethroid exposures in the United States: a longitudinal analysis of incidents reported to poison centers. J Med Toxicol. 2007; 3:94-9.

11 11 Body, Environmental Burden Pyrethroids most common pesticide detected in homes ▫American Healthy Homes Survey Pyrethroid metabolites found in the urine of at least 95% of random US population tested ▪ Levels in females slightly higher than males ▪ Levels in Non-Hispanic Whites, Non-Hispanic Blacks higher than in Mexican Americans ▫CDC National Health and Nutrition Examination Survey (N-HANES) Urine metabolite levels in pest control operators increased after application of pyrethroid pesticides CDC. Third National Report on Human Exposure to Environmental Chemicals 1999-2002. p. 414. Stout M. American Healthy Homes Survey: National Study of Residential Pesticides Measured from Floor Wipes. Environ Sci Technol. 2009; 43:4294-4300. Leng G. Pyrethroids used indoors—biological monitoring. Int J Hyg Env Health. 2003; 206:85-92.

12 12 Case: Farmworker 24 year-old female farmworker complains of headache, eye and throat irritation, tearing, cough, nausea, and numbness and tingling in her hands and feet. Picking leaves off grape vines when a tractor drove by spraying cyfluthrin. Physical exam significant for injected conjunctivae and erythema on face and dorsal hands. Given acetaminophen and sent home. She is told to return to work the next day but comes to the clinic complaining of headache and cough. PE the next day is normal. Symptoms persist for several days; she misses 2 days of work. Worker Illness Related to Ground Application of Pesticide --- Kern County, California, 2005. MMWR 2006; 55:486-488.

13 13 Pyrethrins and Pyrethroids Pyrethrins Natural chrysanthemum extract ▪ “photo-unstable” Low acute systemic toxicity Pyrethroids ▪ Synthetic derivatives ▪ Increased stability ▪ Human toxicity varies Chrysanthemum cinerariaefolium, the pyrethrum flower, is the source of natural insecticidal pyrethrins

14 14 Pyrethrins: Acute Health Effects Respiratory sensitization Asthma ▪ Fatalities have been reported* Skin reactions Paresthesias Allergic dermatitis * Wagner SL. Fatal asthma in a child after use of an animal shampoo containing pyrethrin. West J Med. 2000; 173:86-7.

15 15 Pyrethroids: Acute Health Effects Skin Paresthesia, erythema, dermatitis Eyes Severe irritation, tearing, conjunctival and lid edema Respiratory Rhinitis Increased airway responsiveness in asthmatics Systemic Dizziness, headache Fasciculations, seizures He F. Clinical manifestations and diagnosis of acute pyrethroid poisoning. Arch Toxicol. 1989; 63:54-58. Salome CM. The effect of insecticide aerosols on lung function, airway responsiveness and symptoms in asthmatic subjects. Eur Respir J. 2000; 16:38-43. Top Health Effects Reported by Workers with Pyrethroid Illness CA, 1998—2007 Headache Nausea Eye Pain/Irritation Dizziness Vomiting Upper Resp Irritation Shortness of Breath Skin Tingling/Irritation

16 16 Pyrethroids: Mechanism of Toxicity Sodium channel toxin  Affinity for nerve membrane sodium channels  Prolongs inactivation, or sodium “tail current”  Highly toxic to bees, fish, aquatic invertebrates Effects may be observed in various organs  Central nervous system  Gastrointestinal  Respiratory  Skin Pyrethrins and Pyrethroids. http://

17 17 Structure Determines Toxicity Pyrethroid structure  Type I (non-cyano)  Shorter toxicity  Type II (  -cyano)  Longer toxicity R’R Coats JR. Mechanisms of toxic action and structure-activity relationships for organochlorine and synthetic pyrethroid insecticides. Environ Health Perspect. 1990; 87:255-262.

18 18 Pyrethroids: Chronic Health Concerns Asthma in adults Tetramethrin, allethrin, chlorothalonil, fluazinam Developmental toxicity Resmethrin Reproductive toxicity (decreased fertility) Various Carcinogenicity Resmethrin - “known to cause cancer” (Prop 65) Permethrin- “likely to be carcinogenic to humans” (US EPA) Bifenthrin, cypermethrin, tetramethrin - possible human carcinogens Endocrine disruption Various

19 19 Diagnosing Pyrethroid Illness Occupational & environmental history Occupation Exposure ▪ Including use records, label, MSDS Symptoms ▪ May be nonspecific Physical exam may confirm suspicion Erythema Upper airway irritation CDC. Recognition of Illness Associated With Exposure to Chemical Agents. MMWR. 2003; 52:938-940. In most cases, diagnosis of pesticide illness relies on: Clinical suspicion Occupational and environmental history

20 20 Read the Label

21 21 Pesticide Formulations Technical grade chemical Pyrethroid Adjuvants/synergists Piperonyl butoxide “Inert” ingredients Inert ≠ Benign Toxic effects may be due to any ingredient in the pesticide formulation vary by product

22 22 Laboratory Confirmation Lab tests are not needed to diagnose pyrethroid illness Cholinesterase tests are NOT indicated Urine metabolites Research method, not widely available Indicate exposure, not physiologic effect Future biomonitoring potential? Leng G. Pyrethroids used indoors—biological monitoring. Int J. Hyg Env Health. 2003; 206:85-92. Laboratory tests are not needed to diagnose most pesticide illness

23 23 Pyrethroid Poisoning: Treatment Decontaminate ▪ Protect treating staff Symptomatic treatment ▪ Maintain airway-breathing-circulation Topical Vitamin E cream for paresthesias Provide counseling on prevention Treatment for most pesticide illnesses is based on symptoms and signs and is not specific to the pesticide

24 24 Preventive Guidance for Workers Prevent Exposure At Work Do not enter treated areas until it is safe Do not bring food into a treated areas Keep pesticides off your skin Use respiratory protection when required Wash hands before eating If you become ill, tell your supervisor and seek treatment immediately Don’t Take The Workplace Home Do not use water in drainage ditches Change clothes and shower if possible before entering house and or/playing with your children Never take pesticide containers home Store and wash clothes separately

25 25 Preventive Guidance for All Prevent pests Fix leaks Put food in tightly sealed containers Seal cracks and holes in walls, floors, baseboards Keep floors and surfaces clean at all times Use alternatives at home ▪

26 26 Pesticide Reporting Regulations: Vary by State Pesticide-related illness (WOEMA states*) ▫Reportable condition in AZ, CA, HI ▫No reporting requirement: NV, UT *WOEMA states: AZ, CA, HI, NV, UT

27 27 Pesticide Reporting Requirements for California Physicians Physicians must report suspected Occupational injury or illness ▪ Within 5 days ▪ To Workers’ Compensation carrier Pesticide Illnesses ▪ Within 24 hours ▪ To Local Health Officer ▫Who notifies other parties Failure to comply may result in a civil penalty of $250 Treatment for pesticide illness is not first aid

28 28 Pesticide Illness Reporting: Hawaii Health care providers are required to report to the Department of Health within 1 day in any case of pesticide poisoning involving organophosphates or carbamates Oahu 808-586-4249 ▪ 24 hour hotline 808-247-2191 Toll-free numbers exist for each island

29 29 Reporting Pesticide Illnesses* Arizona ▪ California Doctor’s First Report ▪ Pesticide Illness Report ▪ California Poison Control System ▪ 1-800-411-8080 (national health care provider line) Confidential Morbidity Report ▪ Hawaii ▪ *In WOEMA States

30 30 Pyrethroids: Summary Use is rising, exposure ubiquitous Acute and chronic health effects Diagnosis primarily by history Laboratory test not clinically available Treatment is symptomatic Provide preventive guidance Report pesticide illness

31 31 Poison Control Center : 1-800-411-8080 National Pesticide Information Center (NPIC) 1-800-858-7378 or Extoxnet: Household Products Database: NIOSH: US EPA: Recognition and Management of Pesticide Poisonings. 1999; 5th ed. ▫ California Department of Public Health California Department of Pesticide Regulation: CA Office of Environmental Health Hazard Assessment Pesticide Resources

32 32 Chronic Health Concerns: References Garey J. Estrogenic and antiprogestagenic activities of pyrethroid insecticides. Biochem Biophys Res Comm. 1998; 251:855-859. Hoppin J. Pesticide exposure and asthma. Am J Respir Crit Care Med. 2002;165:683-9. Meeker J. Pyrethroid insecticide metabolites are associated with serum hormone levels in adult men. Reprod Toxicol. 2009; 27:155-60. Welshons W. Large effects from small exposures. I. Mechanisms for endocrine-disrupting chemicals with estrogenic activity. Environ Health Perspect. 2003; 111:994–1006. Wigle D. Epidemiologic evidence of relationships between reproductive and child health outcomes and environmental chemical contaminants. J Toxicol Environ Health B Crit Rev. 2008; 11:373–517.

33 33 Acknowledgments California Dept of Public Health Robert Harrison Barbara Materna California Dept of Pesticide Regulation Louise Mehler Public Health Institute John Beckman Christine Hannigan Patrice Sutton Justine Weinberg WOEMA Shannon Jamieson Kerry Parker Educational Committee

34 34

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