Human Exposure to naled mosquito control pesticides, Florida 2004 .

1. Human Exposure to naled mosquito control pesticides, Florida 2004. A. J. Becker, MPH, PhD 1, Z. Duprey, DVM, MPH 2, S.D. Rivers, MS 1, G. Luber, MA, PhD 2, C. Blackmore, DVM, PhD 1, Carol Rubin, DVM, MPH 2. (1) Bureau of Community Environmental Health, Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, FL 32399. (2) National Center for Environmental Health, Centers for Disease Control and Prevention, MS F-46, Atlanta, GA 30341

2. Hurricane season 2004

4. Mosquito Average per trap by date

5. Florida’s Public Health Response • Request aerial spraying with mosquito adulticide (naled) • Invite CDC to assist in assessing human pesticide exposure

7. Spraying Took place on the evening of October 4, 2004. Naled was applied at 2/3 an ounce per acre, covering approximately 228,000 acres of St. Johns County.

8. Methods • Prospective study design • assessment of a baseline prior to determining exposure

9. Blood Toxicant/Metabolite Urinary Metabolite Concentration 1 10 100 1000 Time (Days) Concentration vs time Post-Exposure Fate of a Nonpersistent Chemical in Blood and Urine

10. Methods • Selection of Participants- Randomly chosen census blocks from 5 proposed spray areas. • DOH/CDC Teams- Teams consisted of one FLDOH and one CDC member and an attempt was made to have one male and one female per team. The teams were trained on how to recruit and complete questionnaires. • Participants- Participants were required to meet the following criteria: • - 18 years of age or older • - Able to speak English • - Able to give informed consent • - In the county during the spray event

11. Participant’s Questionnaire and Sample Collection • Signed consent form • Pre-spray questionnaire + urine specimen, • Five post-spray collection cups and instructions on collecting, labeling and storing the samples • Collections at 8 h increments (morning, noon and night). • Teams returned two days post-spray to collect the samples and administer the post-questionnaire.

12. Verify exposure through environmental sampling • Not done

13. Pre-Exposure Questionnaire • In the past 3 days… • Handle or apply fertilizer • Done farm field work, such as harvesting or weeding, worked in a packing or farm stand with raw fruits, vegetables, or flowers • Worked in a nursery or greenhouse • Worked in a cannery or food processing plant • Done lawn or other landscape maintenance • Applied flea or tick shampoo, dips, powders, or flea collarson pets • Eaten fresh fruit or vegetables • Experienced pesticide-poisoning like illness

14. Post-Exposure Questionnaire Added questions: • From the spray time to 12 hours post spray, how many hours were you in the county? • Did you see or hear the spray plane? • Did you attempt to avoid contact with the mosquito spray? • Close all windows • Turn the air conditioning to recirculate – Clean off all lawn furniture before using – Stay indoors for at least 1 hour after spraying – Clean off all children’s toys before they use them – Wash all garden vegetables before eating or serving

15. Dana Henehan, from CDC, aliquots the urine samples before shipping them to the CDC/NCEH laboratory in Atlanta, Georgia

16. AnalysisOrganophosphate metabolites • Gas chromatography/tandem mass spectrometry (GC/MSMS). • Dimethylphosphate- Non-specific naled metabolite • Other organophosphate metabolites tested in lab.

17. Analysis • N > urine organophosphate metabolite levels post-spray • N < decreases in urine metabolite levels post-spray • Compare metabolite levels to household and workplace exposure questionnaires • Compare metabolite levels to symptoms reported comparing pre and post samples

18. St John’s participation and completion rates • A total of 626 individuals were contacted by the 12 teams and 235 (37%) agreed to participate. Of those 235, 210 completed the study, an 89% study completion rate.

19. Age and gender demographics • Age (n=204) Mean: 50.19, Range 18-78 • Sex (n=205) Male: 92 (44.9%) Female: 113 (55.1%)

20. Ethnicity Census 2000 vs. Study

21. Area participant's residence • N=203 • Hastings: 42 (20.7%) • Jacksonville: 23 (11.3%) • Ponte Verda Beach: 11 (5.4%) • St. Augustine: 125 (61.6%) • Switzerland, FL: 2 (1.0%

22. Pre Eat Fruit & Veg- 72% Lawn- 35.6% (73) Handled-18.5% (38) Flea- 7.8% (16) Field Work- 3.4% (7) Fruit Stand-0.5% (1) Post Eat Fruit & Veg- 72% Lawn- 20% (40) Handled- 8.5% (17) Flea- 3.5% (7) Field Work- 2% (4) Fruit Stand- 0.5% (1) Risk Factors

23. Post Behaviors • Saw plane- 45% (91) • Closed windows- 67% (136) • AC to recirculate- 58% (117) • Wiped lawn furniture- 4.5% (9) • Stayed indoors- 58% (117) • Wiped toys- 1.5% (3)

24. Pre symptoms Headaches 18%(37) Dizziness 6%(12) Nausea 5%(10) Abdominal Pain5%(10) Weakness 4%(9) Excess tearing 4%(9) Trembling hands3%(6) Post symptoms Headaches 13% (26) Nausea 5% (10) Abdominal Pain 4% (9) Dizziness 3% (7) Excess tearing 2% (4) Diarrhea 2% (4) Weakness 2% (4) Trembling hands 2% (3) Symptoms Raw Results

25. Evaluation of pre and post questionnaires for symptoms

26. Symptoms reported by post questionnaire only

27. Pesticide Exposure Reported to Pesticide Exposure Surveillance Program (PESP) • Two complaints a. Small child waiting for the bus the next morning developing respiratory symptoms. b. Skateboarders with irritation to the upper respiratory tract, eyes stinging and skin burning (They reportedly observed the plane fly over).

28. Results-lab analysis

31. Questions