The Health of Farmworkers-Pt. 2

1. The Health of Farmworkers-Pt. 2 Marc Schenker M.D., M.P.H. Dept. Public Health Sciences, University of California at Davis Director, Western Center for Agricultural Health and Safety

2. Part II**** Acute Injuries and Fatalities of Farmworkers

3. Outline • The hazardous passage • Occupational fatalities among agricultural workers • Animal • Machine/tractor • Transportation • Fatalities of children • Pesticides

4. Causes of Death Among Latin Immigrants Crossing US Border • During the crossing • Exposure • Drowning • Accidents • Murder • After the crossing • Disease • Injury (occupational)

5. U.S.-Mexico Border: The Season of Death “The deaths trickle in over the cooler months. A couple here from a rollover. Four dead there during a cold snap. They begin in earnest once the temperature spikes over 100 degrees sometime in May.” PBS Frontline, June 27, 2006

8. Occupational Fatalitiesin Agriculture

12. SOURCE: U.S. Bureau of Labor Statistics, U.S. Department of Labor, 2007

13. Occupational fatality rates by age group for farming, 1992-2004* * Excludes New York City. Rates calculated by NIOSH and may differ from BLS.

14. Agriculture Fatality Rate vs. Private Sector, US, 1992 - 2002

21. Children : The Forgotten Farmworkers “Farmers and Labor Contractors say they allow children to perform field work because the grower needs to get the crop in, parents need the money or children would learn the value of working.” Fresno Bee, 12/14/92

25. José (22) and Angelica Alatorre and son Guillermo. Jose died while working in a manure pit at Aguiar-Faria & Sons Dairy, Gustine, CA. February 22, 2001

26. Pesticide Toxicology • Many toxin categories • Affect various organs • Varied health effects Diagram illustrating various pesticide-related health effects.

27. Definition of Pesticide “Any substance or mixture of substances intended for preventing, destroying, repelling, or mitigating any insects, rodents, nematodes, fungi, or weeds, or any other forms of life declared to be pests; any substance or mixture of substances intended for use as a plant regulator, defoliant, or desiccant.” --Federal Insecticide, Fungicide, and Rodenticide Act (US EPA, 1947)

28. US Pesticide Use • 4.5 billion pounds chemicals per year • 890 active ingredients, 30,000 formulations • Uses • 75% agricultural • 25% home, garden, structural

29. Agricultural Pesticide Use • High volume: • Hand labor (Western states) • Vineyards • Orchard, row vegetables, nursery • Low volume: • Mechanized (Midwest states) • Livestock insecticide dipping • Grain agriculture

30. Pesticide Exposure:Occupational Settings • Multiple industries • Agriculture • Emergency response • Maintenance • Transportation • Variety of workers • Applicators, fieldworkers • Firefighters • Medical personnel • Flight attendants NEETF 2002

31. Pesticide Exposure: Environmental-Occupational Interface • Drift • Off-target physical movement of pesticide through air • Take-home • Contaminated clothing • Pesticide containers brought home

32. Pesticide Exposure:Environmental Settings • Use in schools • Lawn, garden use • Household cleaning • Home pesticide use • Residues in food

33. Improper storage or mislabeling of containers Prescription pesticides resembling oral medications Pesticide Exposure: Accidental Ingestion Photo: John P. Lamb, Pharm D., California Poison Control Center Source: EPA Australia

34. Pesticide Exposure: Suicide/Homicide • Unknown substance • Secondary exposure

35. Unintentional Pesticide Illness, USA Toxic Exposure Surveillance System 1993-1996

36. Pesticide Illness Rates Vary by Occupation Organophosphate pesticide poisoning rates by agricultural sector California, 1982--1990 Source: HS-1688, Cal EPA

37. Pesticide Illness Around the World Annual rates of intentional and unintentional pesticide-related fatalities and hospitalizations in several countries

38. US EPA Toxicity Classification(Systemic toxicity, eye irritation, skin irritation) • Class I: “Danger” • Fatal if ingested; corneal opacity; corrosive to skin • Class II: “Warning” • May be fatal if ingested; reversible corneal opacity; severe skin irritation • Class III: “Caution” • Harmful if ingested; no corneal opacity; moderate skin irritation • Class IV: “Caution” • May be harmful if ingested; no eye irritation; mild/no skin irritation

39. Common Components of Pesticide Formulations • Technical grade chemical (active ingredient) • Adjuvants/synergists • “Inert” ingredients • e.g., formaldehyde, sulfuric acid, benzene, toluene, other organic solvents

40. Diagnosis of Pesticide Illness • Exposure history most important • Occupational and environmental history • Duration, dose, route of potential exposure • Symptom review • Physical exam & lab findings • Health effects may be due to any component of pesticide formulations

41. Salivation Lacrimation Urination Diarrhea Diarrhea Urination Miosis Bronchorrhea Emesis Lacrimation Salivation Commonly-used Acronyms for Cholinesterase Inhibition Syndromes

42. Cholinesterase Inhibitors Clinical Presentations Vary • Some signs & symptoms may be absent • Bronchorrhea more likely with high-dose exposures (ingestion) • Common presentations • Nausea, vomiting • Miosis • Sweating, urinary frequency • Non-specific constitutional symptoms

43. Aspects of History that Suggest Pesticide Illness • Multiple cases • Similar symptoms, exposure history • History of chemical application • Home or office • Accidental ingestion, esp. children • Suicide, homicide attempts

44. Pesticide Illness Nonspecific Symptoms & Signs • Rash • Flu-like symptoms • Dizziness, malaise, respiratory tract irritation • Gastrointestinal symptoms • Seizures • Odor-related effects • Not toxicological effects of active ingredient

45. Pesticide Illness May Mimic Common Medical Conditions • Mild: • Upper respiratory tract infection/influenza • Food-borne illness • Asthma • Plant-induced irritant or allergic dermatitis • Severe: • Cerebrovascular accident • Psychiatric dysfunction • Heat stroke

46. How to Identify Pesticides • Application records • Label • Material Safety Data Sheet • www.msdsonline.com • http://www.ilpi.com/msds/index.html

47. Sources of Pesticide Information • Internet • EXTOXNET: http://ace.orst.edu/info/extoxnet/ • California Department of Pesticide Regulation: http://www.cdpr.ca.gov/docs/label/labelque.htm • Pesticide Action Network: http://www/pesticideinfo.org/index.html • Textbooks • US EPA. Recognition and Management of Pesticide Poisonings. 1999; 5th ed. http://www.epa.gov/pesticides/safety/healthcare • R Krieger (ed). Handbook of Pesticide Toxicology. 2001; 2nd ed. • Poison Control Centers: 1-800-222-1222 • National Pesticide Information Center (NPIC): 1-800-858-7378 or npic@ace.orst.edu

48. Treatment of Pesticide IllnessDecontamination • Shower, shampoo • Scrub under fingernails • Contain contaminated clothing, body fluids • Save for residue analysis • Protect treating staff • Body fluid precautions • Personal protective equipment if appropriate

49. Pesticide IllnessMedical Treatment • Symptomatic treatment • Respiratory distress • Maintain airway, breathing, circulation • Oxygen, bronchodilators if indicated • Ingestion • Gastric lavage, charcoal if indicated • Specific antidotes where applicable

50. Poison Control Centers • Toxicity • Decontamination • Management • Reporting