Pesticide Poisoning Registry - Ten Year Summary Report

Appendix A - Regulatory Authority

The Pesticide Poisoning Registry was established in 1990 within Part 22 of the State Sanitary Code. Part 22 includes a number of additional environmental disease registries, such as heavy metals poisoning, and some lung diseases. The privacy of personal information collected under Part 22 is assured by the provisions of Public Health Law 206(1)(j) and 225(5)(t).

Case Definition and Status Definition

Case Definition for Acute Pesticide-Related Illness and Injury Cases
Reportable to the National Public Health Surveillance System

Clinical Description

This surveillance case definition refers to any acute adverse health effect resulting from exposure to a pesticide product (the technical definition is at the end of this section) including health effects due to an unpleasant odor, injury from explosion of a product, inhalation of smoke from a burning product, and allergic reaction. Because public health agencies seek to limit all adverse effects from regulated pesticides, notification is needed even when the responsible ingredient is not the active ingredient.

A case is characterized by an acute onset of symptoms that are dependent on the formulation of the pesticide product and involve one or more of the following:

• Systemic signs or symptoms (including respiratory, gastrointestinal, allergic and neurological signs/symptoms)
• Dermatologic lesions
• Ocular lesions

This case definition and classification system is designed to be flexible permitting classification of pesticide-related illnesses from all classes of pesticides. Consensus case definitions for specific classes of chemicals may be developed in the future.

A case will be classified as occupational if exposure occurs while at work (this includes: working for compensation; working in a family business, including a family farm; working for pay at home; and, working as a volunteer Emergency Medical Technician (EMT), fire-fighter, or law enforcement officer). All other cases will be classified as non-occupational. All cases involving suicide or attempted suicide should be classified as non-occupational.

A case is reportable to the national surveillance system when there is (see the Classification Criteria section for a more detailed description of these criteria):

• Documentation of new adverse health effects that are temporally-related to a documented pesticide exposure; AND
• Consistent evidence of a causal relationship between the pesticide and the health effects based on the known toxicology of the pesticide from commonly available toxicology texts, government publications, information supplied by the manufacturer, or two or more case series or positive epidemiologic investigations; OR
• Insufficient toxicologic information available to determine whether a causal relationship exists between the pesticide exposure and the health effects

Please note that adverse health effects resulting from exposure to disinfectant products are not reportable in many states because the volume of reports could overwhelm the state's surveillance system; therefore, these cases will not be routinely reported to the national surveillance system. However, states may collect data on health effects resulting from disinfectant exposure, and report relevant cases to the national surveillance system.

Laboratory criteria for diagnosis

If available, the following laboratory data can confirm exposure to a pesticide:

• Biological tests for the presence of, or toxic response to, the pesticide and/or its metabolite (in blood, urine, etc.);
  • Measurement of the pesticide and/or its metabolite(s) in the biological specimen
  • Measurement of a biochemical response to the pesticide in a biological specimen (e.g. cholinesterase levels)
• Environmental tests for the pesticide (e.g. foliage residue, analysis of suspect liquid);
• Pesticide detection on clothing or equipment used by the case subject.

Classification Criteria

Reports received and investigated by state programs are scored on the three criteria provided below (criteria A, B and C). Scores are either 1, 2, 3, or 4, and are assigned based on all available evidence. The classification matrix follows the criteria section (Table 1). The matrix provides the case classification categories and the criteria scores needed to place the case into a specific category. Definite, probable, possible and suspicious cases (see the classification matrix) are reportable to the national surveillance system. Additional classification categories are provided for states that choose to track reports that do not fit the criteria for national reporting.

1. Documentation of Pesticide Exposure
   1. Laboratory, clinical or environmental evidence corroborate exposure (at least one of the following must be satisfied to receive a score of "1"):
      1. analytical results from foliage residue, clothing residue, air, soil, water or biologic samples;
      2. observation of residue and/or contamination (including damage to plant material from herbicides) by a trained professional [Note: a trained professional may be a plant pathologist, agricultural inspector, agricultural extension agent, industrial hygienist or any other licensed or academically trained specialist with expertise in plant pathology and/or environmental effects of pesticides. A licensed pesticide applicator not directly involved with the application may also be considered a trained professional.];
      3. biologic evidence of exposure (e.g. response to administration of an antidote such as 2-PAM, Vitamin K1, or repeated doses of atropine);
      4. documentation by a licensed health care professional of a characteristic eye injury or dermatologic effects at the site of direct exposure to a pesticide product known to produce such effects (these findings must be sufficient to satisfy criteria B.1 under A Documentation documentation of adverse health effects;
      5. clinical description by a licensed health care professional of two or more post-exposure health effects (at least one of which is a sign) characteristic for the pesticide as provided in Appendix 2.
   2. Evidence of exposure based solely upon written or verbal report (at least one of the following must be satisfied to receive a score of "2"):
      1. report by case;
      2. report by witness;
      3. written records of application;
      4. observation of residue and/or contamination (including damage to plant material from herbicides)by other than a trained professional;
      5. other evidence suggesting that an exposure occurred.
   3. Strong evidence that no pesticide exposure occurred.
   4. Insufficient data.
2. Documentation of Adverse Health Effect
   1. Two or more new post-exposure abnormal signs and/or test/laboratory findings reported by a licensed health care professional.
   2. At least one of the following must be satisfied to receive a score of "2":
      1. Two or more new post-exposure abnormal symptoms were reported. When new post-exposure signs and test/laboratory findings are insufficient to satisfy a B1 score, they can be used in lieu of symptoms toward satisfying a B2 score.
      2. Any new illness or exacerbation of pre-existing illness diagnosed by a licensed physician, but information on signs, symptoms and/or test findings are not available or insufficient for a B.1 or B.2.a score.
   3. No new post-exposure abnormal signs, symptoms, or test/laboratory findings were reported.
   4. Insufficient data (includes having only one new post-exposure abnormal sign, symptom, or test/laboratory finding).
3. Evidence Supporting a Causal Relationship Between Pesticide Exposure and Health Effects
   1. Where the findings documented under the Health Effects criteria (criteria B) are:
      1. characteristic for the pesticide, and the temporal relationship between exposure and health effects is plausible (the pesticide refers to the one classified under criteria A), and/or;
      2. consistent with an exposure-health effect relationship based upon the known toxicology (i.e. exposure dose, symptoms and temporal relationship) of the putative agent (i.e. the agent classified under criteria A) from commonly available toxicology texts, government publications, information supplied by the manufacturer, or two or more case series or positive epidemiologic studies published in the peer-reviewed literature;
   2. Evidence of exposure-health effect relationship is not present. This may be because the exposure dose was insufficient to produce the observed health effects. Alternatively, a temporal relationship does not exist (i.e. health effects preceded the exposure, or occurred too long after exposure). Finally, it may be because the constellation of health effects are not consistent based upon the known toxicology of the putative agent from information in commonly available toxicology texts, government publications, information supplied by the manufacturer, or the peer-reviewed literature;
   3. Definite evidence of non-pesticide causal agent;
   4. Insufficient toxicologic information is available to determine causal relationship between exposure and health effects. (This includes circumstances where minimal human health effects data is available, or where there are less than two published case series or positive epidemiologic studies linking health effects to the particular pesticide product/ingredient or class of pesticides.)

Table 1 - Case Classification Matrix:

Classification Categories1
Classification Criteria	Definite Case	Probably Case		Possible Case	Suspicious Case	Unlikely Case	Insufficient Information		Not a Case
									Asmptomatic2	Unrelated3
A. Exposure	1	1	2	2	1 or 2	1 or 2	4	-	-	3
B. Health Effects	1	2	1	2	1 or 2	1 or 2	-	4	3	-
C. Causal Relationship	1	1	1	1	4	2	-	-	-	3

1. Only reports meeting case classifications of Definite, Probable, Possible and Suspicious are reportable to the National Public Health Surveillance system. Additional classification categories are provided for states that choose to track the reports that do not fit the national reporting criteria.
2. The matrix does not indicate whether asymptomatic individuals were exposed to pesticides although some states may choose to track the level of evidence of exposure for asymptomatic individuals.
3. Unrelated illness determined to be caused by a condition other than pesticide exposure, as indicated by a '3' in the evidence of Exposure or Causal Relationship classification criteria.

Comments

For information regarding acute occupational pesticide-related illness and injury, contact the National Institute for Occupational Safety and Health at 1-800-35-NIOSH.

For information about acute non-occupational pesticide-related illness and injury, contact the National Center for Environmental Health (NCEH) 770-488-3450.

For information concerning regulation and use of pesticides, contact the Office of Pesticide Programs, US EPA, at 703-305-5336. The National Pesticide Information Center (1-800-858-7378) provides information about pesticides, acute pesticide-related illness and injury, and the toxicology and environmental chemistry of pesticides.

Official Definition of a Pesticide

Pesticides are defined under the Federal Insecticide Fungicide and Rodenticide Act (FIFRA) as any substance or mixture of substances intended to prevent, destroy, repel or mitigate insects, rodents, nematodes, fungi, weeds, microorganisms, or any other form of life declared to be a pest by the Administrator of the US EPA, and any substance or mixture of substances intended for use as a plant regulator, defoliant, or desiccant. Pesticides include herbicides, insecticides, rodenticides, fungicides, disinfectants, wood treatment products, growth regulators, insect repellents, etc.

Appendix C: List of Abbreviations

AChE	Acetylcholinesterase
ATSDR	Agency for Toxic Substances and Disease Registry
BOH	Bureau of Occupational Health
CEH	Center for Environmental Health
CSTE	Council of State and Territorial Epidemiologists
EPA	Environmental Protection Agency
IPM	Integrated Pest Management
NIOSH	National Institute for Occupational Safety and Health
NYCDHMH	New York City Department of Health and Mental Hygiene.
NYS	New York State
NYSDEC	New York State Department of Environmental Conservation.
NYSDOH	New York State Department of Health
OTC	Over-the-counter (general use pesticides)
PCC	Poison Control Center
PPR	Pesticide Poisoning Registry
USEPA	United State Environmental Protection Agency