pesticide illness
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Pesticide Illness. Part 4 Chronic Health Effects Laws and Regulations. Prepared by: Rupali Das, MD, MPH, California Department of Health Services, Michael O’Malley, MD, MPH, University of California, Davis, Laura Styles, MPH, Public Health Institute. Pesticides Chronic Health Effects. - PowerPoint PPT PresentationTRANSCRIPT
Pesticide IllnessPesticide IllnessPart 4Part 4
Chronic Health EffectsChronic Health EffectsLaws and RegulationsLaws and Regulations
Prepared by:Rupali Das, MD, MPH, California Department of Health Services, Michael O’Malley, MD, MPH, University of California, Davis, Laura Styles, MPH, Public Health Institute
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PesticidesPesticidesChronic Health EffectsChronic Health Effects
Respiratory (asthma)Respiratory (asthma)Neurological Neurological Reproductive and DevelopmentalReproductive and DevelopmentalCarcinogenicCarcinogenic
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Chronic Toxicity of PesticidesChronic Toxicity of Pesticides
Types of chronic effectsTypes of chronic effects– Cumulative effects of low level exposuresCumulative effects of low level exposures– Persistent effects of acute exposurePersistent effects of acute exposure
Individual evaluationsIndividual evaluations– Epidemiologic studies Epidemiologic studies – Specific associationsSpecific associations– Classification of reproductive, cancer Classification of reproductive, cancer
toxicitytoxicity
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Chronic Effect Studies: Chronic Effect Studies: Design & InterpretationDesign & Interpretation
Pre-exposure information absentPre-exposure information absent Exposure difficult to measureExposure difficult to measure Selection of control groups importantSelection of control groups important Multiple, variable compoundsMultiple, variable compounds Confounders, unknown exposuresConfounders, unknown exposures
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Pesticides and Asthma, Children Pesticides and Asthma, Children
Increase in pediatric asthmaIncrease in pediatric asthma Suspected factorsSuspected factors
– Air pollutionAir pollution– GeneticsGenetics– Hygiene hypothesisHygiene hypothesis– Chemicals, including pesticidesChemicals, including pesticides
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Pesticides and Asthma, AdultsPesticides and Asthma, Adults
Farmer occupationFarmer occupation– Canada (Hoppin et al. 2002)Canada (Hoppin et al. 2002)– US (Senthilselvan et al. 1992)US (Senthilselvan et al. 1992)
Case reportsCase reports– Pyrethrin, tetramethrin, Pyrethrin, tetramethrin,
allethrin, chlorothalonil, allethrin, chlorothalonil, fluazinamfluazinam
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Chronic Neurologic Effects of Chronic Neurologic Effects of PesticidesPesticides
OrganophosphateOrganophosphatess
Increased vibration Increased vibration sense; Motor, sensor sense; Motor, sensor neuropathy; Cognitive, neuropathy; Cognitive, affective deficitsaffective deficits
Methyl bromide, Methyl bromide, sulfuryl fluoridesulfuryl fluoride
Olfactory, cognitive, Olfactory, cognitive, behavioral deficitsbehavioral deficits
Paraquat, othersParaquat, others Parkinson’s Disease?Parkinson’s Disease?
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Case Case
Subway Rider Exposed to SarinSubway Rider Exposed to Sarin 35 year-old man 35 year-old man
exposed to sarin with exposed to sarin with severe dyspnea, severe dyspnea, convulsionsconvulsions
Comatose, slightly Comatose, slightly cyanotic; miosis; cyanotic; miosis; profuse muscarinic profuse muscarinic symptomssymptoms
Source: EHP/NIEHS
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Subway Rider Exposed to SarinSubway Rider Exposed to Sarin
Neurobehavioral Status at 6 monthsNeurobehavioral Status at 6 months
Test resultsTest results– No global intellectual impairment No global intellectual impairment – Performance impairmentsPerformance impairments– Retrograde amnesia Retrograde amnesia – Passivity and shallow affectPassivity and shallow affect
Mild neurobehavioral dysfunctionMild neurobehavioral dysfunction
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MPTP
MPP+
Paraquat
Parkinson’s DiseaseParkinson’s Disease Association with Paraquat Association with Paraquat
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Parkinson’s DiseaseParkinson’s Disease Pesticide Theory Pesticide Theory
Direct toxinsDirect toxins– NeurotoxinsNeurotoxins
Dieldrin, rotenoneDieldrin, rotenone– Mitochondrial toxinsMitochondrial toxins
Chlordane, paraquat, permethrinChlordane, paraquat, permethrin Modulators of metabolismModulators of metabolism
– DDT, organophosphates, pyrethrinsDDT, organophosphates, pyrethrins
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Parkinson’s Disease Parkinson’s Disease Postulated CausesPostulated Causes
20% family history 20% family history Environmental associationsEnvironmental associations
– Farmer occupation Farmer occupation – Any occupational pesticide exposureAny occupational pesticide exposure– Living on a farmLiving on a farm
Pesticides Pesticides – Initiator, promoter, or effect modifier?Initiator, promoter, or effect modifier?
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EndpointsEndpoints– ReproductiveReproductive– DevelopmentalDevelopmental
ExposureExposure– Maternal Maternal – PaternalPaternal
Reproductive & Developmental Reproductive & Developmental Effects of Pesticide ExposureEffects of Pesticide Exposure
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Reproductive & Developmental Effects Reproductive & Developmental Effects
Maternal ExposureMaternal Exposure Agricultural exposureAgricultural exposure
– Spontaneous abortions & fetal deathSpontaneous abortions & fetal death– Congenital malformationsCongenital malformations
Greenhouse workersGreenhouse workers– Reduced fecundabilityReduced fecundability– Excess stillbirthsExcess stillbirths
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Reproductive & Developmental EffectsReproductive & Developmental Effects Paternal ExposurePaternal Exposure
DocumentedDocumented– Azospermia, OligospermiaAzospermia, Oligospermia
Dibromochloropropane (DBCP)Dibromochloropropane (DBCP)SuggestedSuggested
– Reduced sex ratio (M/F)Reduced sex ratio (M/F)– Spontaneous abortion, preterm Spontaneous abortion, preterm
deliverydelivery
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Occupation surrogate for exposureOccupation surrogate for exposure Poor exposure assessmentPoor exposure assessment Exposure usually to multiple Exposure usually to multiple
pesticidespesticides Timing of exposure uncertainTiming of exposure uncertain Control for other toxins may be poorControl for other toxins may be poor
Reproductive & Developmental EffectsReproductive & Developmental Effects Methodological ProblemsMethodological Problems
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•34 year-old woman with spontaneous abortion at 17 weeks gestation
•Smokes ½ pack/day; occasional home pesticide use; 2 healthy children
•Fetal pathology: one stub for leg, shortened umbilical cord, no genitals.
CaseCase
WWoman with Spontaneousoman with Spontaneous AbortionAbortion
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Woman with SpontaneousWoman with Spontaneous AbortionAbortion Occupational HistoryOccupational History
Seasonal worker in Seasonal worker in seed-retailing seed-retailing
Became pregnant Became pregnant one month after one month after starting work. starting work.
Husband is a postal Husband is a postal workerworker
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Woman with SpontaneousWoman with Spontaneous AbortionAbortion Maternal Exposure HistoryMaternal Exposure History
OccupationalOccupational– Captan: animal teratogenCaptan: animal teratogen– Carboxin: growth suppression, high dosesCarboxin: growth suppression, high doses– Chlorpyrifos: no evidenceChlorpyrifos: no evidence– Methoxychlor: teratogen; estrogenicMethoxychlor: teratogen; estrogenic– Thiram: reduced growth at high dosesThiram: reduced growth at high doses
Home Home – Permethrin: reduced fertility, high dosesPermethrin: reduced fertility, high doses
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Pesticides and CancerPesticides and Cancer
Animal dataAnimal data– High dose laboratory studiesHigh dose laboratory studies
Human dataHuman data– Epidemiological studiesEpidemiological studies
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Postulated Mechanisms ofPostulated Mechanisms of Pesticide CarcinogenicityPesticide Carcinogenicity
MechanismMechanism Pesticide ExamplesPesticide Examples
GenotoxicityGenotoxicity Captan, DBCPCaptan, DBCP
Tumor promotionTumor promotion OrganochlorinesOrganochlorines
Hormonal actionHormonal action Atrazine, ziramAtrazine, ziram
ImmunotoxicityImmunotoxicity Aldicarb, 2,4-DAldicarb, 2,4-D
Peroxisome Peroxisome proliferationproliferation
2,4-D, 2,4,5-T2,4-D, 2,4,5-T
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InsecticidesInsecticides:: dichlorvos, organochlorines dichlorvos, organochlorines HerbicidesHerbicides:: amitrole, cyanazineamitrole, cyanazine FumigantsFumigants:: ethylene oxide, formaldehydeethylene oxide, formaldehyde FungicidesFungicides:: captan, maneb, zinebcaptan, maneb, zineb Growth regulatorsGrowth regulators:: daminozidedaminozide
Pesticide Animal CarcinogensPesticide Animal Carcinogens
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Pesticides & Cancer inPesticides & Cancer in FarmersFarmers
Low mortality due to other causesLow mortality due to other causes Elevated risks for cancer Elevated risks for cancer Most studies on male farmersMost studies on male farmers Limited data on specific exposuresLimited data on specific exposures Other hazards Other hazards
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Pesticides and Cancer Associations:Pesticides and Cancer Associations:
Human Epidemiologic StudiesHuman Epidemiologic Studies
LindaneLindane: Lymphoma: Lymphoma Dichlorvos, methoxyclorDichlorvos, methoxyclor: Leukemia: Leukemia 2,4-D, diazinon2,4-D, diazinon: Non-Hodgkin’s : Non-Hodgkin’s
lymphomalymphoma AtrazineAtrazine: Ovarian: Ovarian ArsenicalsArsenicals: Lung, skin: Lung, skin
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Pesticides Associated with Cancer: Pesticides Associated with Cancer: Organophospates, CarbamatesOrganophospates, Carbamates
Non-Hodgkin’s lymphomaNon-Hodgkin’s lymphoma – OrganophosphatesOrganophosphates– CarbamatesCarbamates
Lung cancerLung cancer LeukemiaLeukemia
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Pesticides Associated with Cancer: Pesticides Associated with Cancer: Chlorophenoxy Herbicides Chlorophenoxy Herbicides
Non-Hodgkin’s Non-Hodgkin’s lymphoma lymphoma – Farmers, gardenersFarmers, gardeners
Soft tissue sarcomaSoft tissue sarcoma
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Pesticides and Childhood CancerPesticides and Childhood Cancer Malignancies linked to pesticidesMalignancies linked to pesticides
– LeukemiaLeukemia– Brain cancerBrain cancer– Non-Hodgkin’s lymphomaNon-Hodgkin’s lymphoma– Wilm’s tumorWilm’s tumor– Ewing’s sarcomaEwing’s sarcoma
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Pesticides and Childhood CancerPesticides and Childhood Cancer Childhood Pesticide ExposureChildhood Pesticide Exposure Widespread home pesticide use Widespread home pesticide use Pet products, insecticidal Pet products, insecticidal
shampoosshampoos Vertical concentration gradient Vertical concentration gradient Deposit on toys, furnitureDeposit on toys, furniture
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Pesticides and Childhood CancerPesticides and Childhood Cancer Risk FactorsRisk Factors
Parental home/garden pesticide useParental home/garden pesticide use Parental occupational exposure Parental occupational exposure Prenatal exposurePrenatal exposure
Sou
rce:
US
DA
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Human Pesticide Cancer Studies: Human Pesticide Cancer Studies: Methodological IssuesMethodological Issues
Case definition may not be preciseCase definition may not be precise Recall biasRecall bias Small samplesSmall samples Crude exposure assessmentCrude exposure assessment Timing of exposure cannot be Timing of exposure cannot be
confirmedconfirmed Genetic-environmental interactionsGenetic-environmental interactions
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SummarySummaryChronic Pesticide IllnessChronic Pesticide Illness
Risks depend on pesticideRisks depend on pesticide– Neurological disease: Organophosphates Neurological disease: Organophosphates – Cancer: Chlorophenoxy herbicides Cancer: Chlorophenoxy herbicides – Reproductive toxicity: Methyl bromideReproductive toxicity: Methyl bromide
Preventing illnessPreventing illness– Targeted use reductionTargeted use reduction– Worker protectionWorker protection– Reduced home useReduced home use
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Pesticide Laws and RegulationsPesticide Laws and Regulations
FederalFederal– Federal Insecticide, Fungicide, and Federal Insecticide, Fungicide, and
Rodenticide Act (1972)Rodenticide Act (1972)– Federal Food, Drug, and Cosmetic Act Federal Food, Drug, and Cosmetic Act
(1939)(1939)– Worker Protection Standard (1992) Worker Protection Standard (1992) – Food Quality Protection Act (1996)Food Quality Protection Act (1996)
State laws varyState laws vary
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Federal Insecticide, Fungicide, and Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA)Rodenticide Act (FIFRA)
Control of distribution, sale, use Control of distribution, sale, use Gives US EPA authority to Gives US EPA authority to
– Study pesticide consequencesStudy pesticide consequences– Require pesticide purchase Require pesticide purchase
registrationregistration Requires Requires
– Pesticide applicator certification Pesticide applicator certification – Registration, proper labelingRegistration, proper labeling
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Federal Food, Drug, and Federal Food, Drug, and Cosmetic Act (FFDCA)Cosmetic Act (FFDCA)
Allows US EPA to Allows US EPA to establish establish tolerances for tolerances for pesticides in foodpesticides in food
Small fraction of Small fraction of marketed food marketed food tested for pesticide tested for pesticide residueresidue
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Worker Protection StandardWorker Protection Standard
Reduce farmworker pesticide illnessReduce farmworker pesticide illness
Hazard training and communication, Hazard training and communication, decontamination facilities, decontamination facilities, notification, emergency medical notification, emergency medical carecare
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Food Quality Protection Act (FQPA)Food Quality Protection Act (FQPA)
Health-based standard for Health-based standard for pesticides in foodspesticides in foods
Requires US EPA to review Requires US EPA to review tolerances for pesticide tolerances for pesticide tolerances in foodtolerances in food
Focus on childrenFocus on children
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