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Pyrethroid Pesticides:Hidden Hazard
Rupali Das, MD, MPH, FACOEMChief, Exposure Assessment Section
California Department of Public Health Environmental Health Investigations Branch
andAssociate 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:
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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
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Pesticides: Defined by Law
Substances that prevent or destroy pests
• US Environmental Protection Agency▪ Federal Insecticide, Fungicide, and Rodenticide
Act (FIFRA) 1947
http://www.epa.gov/pesticides/regulating/laws.htm
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Pesticide Classes: Examples
Functional Class Chemical Class Target Organisms
Insecticide Organophosphates, Pyrethroids
Aphids, fleas, beetles
Herbicide Glyphosate Invasive grasses
Rodenticide Coumarins Mice, rats
Disinfectant Hypochlorite, Glutaraldehyde Microbes
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Many Pesticides Associated with Worker Illnesses
www.cdph.ca.gov/programs/ohsep/Documents/pestillness.pdf
Occupational Pesticide Illness in California 1998 – 2007
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Pyrethroids: Use Widespread
• Agriculture
• Structures
• Pet flea control, pediculocide
• Vector control
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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. http://www.cdph.ca.gov/programs/ohsep/Documents/aircraftdisinsection.pdf
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Pyrethroid ProductsALLETHRIN (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
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Increasing Use
0
200,000
400,000
600,000
800,000
Pyrethroid Use in CA
Organophosphate Use in CA
Pesticide use data: www.cdpr.ca.gov/docs/pur/pur06rep/tables/table5a.htm and CDPR, personal communication 11/10/09.
Pou
nds
of R
epor
ted
Use
0
4,000,000
8,000,000
12,000,000
16,000,000
20,000,000
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
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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.
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Body, Environmental BurdenPyrethroids 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. www.cdc.gov/exposurereport/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.
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Case: Farmworker24 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. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5517a4.htm
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Pyrethrins and PyrethroidsPyrethrins• 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
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Pyrethrins: Acute Health EffectsRespiratory 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.
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Pyrethroids: Acute Health Effects Skin• Paresthesia, erythema, dermatitisEyes• Severe irritation, tearing, conjunctival
and lid edemaRespiratory• Rhinitis • Increased airway responsiveness in
asthmaticsSystemic• Dizziness, headache• Fasciculations, seizuresHe 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—2007HeadacheNauseaEye Pain/IrritationDizzinessVomitingUpper Resp IrritationShortness of BreathSkin Tingling/Irritation
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Pyrethroids: Mechanism of ToxicitySodium 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://oehha.ca.gov/multimedia/biomon/pdf/0709PyrethrinsPyrethroids.pdf
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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.
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Pyrethroids: Chronic Health ConcernsAsthma 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
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Diagnosing Pyrethroid IllnessOccupational & 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
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Read the Label
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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
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Laboratory ConfirmationLab 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
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Pyrethroid Poisoning: TreatmentDecontaminate
▪ 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
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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
www.cdph.ca.gov/programs/ohsep/Documents/pestillness.pdf
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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▪ http://www.pesticide.org/factsheets.html#alternatives
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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
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Pesticide Reporting Requirements for California PhysiciansPhysicians 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
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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
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Reporting Pesticide Illnesses*Arizona
▪ www.azdhs.gov/phs/oeh/invsurv/pesticide/pestprovreport.htmCalifornia• Doctor’s First Report
▪ www.dir.ca.gov/dlsr/dlsrform5021.pdf
• Pesticide Illness Report▪ www.oehha.ca.gov/pesticides/pdf/PIR_99.pdf
• California Poison Control System▪ 1-800-411-8080 (national health care provider line)
• Confidential Morbidity Report▪ www.cdph.ca.gov/pubsforms/forms/CtrldForms/pm110.pdf
Hawaii▪ hawaii.gov/health/environmental/hazard/poison.html
*In WOEMA States
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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
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Poison Control Center: 1-800-411-8080National Pesticide Information Center (NPIC)
• 1-800-858-7378 or npic.orst.eduExtoxnet: extoxnet.orst.eduHousehold Products Database: http://householdproducts.nlm.nih.gov/NIOSH: www.cdc.gov/niosh/topics/pesticides/US EPA: www.epa.gov/pesticides/index.htm
• Recognition and Management of Pesticide Poisonings. 1999; 5th ed.▫ www.epa.gov/pesticides/safety/healthcare
California Department of Public Health• www.cdph.ca.gov/programs/ohsep/Pages/Pesticide.aspx
California Department of Pesticide Regulation: www.cdpr.ca.govCA Office of Environmental Health Hazard Assessment
• oehha.ca.gov/pesticides/prgram/helpdocs1.html
Pesticide Resources
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Chronic Health Concerns: ReferencesGarey 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.
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AcknowledgmentsCalifornia 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
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