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DHHS (NIOSH) Publication Number 2006–102

October 2005

Foreword

Surveillance data can be used to identify new emerging pesticide problems, estimate the magnitude of pesticide poisoning, and evaluate intervention and prevention efforts. Recognizing this, the National Institute for Occupational Safety and Health (NIOSH) Strategic Surveillance Plan recommends that States conduct surveillance for acute pesticide-related illness and injury.

Since 1987, NIOSH has provided financial and technical support for State-based acute pesticide poisoning surveillance programs. NIOSH is not the only organization that has recommended improved and/or expanded surveillance in this area. Others include the American Medical Association, the Council for State and Territorial Epidemiologists, the United States Government Accountability Office, and the Pew Environmental Health Commission. Despite these recommendations, most States do not conduct acute pesticide-related illness and injury surveillance.

Acute pesticide-related illness is a relatively complex disease. Approximately 16,000 pesticide products are currently registered in the United States. In addition, all organ systems are susceptible to pesticide toxicity. The multitude of pesticide products and associated health effects may act as a barrier to establishing surveillance programs. NIOSH developed this guide to provide standards and principles that can help to master this complexity.

We expect this document will be useful to agencies that are developing an acute pesticide-related illness and injury surveillance program or are interested in maintaining and improving an established surveillance program. The guide provides (1) information about the importance of pesticide poisoning surveillance; (2) mechanisms to improve reporting of cases to surveillance programs; (3) methods to investigate reported cases; (4) guidance on using the case definition; and (5) additional resources on pesticide toxicology, pesticide usage, governmental partners, and surveillance.

To our knowledge, this is the most comprehensive instruction guide for pesticide-related illness and injury surveillance. The goal of this guide is to assist the efforts of our partners to identify pesticide poisoning risk factors. Pesticide poisoning prevention can be achieved by targeting interventions toward these identified risk factors. NIOSH hopes individuals and agencies interested in pesticide poisoning surveillance and prevention (e.g., local, State, and Federal government agencies, community-based organizations, and international agencies) will find this guide useful for identifying and preventing pesticide poisoning.

Acknowledgments

The authors gratefully appreciate the listed contributors who supplied materials that were modified for this guide or provided significant input on the mechanisms of managing a pesticide-related illness and injury surveillance program, including conducting case investigations and coordinating with partner government and nongovernmental agencies. The authors appreciate the many other unnamed persons at State and Federal government agencies and nongovernmental organizations who contributed to this project by providing information. The authors also thank Diana L. Ordin, M.D., M.P.H., who originally conceived this project and Lorraine L. Cameron, M.P.H., Ph.D., who provided guidance in its early stages. The authors also gratefully acknowledge Jerry Blondell, Gene Harrington, Amy Liebman, Ray McAllister, Michael O’Malley, Carol Rubin, Patricia Schnitzer, and Michael Sprinker who reviewed an earlier version of this guide. Countless others have contributed by asking questions over the years, which we hope are answered by this document. Finally, creation of this document was made possible by contracts to Strategic Options Consulting, Inc from both the Oregon Health Division using funds obtained from the National Institute for Occupational Safety and Health (NIOSH) under Cooperative Agreement U60/CCU008161, and from NIOSH using funding support provided by the US Environmental Protection Agency.

Authors
Margot Barnett, M.S., Strategic Options Consulting, Inc.
Geoffrey M. Calvert, M.D., M.P.H., NIOSH, Centers for Disease Control and Prevention

Contributors
Lynden Baum, Washington State Department of Health
Michael Heumann, M.P.H., M.A., Oregon Department of Human Services - Health Services
Louise N. Mehler, M.D., California Environmental Protection Agency
Dorilee Peryea Male, New York State Department of Health
Rachel Rosales, M.S.H.P., formerly with the Texas Department of Health
Robert Stone, Ph.D., New York State Department of Health
Patrice Sutton, M.P.H., California Department of Health Services
Catherine Thomsen, M.P.H., Oregon Department of Human Services - Health Services

Editing
Jane Weber, M.Ed., NIOSH, Centers for Disease Control and Prevention
George Taylor, Cyrano

Design and Desktop Publishing
Donna Pfirman, AAS, NIOSH, Centers for Disease Control and Prevention
Vanessa Becks, NIOSH, Centers for Disease Control and Prevention

Printing
Ronald B. Ergle, Centers for Disease Control and Prevention
David Glaser, Quality Technology
Patricia L. Ulakovic, NIOSH, Centers for Disease Control and Prevention

Web Production
Donna Pfirman, AAS, NIOSH, Centers for Disease Control and Prevention
David Wall, NIOSH, Centers for Disease Control and Prevention

About the cover

The cover drawing is titled “Path to Wellness” and was created by Blake Kidney. His was the winning entry in a Winter 2002 competition held at the School of Art, in the College of Design, Architecture, Art, and Planning, University of Cincinnati. The competition was open to undergraduate and graduate students at the school who were asked to submit works of art for the cover of this document.

Abbreviations