NIOSH Education and Information Division
The
National Institute for Occupational Safety and Health (NIOSH)
warns tobacco harvesters that they may be at risk of developing
green tobacco sickness (GTS), a type of nicotine poisoning.
A recent NIOSH study indicates that a startling number of
tobacco workers are becoming afflicted with this illness,
which may require hospital care. During a two month period
in 1992, NIOSH researchers identified 47 persons seeking emergency
room care for GTS in a five-county Kentucky area alone.
"If
the numbers found in Kentucky are any indication of the magnitude
of this problem, then we are dealing with an illness which
is inflicting a tremendous burden on this nation, both in
terms of human and economic costs," said NIOSH Director, Dr.
J. Donald Millar.
GTS
is caused by absorption of nicotine from the surface of wet
tobacco through the skin. Workers whose clothing becomes saturated
from tobacco wet with rain or morning dew are at high risk
of developing this illness. GTS is most often characterized
by nausea, vomiting, dizziness, and severe weakness, and is
often accompanied by fluctuations in blood pressure or heart
rate. Workers with GTS frequently report abdominal cramping,
headaches, and difficulty in breathing.
Jackie
Scott, a hospitalized Kentucky tobacco farmer, recounts the
severity of his symptoms: "Nothing has ever made me as sick
as working in wet tobacco. It can make you feel like you're
going to die." During the two-month period examined, NIOSH
estimates that there may have been as many as 600 persons
seeking emergency room care for GTS in Kentucky. Even this
figure is likely to underestimate the true burden of GTS,
since many affected persons do not seek treatment, but lose
work time nonetheless.
To help
prevent this illness, workers must be informed of the hazards
of working with wet tobacco and of the work practices that
can protect them. The following page presents these and other
methods for prevention. NIOSH urges farmers and workers to
take the necessary steps to prevent future cases of GTS.
Tobacco
harvesters working in wet clothing are at greater risk for developing
symptoms of GTS severe enough to require medical treatment.
After observing the tobacco harvesting process, NIOSH industrial
hygienists found that workers' clothing often became saturated
within minutes of beginning field work.
Based
on a sample of patients who received hospital treatment for
GTS, NIOSH calculated the average cost to the worker for treatment
of this illness. The fees were, on average, $250 for out-patient
treatment, $566 for hospital admission, and $2,041 for intensive
care treatment.
These
costs can impose an enormous burden on the farm family. In
the state of Kentucky, most agricultural workers are not covered
by workers' compensation and some tobacco harvesters have
no form of health insurance. Moreover, farm workers must also
deal with the added hardship of lost wages.
Gary
Palmer, Ph.D., tobacco specialist with the University of Kentucky,
adds that "medical costs are not the only loss to the farmer
when someone gets sick during the busy tobacco harvest season.
Taking the sick worker to medical care ties up another worker
and a vehicle: thus harvesting is slowed dow by the loss of
one or more workers."
GTS
is not a new problem. It is likely that GTS has existed as long
as workers have been harvesting wet tobacco. Increased surveillance,
as well as increased awareness of the condition, may explain
the recent influx of cases. Because the symptoms of the illness
are similar to those of organophosphate (pesticide) poisoning,
GTS may be misdiagnosed by practitioners who are unfamiliar
with this condition.
Questions
remain about the remarkable number of GTS cases recorded in
Kentucky in 1992. It is unknown whether it was due to an unusually
wet growing season, or if GTS is a regular occurrence in Kentucky
and other tobacco growing states.
The
outbreak reported here was identified through the Occupational
Health Nurses in Agricultural Communities (OHNAC) Program in
Kentucky. The OHNAC program is part of the NIOSH Agriculture
Health and Safety Initiative which supports surveillance, research,
and intervention efforts directed at farmers, farm families,
and farm workers nationwide. To receive a copy of the April
9, 1993 Centers for Disease Control and Prevention's Morbidity
and Mortality Weekly Report dealing with this outbreak all 1-800-843-6356.
- In
order to reduce the risk of GTS, avoid handling wet tobacco.
- Protective
clothing may reduce the amount of nicotine absorbed through
the skin.
- Chemical
resistant gloves, like those recommended for pesticide
mixing can prevent workers' hands from absorbing nicotine.
- Plastic
aprons and rainsuits have been used to reduce the exposure
to nicotine, especially when excess moisture is present.
However, this benefit must be weighed against the increased
risk of heat stress caused by wearing impermeable clothing
in hot weather.
- If
a worker's clothing becomes saturated with moisture from
the green tobacco leaf, the worker should change into dry
clothes as soon as possible.
- If
a worker becomes ill while working in tobacco and requires
medical attention, physician should be informed of the exposure
to nicotine to aid in diagnosis.
For
more information about this or other occupational health concerns,
call toll free: 1-800-35-NIOSH
Disclaimer
and Reproduction Information: Information in NASD does not represent
NIOSH policy. Information included in NASD appears by permission
of the author and/or copyright holder. More
NASD Review: 04/2002
This document
is NIOSH Publication,
93-115
.
Publication date: July 1993.
National
Institute of Occupational Safety and Health, Department of
Health and Human Services, 200 Independence Avenue, SW, Washington,
DC, 20201. Phone: (800) 356-467
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