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Pesticide Illness

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.

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Pesticide Illness

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  1. 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

  2. PesticidesChronic Health Effects • Respiratory (asthma) • Neurological • Reproductive and Developmental • Carcinogenic

  3. Chronic Toxicity of Pesticides • Types of chronic effects • Cumulative effects of low level exposures • Persistent effects of acute exposure • Individual evaluations • Epidemiologic studies • Specific associations • Classification of reproductive, cancer toxicity

  4. Chronic Effect Studies: Design & Interpretation • Pre-exposure information absent • Exposure difficult to measure • Selection of control groups important • Multiple, variable compounds • Confounders, unknown exposures

  5. Pesticides and Asthma, Children • Increase in pediatric asthma • Suspected factors • Air pollution • Genetics • Hygiene hypothesis • Chemicals, including pesticides

  6. Pesticides and Asthma, Adults • Farmer occupation • Canada (Hoppin et al. 2002) • US (Senthilselvan et al. 1992) • Case reports • Pyrethrin, tetramethrin, allethrin, chlorothalonil, fluazinam

  7. Chronic Neurologic Effects of Pesticides

  8. Case Subway Rider Exposed to Sarin • 35 year-old man exposed to sarin with severe dyspnea, convulsions • Comatose, slightly cyanotic; miosis; profuse muscarinic symptoms Source: EHP/NIEHS

  9. Subway Rider Exposed to SarinNeurobehavioral Status at 6 months • Test results • No global intellectual impairment • Performance impairments • Retrograde amnesia • Passivity and shallow affect • Mild neurobehavioral dysfunction

  10. Parkinson’s Disease Association with Paraquat MPTP MPP+ Paraquat

  11. Parkinson’s Disease Pesticide Theory • Direct toxins • Neurotoxins • Dieldrin, rotenone • Mitochondrial toxins • Chlordane, paraquat, permethrin • Modulators of metabolism • DDT, organophosphates, pyrethrins

  12. Parkinson’s Disease Postulated Causes • 20% family history • Environmental associations • Farmer occupation • Any occupational pesticide exposure • Living on a farm • Pesticides • Initiator, promoter, or effect modifier?

  13. Reproductive & Developmental Effects of Pesticide Exposure • Endpoints • Reproductive • Developmental • Exposure • Maternal • Paternal

  14. Reproductive & Developmental Effects Maternal Exposure • Agricultural exposure • Spontaneous abortions & fetal death • Congenital malformations • Greenhouse workers • Reduced fecundability • Excess stillbirths

  15. Reproductive & Developmental EffectsPaternal Exposure • Documented • Azospermia, Oligospermia • Dibromochloropropane (DBCP) • Suggested • Reduced sex ratio (M/F) • Spontaneous abortion, preterm delivery

  16. Reproductive & Developmental EffectsMethodological Problems • Occupation surrogate for exposure • Poor exposure assessment • Exposure usually to multiple pesticides • Timing of exposure uncertain • Control for other toxins may be poor

  17. CaseWoman with SpontaneousAbortion • 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.

  18. Woman with SpontaneousAbortion Occupational History • Seasonal worker in seed-retailing • Became pregnant one month after starting work. • Husband is a postal worker

  19. Woman with SpontaneousAbortionMaternal Exposure History • Occupational • Captan: animal teratogen • Carboxin: growth suppression, high doses • Chlorpyrifos: no evidence • Methoxychlor: teratogen; estrogenic • Thiram: reduced growth at high doses • Home • Permethrin: reduced fertility, high doses

  20. Pesticides and Cancer • Animal data • High dose laboratory studies • Human data • Epidemiological studies

  21. Postulated Mechanisms ofPesticide Carcinogenicity

  22. Pesticide Animal Carcinogens • Insecticides:dichlorvos, organochlorines • Herbicides:amitrole, cyanazine • Fumigants:ethylene oxide, formaldehyde • Fungicides:captan, maneb, zineb • Growth regulators:daminozide

  23. Pesticides & Cancer inFarmers • Low mortality due to other causes • Elevated risks for cancer • Most studies on male farmers • Limited data on specific exposures • Other hazards

  24. Pesticides and Cancer Associations:Human Epidemiologic Studies • Lindane: Lymphoma • Dichlorvos, methoxyclor: Leukemia • 2,4-D, diazinon: Non-Hodgkin’s lymphoma • Atrazine: Ovarian • Arsenicals: Lung, skin

  25. Pesticides Associated with Cancer: Organophospates, Carbamates • Non-Hodgkin’s lymphoma • Organophosphates • Carbamates • Lung cancer • Leukemia

  26. Pesticides Associated with Cancer: Chlorophenoxy Herbicides • Non-Hodgkin’s lymphoma • Farmers, gardeners • Soft tissue sarcoma

  27. Pesticides and Childhood Cancer • Malignancies linked to pesticides • Leukemia • Brain cancer • Non-Hodgkin’s lymphoma • Wilm’s tumor • Ewing’s sarcoma

  28. Pesticides and Childhood CancerChildhood Pesticide Exposure • Widespread home pesticide use • Pet products, insecticidal shampoos • Vertical concentration gradient • Deposit on toys, furniture

  29. Pesticides and Childhood CancerRisk Factors • Parental home/garden pesticide use • Parental occupational exposure • Prenatal exposure Source: USDA

  30. Human Pesticide Cancer Studies: Methodological Issues • Case definition may not be precise • Recall bias • Small samples • Crude exposure assessment • Timing of exposure cannot be confirmed • Genetic-environmental interactions

  31. SummaryChronic Pesticide Illness • Risks depend on pesticide • Neurological disease: Organophosphates • Cancer: Chlorophenoxy herbicides • Reproductive toxicity: Methyl bromide • Preventing illness • Targeted use reduction • Worker protection • Reduced home use

  32. Pesticide Laws and Regulations • Federal • Federal Insecticide, Fungicide, and Rodenticide Act (1972) • Federal Food, Drug, and Cosmetic Act (1939) • Worker Protection Standard (1992) • Food Quality Protection Act (1996) • State laws vary

  33. Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) • Control of distribution, sale, use • Gives US EPA authority to • Study pesticide consequences • Require pesticide purchase registration • Requires • Pesticide applicator certification • Registration, proper labeling

  34. Federal Food, Drug, and Cosmetic Act (FFDCA) • Allows US EPA to establish tolerances for pesticides in food • Small fraction of marketed food tested for pesticide residue

  35. Worker Protection Standard • Reduce farmworker pesticide illness • Hazard training and communication, decontamination facilities, notification, emergency medical care

  36. Food Quality Protection Act (FQPA) • Health-based standard for pesticides in foods • Requires US EPA to review tolerances for pesticide tolerances in food • Focus on children

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