Progress 10/01/02 to 09/30/07
Outputs
OUTPUTS: During the project period, the Principal Investigator responded to over 1,500 inquiries on pesticides and their toxicology. These inquiries came from health care providers, public health professionals, regulatory agencies, and the general public. In addition to providing informational assistance in these inquiries, the most significant outputs of this project include quarterly and annual reports that have been submitted to the US EPA Office of Pesticide Programs. Extension activities from this project have included invited presentations on pesticide toxicology at national meetings of physicians, toxicologists, and public health professionals. Drawing from quarterly and annual reports generated in association with this project's activities, the Principal Investigator has published and presented to diverse audiences in matters relating to the pesticides and human health. The project has accumulated an electronic library of over 3,000 publications focused on pesticides and
their environmental and clinical toxicology. These electronic resources are in addition to the extensive hardcopy library of materials that the project has maintained throughout its lifetime.
PARTICIPANTS: Participants: Daniel Sudakin, MD, MPH (Principal Investigator) and Laura Power, MS (Faculty Research Assistant)
TARGET AUDIENCES: The target audience of this project includes regulatory officials (including the US EPA Office of Pesticide Programs), health care providers, public health professionals, and the general public.
Impacts
The Principal Investigator of this project has become a nationally recognized expert in the recognition, management, and prevention of pesticide poisonings. The reports to the US EPA Office include a summary of relevant informational inquiries as well as pesticide exposure incidents involving humans. The reports include a detailed description and analysis of inquiries that are of relevance to the clinical and regulatory toxicology of pesticides. This work has included a publication intended to inform clinicians of reliable electronic (web-based) resources in the clinical toxicology of pesticides, with a focus on agricultural exposures. This work has also emphasized the importance of prevention and recognizing agricultural workers and their families who are at higher risk of exposure to pesticides. These efforts have been intended to reduce the risk of adverse health effects in association with the use of pesticides in the United States.
Publications
- Power LE, Sudakin DL. Pyrethrin and pyrethroid exposures in the United States: a longitudinal analysis of incidents reported to poison centers. J Med Toxicol. 2007 Sep;3(3):94-9.
- Sudakin DL. Appendix A: informational sources on pesticides and health. J Agromedicine. 2007;12(1):77-82.
- Sudakin DL. Organophosphate exposures in the United States: a longitudinal analysis of incidents reported to poison centers. J Toxicol Environ Health A. 2007 Jan 15;70(2):141-7.
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Progress 01/01/06 to 12/31/06
Outputs
The NPMMP receives approximately 200-300 inquiries from throughout the United States per year. Inquiries are received from the general public, health care providers, federal and state public health and regulatory agencies (including state departments of agriculture). Approximately 15-20% of inquiries received by the NPMMP are in relation to the agricultural use of pesticides. These include informational and exposure-related inquiries, for which the PI provides technical consultation and support in relation to the clinical toxicology of pesticides. As an example of relevant agriculturally-related inquiries, the NPMMP provided assistance in the investigation of an accidental fatality that occurred in association with aluminum phosphide from grain fumigation activities. The NPMMP also serves on the advisory committee of two other federally funded cooperative agreements that aim to improve the education of health care providers in environmental health, particularly in
relation to agricultural workers and risks from pesticide exposure. In the past year, the Principal Investigator of the NPMMP provided several peer-selected presentations at national and international meetings, which described the Program's activities. The audience at these meetings included public health and regulatory officials, as well as physicians and toxicologists. These presentations included reviews of epidemiological and toxicological research on human exposure to pesticides, and the use of reliable internet resources that focus on the clinical toxicology of pesticides. The PI published two articles in the peer-reviewed literature. The first article describes changing trends in epidemiological statistics on pesticide exposure incidents involving organophosphates, in association with their phase-out from residential uses. The second article summarizes advances and limitations in the assessment of human exposure to pyrethroid insecticides, a classification of pesticides that
are of agricultural importance in the United States and throughout the world. The NPMMP continues to expand the hardcopy and electronic library of technical and scientific information on the toxicology of pesticides. At the current time, over 2,700 articles have been scanned and are readily accessible to the investigators and inquirers to the NPMMP. The NPMMP delivers information through a website, and in the past year the website received over 9,000 visitors. Over 1,114 copies of the 2005 Annual Report of the NPMMP have been accessed from the website.
Impacts
Public health and regulatory officials benefit from the work conducted by the NPMMP, through an improved understanding of the epidemiology of human exposure to pesticides throughout the United States. The NPMMP provides relevant case reports of human exposure to pesticides of agricultural importance. This information provides risk assessors and health care providers with useful information to help reduce the risk of adverse impacts of pesticides on human health. The general public benefits from having access to a physician with knowledge and training in the clinical toxicology of pesticides.
Publications
- Sudakin DL. Pyrethroid Insecticides: Advances and Challenges in Biomonitoring. Clinical Toxicology. 2006:44(1):31-7.
- Sudakin DL, Power LE. Organophosphate Exposures in the United States: A Longitudinal Analysis of Incidents Reported to Poison Control Centers. Journal of Toxicology and Environmental Health, Part A. 2006. 70(2):141-7.
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Progress 01/01/05 to 12/31/05
Outputs
The National Pesticide Medical Monitoring Program (NPMMP) was awarded a competitive renewal for a five year period from April 1, 2005 - March 31, 2010. The award was received from the US EPA Office of Pesticide Programs. The objectives of the NPMMP for the current project period include: 1. To make information pertaining to both the clinical and basic toxicology of pesticides available to all inquiries from the United States, including health care providers, public health professionals, regulatory agencies, and the general public. 2. To provide written information on pesticide toxicology, when needed to respond to inquiries. 3. To provide quantitative laboratory measurements of pesticides in environmental samples, as well as in select cases, in biological samples of exposed human beings. 4. To define inquiries and incidents relating to human pesticide exposures, and provide summaries and interpretations to the U.S. EPA Office of Pesticide Programs. 5. Develop and
maintain a comprehensive hardcopy and electronic library of resources relevant to the clinical toxicology of pesticides, including technical reports, peer-reviewed publications, and scientific databases. During the past year, the NPMMP has responded to over 300 inquiries originating from federal and state regulatory and public health agencies, health care providers, and the general public. Approximately 15% of inquiries have been in relation to the agricultural use of pesticides. These inquiries have included exposure incidents among applicators, as well as allegations of spray drift. The NPMMP has provided quarterly as well as annual reports to the US EPA Office of Pesticide Programs, which summarize the nature of these inquiries, and provide specific discussion relating to opportunities to reduce the risk of exposure and adverse health effects. The activities of the NPMMP have been the subject of invited presentations at a number of regional and national meetings which have included
audiences such as regulatory officials and health care providers. Several peer-reviewed manuscripts have been published in the past year, each of which include discussion of activities of the NPMMP. The NPMMP continues to work closely with regional and federal officials who are involved in the regulation of pesticides, and these interactions enable the NPMMP to have a significant impact on reducing the potential impact of pesticides on human health.
Impacts
Material contained in the NPMMP quarterly and annual reports is currently circulated widely within the US EPA Office of Pesticide Programs. Regulatory officials who review NPMMP reports include individuals in the Health Effects Division and the Director's Office. It is clear that the US EPA Office of Pesticide Programs is aware of the activities of the NPMMP, as the NPMMP has been requested to provide additional information in follow-up to the NPMMP reports. Over 250 copies of the 2003 Annual report of the NPMMP have been downloaded from the NPMMP website. The NPMMP electronic library currently contains over 1,800 scientific publications on the clinical toxicology of pesticides. These electronic as well as hard-copy resources have been utilized to respond to hundreds of complex inquiries that have been received by the NPMMP. The NPMMP has been an invited speaker at national meetings of pesticide regulatory officials, including presentations that have focused on
biomarkers of human exposure to pesticides, epidemiological studies, and emerging issues in the regulation and toxicology of pesticides. The NPMMP has also provided consultation to State Departments of Agriculture and Public Health Officials to assist in the investigation of community concerns relating to the use of pesticides in agriculture and in forestry environments. The NPMMP has provided objective, science-based information to assist regulatory officials, health care providers, and the general public to recognize and reduce the potential adverse impact of pesticides on human health.
Publications
- Sudakin DL. Book Chapter: "Fungicides", in Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient (2005).
- Sudakin DL. "Informational Sources on Pesticides and Health (Appendix)" Invited publication in Journal of Agromedicine, submitted for publication July, 2005
- Sudakin DL. "Pesticide Exposures: Web-Based Resources for Health Care Providers" Journal of Agromedicine 2005;10(1):43-9.
- Sudakin DL. "Occupational Exposure to Phosphine Gas? A Suspected Case Report and Review of the Literature" Human and Experimental Toxicology 2005;24:27-33.
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Progress 01/01/04 to 12/31/04
Outputs
The NPMMP has responded to over 300 inquiries in the past year, relating to human health effects and the use of pesticides in agricultural, residential, and other scenarios. Inquiries have been received from the State of Oregon and other regions throughout the United States. The nature of inquiries received is diverse, and includes spray drift from use of pesticides in agriculture, health implications of inert ingredients in pesticide formulations, and the misuse of antimicrobial pesticides for the purpose of mold control in residential environments. The NPMMP has also continued to expand the library of hardcopy and electronic resources on the clinical toxicology of pesticides. These technical reports and scientific publications of relevance to pesticides and human health have been electronically scanned and indexed, and are readily available for electronic transmission in response to inquiries from health care providers, regulatory officials, and the general public.
The NPMMP has also prepared an electronic presentation on electronic resources of relevance to health care providers who provide medical care to agricultural workers. The NPMMP has delivered this presentation to medical and public health professionals in Oregon and throughout the United States. A website describing the activities of the NPMMP has been established. The website includes the annual report of the NPMMP, electronic presentations, and links to relevant resources on the clinical toxicology of pesticides. The NPMMP has also provided technical assistance and consultation to the State of Oregon Pesticide Analytical and Response Center, a multi-agency group of officials who meet regularly to investigate concerns relating to the use of pesticides in the State of Oregon. The NPMMP is closely involved in an ongoing investigation of concerns relating to spray drift from agricultural nurseries in a rural community in the State of Oregon.
Impacts
Over 209 copies of the NPMMP 2003 annual report have been downloaded from the NPMMP website in the past year. Electronic presentations describing the NPMMP and presenting electronic resources on pesticide toxicology for health care providers have been downloaded over 181 times since their deployment on the NPMMP website. The NPMMP has been an invited presenter at the Oregon Department of Health Services Public Health Grand Rounds, and delivered a presentation on electronic resources on pesticides for public health professionals. The presentation described an investigation of health effects among agricultural workers. This presentation was videotaped by the Oregon Department of Health Services, and will be distributed to public health departments throughout the state of Oregon. In the past year, the NPMMP was also an invited presenter on topics pertaining to pesticide toxicology at regional and national meetings of the Northwest Association of Occupational and
Environmental Medicine, the Agency for Toxic Substances and Diseases Registry, and the American College of Occupational and Environmental Medicine. The NPMMP electronic library currently maintains over 625 indexed technical reports and peer-reviewed publications on the clinical toxicology of pesticides. These publications are readily accessible and can be electronically transmitted in response to inquiries. As a result of a competitive proposal, the NPMMP at Oregon State University has received a 5-year renewal for continuing activities from the US EPA Office of Pesticide Programs.
Publications
- Sudakin DL. "Biopesticides." Toxicological Reviews 2003:22(2):83-90.
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Progress 01/01/03 to 12/31/03
Outputs
The National Pesticide Medical Monitoring Program responded to over 300 inquiries pertaining to human exposures to pesticides during the period from 1/2003-12/2003. Inquiries were received from the general public, federal agencies (including the U.S. E.P.A. Office of Pesticides Programs), state enforcement and public health agencies (including Departments of Agriculture and Environmental Quality), and health care providers. The inquiries that were received were predominantly in relation to the use of pesticides in residential environments. Approximately 15-20% of inquiries involved health implications of pesticide use in agricultural settings. Quarterly reports summarizing these inquiries were submitted to the Pesticide Incident Response Officer at the U.S. E.P.A. Office of Pesticides Programs, and these reports were generated for the purpose of providing the regulatory agency with information that could be utilized in the risk assessment process for pesticides that
are utilized in agriculture throughout the United States.
Impacts
The investigator participated on a National Review Board for the National Environmental Education and Training Foundation (NEETF), to develop a Pesticide Information Gateway for Health Care Providers. The impact of this work includes developing new resources that specifically focus on the recognition and management of pesticide-related illness arising from their use in agriculture and the general environment. The investigator developed a series of technical fact sheets for health care providers, which provide examples of exposure scenarios involving the agricultural and residential use of pesticides. The fact sheets are available on the National Pesticide Information Center website. Web activity indicates that these fact sheets have been accessed on over 1,000 occassions since their posting. Positive feedback has been received from health care providers and investigators from the National Institute of Occupational Safety and Health. A review article on the safety of
insect repellents containing DEET was published by the investigator, in response to a perceived need for an update on this important class of pesticides that are commonly used by individuals in agriculture and the general population. The investigator presented at the Nez Perce Indian Reservation in a conference for tribal members and health care providers, on topics relating to pesticides and agricultural health. Feedback from the conference organizers indicated that the presentation made a significant contribution towards delivering important information about pesticides to a high-risk community.
Publications
- Sudakin DL 2003. DEET: A Review and Update of Safety and Risk in the General Population. Journal of Toxicology Clinical Toxicology 2003;41(6):831-9.
- Sudakin DL 2003. Medical Case Profiles (Technical Fact Sheet) developed for the National Pesticide Information Center: Biomarkers of Exposure: Organophosphates http://www.npic.orst.edu/mcapro/OPBIOMARKERs.pdf
- Sudakin DL 2003. Synthetic Pyrethroids and Paresthesias http://www.npic.orst.edu/mcapro/PyrethroidsParesthesia.pdf
- Sudakin DL 2003. Inhalation Risks from Phosphide Fumigants http://www.npic.orst.edu/mcapro/Phosphine.pdf
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