APPENDIX B

Surveillance of Possible Health Effects from Pesticide Exposure

Introduction

The approach to combating the WNV is to use a tiered approach, starting with education, mosquito habitat reduction, larvicides, and adulticides in that order. There are limited opportunities for human exposure to larvicides. If adulticides are used, either by land or aerial application, people may be exposed to them. Pesticide exposure carries some inherent risk to people. The application rates for adulticides are low and, if they are applied properly, it is unlikely that many people would experience significant health effects. However, some people may be particularly sensitive to certain pesticides and could experience short-term effects such as eye, skin, nose or throat irritation. The extensive use of adulticides in 1999 has also raised public concern about other short-term (e.g., exacerbation of asthma) and long-term (e.g., chronic disease) health effects of population exposure to the pesticides used for mosquito control. Also, the threat of viral transmission may result in greater-than-average use of repellents or individually applied pesticides. Therefore, monitoring of possible health effects is important.

Many signs or symptoms that might be related to pesticide exposure are non-specific and could be confused with other conditions or caused by other exposures. Also, individuals with symptoms may not seek medical care, and the provider may not associate symptoms or conditions with pesticide exposure. Thus, surveillance of possible health effects cannot provide a comprehensive accounting of all outcomes. However, it is prudent to monitor the nature and extent of concerns and common outcomes to verify that no severe, unanticipated health effects are occurring.

Objectives

• To identify any potential acute health effects associated with pesticide use that might require immediate investigation and response.
• To establish a consistent information base and to retrospectively assess the possible health effects of pesticide exposure.

1. Prospectively collect data on reports of possible health effects of pesticide use.

The NYSDOH will periodically confer with the appropriate Poison Control Centers during the pesticide application season to review updates on relevant reports received.

The NYSDOH will establish standard forms, data collection processes, and referral procedures for reports of potential pesticide health effects from individuals and health care providers. The procedures will be used by NYSDOH and can be used as models and resources for LHUs. The forms and procedures will be in place by April 1, 2000 and will be compatible with those already in use by NYS Poison Control Centers. The information collected would identify, at least, the following information:

• Name of caller (optional)
• County of residence
• Gender, age of exposed or affected individual
• Location of exposure
• Mode of exposure
• Summary of symptoms or complaints
• Involvement of health care provider
• Information requested, if any.

The NYSDOH will utilize standard data collection procedures for all calls concerning possible human health problems associated with mosquito control pesticides.

NYSDOH will monitor all reports received by the Pesticide Poisoning Registry. By law, physicians and health care facilities are required to report confirmed or suspected pesticide poisonings to the NYSDOH, via a toll-free telephone call. The NYSDOH is preparing a physician fact sheet for the commonly used pesticides and will be distributing it to hospital emergency rooms.

During the mosquito control season, the NYSDOH will contact agencies receiving calls and inquiries related to pesticide application (LHUs, NYSDEC, and Poison Control Centers) and will maintain communication to encourage sharing of information. By monitoring reports and inquiries related to pesticide use, the NYSDOH will identify:

• Serious, unusual, or repeated acute health effects that show a pattern of association with local or aerial spraying that might need further evaluation. More intensive evaluation by NYSDOH or LHUs might include collection of detailed case histories for a subset of reports or review of emergency department records.
• Unexpected avenues of exposure that are identified and that might require investigation and referral to the appropriate agency.
• Frequent problems in responding to concerns and inquiries about pesticide health effects, including knowledge gaps or problems with educational materials.

2. Retrospectively collect and analyze data on potential health outcomes associated with pesticide use.

At the end of the spraying season, the NYSDOH will summarize information on all calls received including the volume of calls, the nature of the complaints, concordance of reported symptoms with known spraying schedules and pesticides used, differences between outcomes reported by affected individuals and health care providers, and other summary analysis.

The NYSDOH will collect information from existing data collection streams to describe health outcomes potentially related to the pesticides used. The outcomes chosen will depend on the geographic extent of potential pesticide exposure, the pesticides used, and the methods of application. If widespread aerial or ground spraying of adulticides occurred, for example, these outcomes might include acute asthma attacks, other respiratory problems, or dermatological problems. One specific database that is available is hospitalization data. The NYSDOH will summarize hospitalization data collected for trends over time and compare the results with control locations. NYSDOH will also assess concordance with records describing areas of potential pesticide exposure.

Revised: May 2000

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