Th The SE SENSOR-Pestic icid ides P Prog ogram Walter A. - - PowerPoint PPT Presentation

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Th The SE SENSOR-Pestic icid ides P Prog ogram Walter A. - - PowerPoint PPT Presentation

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Th The SE SENSOR-Pestic icid ides P Prog ogram Walter A. Alarcon & Geoffrey M. Calvert Methodologies to identify work-related diseases Review on sentinel and alert systems: Seminar to discuss the current approaches European Agency

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Th The SE SENSOR-Pestic icid ides P Prog

  • gram

Walter A. Alarcon & Geoffrey M. Calvert

The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be construed to represent any agency determination or policy.

Methodologies to identify work-related diseases – Review on sentinel and alert systems: Seminar to discuss the current approaches

European Agency for Safety and Health at Work May 18, 2017. Brussels, Belgium

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Outl tline

1) Introduction (pesticides and surveillance) 2) SENSOR-Pesticides program 3) Uses and impact of SENSOR-Pesticides program 4) Conclusion

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Occupational safety a and h d health framework rk in t the U USA

Mine Safety and Health Administration (MSHA)

Department of Health and Human Services (HHS) Department of Labor (DOL)

Occupational Safety and Health Administration (OSHA) Research and Prevention Recommendations Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Regulation/Enforcement

Environmental Protection Agency (EPA)

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SLIDE 4

Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Surveillance

The ongoing collection, analysis, interpretation, and dissemination of data to prevent and control disease.

Thacker and Berkelman, 1988

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Why conduct p t pesti ticide poisoning surveillance?

  • Ongoing concern about pesticide toxicity
  • >16,000 pesticide products/~600 active

ingredients

  • Approx. 2.1 billion pounds (952,543,977 Kg) used

annually in US

  • Pre-market testing of pesticides isn’t comprehensive
  • Useful for identifying emerging pesticide hazards
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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Surveillance systems for acute p pesticide- rel elated Illn lnes ess i s in the U e U.S. S.A.

  • State-based surveillance systems
  • SENSOR-Pesticides
  • California Department of Pesticide Regulation
  • Other systems used by US EPA
  • National Poison Data System
  • Data submitted under FIFRA Section 6(a)(2)
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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

SENS NSOR OR

  • "Sentinel" case identification and follow-up
  • State-based surveillance program
  • Provides timely opportunities for prevention

and intervention

  • Develop state-based models for national

implementation Sentinel Event Notification System for Occupational Risk

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

SENS NSOR OR-Pes esticides es p prog

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is 30 30 years rs old: 1987 1987 - 2017! 2017!

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

SENS NSOR OR-Pes esticides es P Progr

  • gram
  • The SENSOR-Pesticides program began in

1987

  • Mission: To build and maintain occupational

illness & injury surveillance capacity within state health departments

  • “Sentinel” case identification and follow-up
  • Funding provided by NIOSH and EPA

http://www.cdc.gov/niosh/topics/pesticides/

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

1988-1997 California (88-92) New York (93-97) Oregon Texas 1998-2000 Arizona* California Florida Louisiana* New York Oregon Texas

St States es Partic icip ipatin ing i in SE SENSOR-Pes esticides es

2001-2006 Arizona* California Florida* Louisiana* Michigan New York Oregon Texas Washington 2007-2010 Arizona* California Florida* Louisiana* Iowa Michigan New Mexico* New York

  • N. Carolina*

Oregon* Texas* Washington *= receives no federal support 2011-2012 California Florida Louisiana Iowa Michigan New Mexico* New York North Carolina Oregon* Texas* Washington 2013-2016 California Florida Louisiana Iowa* Michigan Nebraska* New Mexico* New York North Carolina Oregon* Texas* Washington 2017 California Florida* Louisiana* Illinois Iowa* Michigan Nebraska* New Mexico* New York* North Carolina* Oregon* Texas Washington

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

SENS NSOR OR-Pesti ticides Program C Case Definition

  • Consists of three parts:
  • Determination of

pesticide exposure

  • Determination of health

effects

  • Evidence of causal

relationship between pesticide exposure and

  • bserved health effects

http://www.cdc.gov/niosh/topics/pesticides/

  • Case classification category

based on strength of exposure and health effects information

  • Definite
  • Probable
  • Possible
  • Suspicious
  • Not a case
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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Standardized variables

Standardized variables for state surveillance of pesticide-related illness and injury

  • Pesticide product information (EPA registration

number, name, active ingredients, …)

  • Health effects and severity index
  • Flow diagram for assigning severity to cases
  • Table of signs and symptoms by severity category
  • Industry, occupation, exposure source
  • Root causes of pesticide poisonings
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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

How-to guide for pesticide poisoning surveillance (2005). For developing and maintaining a state-based occupational / environmental surveillance program. SPIDER (SENSOR-Pesticides Incident Data Entry and Reporting). Software for incident data entry and reporting.

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

So Sources s of

  • f Ca

Cases ses

  • Poison control centers (PCC) and the National

Poison Data System (NDPS)

  • State department of agriculture
  • Workers' compensation
  • Other: Physician and other health care

professional reports, hospital discharge, lab reports (cholinesterase test), death certificates.

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Cu Current uses es of

  • f PCC data a

and t the N e Nation

  • nal P

Poison

  • n

Data S Syste tem ( (NPDS)

  • PCCs are and important source of case reports. especially for

nonoccupational pesticide poisonings

  • All SENSOR-Pesticides states have strong collaborations with

PCCs

  • NIOSH uses NPDS data to track acute work-related pesticide

poisonings

  • Some NDPS limitations: high financial cost and lack of some

important variables (industry and occupation of case, EPA registration number, and root cause )

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Wo Workers’ Compen ensation

  • n (

(WC) C)

  • Can be a valuable source of information about
  • ccupational pesticide poisoning cases
  • Form of insurance. Premiums covered by employers
  • WC Laws exist in all states, details differ from state to

state

  • Submitted claims for:
  • medical-only (reimbursement of medical expenses only) and
  • Lost time cases (reimbursement for medical expenses and to

recover lost wages)

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Uses and impacts of the SENS NSOR OR-Pes esticides es p prog

  • gram
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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Uses ses of

  • f SE

SENSOR-Pes esticides es data ta f for S Surve veillance

  • Estimate magnitude and trend of problem
  • Determine geographic distribution of poisonings
  • Detect emerging problems
  • Generate hypotheses, stimulate research
  • Evaluate control measures
  • Facilitate planning
  • Inform policy change (examples in next slides)
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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Work rker r Protection Standard

  • Intent is to protect agricultural workers from pesticides
  • Amendment to FIFRA (Federal Insecticide, Fungicide, and Rodenticide

Act)

  • Worker Protection Standard, 2015 revision
  • First major WPS revision since 1992
  • Revision proposed in March 2014
  • Finalized in November 2015
  • Compliance with most items required by Jan 2, 2017
  • Revisions include:
  • Annual training of farmworkers, requirements for respirator use, age restrictions for

pesticide handlers, establish buffer zones, enhanced record-keeping and notification requirements

  • Inspector General plans review of the standard.
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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

  • EPA used several SENSOR-Pesticides studies to justify the WPS-

2014 revisions

  • Calvert et al. Acute pesticide-related illnesses among working youths,

1988-1999. Am J Public Health 2003; 93:605-610.

  • Calvert et al. Case report: Three farmworkers who gave birth to infants

with birth defects… Environ Health Perspect 2007; 115:787-791.

  • Calvert et al. Acute pesticide poisoning among agricultural workers in the
  • US. Am J Ind Med 2008; 51:883-898.
  • Lee et al. Acute pesticide illnesses associated with off-target pesticide

drift from agricultural applications. Environ Health Perspect 2011; 119:1162-1169.

SENS NSOR OR-Pesticides a and the Work rker r Prot

  • tec

ection Standa dard

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

  • Intent is protect workers who apply the riskiest pesticides (i.e.

restricted use pesticides)

  • Ensure standards adequately protect applicators, the public, and the

environment

  • Amendment to FIFRA
  • Revision proposed in August 2015
  • First major WPS revision since 1974
  • Finalized in December 2016 (but frozen on Jan 26, 2017)
  • Revisions include:
  • improve the competency of certified RUP applicators, increase protection for noncertified

RUP applicators operating under supervision of a certified applicator through enhanced training and standards for supervision of noncertified applicators, and establish a minimum age requirement for applicators

Certi tificati tion of Pesticide Applicators Rule

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

  • EPA used several SENSOR-Pesticides studies to justify the 2016

revisions

  • ~120 cases from SENSOR-Pesticides states in 2009-2010 that involved RUP

exposure

  • Used to calculate value of incidents avoided, based on illness severity
  • Lee et al. Acute pesticide illnesses associated with off-target pesticide drift

from agricultural applications. Environ Health Perspect 2011; 119:1162- 1169.

  • Calvert et al. Acute pesticide-related illnesses among working youths,

1988-1999. Am J Public Health 2003; 93:605-610.

  • Calvert et al. Acute pesticide poisoning among agricultural workers in the
  • US. Am J Ind Med 2008; 51:883-898.

SENS NSOR OR-Pesti ticides a and C Certifi fication of Pesti tici cide Applicators Rule

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

  • Announced in March 2016
  • Finalized in December 2016
  • Intent is to protect workers
  • Actions include:
  • Label changes
  • Closed system for mixing and loading application equipment
  • Enhanced training for certified applicators
  • Only certified applicators can apply
  • SENSOR data used to support these actions

Rec ecent E EPA Actio ions: P Paraquat

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

Other r import rtant impacts by SENS NSOR OR-Pes esticides es ( (befor

  • re

e 2015)

  • After we published and article in The JAMA, at least five states

passed laws requiring schools to control pests using methods with the least possible health hazards

  • SENSOR-Pesticides findings have led to label changes for many

pesticide products to enhance clarity and improve safety

  • SENSOR-Pesticides findings have led to passage of state laws in CA,

FL and NC to provide greater protection from pesticide hazards

  • USDA adopted our recommendations to prevent Medfly

infestations

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Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

CONCL CLUS USION Th The SE e SENSOR-Pes esticides es is an i import rtant p t program

  • Addresses widespread concern about pesticides
  • Has been productive and has made many meaningful

contributions

  • Builds on CDC’s long history of collaboration with

state departments of health

  • “Best” national surveillance system for acute
  • ccupational pesticide poisoning