SENSOR-Pesticides
Encyclopedia
Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides is a U.S. state-based surveillance
Clinical surveillance
Clinical surveillance refers to the surveillance of health data about a clinical syndrome that has a significant impact on public health, which is then used to drive decisions about health policy and health education...

 program that monitors pesticide
Pesticide
Pesticides are substances or mixture of substances intended for preventing, destroying, repelling or mitigating any pest.A pesticide may be a chemical unicycle, biological agent , antimicrobial, disinfectant or device used against any pest...

-related illness and injury. It is administered by the National Institute for Occupational Safety and Health
National Institute for Occupational Safety and Health
The National Institute for Occupational Safety and Health is the United States’ federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the Centers for Disease Control and Prevention within the U.S...

 (NIOSH), twelve state health agencies
State health agency
A state health agency , or state department of health, is a department or agency of the state governments of the United States focused on public health. The state secretary of health is a constitutional or at times a statutory official in several states of the United States...

 participate. NIOSH provides technical support to all participating states. It also provides funding to some states, in conjunction with the US Environmental Protection Agency (US EPA).

Pesticide-related illness is a significant occupational health issue, but it is believed to be underreported. Because of this, NIOSH proposed the SENSOR program to track pesticide poisonings. Because workers in many industries are at risk for pesticide exposure, and public concern exists regarding the use of and exposure to pesticides, government and regulatory authorities experience pressure to monitor health effects associated with them. SENSOR-Pesticides state partners collect case data from several different sources using a standard case definition and set of variables. This information is then forwarded to the program headquarters at NIOSH where it is compiled and put into a national database.

Researchers and government officials from the SENSOR-Pesticides program have published research articles that highlight findings from the data and their implications for environmental and occupational pesticide issues. These issues include eradication of invasive species, pesticide poisoning
Pesticide poisoning
A pesticide poisoning occurs when chemicals intended to control a pest affect non-target organisms such as humans, wildlife, or bees.-Cause:The most common exposure scenarios for pesticide-poisoning cases are accidental or suicidal poisonings, occupational exposure, by-stander exposure to...

 in schools, birth defects, and residential use of total release foggers
Fogger
A fogger is any device that creates a fog, typically containing an insecticide for killing insects and other arthropods. Foggers are often used by consumers as a low cost alternative to professional pest control services. The number of foggers needed for pest control depends on the size of the...

, or "bug bombs," which are devices that release an insecticide mist.

Background

Although it is a significant occupational health issue, work-related pesticide poisoning is believed to be under-reported
Reporting bias
In empirical research, reporting bias refers to a tendency to under-report unexpected or undesirable experimental results, attributing the results to sampling or measurement error, while being more trusting of expected or desirable results, though these may be subject to the same sources of error...

. Before the SENSOR program began, state programs that collected reports of occupational disease
Occupational disease
An occupational disease is any chronic ailment that occurs as a result of work or occupational activity. It is an aspect of occupational safety and health. An occupational disease is typically identified when it is shown that it is more prevalent in a given body of workers than in the general...

s did not usually conduct interventions. While over 25 states required reporting of pesticide-related illness, most of them could not compile useful information on incidence or prevalence. In response to these challenges, NIOSH proposed the SENSOR program as a model to track certain occupational conditions, including pesticides.
Pesticide poisoning is an important occupational health issue because pesticides are used in a large number of industries, which puts many different categories of workers at risk. From 1995 to 2001, use in agriculture accounted for at least 70% of conventional pesticide use in the U.S., and the US EPA estimates that the agricultural sector has had a similar market share of pesticides since 1979. Pesticides are particularly useful in agriculture because they increase crop yields and reduce the need for manual labor. However, this extensive use puts agricultural workers at increased risk for pesticide illnesses.

Workers in other industries are at risk for exposure as well. For example, commercial availability of pesticides in stores puts retail workers at risk for exposure and illness when they handle pesticide products. The ubiquity of pesticides puts emergency responders such as fire-fighters and police officers at risk, because they are often the first responders to emergency events and may be unaware of the presence of a poisoning hazard. The process of aircraft disinsection
Aircraft disinsection
Aircraft disinsection is a process of using insecticide on inbound international aircraft for insect and disease control. It was first used in the 1930s but it is being reduced because of the ill effects on passengers and crew...

, in which pesticides are used on inbound international flights for insect and disease control, can also make flight attendants sick.

The widespread use of pesticides, their release into the environment, and the potential for adverse public health effects due to exposure may raise public concern. Some feel that regulatory authorities have an ethical obligation to track the health effects of such chemicals. In the Handbook of Pesticide Toxicology, Calvert et al. write "[b]ecause society allows pesticides to be disseminated into the environment, society also incurs the obligation to track the health effects of pesticides." Jay Vroom, president of CropLife America, said in a press release that "...our industry has a moral and ethical obligation...to know how these products impact humans." Surveillance of pesticide-related injuries and illnesses is recommended by the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...

, the Council of State and Territorial Epidemiologists
Council of State and Territorial Epidemiologists
The Council of State and Territorial Epidemiologists was organized in the USA in the early 1950s in response to the need to have at least one person in each state and territory responsible for public health surveillance of diseases and conditions of public health significance. Since then, CSTE has...

 (CSTE), the Pew
The Pew Charitable Trusts
The Pew Charitable Trusts is an independent non-profit, non-governmental organization , founded in 1948. With over US$5 billion in assets, its current mission is to serve the public interest by "improving public policy, informing the public, and stimulating civic life."-History:The Trusts, a single...

 Environmental Health Commission, and the Government Accountability Office
Government Accountability Office
The Government Accountability Office is the audit, evaluation, and investigative arm of the United States Congress. It is located in the legislative branch of the United States government.-History:...

.

History

Beginning in 1987, NIOSH supported the implementation of the Sentinel Event Notification System for Occupational Risks (SENSOR) program in ten state health departments. The objectives of the program were to help state health departments to develop and refine reporting systems for certain occupational disorders so that they could conduct and evaluate interventions
Health intervention
A health intervention is an effort to promote good health behaviour such as physical exercise or to prevent bad health behaviours, e.g. promoting tobacco smoking cessation or discouraging the use of illicit drugs or excessive drinking....

 and prevention efforts. The disorders covered by SENSOR included silicosis
Silicosis
Silicosis, also known as Potter's rot, is a form of occupational lung disease caused by inhalation of crystalline silica dust, and is marked by inflammation and scarring in forms of nodular lesions in the upper lobes of the lungs...

, occupational asthma
Occupational asthma
Occupational asthma is an occupational condition defined as: "a disease characterized by variable airflow limitation and/or airway hyper-responsiveness due to causes and conditions attributable to a particular occupational environment and not stimuli encountered outside the workplace".Asthma is...

, carpal tunnel syndrome
Carpal tunnel syndrome
Carpal Tunnel Syndrome is an entrapment idiopathic median neuropathy, causing paresthesia, pain, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression...

, lead poisoning
Lead poisoning
Lead poisoning is a medical condition caused by increased levels of the heavy metal lead in the body. Lead interferes with a variety of body processes and is toxic to many organs and tissues including the heart, bones, intestines, kidneys, and reproductive and nervous systems...

, and pesticide poisoning
Pesticide poisoning
A pesticide poisoning occurs when chemicals intended to control a pest affect non-target organisms such as humans, wildlife, or bees.-Cause:The most common exposure scenarios for pesticide-poisoning cases are accidental or suicidal poisonings, occupational exposure, by-stander exposure to...

. While each participating state health department had previously done surveillance or interventions for some of these occupational illnesses, SENSOR helped the states to develop and refine their reporting systems and programs.

The original SENSOR-Pesticides model was based on physician reporting. Each state contacted a select group of sentinel health care professionals on a regular basis to collect information. However, this system was labor-intensive and did not yield many cases. Because different states used different methods for collecting information, their data could not be compiled or compared to analyze for trends. In response, NIOSH, along with other federal agencies (US EPA, National Center for Environmental Health), non-federal agencies (CSTE, Association of Occupational and Environmental Clinics), and state health departments, developed a standard case definition
Case definition
A case definition from a broader sense encompassing its use in more than just medical terms. A case is a request for a service for a subject - customer, employee, or citizen. The case has supporting information - documents, data, forms, etc. - as part of the request for service...

 and a set of standardized variables. As of 2011, SENSOR-Pesticides had 11 participating states contributing occupational pesticide-related injury and illness data: California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...

, Florida
Florida
Florida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it...

, Iowa
Iowa
Iowa is a state located in the Midwestern United States, an area often referred to as the "American Heartland". It derives its name from the Ioway people, one of the many American Indian tribes that occupied the state at the time of European exploration. Iowa was a part of the French colony of New...

, Louisiana
Louisiana
Louisiana is a state located in the southern region of the United States of America. Its capital is Baton Rouge and largest city is New Orleans. Louisiana is the only state in the U.S. with political subdivisions termed parishes, which are local governments equivalent to counties...

, Michigan
Michigan
Michigan is a U.S. state located in the Great Lakes Region of the United States of America. The name Michigan is the French form of the Ojibwa word mishigamaa, meaning "large water" or "large lake"....

, New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...

, North Carolina
North Carolina
North Carolina is a state located in the southeastern United States. The state borders South Carolina and Georgia to the south, Tennessee to the west and Virginia to the north. North Carolina contains 100 counties. Its capital is Raleigh, and its largest city is Charlotte...

, and Washington received federal funding to support surveillance activities, while New Mexico
New Mexico
New Mexico is a state located in the southwest and western regions of the United States. New Mexico is also usually considered one of the Mountain States. With a population density of 16 per square mile, New Mexico is the sixth-most sparsely inhabited U.S...

, Oregon
Oregon
Oregon is a state in the Pacific Northwest region of the United States. It is located on the Pacific coast, with Washington to the north, California to the south, Nevada on the southeast and Idaho to the east. The Columbia and Snake rivers delineate much of Oregon's northern and eastern...

, and Texas
Texas
Texas is the second largest U.S. state by both area and population, and the largest state by area in the contiguous United States.The name, based on the Caddo word "Tejas" meaning "friends" or "allies", was applied by the Spanish to the Caddo themselves and to the region of their settlement in...

 were unfunded SENSOR-Pesticides program partners.

Case definition

A case of pesticide-related illness or injury is characterized by an acute onset of symptoms that are temporally related to a pesticide exposure. Cases are classified as occupational if exposure occurs at work, unless the case was a suicide or an attempted suicide.

Cases are reportable when:
  • there is documentation of new adverse health effects temporally related to a documented pesticide exposure AND
  • there is consistent evidence of a causal relationship between the pesticide and the health effects based on the known toxicology of the pesticide OR
  • there is not enough information to determine whether there is a causal relationship between the exposure and the health effects.

State public health officials rate each case as definite, probable, possible or suspicious. Illness severity is assigned as low, moderate, severe, or fatal.

Data collection

All states in the program require physicians to report pesticide-related injuries and illnesses; however, most states collect the majority of their data from workers’ compensation
Workers' compensation
Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence...

 claims, poison control centers
American Association of Poison Control Centers
The American Association of Poison Control Centers is a private non-governmental, non-profit association representing the poison control center network of the United States and their staff and affiliated toxicologists...

, and state agencies with jurisdiction over pesticide use, such as state departments of agriculture. When they receive a report, health department officials review the information to determine whether it was pesticide related. If it was, they request medical records and try to interview the patient (or a proxy) and anyone else involved in the incident (e.g. supervisors, applicators, and witnesses). The data is compiled each year and put into a national database.

In addition to identifying, classifying, and tabulating pesticide poisoning cases, the states periodically investigate pesticide-related events and develop interventions aimed at particular industries or pesticide hazards.

Impact

Federal and state-level scientists and researchers with SENSOR-Pesticides have published articles on pesticide exposure events and trends using program data. These articles include MMWR publications and articles in peer-reviewed journals on exposures such as acute pesticide-related illness in youth, agricultural workers, retail workers, migrant farm workers, and flight attendants. Several articles have attracted media attention and motivated legislative or other governmental action.

Florida Medfly Eradication Program

In response to a Mediterranean fruit fly
Ceratitis capitata
Ceratitis capitata, the Mediterranean fruit fly, or medfly for short, is a species of fruit fly capable of causing extensive damage to a wide range of fruit crops...

 (also known as “Medfly”) outbreak, officials from the Florida Department of Agriculture sprayed pesticides (primarily malathion
Malathion
Malathion is an organophosphate parasympathomimetic which binds irreversibly to cholinesterase. Malathion is an insecticide of relatively low human toxicity, however one recent study has shown that children with higher levels of organophosphate pesticide metabolites in their urine are more likely...

) and bait over five counties during the spring and summer of 1998. Scientists from the University of Florida
University of Florida
The University of Florida is an American public land-grant, sea-grant, and space-grant research university located on a campus in Gainesville, Florida. The university traces its historical origins to 1853, and has operated continuously on its present Gainesville campus since September 1906...

’s Institute of Food and Agricultural Sciences
Institute of Food and Agricultural Sciences
The University of Florida’s Institute of Food and Agricultural Sciences is a federal-state-county partnership dedicated to developing knowledge in agriculture, human and natural resources, and the life sciences, and enhancing and sustaining the quality of human life by making that information...

 stated that malathion was being sprayed in a manner that did not pose a significant risk to public health. During the eradication effort, the Florida Department of Health
Florida Department of Health
The Florida Department of Health is responsible for protecting the public health and safety of the residents and visitors of the State of Florida. It is a cabinet level agency of the state government, headed by a State surgeon general who reports to the Governor...

 investigated 230 cases of illness that were attributed to the pesticide. Officials from the Florida Department of Health and the SENSOR-Pesticides program published an article in Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report
Morbidity and Mortality Weekly Report
The Morbidity and Mortality Weekly Report is a weekly epidemiological digest for the United States published by the Centers for Disease Control and Prevention...

 (MMWR) that described these case reports and recommended alternative methods for Medfly control, including exclusion activities at ports of entry
Port of entry
In general, a port of entry is a place where one may lawfully enter a country. It typically has a staff of people who check passports and visas and inspect luggage to assure that contraband is not imported. International airports are usually ports of entry, as are road and rail crossings on a...

 to prevent importation, more rapid detection through increased sentinel trapping
Insect trap
Insect traps are used to monitor or directly reduce insect populations. They typically use food, visual lures, chemical attractants and pheromones as bait and are installed so that they do not injure other animals or humans or result in residues in foods or feeds. Visual lures use light, bright...

 densities, and the release of sterile male flies
Sterile insect technique
The sterile insect technique is a method of biological control, whereby overwhelming numbers of sterile insects are released. The released insects are normally male as it is the female that causes the damage, usually by laying eggs in the crop, or, in the case of mosquitoes, taking a bloodmeal from...

 to interrupt the reproductive cycle. The United States Department of Agriculture
United States Department of Agriculture
The United States Department of Agriculture is the United States federal executive department responsible for developing and executing U.S. federal government policy on farming, agriculture, and food...

 (USDA) incorporated these suggestions into their 2001 Environmental Impact Statement
Environmental impact statement
An environmental impact statement , under United States environmental law, is a document required by the National Environmental Policy Act for certain actions "significantly affecting the quality of the human environment". An EIS is a tool for decision making...

 on the Fruit Fly Cooperative Control Program. These impact statements guide the USDA's development of insect control strategies and decisions.

Pesticides in schools

Researchers from the SENSOR-Pesticides program published an article in 2005 in the Journal of the American Medical Association
Journal of the American Medical Association
The Journal of the American Medical Association is a weekly, peer-reviewed, medical journal, published by the American Medical Association. Beginning in July 2011, the editor in chief will be Howard C. Bauchner, vice chairman of pediatrics at Boston University’s School of Medicine, replacing ...

 (JAMA) on pesticide poisoning in schools. The article, which included data collected by SENSOR, described illnesses in students and school employees associated with pesticide exposures. The study found that rates of pesticide-related illnesses in children rose significantly from 1998 to 2002 and called for a reduction in pesticide use to prevent pesticide-related illness on or near school grounds. The article generated media coverage and drew attention to pesticide safety in schools and to safer alternatives to pesticides through integrated pest management
Integrated Pest Management
Integrated pest management is an ecological approach to agricultural pest control that integrates pesticides/herbicides into a management system incorporating a range of practices for economic control of a pest...

 (IPM). "[T]he study does provide evidence that using pesticides at schools is not innocuous and that there are better ways to use pesticides," said study co-author Dr. Geoffrey Calvert. Officials in organizations supporting the pesticide industry, such as CropLife America and RISE (Responsible Industry for a Sound Environment, a trade association representing pesticide manufacturers and suppliers), reacted strongly to the report, calling it “alarmist” and “incomplete” in its health reporting. CropLife America president Jay Vroom claimed that the report was “written without context about the proper use of pesticides in schools and [did] not mention the positive public health protections they provide" and stated that pesticide use in schools is "well regulated" and can be managed so that the risk is low. RISE president Allen James faulted the article for relying on unverified reports and said that evidence suggested that such incidents were extremely rare. The increased awareness of pesticide use in schools influenced parents and other stakeholders in numerous states to call for the adoption of integrated pest management programs. According to the National Pest Management Association
National Pest Management Association
The National Pest Management Association , a non-profit organization with more than 5,000 members, was established in 1933 to support the professional pest control industry. The headquarters are Fairfax, Virginia, just outside of Washington, DC....

, three more states passed IPM rules or laws between October 2005 and October 2008.

Birth defects in Florida and North Carolina

In February 2005, three infants were born with birth defects
Congenital disorder
A congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life , regardless of causation...

 to migrant farmworkers within eight weeks of each other in Collier County, Florida
Collier County, Florida
Collier County is a county located in the U.S. state of Florida. As of 2000, the population was 251,377. The U.S. Census Bureau 2007 estimate for the county is 315,839...

. Because one of the mothers had worked in North Carolina and the other two worked in Florida, neither state's health department attributed the cluster to pesticide exposure at first. However, when they presented their findings at the annual SENSOR-Pesticides workshop in 2006, they realized that all three mothers worked for the same tomato grower during the period of organogenesis
Organogenesis
In animal development, organogenesis is the process by which the ectoderm, endoderm, and mesoderm develop into the internal organs of the organism. Internal organs initiate development in humans within the 3rd to 8th weeks in utero...

 while pregnant, and that they may have been exposed to pesticides. The state health departments reported the cluster to their respective state agricultural departments. The Florida Department of Agriculture and Consumer Services inspected the grower's farms in Florida and fined the company $111,200 for violations they discovered; the North Carolina Department of Agriculture and Consumer Services conducted a similar inspection of farms in North Carolina and fined the company $184,500. After the investigation, North Carolina Governor Mike Easley
Mike Easley
Michael Francis "Mike" Easley is an American politician who served as the 72nd Governor of the U.S. state of North Carolina, from 2001 to 2009. He is member of the North Carolina Democratic Party and became the first North Carolina governor to admit to a felony in a deal that halted a lengthy...

 assembled the “Governor’s Task Force on Preventing Agricultural Pesticide Exposure.” It presented its findings in April 2008, which caused the state legislature to pass anti-retaliation and recordkeeping laws, training mandates to protect the health of agricultural workers, and funding for improved surveillance. In Florida, the state legislature added ten new pesticide inspectors to the Florida Department of Agriculture and Consumer Services
Florida Department of Agriculture and Consumer Services
The Florida Department of Agriculture and Consumer Services is an executive department of the government of Florida.The Commissioner of Agriculture is the head of the department...

.

Total release foggers

Total release foggers
Fogger
A fogger is any device that creates a fog, typically containing an insecticide for killing insects and other arthropods. Foggers are often used by consumers as a low cost alternative to professional pest control services. The number of foggers needed for pest control depends on the size of the...

 (TRFs), or "bug bombs," release a fog of insecticide to kill bugs in a room and coat surfaces with a chemical so the insects do not return. It is estimated that 50 million TRFs are used in the US annually. SENSOR-Pesticides federal and state staff, along with officials from the California Department of Pesticide Regulation (CDPR), published an article in the CDC MMWR that called attention to injuries and illnesses resulting from use of total release foggers. The New York State Department of Environmental Conservation
New York State Department of Environmental Conservation
The New York State Department of Environmental Conservation is responsible for the conservation, improvement, and protection of natural resources within the U.S. state of New York. It was founded in 1970, replacing the previous Conservation Department...

 (DEC) published a press release in response, stating that the state would restrict their use. DEC Commissioner Pete Granis
Alexander Pete Grannis
Alexander B. "Pete" Grannis is a former Commissioner of the New York State Department of Environmental Conservation . Before his tenure as Commissioner, he was a member of the New York State Assembly and represented District 65 as a member of the Democratic Party for the neighborhoods of the...

 announced that the department would move to classify foggers as a restricted-use product in New York State, meaning that only certified pesticide applicators would be able to obtain them. In March 2010, US EPA announced required label changes on indoor TRF products that reflect the label change recommendations made in the MMWR article.

External links

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