Acute Human Lethal Toxicity of Agricultural Pesticides: A Prospective Cohort Study
Background:
Agricultural pesticide poisoning is a major public health problem in the developing world, killing at least 250,000–370,000 people each year. Targeted pesticide restrictions in Sri Lanka over the last 20 years have reduced pesticide deaths by 50% without decreasing agricultural output. However, regulatory decisions have thus far not been based on the human toxicity of formulated agricultural pesticides but on the surrogate of rat toxicity using pure unformulated pesticides. We aimed to determine the relative human toxicity of formulated agricultural pesticides to improve the effectiveness of regulatory policy.
Methods and Findings:
We examined the case fatality of different agricultural pesticides in a prospective cohort of patients presenting with pesticide self-poisoning to two clinical trial centers from April 2002 to November 2008. Identification of the pesticide ingested was based on history or positive identification of the container. A single pesticide was ingested by 9,302 patients. A specific pesticide was identified in 7,461 patients; 1,841 ingested an unknown pesticide. In a subset of 808 patients, the history of ingestion was confirmed by laboratory analysis in 95% of patients. There was a large variation in case fatality between pesticides—from 0% to 42%. This marked variation in lethality was observed for compounds within the same chemical and/or WHO toxicity classification of pesticides and for those used for similar agricultural indications.
Conclusion:
The human data provided toxicity rankings for some pesticides that contrasted strongly with the WHO toxicity classification based on rat toxicity. Basing regulation on human toxicity will make pesticide poisoning less hazardous, preventing hundreds of thousands of deaths globally without compromising agricultural needs. Ongoing monitoring of patterns of use and clinical toxicity for new pesticides is needed to identify highly toxic pesticides in a timely manner.
: Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Acute Human Lethal Toxicity of Agricultural Pesticides: A Prospective Cohort Study. PLoS Med 7(10): e32767. doi:10.1371/journal.pmed.1000357
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1000357
Souhrn
Background:
Agricultural pesticide poisoning is a major public health problem in the developing world, killing at least 250,000–370,000 people each year. Targeted pesticide restrictions in Sri Lanka over the last 20 years have reduced pesticide deaths by 50% without decreasing agricultural output. However, regulatory decisions have thus far not been based on the human toxicity of formulated agricultural pesticides but on the surrogate of rat toxicity using pure unformulated pesticides. We aimed to determine the relative human toxicity of formulated agricultural pesticides to improve the effectiveness of regulatory policy.
Methods and Findings:
We examined the case fatality of different agricultural pesticides in a prospective cohort of patients presenting with pesticide self-poisoning to two clinical trial centers from April 2002 to November 2008. Identification of the pesticide ingested was based on history or positive identification of the container. A single pesticide was ingested by 9,302 patients. A specific pesticide was identified in 7,461 patients; 1,841 ingested an unknown pesticide. In a subset of 808 patients, the history of ingestion was confirmed by laboratory analysis in 95% of patients. There was a large variation in case fatality between pesticides—from 0% to 42%. This marked variation in lethality was observed for compounds within the same chemical and/or WHO toxicity classification of pesticides and for those used for similar agricultural indications.
Conclusion:
The human data provided toxicity rankings for some pesticides that contrasted strongly with the WHO toxicity classification based on rat toxicity. Basing regulation on human toxicity will make pesticide poisoning less hazardous, preventing hundreds of thousands of deaths globally without compromising agricultural needs. Ongoing monitoring of patterns of use and clinical toxicity for new pesticides is needed to identify highly toxic pesticides in a timely manner.
: Please see later in the article for the Editors' Summary
Zdroje
1. GunnellD
EddlestonM
PhillipsMR
KonradsenF
2007
The global distribution of fatal pesticide self-poisoning: systematic review.
BMC Public Health
7
357
2. GunnellD
EddlestonM
2003
Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries.
Int J Epidemiol
32
902
909
3. BertoloteJM
FleischmannA
EddlestonM
GunnellD
2006
Deaths from pesticide poisoning: a global response.
Br J Psychiatry
189
201
203
4. EddlestonM
KarunaratneA
WeerakoonM
KumarasingheS
RajapaksheM
2006
Choice of poison for intentional self-poisoning in rural Sri Lanka.
Clin Toxicol (Phila)
44
283
286
5. EddlestonM
BuckleyNA
GunnellD
DawsonAH
KonradsenF
2006
Identification of strategies to prevent death after pesticide self-poisoning using a Haddon matrix.
Inj Prev
12
333
337
6. FAO
2003
International code of conduct on the distribution and use of pesticides
Rome
FAO
9251049149 9251049149
7. GunnellD
FernandoR
HewagamaM
PriyangikaWD
KonradsenF
2007
The impact of pesticide regulations on suicide in Sri Lanka.
Int J Epidemiol
36
1235
1242
8. DawsonA
BuckleyN
2007
Integrating approaches to paraquat poisoning.
Ceylon Med J
52
45
47
9. EddlestonM
KarallieddeL
BuckleyN
FernandoR
HutchinsonG
2002
Pesticide poisoning in the developing world–a minimum pesticides list.
Lancet
360
1163
1167
10. WrightonSA
StevensJC
1992
The human hepatic cytochromes P450 involved in drug metabolism.
Crit Rev Toxicol
22
1
21
11. TangJ
CaoY
RoseRL
BrimfieldAA
DaiD
2001
Metabolism of chlorpyrifos by human cytochrome P450 isoforms and human, mouse, and rat liver microsomes.
Drug Metab Dispos
29
1201
1204
12. EddlestonM
SudarshanK
SenthilkumaranM
ReginaldK
KarallieddeL
2006
Patterns of hospital transfer for self-poisoned patients in rural Sri Lanka: implications for estimating the incidence of self-poisoning in the developing world.
Bull World Health Organ
84
276
282
13. SenarathnaL
2006
How the level of resources and hospital staff attitude in primary care hospitals in rural Sri Lanka affect poisoning patient outcome
University of Newcastle
Available: http://www.sactrc.org/thesis.html Accessed 15 July 2010
14. EddlestonM
DawsonA
KarallieddeL
DissanayakeW
HittarageA
2004
Early management after self-poisoning with an organophosphorus or carbamate pesticide - a treatment protocol for junior doctors.
Crit Care
8
R391
397
15. DeanAGSK
SoeMM
2008
OpenEpi: open source epidemiologic statistics for public health, version 2.2.1.
www.OpenEpi.com. 2.2.1 ed. Accessed 10 August 2009
16. EddlestonM
EyerP
WorekF
MohamedF
SenarathnaL
2005
Differences between organophosphorus insecticides in human self-poisoning: a prospective cohort study.
Lancet
366
1452
1459
17. Srinivas RaoC
VenkateswarluV
SurenderT
EddlestonM
BuckleyNA
2005
Pesticide poisoning in south India: opportunities for prevention and improved medical management.
Trop Med Int Health
10
581
588
18. WHO
2005
The WHO recommended classification of pesticides by hazard and guidelines to classification 2004
Geneva
World Health Organisation
19. KonradsenF
van der HoekW
GunnellD
EddlestonM
2005
Missing deaths from pesticide self-poisoning at the IFCS Forum IV.
Bull World Health Organ
83
157
158
20. RobertsDM
KarunarathnaA
BuckleyNA
ManuweeraG
SheriffMH
2003
Influence of pesticide regulation on acute poisoning deaths in Sri Lanka.
Bull World Health Organ
81
789
798
21. ManuweeraG
EddlestonM
EgodageS
BuckleyNA
2008
Do targeted bans of insecticides to prevent deaths from self-poisoning result in reduced agricultural output?
Environ Health Perspect
116
492
495
22. WilksMF
FernandoR
AriyanandaPL
EddlestonM
BerryDJ
2008
Improvement in survival after paraquat ingestion following introduction of a new formulation in Sri Lanka.
PLoS Med
5
e49
doi:10.1371/journal.pmed.0050049
23. SenarathnaL
AdamsJ
De SilvaD
BuckleyNA
DawsonAH
2008
Personal and professional challenges in the management of deliberate self-poisoning patients in rural Sri Lanka: a qualitative study of rural hospital doctors' experiences and perceptions.
BMC Public Health
8
373
24. EddlestonM
RajapaksheM
RobertsD
ReginaldK
Rezvi SheriffMH
2002
Severe propanil [N-(3,4-dichlorophenyl) propanamide] pesticide self-poisoning.
J Toxicol Clin Toxicol
40
847
854
25. EddlestonM
HaggallaS
ReginaldK
SudarshanK
SenthilkumaranM
2007
The hazards of gastric lavage for intentional self-poisoning in a resource poor location.
Clin Toxicol (Phila)
45
136
143
26. EddlestonM
WilksMF
BuckleyNA
2003
Prospects for treatment of paraquat-induced lung fibrosis with immunosuppressive drugs and the need for better prediction of outcome: a systematic review.
QJM
96
809
824
27. EddlestonM
BuckleyNA
EyerP
DawsonAH
2008
Management of acute organophosphorus pesticide poisoning.
Lancet
371
597
607
28. RobertsDM
AaronCK
2007
Management of acute organophosphorus pesticide poisoning.
BMJ
334
629
634
29. LinTJ
WalterFG
HungDZ
TsaiJL
HuSC
2008
Epidemiology of organophosphate pesticide poisoning in Taiwan.
Clin Toxicol (Phila)
46
794
801
30. JoshiPK
GulatiA
BirthalPS
TewariL
2003
Agriculture diversification in South Asia: patterns, determinants, and policy implications.
Econ Polit Wkly
39
2457
2467
31. GunnellD
FernandoR
HewagamaM
PriyangikaW
KonradsenF
2007
The impact of pesticide regulations on suicide in Sri Lanka.
Int J Epidemiol
36
1235
1242
32. EddlestonM
UdayakumaraN
AdhikariS
de SilvaD
SheriffMH
2007
The importance of poisoning vs. road traffic injuries as a cause of death in rural Sri Lanka.
PLoS One
2
e599
doi:10.1371/journal.pone.0000599
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