Magnitude and characteristics of acute paraquat- and diquat-related illnesses in the US: 1998–2013

Authors

Gamola Z. Fortenberry, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
John Beckman, Public Health Institute, Oakland, CA
Abby Schwartz, Michigan Department of Health and Human Services, Lansing, MI
Joanne Bonnar Prado, Washington State Department of Health, Olympia, WA
Lucia S. Graham, California Department of Pesticide Regulation, Sacramento, CA
Sheila Higgins, North Carolina Department of Health and Human Services, Raleigh, NC
Michelle Lackovic, Louisiana Department of Health and Hospitals, New Orleans, LA
Prakash Mulay, Florida Department of Health, Tallahassee, FL
Heidi Bojes, Texas Department of State Health Services, Austin, TX
Justin Waltz, Oregon Health Authority, Portland, OR
Yvette Mitchell, New York State Department of Health, Albany, NY
Kathy Leinenkugel, Iowa Department of Public Health, Des Moines, IA
Michel S. Oriel, California Department of Pesticide Regulation, Sacramento, CA
Elizabeth Evans, United States Environmental Protection Agency, Washington, D.C.
Geoffrey M. Calvert, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH

Date of this Version

2016

Citation

Environmental Research 146 (2016) 191–199

Comments

U.S. Government Work

Abstract

Background: Paraquat and diquat are among the most commonly used herbicides in the world.

Objectives: Determine the magnitude, characteristics, and root causes for acute paraquat- and diquatrelated illnesses in the US

Methods: Illnesses associated with paraquat or diquat exposure occurring from 1998 through 2011 were identified from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program, the California Department of Pesticide Regulation (CDPR) Pesticide Illness Surveillance Program (PISP), and the Incident Data System (IDS). Cases identified by the National Poison Data System (NPDS) were reviewed for the years 1998–2003 and 2006–2013.

Results: A total of 300 paraquat- and 144 diquat-related acute illnesses were identified by SENSOR, PISP, and IDS. NPDS identified 693 paraquat- and 2128 diquat-related acute illnesses. In SENSOR/PISP/IDS, illnesses were commonly low severity (paraquat=41%; diquat=81%); however, SENSOR/PISP/IDS identified 24 deaths caused by paraquat and 5 deaths associated with diquat. Nineteen paraquat-related deaths were due to ingestion, seven of which were unintentional, often due to improper storage in beverage bottles. In SENSOR/PISP/IDS, paraquat and diquat-related acute illnesses were work-related in 68% (n=203) and 29% (n=42) of cases, respectively. When herbicide application site was known, the vast majority of acute paraquat-related illnesses (81%) arose from agricultural applications. Common root causes of illness were failure to use adequate personal protective equipment (PPE), application equipment failure, and spill/splash of herbicide.

Conclusions: Although the magnitude of acute paraquat/diquat-related illnesses was relatively low, several fatalities were identified. Many illnesses could be prevented through stricter compliance with label requirements (e.g. ensuring proper herbicide storage and PPE use), and through enhanced training of certified applicators.