# Green Tobacco Sickness

Green Tobacco Sickness (GTS) is a type of nicotine poisoning caused by the transdermal absorption of nicotine from the surface of tobacco plants. Tobacco plants that have yet to be cured are referred to as "green tobacco". Nicotine is a water soluble chemical, therefore the risk of GTS is elevated if this chemical from the tobacco plants mixes with any sort of moisture.
Green Tobacco Sickness is characterized by a wide range of symptoms, including nausea, vomiting, headache, dizziness, and severe weakness. These symptoms may be accompanied by fluctuations in blood pressure or heart rate. Abdominal cramping, chills, increased sweating, salivation and difficulty breathing are also common.

## Signs and symptoms

Symptoms of Green Tobacco Sickness may begin while at work or hours after the conclusion of the workday. They do not typically persist for more than one day. The primary symptoms of GTS can be separated into two categories, neurological and respiratory. Those referred to as neurological complaints include headaches, dizziness, nausea, vomiting, chills, weakness, and increased perspiration and salivation. Symptoms that fall into the respiratory category include coughing and trouble breathing.

## Cause

Green Tobacco sickness is caused by the transdermal absorption of nicotine that frequently occurs when tobacco farm workers are in contact with uncured tobacco leaves. Nicotine is then able to be distributed throughout the body because it passes directly into the bloodstream upon absorption.

## Epidemiology

A majority of the tobacco that is produced is grown in China, Brazil, India, and the United States. It is estimated that over 15 million people contribute to the process of farming tobacco worldwide. Previous publications attempting to determine the prevalence of GTS typically only report the prevalence of this illness in one area during one farming season. Reported prevalence rates from these studies range from 8.2-47%, so further research is necessary to be able to definitively state the prevalence of GTS. The long-term health outcomes for individuals who experience GTS are not known.

### Risk factors

Workers that are involved in directly harvesting the tobacco by hand are at the highest risk for developing GTS, especially those who harvest in the early morning in the presence of dew, those working with wet clothes, and those working with wet tobacco plants. Those involved in barning the tobacco, a process in which the leaves are hung up to be cured, are also at a higher risk. Individuals who are new to working on tobacco farms could also be at an elevated risk due to a lack of knowledge about GTS as well as having little experience with safe harvesting practices. Younger workers have been shown to have a higher risk of GTS when compared to older workers, as younger workers might be more sensitive to this kind of exposure. Tobacco harvesters, whose clothing becomes saturated from tobacco wet with rain or morning dew, are at high risk of developing GTS. Workers can avoid getting this sickness by waiting to harvest until the tobacco leaves are dry, or by wearing a rain suit. Wet clothing that has come in contact with tobacco leaves should be removed immediately and the skin should be washed with warm soapy water. Individuals who are working in the heat are also at a higher risk for GTS, as high temperatures can increase absorption. It is also suggested that some workers may be at a lower risk than others due to activities that may increase their nicotine tolerance, such as personal tobacco use or a long history harvesting tobacco.

## Prevention and treatment

Proper workplace training and preventative efforts are important to reduce the risk of GTS. Employers should ensure any worker handling tobacco leaves has gloves that can be substituted for a new pair should they become wet. Long pants, long sleeve shirts, and water resistant suits are also protective against GTS as long as they are kept dry. However, those working with tobacco plants often do so in very warm weather, so it is essential that workers are given adequate breaks and opportunities for hydration in order to avoid heat exhaustion. Wet clothing that has come in contact with tobacco leaves should be removed immediately and the skin should be washed with warm soapy water. Another way workers can avoid getting this sickness is by waiting to harvest until the tobacco leaves are dry. Training tobacco farm workers to identify the signs and symptoms in themselves and others is helpful in early identification of GTS.
There is no specific treatment for Green Tobacco Sickness, but rest and rehydration are helpful in managing symptoms. In most cases, the illness will resolve on its own within one to two days, but symptoms may be so severe as to require emergency medical treatment which could include medication to treat nausea and vomiting and IV fluids. The symptoms of GTS are similar to those of other conditions that are common in this profession, such as heat illness and pesticide poisoning, which can sometimes lead to misdiagnosis.