Rodenticides: Human 

Incident Analysis

Presentation to the SAP

November 29, 2011

Shanna Recore

Health Effects Division
Presentation Outline

• Introduction• Results and Analysis• Literature Review • Conclusion
Child Behaviors/Vulnerabilities

• Hand-to-mouth behaviors of small children

• 20 t /h f h d 20 even

t

s/hr 

for 

han

d

-

to-mouth

• 1/10 of the product available in ft

2

• Size and shape of baits allow them to be Size and shape of baits allow them to be

easily handled by children

• Placement of baits allow them to be easily Placement of baits allow them to be easily

accessed by children

• Review of available exposure information Review of available exposure information

from published literature and incident 

databases

• supports accessibility to children supports accessibility to children
Incident Data

• Data Sources

• The American Association of Poison Control Cen

(AAPCC) National Poison Data System (NPDS) (AAPCC) National Poison Data System (NPDS)

• EPA’s Incident Data System (IDS)• The National Pesticide Information Center (NPIC• Th C t f Di C t l d P ti /N 

The Centers for Disease Control and Prevention/N

Institute for Occupational Safety and Health SentiEvent Notification System for Occupational Risk 

SENSOR)

• The California Pesticide Illness Surveillance Prog

(PISP)

• Uncertainties

• Market share• Reporting bias• Under-reporting
Overview of AAPCC

• American Association of Poison Control Ce

(AAPCC

)

• National scope• Able to summarize and organize information ba

d t fi ld th t t ti ll d d b t d

a

ta fi

elds th

a

t are sys

tematically recor

d

e

d

by 

tr

poison center professions

• Clinically oriented

• Over 1.5 million pesticide records • Annual reports•

~93% of the pesticide incidents reported occ rre

93% of the pesticide incidents reported occ

urre

residential setting
AAPCC Annual Report Analysis

(1999-2009)

Exposures to Children <6 years old per Pesticide Cin AAPCC from 1999-2009 

Pesticide 

Category Total Exposures

# of Exposures to 

Children <6 years 

old

% Expos

Children <

old

Rodenticides 195,263 166,250 85% 

Disinfectants 224,578 122,868 55% 

Insecticides 474,149 192,745 41% 

Organophosphates 84,931 24,877 29% 

Herbicides 101,832 26,774 26% 

Fungicides 14,308 3,593 25% 
AAPCC Annual Report Analysis

(1999-2009) 

• 26% of all reported pesticide-relat

exposures to children under 6 yearare due to rodenticide ex

posures

• Child di i l Children are disproport

ionate

ly 

exposed to rodenticides than other 

types of pesticides
AAPCC Annual Report Analysis (1999-2009

)

AAPCC Annual Report Rodenticide Incidents from 

1500020000

5000

10000

0

1999 2000 2001 2002 2003 2004 2005 2006 2007 20

sum of rodenticide exposuresrodenticide exposures to children <6 years oldNumber of rodenticide incidents with known exposures outcomes (includes none, minor, mmajor, and death)number of rodenticide exposures resulting in treatment at a health care facility
AAPCC Annual Report Analysis

(1999-2009)

• EPA analyzed AAPCC annual report da

and f d th t d

foun

d th

a

t: 

• annual average of 17,000 exposures attribu

residential rodenticide use

• ~ 85% (~15,000 per year) of these 17,000 

exposures occurred to children under 6 yea

over the 11 

year period anal

yzed. 

• ~ 5000 annually treated in a health care fac

•

~25% f ll i id 25% o

f all pest

i

cide-reld i ate

d cases seen 

in 

health care facility were related to rodenticex

posures.
AAPCC NPDS Data Analysis (1999-2005

)

• Rodenticide exposure to children l

th 6 ld than 

6 years old:

• ~26% exposed children sought treat

in a health care facilit

y. 

• ~1% of ex

posures to children result 

medical outcome (minor , moderatemaj ) or

)

• No deaths to children
AAPCC NPDS Data Analysis (1999-2005

)

• 894 cases were symptomatic

• Hematological effects were the mos

commonl

yp j re

ported effects for majo

moderate cases

• These effects are expected and cons

These effects are expected and cons

with anticoagulant rodenticide mode 

action
Other Databases

• IDS (1999-2009) 

• 1522 incidents* 1522 incidents*

• NPIC (2005-2010)

• 204 incidents* 2 suspected incidents* 204 incidents*, 

2 suspected incidents*

• NIOSH SENSOR (1998-2006)

• 50 incidents* 50 incidents*

• CA PISP (2004-2008)

• 16 incidents 16 incidents

*

*These incidents are inclusive of all age 

These incidents are inclusive of all age 
Literature Review

• Available literature suggests concern that accidental 

of anticoa

gulant rodenticides is occurrin

g to children

• Literature based on analysis of AAPCC data

• Shepherd et al. (2002) identified 10,762 cases of acute un

b difi ro coum exposures t hild <6 ld f 199

to children <6 years old

from 199

• Mullins et al. (2000) identified 542 second generation an

rodenticides (SGAR) exposures to 2 year olds from Jan 1

1994 an

d Jan 1996 to Dec 1997

• Kendrick (2006) reviewed records for 2004 , and found 

(14,229) of the exposures to SGARs were to children <6 

• Caravati et al. (2007) identified 58,710 SGAR exposures 

children <6 years old from 2000 to 2003 
Literature Review

• Badakhs et al (2010) et al (2010)

• Louisiana Hospital Inpatient Disch

Database from 1998 Database from 1998

-2007

• rodenticides were responsible for 

(22) of cases (22) of cases

• children had a higher rate of roden

exposure than adults exposure than adults
Risk Mitigation

• Childrens' Risk Mitigation 

• EPA is requiring that all rodenticide bait produc

available for sale to consumers be sold only witstations. Loose bait such as pellets will be prohistations. Loose bait such as pellets will be prohi

a bait form. 

• Bait Station Requirements for Consumer-Use Prod

• Tamper-resistant for children• tested according to EPA protocols
Conclusions

• Current label directions intended t

keep bait away from children are nfully effective at preventing exposto children. 

• EPA exp pp ects that the RMD propos

(to contain rodenticides in tamperresistant bait stations) g will mitigatchild incidents involving rodentici