Rodenticides: HumanIncident AnalysisPresentation to the SAPNovember 29, 2011Shanna RecoreHealth Effects Division1Presentation Outline•Introduction•Results and Analysis•Literature Review•Conclusion2Child Behaviors/Vulnerabilities•Hand-to-mouth behaviors of small children20 t /h f h dtth•20events/hrforhand-o-mou•1/10 of the product available in ft2•Size and shape of baits allow them to beSizeandshapeofbaitsallowthemtobeeasily handled by children•Placement of baits allow them to be easilyPlacementofbaitsallowthemtobeeasilyaccessed by children•Review of available exposure informationReviewofavailableexposureinformationfrom published literature and incidentdatabases•supports accessibility to childrensupportsaccessibilitytochildren3Incident Data•Data Sources•The American Association of Poison Control Centers(AAPCC) National Poison Data System (NPDS)(AAPCC)NationalPoisonDataSystem(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 ti l•TheCentersforDiseaseControlandPrevention/NationalInstitute for Occupational Safety and Health SentinelEvent Notification System for Occupational Risk (NIOSHSENSOR)•The California Pesticide Illness Surveillance Program(PISP)•Uncertainties•Market share•Reporting bias•Underreporting-4Overview of AAPCC•American Association of Poison Control Centers(AAPCC)•National scope•Able to summarize and organize information based ond t fi ld th t t ti ll d d b t i ddatafieldsthatare systematically recordedbytrainedpoison center professions•Clinically oriented•Over 1.5 million pesticide records•Annual reports•93% of the pesticide incidents reported occ rred in a~93%ofthepesticideincidentsreportedoccurredinaresidential setting5AAPCC Annual Report Analysis(1999-2009)Exposures to Children <6 years old per Pesticide Categoryin AAPCC from 1999-2009PesticideCategoryTotal Exposures# of Exposures toChildren <6 yearsold% Exposures toChildren <6 yearsoldRodenticides195,263 166,25085%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%6AAPCC Annual Report Analysis(1999-2009)•26% of all reported pesticide-relatedexposures to children under 6 years oldare due to rodenticide exposuresChild di i l•Children aredisproportionatelyexposed to rodenticides than othertypes of pesticides7AAPCC Annual Report Analysis(1999-2009)AAPCC Annual Report Rodenticide Incidents from 1999-2009150002000050001000001999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009sum of rodenticide exposuresrodenticide exposures tochildren <6 years oldNumber of rodenticide incidents with known exposures outcomes (includes none, minor, moderate,major, and death)number of rodenticide exposuresresulting in treatmentat a health care facility8AAPCC Annual Report Analysis(1999-2009)•EPA analyzed AAPCC annual report datad f d th tandfoundthat:•annual average of 17,000 exposures attributed toresidentialrodenticideuse•~ 85% (~15,000 per year) of these 17,000exposures occurred to children under 6 years oldover the 11year period analyzed.•~ 5000 annually treated in a health care facility25% f ll i idld i•~25%ofallpesticide-reatedcases seenin ahealth care facility were related to rodenticideexposures.9AAPCC NPDS Data Analysis(1999-2005)•Rodenticide exposure to children lessth 6 ldthan6years old:•~26% exposed children sought treatmentin a health care facility.•~1% of exposures to children result in amedical outcome (minor , moderate,major))•No deaths to children10AAPCC NPDS Data Analysis(1999-2005)•894 cases were symptomatic•Hematological effects were the mostcommonlyreported effects for major andp jmoderate cases•These effects are expected and consistentTheseeffectsareexpectedandconsistentwith anticoagulant rodenticide mode ofaction11Other Databases•IDS (1999-2009)•1522 incidents*1522incidents*•NPIC (2005-2010)•204 incidents* 2 suspected incidents*204incidents*,2suspectedincidents*•NIOSH SENSOR (1998-2006)•50 incidents*50incidents*•CA PISP (2004-2008)•16 incidents*16incidents*These incidents are inclusive of all age groupsTheseincidentsareinclusiveofallagegroups12Literature Review•Available literature suggests concern that accidental ingestionof anticoagulant rodenticides is occurringto children.•Literature based on analysis of AAPCC data•Shepherd et al. (2002) identified 10,762 cases of acute unintentionalb difit hild <6 ld f 19931996rocoum exposuresto children<6years oldfrom1993-•Mullins et al. (2000) identified 542 second generation anticoagulantrodenticides (SGAR) exposures to 2 year olds from Jan 1993 to Decd1994 anJan 1996 to Dec 1997•Kendrick (2006) reviewed records for 2004 , and found that 88%(14,229) of the exposures to SGARs were to children <6 years old•Caravati et al. (2007) identified 58,710 SGAR exposures involvingchildren <6 years old from 2000 to 200313Literature Review•Badakhset al (2010)etal(2010)•Louisiana Hospital Inpatient DischargeDatabase from 1998-2007Databasefrom1998•rodenticides were responsible for 6%(22) of cases(22)ofcases•children had a higher rate of rodenticideexposure than adultsexposurethanadults14Risk Mitigation•Childrens' Risk Mitigation•EPA is requiring that all rodenticide bait productsavailable for sale to consumers be sold only with baitstations. Loose bait such as pellets will be prohibited asstations.Loosebaitsuchaspelletswillbeprohibitedasa bait form.•Bait Station Requirements for Consumer-Use Products•Tamper-resistant for children•tested according to EPA protocols15Conclusions•Current label directions intended tokeep bait away from children are notfully effective at preventing exposuresto children.•EPA expects that the RMDproposalpp(to contain rodenticides in tamperresistant bait stations)will mitigategchild incidents involving rodenticides.16