Acute Illnesses and Injuries Related to Total Release Foggers — 10 States, 2007–2015
Authors: Ruiling Liu, Walter A. Alarcon, Geoffrey M. Calvert, Kathleen G. Aubin, John Beckman, Karen R. Cummings, Lucia S. Graham, Sheila A. Higgins, Prakash Mulay, Ketki Patel, Joanne B. Prado, Abby Schwartz, Derry Stover, Justin Waltz
Journal: MMWR Morbidity and Mortality Weekly Report (2018)

Total release foggers (TRFs) (also known as "bug bombs") are pesticide products often used indoors to kill insects.After an earlier report found that TRFs pose a risk for acute illness (1), the Environmental Protection Agency required improved labels on TRFs manufactured after September 2012 (2).To examine the early impact of relabeling, the magnitude and characteristics of acute TRF-related illness were evaluated for the period 2007-2015.A total of 3,222 TRF-related illnesses were identified in 10 participating states, based on three data sources: Sentinel Event Notification System for Occupational Risk-Pesticides (SENSOR) programs, the California Department of Pesticide Regulation (CDPR) program, and poison control centers (PCCs) in Florida, Texas, and Washington.No statistically significant decline in the overall TRF-illness incidence rate was found.Failure to vacate treated premises during application was the most commonly reported cause of exposure.To reduce TRF-related illness, integrated pest management strategies (3) need to be adopted, as well as better communication about the hazards and proper uses of TRFs.Redesigning TRFs to prevent sudden, unexpected activation might also be useful.Acute TRF-related illnesses were identified from the SENSOR programs in 10 participating states (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015),* CDPR † (2007-2014), and PCCs in Florida, Texas, and Washington (2007-2015).Complete PCC data were unavailable from the other seven states with SENSOR programs.Cases * Under the SENSOR-Pesticides program, CDC provides cooperative agreement funding and technical support to state health departments to conduct surveillance for acute, occupational, pesticide-related illness and injury.Funding support is also provided by the Environmental Protection Agency.In 2017, a total of 13 states participated in this program.Data were available for this study for the period 2007 -2013 in Oregon; in Oregon; 2007-2014 in California, Nebraska, and New York; and 2007-2015 in Florida, Louisiana, Michigan, North Carolina, Texas, and Washington.https://www.cdc.gov/niosh/topics/pesticides/overview.html.† In California, two programs identify cases of acute pesticide-related illness and injury; one is located at the California Department for Public Health (CDPH) and participates in the SENSOR program; the other is the Pesticide Illness Surveillance Program (PISP), administered by CDPR.PISP operates similarly to the SENSOR program, but the case definition and the variables used to characterize cases differ between the two programs (http://www.cdpr.ca.gov/ docs/whs/pisp.htm).Although PISP does not formally participate in the SENSOR program, both programs collaborate on joint activities.CDPH collects only work-related cases of acute pesticide-related illness and injury; PISP collects data for work-related and nonwork-related acute pesticide-related illness and injury.To ensure California cases were counted only once, CDPH cross-referenced its cases with those from PISP using name, date of illness and injury and, if available, Social Security number and date of birth.