Greenville, NC -- The Brody School of Medicine at East Carolina University, North Carolina Agromedicine Institute, and Eastern Area Health Education Center, supported by PERC-med (Pesticide Educational Resources Collaborative for Medical Professionals) and the Pesticide Environmental Trust Fund (PETF) have collaborated to provide free education and training continuing medical education (CMEs) for clinicians. This program, titled Farm Toxicology for Primary Care: Recognition and Management of Pesticide Poisonings, is a three part course on pesticide illnesses, diagnosis, treatment, long term effects, and clinical preparedness and surveillance. It contains medical information on the recognition of symptoms and medical management of pesticide poisoning and presents information on how to diagnose and treat pesticide illnesses, including those due to cholinesterase inhibiting pesticides. This course is designed for health care providers, including physicians, residents, physician assistants, community clinic staff, medical students, nurse practitioners, registered nurses and first responders. The course can be accessed through the PERC-med website.
William J. Meggs, MD, PhD, Professor, Division of Toxicology at the Brody School of Medicine at East Carolina University said, “Healthcare providers must be prepared to diagnose and treat every patient that comes their way. Practitioners in rural areas need to consider toxicants found on the farm in their differential diagnosis of acute and chronic illnesses. Farm Toxicology for Primary Care is an online education course that gives providers the tools needed to effectively recognize and manage farm-related pesticide exposures.”
The Eastern AHEC (Area Health Education Center) program provides and supports educational activities and services with a focus on primary care in rural communities and those with less access to resources to recruit, train, and retain the workforce needed to create a healthy North Carolina.
PERC-med is the Pesticide Educational Resources Collaborative for Medical Professionals, a 5-year cooperative agreement (#X-83935901) between the U.S. EPA's Office of Pesticide Programs and University of California Davis Extension, in collaboration with Oregon State University. PERC-med is an interdisciplinary team with a strong culture of collaboration. The project’s Advisory Board includes scholars in toxicology, nursing, public health, agricultural education, as well as practicing medical providers. The primary goal of this project is to widely promote and market pesticide-related health resources to medical providers across the U.S. to help them prevent, recognize and treat pesticide-related health conditions.
The North Carolina Agromedicine Institute is a University of North Carolina inter-institutional institute whose partners are East Carolina University, North Carolina State University, and North Carolina Agricultural and Technical State University. In addition to the university partners, the Institute relies heavily on its collaborative partnerships with the agricultural community, other universities, businesses, health care organizations, governmental agencies, and non-governmental organizations who are dedicated to identifying and addressing the health and safety risks of farmers, foresters, fishermen, their families and communities in North Carolina. The goal of the program is to reduce injury and illness by conducting research that leads to practical solutions and developing effective educational approaches that can be of benefit daily to the end user. Ultimately, the partnership wants farming, logging and fishing workplaces to be safe and healthy for all.
In 1993, the North Carolina General Assembly enacted legislation creating the Pesticide Environmental Trust Fund (PETF). The predominant purpose of the fund is for those pesticide-related environmental programs administered by North Carolina Department of Agriculture & Consumer Services (NCDA&CS). The authority to use this funding is "...as directed by the Board...", therefore, the NCDA&CS may utilize these funds for Departmental environmental programs, with oversight from the North Carolina Pesticide Board.
For more information or media inquiries, connect with PERC-med at:
Pesticide Education Programs
UC Davis Continuing and Professional Education
1333 Research Park Drive
Davis, CA 95618
Family medicine practitioners play a key role in preventing and mitigating the health effects of pesticide exposures. The COVID-19 pandemic has been accompanied by a sharp increase in the use of antimicrobial pesticides—disinfectants—as infection control measures surge.1,2 This upward trend highlighted the lack of consumer knowledge around common pesticide exposures and the potentially hazardous effects of such products deployed for disinfection purposes. It’s important that family medicine physicians are equipped to not only recognize signs of pesticide poisoning but also to help patients understand when and how they may be exposed to pesticides in everyday settings.
Pesticides are substances that are used to prevent, kill, and/or mitigate pests and are most often used to prevent illness in humans or damage to crops.3,4 There are hundreds of pesticide active ingredients incorporated into an enormous number of readily available products. Pesticides include insecticides, herbicides, fungicides, rodenticides, molluscicides, nematicides, and others.5 While pesticides are effective because they disrupt biological processes in the targeted pests, they can lack high selectivity, making them potentially hazardous for humans.3,4
Pesticides can pose health risks to humans through mechanisms of impairing biochemical targets. Targets include enzymes such as acetylcholinesterase (AChE) and cytochrome c reductase, ion channels, and receptors.3 For instance, organophosphorus pesticides are often neurotoxic because of their inhibition of AChE in neuromuscular junctions and other areas of the central nervous system.6,7 Similarly, organochlorine pesticides are toxic because of enzyme inhibition and effects on metabolism and transcription.8 Pesticide type; exposure amount, route, and duration; and the susceptibility of the exposed individual affect health outcomes.7
Given the non-specific symptoms associated with pesticide poisoning, it is important physicians have accurate patient information to assess relevant risk. A pesticide exposure scenario can occur at home, at work, or through hobbies. Recognition and Management of Pesticide Poisonings provides a comprehensive guide to aid clinicians. Family medicine clinicians may consider advising patients who spend time around pesticides—such as gardeners or golfers—how to reduce exposure. Similarly, clinicians in areas known to have higher pesticide usage rates may consider incorporating pesticide exposure prevention education into routine clinical care.
There are an enormous number of pesticide products on the market ranging from pet flea collars and common household disinfectant wipes to garden-ready herbicides and sprays used across agricultural lands. There are inherent health risks associated with such products. Family medicine physicians[KM1] who are knowledgeable about the vast array of products and can identify active ingredients may be able to more readily identify pesticide-related health conditions. Screening for both acute and chronic exposure provides concrete information for reducing health risks. Screenings could include questions about occupation and hobbies, as well as common household products.
With known or suspected exposure, treatment is the clear priority. While pesticide reporting requirements for physicians providers[KM2] vary across the country, reporting is mandatory in over 60% of states. Learn about requirements in your state of practice here.
Poison Control Center data shows over 35,000 calls related to pesticide exposure concerns for children ≤5 years old in 2018. Most serious acute poisonings occur after unintentional ingestion, although poisoning may also follow inhalational exposure or significant dermal exposure, such as in drift events. Misuse, such as violating label instructions, may also lead to overexposure. It is well recognized that pesticide poisonings are likely to be underreported because of difficulty with diagnosis, incomplete reporting and symptoms not being recognized as a poisoning. High-risk children may include those who:
Pesticides are toxic by design. Insecticides and rodenticides are most commonly associated with acute pediatric poisoning. Warfarin-type rodenticides are also a significant ingestion risk for young children. Many insecticide chemical classes designed to be neurotoxic for insects have been shown to be neurotoxic in humans, such as the cholinesterase-inhibiting organophosphate and carbamate insecticides and the pyrethroids. Toxicity varies by the active ingredient(s) and formulation.
Many signs and symptoms related to acute pesticide exposure are nonspecific and resemble other common childhood illnesses. Diagnosis depends on identifying an exposure and determining that the exposure scenario was likely to lead to significant uptake and the signs and symptoms experienced.
Determine if the child might have been exposed to pesticides in suspected illness events.
Determine if the pesticide of concern is associated with the signs and symptoms. The EPA’s Recognition and Management of Pesticide Poisonings offers a comprehensive online Index of Signs and Symptoms organized by pesticide class.
Linkage of signs and symptoms to pesticide exposure, further workup, and poisoning management may require specialist consultation. For poisoning management, contact the Poison Control Center (800-222-1222). The regional Pediatric Environmental Health Specialty Units (PEHSU) programs can provide consultation for subacute concerns, post-acute phase questions, or assistance in determining pesticide active ingredients and potential toxicity.
Cholinesterase testing may be useful for guiding the early treatment of suspected organophosphate and carbamate poisoning. Preserved urine or clothing samples may be useful for future analysis as evidence of exposure or to assist in public health investigations. Samples should be obtained as soon as possible as many pesticides metabolize quickly.
Clinician reporting of suspected pesticide-related illnesses is required by law in many states. Regardless, clinicians should notify the local or state public health department or state pesticide regulatory agency if the exposure source may present a hazard to others or if help is desired in identifying an environmental exposure source. State-specific reporting requirements can be found at PERC-med.
Download Acute Pediatric Pesticide Poisoning Resource
Download Chronic Pediatric Pesticide Poisoning Resource
The Pesticide Educational Resources Collaborative – Medical is a cooperative agreement (agreement #X-83935901) between the U.S. EPA's Office of Pesticide Programs and University of California Davis Extension, in collaboration with Oregon State University.
Adapted from material originally supported by the American Academy of Pediatrics (AAP) and funded (in part) by the cooperative agreement award number 5 NU61TS000296-02-00 from the Agency for Toxic Substances and Disease Registry (ATSDR). The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing partial funding to ATSDR under Inter-Agency Agreement number DW-75-95877701. Neither EPA nor ATSDR endorse the purchase of any commercial products or services mentioned in PEHSU publications.
Davis, California -- A free course to train health professionals to recognize, treat and report pesticide poisoning and illnesses in California has been expanded to provide information on reporting requirements throughout the nation.
The California Office of Environmental Health Hazard Assessment (OEHHA) has joined forces with the Pesticide Educational Resources Collaborative for Medical Professionals (PERC-med) to expand the reach of the 60-minute online course. The continuing medical education (CME) program, titled Recognition, Management and Reporting of Pesticide Illness, provides medical information on the recognition and management of symptoms of pesticide poisoning. It also presents information on how to diagnose and treat pesticide illnesses, including those due to cholinesterase-inhibiting pesticides.
The original course, designed by OEHHA for health care providers in California, contained information on reporting requirements of pesticide illnesses in the state. A national module created by PERC-med has been added to the course.
With the addition of this new module, providers across the United States will find information on reporting pesticide illnesses in their specific state. The information is designed to be useful to hospitals, physicians, nurses, physician assistants, health centers, medical students, and first responders.
The course can be accessed through the PERC-med website at pesticideresources.org/med/resources/training.html or through the OEHHA website at oehha.ca.gov/pesticides/education-and-training.
"The addition of the reporting module extends the reach of this course to a national audience," said Dr. Ouahiba Laribi of OEHHA, CalEPA, and the PERC-med Advisory Board. "The national expansion ensures a comprehensive training for health-care providers, with health benefits for all US residents, especially people in agricultural areas."
OEHHA works to protect human health from the toxic effects of pesticides, including:
Visit OEHHA online at oehha.ca.gov/pesticides or on LinkedIn at linkedin.com/company/office-of-environmental-health-hazard-assessment/.
PERC-med's goal is to raise awareness among health care providers by making it easier for them to:
Davis, California -- PERC-med appointed David Vearrier, MD, MPH to its Advisory Board. Dr. Vearrier is Professor of Emergency Medicine and Preventive Medicine at the University of Mississippi Medical Center; Adjunct Associate Professor of Emergency Medicine at the Perelman School of Medicine at the University of Pennsylvania; and Associate Professor of Emergency Medicine, and was Medical Toxicology Associate Fellowship Director at Drexel University College of Medicine. PERC-med is the Pesticide Educational Resources Collaborative for Medical Professionals, a 5-year cooperative agreement (#X-83935901) between the U.S. EPA's Office of Pesticide Programs and University of California Davis Extension, in collaboration with Oregon State University. The primary goal of this project is to widely promote and market pesticide-related health resources to medical providers across the U.S. to help them prevent, recognize and treat pesticide-related health conditions.
Diana Simmes, MPH, Pesticide Medical Education Director at UC Davis said, "Dr. Vearrier's expertise in emergency medicine and medical toxicology positions him to advance healthcare providers' knowledge of pesticide-related conditions. His professional relationships and educational roles, along with his credentials, will ensure that more clinicians are trained on recognizing, treating and preventing these illnesses and injuries," she added.
"Pesticide spans many medical subspecialties -- public health, emergency medicine, preventive medicine, and toxicology," said Dr. Vearrier. "PERC-med's mission and mine are aligned -- teaching clinicians to recognize, treat and prevent pesticide illnesses and injuries."
Dr. Vearrier has published over 70 peer-reviewed publications; led as site principal investigator in several funded grants including those from the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and the Federal Drug Administration (FDA); and has written seven book chapters. He is board certified in medical toxicology, occupational medicine, and emergency medicine. He is Chair of the Occupational and Environmental Toxicology Section of the American Academy of Clinical Toxicology; and is a member of the the American College of Occupational and Environmental Medicine, the American College of Medical Toxicology, and the American Academy of Emergency Medicine.
Dr. Vearrier received his Bachelor of Arts from the University of California Berkeley and his Doctor of Medicine from University of California San Diego. He completed his Residency in Emergency Medicine at Drexel University College of Medicine, his Fellowship in Medical Toxicology in the Department of Emergency Medicine at Drexel University College of Medicine, and completed his Residency in Occupational Medicine from Perelman School of Medicine at the University of Pennsylvania. Dr. Vearrier also received his Master of Public Health from Drexel University.
Dr. Vearrier joins other members of the PERC-med Advisory Board, including:
Davis, California -- PERC-med appointed Michael Yeh, MD to its Advisory Board, effective immediately. Board-certified in both emergency medicine and internal medicine, Dr. Yeh is finishing his medical toxicology fellowship at Emory University and the Centers for Disease Control and Prevention (CDC). PERC-med is the Pesticide Educational Resources Collaborative for Medical Professionals, a 5-year cooperative agreement (#X-83935901) between the U.S. EPA's Office of Pesticide Programs and University of California Davis Extension, in collaboration with Oregon State University. The primary goal of this project is to widely promote and market pesticide-related health resources to medical providers across the U.S. to help them prevent, recognize, and treat pesticide-related health conditions.
Diana Simmes, MPH, Pesticide Medical Education Director at UC Davis said, "Dr. Yeh's focus on medical toxicology and emergency medicine complements PERC-med's work." She continued, "His medical toxicology work with the CDC and Emory enhances our mission to provide clinicians with practical, timely, science-based resources on pesticide-related illnesses."
"The important work that PERC-med is doing coordinates perfectly with my medical toxicology interests," said Dr. Yeh. "Working in the field, researching, and educating clinicians are my passions. Collaborating with PERC-med enables me to further those goals."
Dr. Yeh received his Doctor of Medicine and his Master of Science in Epidemiology degrees from State University of New York at Buffalo; his Master of Science in Journalism from Columbia University; and his Bachelor of Science in Biology from SUNY at Stony Brook. Dr. Yeh completed his emergency medicine/internal medicine residencies at Allegheny General Hospital in Pittsburgh, Pennsylvania.
Dr. Yeh currently resides in Atlanta, Georgia. He joins other members of the PERC-med Advisory Board, including:
Davis, California -- PERC-med appointed James Russell Roberts, MD, MPH to its Advisory Board. A board-certified pediatrician, Dr. Roberts is a Professor of Pediatrics with Tenure at the Medical University of South Carolina. PERC-med is the Pesticide Educational Resources Collaborative for Medical Professionals, a five-year cooperative agreement (#X-83935901) between the U.S. EPA's Office of Pesticide Programs and University of California Davis Extension, in collaboration with Oregon State University. The primary goal of this project is to widely promote and market pesticide-related health resources to medical providers across the U.S. to help them prevent, recognize and treat pesticide-related health conditions.
Diana Simmes, MPH, Pesticide Medical Education Director at UC Davis said, "Dr. Roberts has significantly contributed to the field as co-author of the most authoritative reference on pesticide poisonings -- Recognition and Management of Pesticide Poisoning." She continued, "His work with the EPA and the Children's Environmental Health Network -- plus his dedication to pediatrics, environmental health and public health -- makes him a great resource for PERC-med and our mission to educate clinicians on pesticide-related illnesses."
"I am honored to join the Advisory Board at PERC-med," said Dr. Roberts. "My passion for educating healthcare practitioners on pesticide-related illnesses aligns perfectly with PERC-med's vision. By working with this diverse group of environmental, healthcare and scientific professionals, I hope to bring awareness to this medical and environmental issue."
Dr. Roberts has published over 50 peer-reviewed publications, received 20 grants, and has written seven chapters and six books. He is a member of the American Academy of Pediatrics, the Academic Pediatric Association and the American Academy of Clinical Toxicology.
Dr. Roberts received his Bachelor of Science in Biology from McMurry College in Abilene, Texas; and his Doctor of Medicine from Texas Tech University Health Sciences Center in Lubbock, Texas. He completed his Pediatric Internship and Residency at the Medical College of Georgia in Augusta, Georgia; and was a General Academic Pediatrics Fellow at the University of Alabama at Birmingham School of Medicine in Birmingham, Alabama. Dr. Roberts also received his Master of Public Health in Maternal and Child Health at the University of Alabama at Birmingham School of Public Health in Birmingham, Alabama.
Dr. Roberts currently resides in Charleston, South Carolina. He joins other members of the PERC-med Advisory Board, including:
A pesticide is any substance or mixture of substances intended for preventing, destroying, or mitigating any pest. Children and pregnant women are uniquely vulnerable to toxic effects from exposure to pesticides. Some of the widely used pesticides of concern in the United States include the herbicide glyphosate, organophosphate insecticides (e.g., chlorpyrifos, malathion), carbamate insecticides (e.g., carbaryl, propoxur), neonicotinoid insecticides (e.g., imidacloprid, thiamethoxam), and pyrethroid insecticides (e.g., permethrin, cypermethrin). Chronic or repeated low-dose exposures are common. There is growing evidence on the relationship between this non-acute pesticide exposure in early life and adverse neurocognitive and neurobehavioral outcomes (ADHD, autism) in children. Additional associated morbidities include cancer (brain tumors, leukemia) and adverse birth outcomes (reduced intrauterine growth, preterm birth, congenital anomalies, fetal death).
Read full article here.
Poison Control Center data shows over 35,000 calls related to pesticide exposure concerns for children ≤ 5 years old (2018). Most serious acute poisonings occur after unintentional ingestion, although poisoning may also follow inhalational exposure (particularly from fumigants) and/or significant dermal exposure, such as in drift events. Misuse, such as violating label instructions, may also lead to overexposure. It is well recognized that pesticide poisonings are likely to be underreported because of difficulty with diagnosis, incomplete reporting and symptoms not being recognized as a poisoning.
Read full article here.
You may be surprised to learn that many infection control products commonly used in healthcare are actually pesticides.
More specifically, they are antimicrobial pesticides. Antimicrobial pesticides are essential public health tools because we use them in hospitals, schools, bathrooms and food preparation areas to prevent the spread of germs that can cause disease. So, what exactly constitutes a pesticide? A pesticide is defined as any substance or mixture of substances intended for preventing, destroying, repelling, or mitigating any pest. Microorganisms, bacteria and viruses are included in the definition of pests. Pesticides help protect our food, water, and health. However, there are always risks related to their use.
Given global challenges with the COVID-19 pandemic, an increasing number of antimicrobial pesticides are being used to help control the spread of the novel coronavirus, SARS-CoV-2, that causes COVID-19. Since the emergence of COVID-19, the demand for antimicrobial pesticides has risen sharply. A recent CDC Morbidity and Mortality Weekly Report, found that U.S. poison centers received an increase in calls (45,550) related to exposure to cleaners (28,158) and disinfectants (17,392) from January–March 2020, compared to January–March 2019 (37,822) and January–March 2018 (39,122). Although this data does not provide a definite link between exposures and COVID-19 related cleaning activity, a clear temporal association can be seen (Chang, 2020).
Read full article here.
To arrange an interview with an expert on pesticides and pesticide-related illnesses, contact us at PERC-MedSupport@ucdavis.edu. Our experts can speak about pesticides, pesticide-related illnesses, toxicology, occupational health, environmental health, pediatrics, agromedicine, and public health.