title: Magnitude and characteristics of acute paraquat- and diquat-related illnesses in the US: 1998-2013.
abstract: BACKGROUND
  Paraquat and diquat are among the most commonly used herbicides in the world.
  
  
  OBJECTIVE
  Determine the magnitude, characteristics, and root causes for acute paraquat- and diquat-related illnesses in the US METHODS: Illnesses associated with paraquat or diquat exposure occurring from 1998 through 2011 were identified from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program, the California Department of Pesticide Regulation (CDPR) Pesticide Illness Surveillance Program (PISP), and the Incident Data System (IDS). Cases identified by the National Poison Data System (NPDS) were reviewed for the years 1998-2003 and 2006-2013.
  
  
  RESULTS
  A total of 300 paraquat- and 144 diquat-related acute illnesses were identified by SENSOR, PISP, and IDS. NPDS identified 693 paraquat- and 2128 diquat-related acute illnesses. In SENSOR/PISP/IDS, illnesses were commonly low severity (paraquat=41%; diquat=81%); however, SENSOR/PISP/IDS identified 24 deaths caused by paraquat and 5 deaths associated with diquat. Nineteen paraquat-related deaths were due to ingestion, seven of which were unintentional, often due to improper storage in beverage bottles. In SENSOR/PISP/IDS, paraquat and diquat-related acute illnesses were work-related in 68% (n=203) and 29% (n=42) of cases, respectively. When herbicide application site was known, the vast majority of acute paraquat-related illnesses (81%) arose from agricultural applications. Common root causes of illness were failure to use adequate personal protective equipment (PPE), application equipment failure, and spill/splash of herbicide.
  
  
  CONCLUSIONS
  Although the magnitude of acute paraquat/diquat-related illnesses was relatively low, several fatalities were identified. Many illnesses could be prevented through stricter compliance with label requirements (e.g. ensuring proper herbicide storage and PPE use), and through enhanced training of certified applicators.
authors.affiliation: Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA.
authors.forename: Gamola Z
authors.initials: GZ
authors.lastname: Fortenberry
authors.affiliation: Public Health Institute, Oakland, CA, USA; California Department of Public Health, Richmond, CA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Beckman
authors.affiliation: Michigan Department of Health and Human Services, Lansing, MI, USA.
authors.forename: Abby
authors.initials: A
authors.lastname: Schwartz
authors.affiliation: Washington State Department of Health, Olympia, WA, USA.
authors.forename: Joanne Bonnar
authors.initials: JB
authors.lastname: Prado
authors.affiliation: California Department of Pesticide Regulation, Sacramento, CA, USA.
authors.forename: Lucia S
authors.initials: LS
authors.lastname: Graham
authors.affiliation: North Carolina Department of Health and Human Services, Raleigh, NC, USA.
authors.forename: Sheila
authors.initials: S
authors.lastname: Higgins
authors.affiliation: Louisiana Department of Health and Hospitals, New Orleans, LA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lackovic
authors.affiliation: Florida Department of Health, Tallahassee, FL, USA.
authors.forename: Prakash
authors.initials: P
authors.lastname: Mulay
authors.affiliation: Texas Department of State Health Services, Austin, TX, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Bojes
authors.affiliation: Oregon Health Authority, Portland, OR, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Waltz
authors.affiliation: New York State Department of Health, Albany, NY, USA.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Mitchell
authors.affiliation: Iowa Department of Public Health, Des Moines, IA, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Leinenkugel
authors.affiliation: California Department of Pesticide Regulation, Sacramento, CA, USA.
authors.forename: Michel S
authors.initials: MS
authors.lastname: Oriel
authors.affiliation: Office of Pesticide Programs, United States Environmental Protection Agency, Washington, D.C., USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Evans
authors.affiliation: Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA. Electronic address: jac6@cdc.gov.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Calvert
mesh_terms: D000062:Accidents, Occupational; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004178:Diquat / Q000506:poisoning*; D004781:Environmental Exposure; D005260:Female; D006540:Herbicides / Q000506:poisoning*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D010269:Paraquat / Q000506:poisoning*; D014481:United States; D055815:Young Adult
chemical_list: D006540:Herbicides; D004178:Diquat; D010269:Paraquat
keywords: Acute Poisonings; Diquat; Paraquat; Pesticides; Surveillance