title: Surveillance of paediatric exposures to liquid laundry detergent pods in Italy.
abstract: To analyse paediatric exposures to pod and traditional laundry detergents in Italy and changes in exposure trends.
  
  
  
  Analyses of a series of patients aged <5 years and exposed to laundry detergents between September 2010 and June 2015, identified by the National Poison Control in Milan.
  
  
  
  In comparison with patients exposed to traditional laundry detergents (n=1150), a higher proportion of those exposed to pods (n=1649) were managed in hospital (68% vs 42%), had clinical effects (75% vs 22%) and moderate/high severity outcomes (13% vs <1%). Exposure rates were stable over time for traditional detergents (average 0.65 cases/day), but an abrupt decline in major company pods was seen in December 2012, 4 months after the introduction of opaque outer packaging (from 1.03 to 0.36 cases/day and from 1.88 to 0.86 cases/million units sold). The odds of clinical effects was higher for exposure to pods than for traditional detergents (OR=10.8; 95% CI 9.0 to 12.9). Among patients exposed to pods, the odds of moderate/high severity outcomes was four times higher for children aged <1 years than for the other age groups (OR=3.9; 95% CI 2.2 to 7.0). Ten children exposed to laundry detergent pods had high severity outcomes while no children exposed to traditional laundry detergents developed high severity effects.
  
  
  
  The study confirms that exposure to laundry detergent pods is more dangerous than exposure to traditional detergents. In Italy, 4 months after the introduction of opaque outer packaging by a major company, product-specific exposure rates decreased sharply, suggesting that reducing visibility of laundry detergent pods may be an effective preventive measure. Further efforts are needed to improve safety.
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Settimi
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Giordano
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Lauria
authors.affiliation: National Poison Control Center in Milan, Niguarda Cà Granda Hospital, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Celentano
authors.affiliation: National Poison Control Center in Milan, Niguarda Cà Granda Hospital, Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sesana
authors.affiliation: National Poison Control Center in Milan, Niguarda Cà Granda Hospital, Milan, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Davanzo
mesh_terms: D000056:Accident Prevention; D000061:Accidents, Home / Q000517:prevention & control* / Q000706:statistics & numerical data*; D017028:Caregivers / Q000193:education; D002675:Child, Preschool; D003257:Consumer Product Safety / Q000331:legislation & jurisprudence / Q000592:standards; D003902:Detergents / Q000506:poisoning*; D004435:Eating; D004781:Environmental Exposure / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D007846:Laundering; D008297:Male; D011041:Poisoning / Q000517:prevention & control*; D011159:Population Surveillance; D019064:Product Packaging / Q000331:legislation & jurisprudence; D012189:Retrospective Studies
chemical_list: D003902:Detergents