Epidemiologic Notes and Reports Organophosphate Insecticide
Poisoning Among Siblings -- Mississippi
On August 6, 1984, the Mississippi State Department of Health
was
informed of the death of an 11-year-old girl from Tunica County,
Mississippi, and the hospitalization of her six siblings. The
initial
clinical diagnosis for the seven children was organophosphate
poisoning. Neither the children's mother nor her live-in male
companion was ill. Following is a summary of the State Department
of
Health's investigation.
On August 2, five of the seven children had visited a local
physician complaining of abdominal pain of 2 days' duration. One
child also had fever and diarrhea. The physician diagnosed viral
gastroenteritis and suggested fluids and rest. There was no
improvement during the next day, and on the morning of August 4,
three
children did not respond to vocal sounds, and the others were
obviously ill.
Later that day, all seven children presented to a Memphis,
Tennessee, hospital with signs and symptoms of organophosphate
poisoning. Two were in respiratory arrest, and the other five had
various degrees of lethargy, increased salivation, increased
respiratory secretions, and pinpoint pupils. All the children had
depressed serum and erythrocyte cholinesterase levels (Table 1).
One
child could not be resuscitated and died. Preliminary autopsy
findings were consistent with organophosphate poisoning and
suggested
ingestion as a primary route of exposure. A second child died
August
9, and the other five children recovered and were discharged. A
survey of local physicians and emergency rooms revealed no other
similar cases.
Because both adults in the household and a nearby adult
neighbor
were clinically well, it was felt that the source of poisoning was
confined to the children's household. The male live-in companion
reported having sprayed the inside of the house July 26 with a
solution of insecticide in an attempt to control spiders. He had
obtained a nearly empty insecticide container from the farm where
he
worked and had added water to it. He reported using a hand sprayer
to
spray the solution on the inside upper walls of three of the four
rooms (excluding the kitchen) in the house. He reported no
subsequent
spraying, but the sprayer, still partly filled, was found on the
back
porch of the house the day after the children became ill. The
house
had no running water, and drinking water was obtained from the
nearby
neighbor's well and stored in an open ice chest. Therefore,
contamination of the drinking water was considered a strong
possibility for exposure.
Samples of insecticide solution from the sprayer, water,
prepared
food, other liquids, and indoor and outdoor air were obtained
(Table
2). The sprayer solution contained the organophosphate insecticide
methyl parathion ((CH((3))O)((2))-PS-O-C((6))H((3))(NO((2)))Cl) in
a
concentration nearly three times that used for outdoor agricultural
spraying. The drinking water in the house contained methyl
parathion
in a concentration above the suggested no adverse response level
(SNARL); water from the well was negative for methyl parathion.
The
air inside the house contained over 100 times the concentration of
methyl parathion measured in the air in the same locality during
the
spraying season (2); the air on the porch contained only
one-seventh
the amount found inside.
Food histories showed that, since the visit to the doctor
August
2, the children had eaten primarily canned soups cooked with water
and
drunk liquids prepared with the household drinking water. In
contrast, the adults apparently ate other foods (e.g., catfish) and
drank more bottled soda. Samples of blood and urine from the
adults
were analyzed for evidence of exposure to organophosphate compounds
and compared with those of the children (Table 1). The higher
levels
of exposure among the children are evident, although the adults
were
sampled several days later.
It seems likely that the seven siblings were exposed to methyl
parathion by multiple routes, primarily ingestion, inhalation, and
possibly surface contact via contaminated clothing. The absence of
clinical illness in the two adults in the household may reflect
lower
levels of exposure due in part to different food intake. The 8-day
delay between the reported spraying and the manifestation of
classic
symptoms of organophosphate poisoning is not explained. Efforts
are
under way to decontaminate the house and to reemphasize to the
public
the danger of organophosphate insecticides used inappropriately.
Reported by A Dean, J Pugh, Tunica County Health Dept, K Embrey,
District I Health Office, J Cain, MS, L Lane, PhD, Mississippi
State
Chemical Laboratory, B Brackin, MPH, FE Thompson, Jr, MD, State
Epidemiologist, Mississippi State Dept of Health; Div of Field
Svcs,
Epidemiology Program Office, CDC.
References
U.S. Environmental Protection Agency. Advisory opinions for
toxic
chemicals in drinking water. Criteria and Standards Division,
U.S. Environmental Protection Agency, January 19, 1979.
Mississippi State Chemical Laboratory. Mississippi
Epidemiologic
Studies Program, Annual Report No. 9, Mississippi State
University, Starkville, Mississippi, 1976.
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