"Published Occasionally at Irregular Intervals"
~ Dr.
Arthur L. Craigmill ~
Extension
Toxicologist
Lead Poisoning from Ingestion of a Toy Necklace
~~TOXICOLOGY TIDBITS ~~
New Surgeon General's Report Expands List of Smoking-Related Diseases
Recent Health Warnings from the California Department of Health Services:
West Nile Virus has Spread to 48 of California's 58 Counties
State Health Department Advises Consumers About Lead in Seasonings Imported from Mexico
Although ingestion of dust from lead-based paint
is the most common
source of lead exposure among children in the United States,
lead also can be present in unsuspected objects. Ingestion of these
objects can result in elevated blood lead levels (BLLs). This report
describes an investigation by the Deschutes County Health Department
and the Oregon Department of Human Services of lead poisoning in a boy
who swallowed a medallion pendant from a necklace sold in a toy vending
machine. The investigation resulted in a nationwide recall in September
2003 of
the implicated toy necklace.
In July 2003, a boy aged 4 years was taken to a physician in Oregon after several days of abdominal cramping, vomiting, and diarrhea without fever. His symptoms resolved until 1-2 weeks later when he had another bout of vomiting and abdominal pain. He was returned to his physician, and his condition was diagnosed as probable viral syndrome and anemia of undetermined etiology. Two days later he was brought to the emergency department with worsening symptoms, including constipation and inability to eat or sleep because of his abdominal pain. An abdominal radiograph showed a metallic object in the stomach with no evidence of obstruction. Initially, the object was believed likely to pass on its own; however, on the next day, an abdominal computerized tomography showed the object more superiorly located. Endoscopy was performed, resulting in retrieval of a medallion pendant (along with a quarter) from the boy's stomach.
Three days later, the boy returned with edema of the left cheek and gingiva, suggesting either a dental abscess or excessive biting of the cheek. Concern that the cheek bite might have been caused by a seizure prompted testing of his BLL. The boy was admitted to the pediatric intensive care unit for intravenous chelation therapy. Subsequently, neurodevelopmental, cognitive, and speech therapy evaluations of the boy all showed appropriate development.
An environmental investigation of the boy's home, which was built in 1996, did not reveal any additional sources of lead exposure. A sibling, aged 6 years, had a BLL of <5 µg/dL.
The medallion retrieved from the boy's stomach was reportedly purchased from a toy vending machine in Oregon, approximately 3 weeks before it was retrieved. The state environmental quality lab found the medallion's contents to be 38.8% lead (388,000 mg/kg), 3.6% antimony, and 0.5% tin. Similar medallions purchased from toy vending machines in other areas of Oregon were found to have similar high proportions of lead (44% and 37%). These medallions are round, measuring approximately 7/8 of an inch in diameter, gray in color, with a symbol on one side. State health officials notified the U.S. Consumer Product Safety Commission; a national voluntary recall was announced on September 10, 2003, of approximately 1.4 million of the metal toy necklaces. A distributor of the medallions reported that they had been manufactured in India and distributed throughout the United States. Oregon health officials cautioned that more of the medallions might still be sold in vending machines in the state.
New Hampshire. A woman aged 37 years with rheumatoid arthritis visited an emergency department (ED) with diffuse abdominal pain, nausea, and vomiting of 6 days' duration. Her blood lead level (BLL) was 81 µg/dL (geometric mean BLL = 1.75 µg/dL for U.S. population aged >20 years), and her zinc protoporphyrin (ZPP) concentration was 286 µg/dL (normal: <35 µg/dL). She reported ingesting five different traditional medications (two powders and three tablets) obtained from an ayurvedic physician in India for her rheumatoid arthritis. Analysis of the two powders revealed 17,000 and 12,000 parts per million (ppm) lead, respectively, and 60-100 ppm lead in the three tablets. She began oral chelation therapy; 1 week after completion, her BLL was 35 µg/dL. Her two children, aged 6 and 7 years, had BLLs of 5 and 3 µg/dL, respectively. Two years later, the woman reported to her physician with joint symptoms from rheumatoid arthritis and was found to have microcytic anemia and a BLL of 64 µg/dL. She reported restarting ayurvedic medications 2 weeks previously. She agreed to stop taking the medications, and her physician decided against chelation therapy.
California. A woman aged 31 years visited an ED with nausea, vomiting, and lower abdominal pain 2 weeks after a spontaneous abortion. One week later, she was hospitalized for severe, persistent microcytic anemia. A heavy metals screen revealed a BLL of 112 µg/dL; a repeat BLL 10 days later was 71 µg/dL, before initiation of oral chelation therapy. A ZPP measurement performed at that time was >400 µg/dL. Her husband's BLL was 6 µg/dL. No residential or occupational lead sources were identified, but the woman reported taking nine different ayurvedic medications prescribed by a practitioner in India for fertility during a 2-month period, including one pill four times daily. She discontinued the medications after an abnormal fetal ultrasound 1 month before her initial BLL. Analysis of her medications revealed 73,900 ppm lead in the pill taken four times daily and 21, 65, and 285 ppm lead in three other remedies. Her BLL was 22 µg/dL when she was tested 9.5 months after the initial BLL testing.
A man aged 34 years was evaluated twice in an ED for back pain and abdominal pain. A screen for heavy metals revealed a BLL of 80 µg/dL. He was hospitalized for chelation therapy and disclosed that he had been taking ayurvedic medications prescribed by a practitioner in India to increase fertility. He had discontinued use the previous day. The 10 preparations included pills, powders, and syrups, most of which were not labeled. He had taken one type of tablet once daily for 3 months; samples of one of these tablets contained 78,000 ppm lead. A second variety of pill contained 36 ppm lead. A home investigation revealed no other sources of lead. His BLL was 17 µg/dL when tested 7.5 months after the initial BLL test.
Massachusetts, New York, and Texas. Nine additional cases were reported from Massachusetts, New York, and Texas. The median age of patients was 52 years; five patients were female. The five women were taking the medications for arthritis (one), menstrual health (one), and diabetes (three). The four men were taking the medications for arthritis (one) and diabetes (three).
EDITORIAL NOTE: Although the majority of cases of lead poisoning in adults result from occupational exposures, use of traditional or folk medications also can cause lead poisoning. In the United States, lead exposure in adults has decreased substantially during the preceding two decades because of removal of lead from gasoline and regulation of lead exposure in the workplace. Nevertheless, 10,658 cases of BLLs >25 µg/dL in adults (aged >16 years) were reported from the 35 states that provided data to the program in 2002. Certain traditional or folk medications used in East Indian, Indian, Middle Eastern, West Asian, and Hispanic cultures contain lead and other adulterants. In this report, the majority of persons affected were of Asian Indian or other East Indian descent. Several ayurvedic and other traditional medications do not contain lead; however, lead content has ranged from 0.4 to 261,200 ppm in certain common ayurvedic preparations. Certain branches of ayurvedic medicine consider heavy metals to be therapeutic and encourage their use in the treatment of certain ailments.Symptoms of lead toxicity in adults often vary and are nonspecific; these include abdominal pain, fatigue, decreased libido, headache, irritability, arthralgias, myalgias, and neurologic dysfunction ranging from subtle neurocognitive deficits to a predominantly motor peripheral neuropathy to encephalopathy. The number and severity of symptoms typically increase as BLLs increase; however, the toxic effects of lead can occur without overt symptoms. Primary management of lead toxicity is source identification and exposure cessation. In adults, chelation therapy usually is reserved for patients with substantial symptoms or signs of lead toxicity or BLLs of >80 µg/dL.
Culturally appropriate educational efforts are needed to inform persons of the potential health risks posed by these remedies, particularly in populations in which traditional or folk medication use is prevalent. For remedies known to contain lead or to be possibly adulterated with lead, educational materials should state the potential health effects. Young children and fetuses of pregnant women are at added risk for the toxic effects of lead, particularly because of the use of these products to treat infertility in women.
REF: MMWR, July 9, 2004 / 53(26);582-584 In July 2002, the patient's lead exposure was
first identified when a routine lead screening at age 12 months
revealed a BLL of 15 µg/dL, which exceeds CDC's level of
concern (>10 µg/dL). Follow-up at age 15 months
documented a BLL of 18 µg/dL. The child's pediatrician
provided guidance to the child's parents on lead hazards. A private
environmental testing company confirmed the absence of lead-based paint
in the family's home by using x-ray fluorescence. However, at age 18
months, the child's BLL increased to 23 µg/dL. In
February 2003, LPPP completed a comprehensive investigation of the
child's home and assessed the child's routine daily activities and
physical environment and found no lead paint hazards, although concern
was raised by an LPPP investigator about the ceramic dinnerware used
regularly by the child. A home lead test was conducted by the
family and revealed that the ceramic dinnerware was positive
for lead.
In March 2003, the child was referred to Mount Sinai PEHSU for a secondary evaluation. A plate from the dinnerware also was submitted for evaluation, and PEHSU requested assistance from the Food and Drug Administration (FDA) to test the plate. The sample plate appeared to be in good condition and had no visible cracks or signs of wear. The plate was tested for lead by using an FDA protocol, whereby lead is extracted from the food contact surface. The ceramic plate released 29.6 µg/mL of lead into the leaching solution, a level exceeding the FDA compliance guideline of <3 µg/mL.
The child was home full time and consumed all
meals and beverages
using the dinnerware. Because of concerns about lead exposure to other
family members, BLLs of the child's mother and grandmother also were
assessed. Results for both were <5 µg/dL,
substantially lower than the child's BLLs. The family was advised to
discontinue use of the dinnerware. On follow-up at age 23 months, the
child's BLL had decreased to 8 µg/dL.
The particular brand of dinnerware identified in
this investigation
is no longer sold in the United States. However, plates of this brand
are available online and might still be available for sale in discount
stores, flea markets, and online auctions. Additional tests will be
conducted on plates from the same manufacturer to determine the extent
of the problem. A complete listing of dinnerware that has been
restricted for importation into the United States is available at http://www.fda.gov/ora/fiars/ora_import_ia5208.html.
Lead can leach out of ceramic ware when the glaze
is improperly
fired or when the glaze has broken down because of wear from daily
usage, particularly after repeated use in a microwave or dishwasher.
Chips and cracks in ceramic ware also allow leaching of lead. When lead
is released into food and drink from ceramics, hazardous levels can
contaminate food substances and expose children and adults to toxic
levels. Children's risk for such exposures is compounded by their
diets, especially their frequent consumption of acidic juices (e.g.,
orange and apple juices) that promote leaching of lead from ceramics.
REF: MMWR, July 9, 2004, 53(26).
During investigations relating to review of a petition for the use of irradiation in certain foods, FDA scientists identified the substance furan in a number of foods that undergo heat treatment, such as canned and jarred foods. The presence of furan is a potential concern because, based on high-dose animal tests, furan is considered possibly carcinogenic to humans.
What consumers should understandConsumers should not view the furan
levels as an
indicator of furan exposure, or as the "risk" of eating certain
foods.
First, furan
levels alone do not equate to furan exposure; calculating exposure
requires consideration of both furan levels, and the amounts of food
that consumers
eat. Second, estimates of furan exposure take into account not single
food items, but the wide variety of foods found in a range of diets.
Third,
the scope of data is too limited to properly consider
potential sources of variation in measured furan levels, such as
variability between
different units or lots of food and the effect of consumer cooking
practices on furan levels.
Data from 5,209 inspections of spas were collected from the Florida Department of Health, Bureau of Water Programs (n = 4,463); the Los Angeles County Recreational Water Program, California (n = 588); the City of St. Paul Office of License, Inspections, and Environmental Protection, Minnesota (n = 53); the Wyoming Department of Agriculture (n = 49); the Allegheny County Department of Health, Pennsylvania (n = 35); and the St. Louis County Department of Public Health, Minnesota (n = 21). The sites selected were a convenience sample of spa inspection programs with computerized data available. The data were merged into a database, including date of inspection, water chemistry data (e.g., disinfectant residual and pH level), mechanical system data (e.g., operating filters and water turnover rates), and policy and management data (e.g., record keeping and operator training). A violation was noted when an inspection item was not in compliance with state or local regulations. Other inspection items (e.g., support facilities and injury control) were not addressed in this analysis.
A total of 5,378 violations were documented during the 5,209 inspections; 2,736 (52.5%) inspections occurred in spas for which the location (e.g., hotel or motel) was known. Approximately half (56.8%) of the inspections (2,958 of 5,209) had one or more violations (median: one; range: one to eight). Eleven percent (500 of 4,533) of inspections resulted in the immediate closing of spas, pending correction of the violation item(s). Water chemistry violations constituted 50.7% of all violations (2,725 of 5,378); followed by filtration and recirculation systems, 32.2% (1,732 of 5,378); and policy and management, 17.1% (921 of 5,378). Various violations for policy and management issues were documented; during inspections, 23.3% (162 of 695) of spa operators lacked required training, and 12.7% (654 of 5,153) had inadequate record keeping. For the 52.5% of inspections for which spa location could be ascertained, a range of violations occurred. For known locations collecting disinfectant residual data, the highest percentages of violations occurred in campgrounds (21.9%) and hotel/motel spas (19.6%). The percentage of inspections that documented pH level violations, which can compromise disinfectant efficiency, ranged from 14.1%-16.2% in known locations. Of those inspections that revealed violations that warranted spa closure, the highest percentages also were in campgrounds (15.1%) and hotel/motel spas (12.2%).
Editorial Note: Environmental health inspections can identify weaknesses in the management and inspection of spas. In this report, the proportions of spa inspections in violation of local ordinances (56.8%) or requiring immediate closure (11.0%) are similar to those documented for public swimming pools (54.1% and 8.3%, respectively). The inspections document a gap in the training of spa operators; more than 20% of spa inspections cited operators who had not received adequate training. These data emphasize that spa operators can protect the health of users by adhering to maintenance procedures and obtaining appropriate training; regular public health enforcement of these items is necessary. The findings also demonstrate the utility of maintaining spa inspection data in a computerized format that can be analyzed routinely and used to evaluate spa inspection programs.Poor disinfectant and pH control, high temperatures that quickly dissipate disinfectant, small water volumes, poor hygiene, high bather loads, inadequate maintenance, and opportunities for environmental contamination of the water can lead to proliferation and to pathogen contamination in the spa environment. RWIs spread through spa use are typically skin and respiratory infections in contrast to gastrointestinal illnesses commonly associated with full-body recreational activities found in swimming pools. During 1999-2000, a total of 13 reported outbreaks of infectious diseases, affecting 183 persons, were attributable to public and private spa use.
The high temperature of water in spas makes them particularly vulnerable to depletion of disinfectant, which facilitates pathogen amplification. Pathogens such as Pseudomonas spp. can multiply rapidly when the disinfectant residual falls below 0.5 mg/L or the pH rises above 8.0. Pathogens also can reside in biofilm layers that form in spa pipes and surfaces, where they can be protected from disinfection, which necessitates routine scrubbing and maintenance to decrease biofilm formation. Because domestic acquisition of Legionella spp. appears to be travel-related, venues (e.g., campgrounds and hotels or motels) should pay particular attention to operator training and maintenance of their spas.
Additional information and health communication materials designed to reduce the spread of RWIs are available at http://www.cdc.gov/healthyswimming.
REF: MMWR http://www.cdc.gov/
Chloropicrin is the fourth most commonly used soil fumigant in California. Exposure to chloropicrin causes eye and respiratory tract irritation, vomiting, and diarrhea. This report describes an investigation by the California Department of Pesticide Regulation (CDPR) and the Kern County Agriculture Commissioner (KCAC) into illnesses associated with the offsite drift of chloropicrin in Kern County. A total of 165 persons experienced symptoms consistent with chloropicrin exposure. The findings underscore health risks associated with fumigants and the usefulness of procedures adopted in California to ensure both prompt identification of exposure events and timely notification of the affected public.
On October 3, 2003, an agricultural pest control service began applying 100% chloropicrin at a concentration of 80 pounds/acre to 34 acres of fallow land in Kern County. Chloropicrin was injected 17-18 inches into the soil; a weighted board was used to compact the soil, treating 18 acres. That evening, residents living one quarter mile west of the application site experienced irritant symptoms. The Kern County Fire Department (KCFD) was contacted to investigate; however, darkness, distance from the treated field, and absence of chloropicrin odor prevented firefighters from identifying the source of the irritation. Records from a weather station approximately 7 miles southeast of the application site indicated low wind speeds and stable atmospheric conditions but also that the wind direction had changed that evening, blowing from the field toward the residential dwellings.
The next day, chloropicrin was applied to the
remaining 16 acres. A
60-foot, chloropicrin-free buffer was maintained around the perimeter
of the field because workers noted a persistent odor when they arrived.
Residents one quarter mile west and south of the field complained about
irritant symptoms that evening. Residents notified KCFD; several
responding firefighters experienced eye irritation. The wind had
changed again that evening and begun blowing from the field toward the
residential dwellings. Suspecting a pesticide release, KCFD notified
KCAC. The field was recompacted, and the odor ceased.
On October 6, KCAC notified CPDR about the incident. KCAC and CDPR conducted in-person interviews at 35 households located approximately one quarter mile west and south of the field and at a day care center; additional interviews were conducted on October 15. The 35 households and day care center had a total of 172 persons present during the exposure period. Representatives from each household and the day care center were interviewed by using a standardized questionnaire. In addition, five workers involved with the fumigation were questioned informally, and KCFD records were reviewed to identify affected firefighters.
The investigation determined that 165 persons reported symptoms compatible with illness caused by chloropicrin; median age of the persons was 16 years (range: 3 months-63 years). Nearly all (99%) had irritant symptoms (e.g., eye or upper respiratory); nine (5%) received medical evaluations. Seven had persistent respiratory symptoms when interviewed 11 days after the event. Follow-up medical care was limited because most of the affected persons lacked health insurance.
Exposures were retrospectively estimated by using a standard air dispersion model. Estimated 1-hour average chloropicrin air concentrations in areas south and west of the field ranged up to 0.20 parts per million (ppm). Peak-to-mean extrapolations indicated that peak concentrations might have exceeded 1 ppm. The Occupational Safety and Health Administration permissible exposure limit and the National Institute for Occupational Safety and Health (NIOSH)-recommended exposure limit is 0.10 ppm averaged during 8 hours. However, extrapolations from animal studies suggest 0.0044 ppm as a safe level for a 1-hour environmental exposure.
According to KCAC, a possible cause of the offsite drift was failure to contain the chloropicrin adequately after application. After the incident, KCAC imposed new restrictions on chloropicrin applications, including prohibition of applications within one quarter mile of an occupied structure and mandatory use of a heavy-duty tarp or water seal for applications within one half mile of such structures.
The findings in this report are subject to at least two limitations. First, this report is limited by an imprecise estimate of reported cases. Some affected persons likely were not interviewed, leading to an underestimation. Conversely, false-positive cases cannot be excluded because some self-reported symptoms might not have been related to exposure. Second, environmental measurements were not conducted to confirm chloropicrin exposure.
Adequate chloropicrin containment measures are
needed to prevent
similar community outbreaks. In addition, when outbreaks occur,
measures are needed to prevent the community distress that arises when
government authorities do not provide timely information regarding the
emergency response and follow-up investigation findings. In 2003, CDPR
developed procedures to respond to incidents involving offsite drift of
pesticides. This approach might be useful in other
jurisdictions where offsite pesticide drift can occur.
TOXICOLOGY
TIDBITS The free, easy-to-read guide, Diagnosis and Management of Foodborne Illnesses: A Primer for Physicians and Other Health Care Professionals, is a revision of a publication originally done in 2001. The updated version contains five new sections on new and re-emerging foodborne illnesses, as well as charts, scenarios, and a continuing medical education section.
After microbes that produce illness are swallowed, they pass through the stomach into the intestine, attach to the cells lining the intestinal walls, and begin to multiply. According to the Centers for Disease Control and Prevention (CDC), some types of microbes stay in the intestine, some produce a toxin that is absorbed into the bloodstream, and some can directly invade the deeper body tissues. The symptoms produced, including diarrhea, abdominal cramps, and nausea, depend greatly on the type of microbe. It is rarely possible to say which microbe is likely to be causing a given illness unless laboratory tests are done to identify the microbe, or unless the illness is part of a recognized outbreak.
"Recent concerns about hepatitis A and norovirus outbreaks have emphasized the need for health professionals to be vigilant for foodborne pathogens, and this need is further emphasized by concerns about intentional contamination of food," says David Acheson, M.D., director of the Food Safety and Security Staff at the FDA's Center for Food Safety and Applied Nutrition.
More than 75 percent of foodborne illness deaths are caused by just three pathogens: salmonella, listeria, and toxoplasma. Greater understanding of foodborne illnesses by nurses and other front-line health care providers is also important for early detection. Collaborators on the primer include the American Medical Association (AMA), American Nurses Association-American Nurses Foundation, the CDC, the FDA's Center for Food Safety and Applied Nutrition, and the U.S. Department of Agriculture's Food Safety and Inspection Service.
Health care professionals can request a free copy of the primer by visiting the AMA Web site. Consumer tips on food safety also are available at this site.
REF: FDA Consumer Magazine, July-August 2004
Some Mexican candy sold in the United States has been associated with lead contamination, and the FDA is advising that it would be prudent to not allow children to eat these products. The health effects of elevated lead levels in children are well documented and can result in learning deficiencies and delayed mental and physical development.
The FDA has compiled information indicating that candy containing significant amounts of chili powder may contain higher lead levels than other types of candy, such as candy that contains predominantly sugar. Examples of chili-containing products include lollipops coated with chili and chili seasoning sold in packets as a snack item. The FDA believes that contamination of chili powder may be occurring at certain steps in the manufacturing process.Also, tamarind, a popular Mexican candy item, can become contaminated with lead if it is sold in poorly made glazed ceramic vessels that release lead from the glaze into the candy. The FDA will be working with Mexican government and industry personnel on this issue and plans to establish more stringent guidance for considering regulatory action against candy containing lead.
REF: FDA Consumer Magazine, July-August 2004.
The Food and Drug Administration (FDA) is alerting the public to a number of reported adverse events associated with individuals who have undergone certain micropigmentation procedures, a form of tattooing, used to apply "permanent makeup" for lip liner, eyeliner, or eyebrow color. The adverse events are associated with certain ink shades of the Premier Pigment brand of permanent makeup inks, which are manufactured by the American Institute of Intradermal Cosmetics, doing business as Premier Products, in Arlington, TX. FDA is currently investigating this matter.
To date, FDA has been made aware of more than 50 adverse events and is investigating additional reports sent to the manufacturer. Reactions that have been reported include swelling, cracking, peeling, blistering, and scarring as well as formation of granulomas (chronically inflamed tissue mass associated with an infection) in the areas of the eyes and lips. In some cases, the effects reported caused serious disfigurement, resulting in difficulty in eating and talking.
In July 2003, the manufacturer reported to FDA its intent to remove
five of its ink shades from the market, based on six adverse events
that had been reported. However, FDA has obtained additional reports of
adverse events involving ink shades that were not included in the
firm's removal effort. While the investigation continues, FDA is
alerting consumers about associated adverse event reports received
about Premier Products ink shades identified on the FDA website at: http://www.cfsan.fda.gov/~dms/cos-tat2.html.
FDA considers intradermal tattoos (including permanent makeup) cosmetics and considers the pigments used in the inks to be color additives requiring premarket approval under the Federal Food, Drug, and Cosmetic Act. However, FDA has not traditionally regulated tattoo inks or the pigments used in them. The actual practice of tattooing is regulated by local jurisdictions.
As FDA continues its investigation, the agency urges consumers and healthcare providers to continue to report adverse reactions from tattoos, including permanent makeup, to FDA as well as to state and local health authorities. Contact information for your nearest FDA district office is available online at http://www.fda.gov/ora/fed_state/Small_business/sb_guide/regions.htm and in the blue pages of your local phone directory. Reports of adverse reactions may be reported also to FDA’s Emergency Operations Center at 301-443-1240 or Center for Food Safety and Applied Nutrition (CFSAN) Adverse Events Reporting System (CAERS) at (301) 436-2405 or email at CAERS@cfsan.fda.gov.
For related information, see Tattoos and Permanent Makeup http://www.cfsan.fda.gov/~dms/cos-204.html.
REF: FDA website T04-20, July 2, 2004
A new report on smoking and health released by U.S. Surgeon General Richard H. Carmona, M.D., M.P.H., shows for the first time that smoking causes diseases in nearly every organ of the body. Published 40 years after the surgeon general's first report on smoking--which concluded that smoking was a definite cause of three serious diseases-this newest report finds that cigarette smoking is conclusively linked to many other diseases and conditions.
"We've known for decades that smoking is bad for your health, but this report shows that it's even worse than we knew," Carmona said in releasing the report in May 2004. "The toxins from cigarette smoke go everywhere the blood flows."
According to the report, smoking kills an estimated 440,000 Americans each year. On average, men who smoke cut their lives short by 13.2 years, and female smokers lose 14.5 years. The economic toll exceeds $157 billion each year in the United States-$75 billion in direct medical costs and $82 billion in lost productivity.
In 1964, the surgeon general's report announced medical research showing that smoking was a definite cause of cancers of the lung and voice box (larynx) in men and chronic bronchitis in both men and women. Later reports concluded that smoking causes other diseases, such as cancers of the bladder, esophagus, mouth, and throat; cardiovascular diseases; and reproductive effects.
The new report, titled The Health Consequences of Smoking: A Report of the Surgeon General, expands the list of illnesses and conditions linked to smoking. The new illnesses and diseases are cataracts, pneumonia, acute myeloid leukemia, abdominal aortic aneurysm, stomach cancer, pancreatic cancer, cervical cancer, kidney cancer, and periodontitis.
Statistics indicate that more than 12 million Americans have died from smoking since the 1964 report of the surgeon general. Another 25 million Americans alive today will most likely die of a smoking-related illness.
To read the full article link to: www.cdc.gov
REF: MMWR, September 24, 2004 / 53(37);866-870.
West Nile virus (WNV) has been detected in seven more counties and
the number of Californians who have tested positive for the virus has
climbed to 249, including a Los Angeles County man who died,
State Public Health Officer Dr. Richard Joseph Jackson announced. The
number of deaths in California from WNV infections is now six.
"Even though West Nile virus has not been detected yet in all 58
counties, the evidence shows that it is widespread in California and we
all need to be vigilant about avoiding mosquito bites," Jackson said.
"In addition to personal protection, I encourage all Californians to
eliminate sources of standing water in their yards that support
mosquito breeding and avoid mosquito-infested areas at dusk and dawn
when mosquitoes are most active."
A Merced County man tested positive for the virus in August, which
was the first evidence of the virus in that county. In addition, tests
of dead birds this week confirmed that WNV has spread to Madera, Napa,
Nevada, Siskiyou and Trinity counties. The virus was also detected for
the first time in Colusa County after a horse tested positive.
Of the six Californians who have died from WNV infections, three
were from Los Angeles County, two from San Bernardino County and one
from Orange County. WNV infections were reported in the following
counties: San Bernardino, 96; Los Angeles, 81; Riverside, 51; Orange,
eight; Kern, four; Fresno, two; and one each in Butte, Imperial,
Lassen, Merced, Tulare, Ventura and Yolo. WNV human infections also
were reported for the first time this week in Butte and Lassen counties.
WNV has also infected 122 horses, of which 60 have died. Since horses are susceptible to WNV and a vaccine for horses is available, horse owners are advised to contact their veterinarians about timely vaccinations.
Most individuals who are infected with WNV will not experience any illness. Up to 20 percent of infected individuals will have only mild to moderate symptoms, such as fever, headache and body aches. Less than 1 percent of individuals will develop serious neurologic illness such as encephalitis and meningitis. The elderly and those with lowered immune systems are more susceptible to serious illness.
WNV is generally transmitted to humans and animals through a
mosquito bite. Mosquitoes become infected when they feed on infected
birds. Individuals can reduce their risk of mosquito-borne diseases by
taking these precautions:
For the year to date, WNV has been found in 1,726 dead birds, 616
"pools" of mosquitoes and 263 sentinel chickens.
The current surveillance program to monitor for WNV in California has been established by the California Department of Health Services (CDHS) in collaboration with the University of California, Davis, California Department of Food and Agriculture, local mosquito and vector control districts, local health departments and other state and local agencies.
For more information about WNV in California or to report dead birds online, visit CDHS’ Web site at http://www.westnile.ca.gov/.
REF: Issued: August 20, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
State
Health Department Advises
Consumers About Lead in Seasonings Imported from Mexico
State Public Health Officer Dr. Richard Joseph Jackson warned that lead has been found in four seasonings imported from Mexico: Lucas Limon, Lucas Acidito, Super Lucas and Super Jovy Chili Powder.
Lead from food and other environmental sources accumulate in the body. Elevated levels of lead can cause serious health problems, but even relatively low levels can cause learning disabilities and behavioral problems in children, Jackson said.
Testing by the California Department of Health Services (CDHS) found that the products contained levels of lead that exceed the federal and state regulatory standard of 0.5 parts per million (ppm) for candy. There is no regulatory health standard for lead levels in seasonings.
CDHS, which detected the lead in the products during random testing of 172 samples of candies, gums and candy ingredients/seasonings, has shared its findings with the U.S. Food and Drug Administration (FDA) and will be working with the manufacturers and FDA to reduce the level of lead in these products. The results are on CDHS' Web site at http://www.dhs.ca.gov/fdb/
The lead analysis results of the four individual brands of seasonings are:
Lucas Limon is packaged in a 0.87-ounce cylindrical container with a green label, with a prominently displayed logo of a goose head wearing glasses on top of a yellow circle. Lucas Acidito is packaged in a 1.5-ounce cylindrical container with a yellow label, with a prominently displayed logo of a goose head wearing glasses on top of a purple circle. Super Lucas is packaged in a 1.2- ounce cylindrical container with a red label, with a prominently displayed logo of a goose head wearing glasses on top of a yellow circle. Super Jovy Chili Powder is packaged in a 1.2-ounce cylindrical container with a red label and red cap. These products can be found in small markets and flea markets throughout California.
Pregnant women and the parents of children who may have consumed any of these products and are concerned about their exposure to lead should consult with their physician or health care provider about the need for a blood lead test.
For more information about lead poisoning, parents and caretakers should contact their local childhood lead poisoning prevention program or local public health department. Additional information and a list of local childhood lead prevention programs are available at DHS' Web site at: http://www.dhs.ca.gov/childlead. The California Childhood Lead Poisoning Prevention Branch can also be reached at (510) 622-5000 for a list of these programs.
REF: California Department of Health Services Warnings Issued: August 4, 2004
Captan (fungicide) – probable human carcinogen
Carbaryl (insecticide) – likely to be carcinogenic to humans
Chlorpyrifos (insecticide) – evidence of non-carcinogenicity for humans
DEET (insect repellent) – not classifiable as to human carcinogenicity
Glyphosate (herbicide) - evidence of non-carcinogenicity for humans
You will find the whole list here http://www.pestmanagement.rutgers.edu/
REF: Georgia Pest Management Newsletter, August 2004/Volume 27, No. 8
National
Pesticide Medical Monitoring Report
EPA Guidance on Uses Of
CCA-treated Wood Products
EPA has released the “Supplemental
Guidance on Interpretation of Revised Chromated Copper Arsenate (CCA)
Wood Preservative Label.” This document clarifies
allowed and not allowed uses of CCA. It also provides a reference table
with the American Wood Preservers Association Commodity Standards
related to CCA, with examples of some of the uses that are permitted
and disallowed since the December 31, 2003, voluntary cancellation date.
The Food and Drug Administration today reminded consumers of the dangers associated with drinking unpasteurized fruit and vegetable juices. This warning follows reports that the New York State Departments' of Health and Agriculture and Markets, and local health departments in northern New York are investigating a recent foodborne disease outbreak possibly linked to the consumption of unpasteurized apple cider.
Under FDA regulations, most juice processors are required to use Hazard Analysis and Critical Control Point (HACCP) principles to increase the protection of consumers from illness-causing microbes and other hazards in juices. But not all juice that consumers purchase comes from a facility for which HACCP is required.
In light of this outbreak, FDA would like to remind consumers that there are health risks associated with drinking juice or cider that has not been treated in any way to kill harmful bacteria. Such products may be sold in bottles or by the glass in supermarkets, at farmers markets, at roadside stands, or in some juice bars. Untreated products that are sold in bottles are generally displayed on ice or in refrigerated cases and are required to carry the following warning statement on their label:
WARNING: This product has not been pasteurized and therefore, may contain harmful bacteria that can cause serious illness in children, the elderly, and persons with weakened immune systems.
Untreated products that are fresh squeezed and sold by the glass are not required to carry the warning label statement.
FDA advises consumers that, when in doubt, look for this warning statement on bottled juice and ask if fresh squeezed juice has been treated in a way to kill bacteria.
Consumers who do not wish to risk illness from consumption of raw juices should not drink unpasteurized juices. If you cannot determine if a juice has been processed to destroy harmful bacteria, either don't drink it or bring it to a boil in an open container to kill any harmful bacteria that may be present.
For additional information visit, http://www.cfsan.fda.gov.
The FDA and the U.S. Department of Agriculture (USDA) have taken three actions to strengthen existing safeguards that protect consumers against the agent that causes bovine spongiform encephalopathy (BSE), also known as "mad cow disease."
In July 2004, the FDA published an interim final rule (IFR) that prohibits the use of certain materials from cattle that could carry the BSE-infectious agent in human food, dietary supplements, and cosmetics. These high-risk materials, known as "specified risk materials" (SRMs), include the brain, skull, eyes, and spinal cord of cattle 30 months of age or older, and a portion of the small intestine and tonsils from all cattle, regardless of their age. Also prohibited are materials from non-ambulatory disabled cattle, material from cattle not inspected and passed for human consumption, and mechanically separated beef.
This IFR, in conjunction with IFRs issued by the USDA in January 2004, will minimize human exposure to materials that may put people at risk for a disease similar to BSE called variant Creutzfeldt-Jakob disease (vCJD). Scientific studies have demonstrated that SRMs could contain the BSE agent when derived from cattle that are harboring the BSE agent. Consumption of products contaminated with the agent that causes BSE is the likely cause of vCJD in people. This rule was effective immediately, but the FDA was accepting comments until Oct. 12, 2004, for consideration before publishing a final rule.
In a second action, the FDA published a proposed rule requiring manufacturers and processors of human food, dietary supplements, and cosmetics derived from certain cattle materials to maintain records showing that prohibited materials are not used in their products.
Finally, the USDA and the FDA jointly published an advance notice of proposed rulemaking (ANPR) requesting comments and scientific information on additional measures to help prevent the spread of BSE. In the ANPR, the FDA is requesting comments on potential new controls on animal feed, including:
The FDA's current animal feed rule, which became effective in 1997, helps prevent the establishment and spread of BSE through feed in the United States. FDA and state investigators inspect animal feed firms to ensure compliance with the rule. According to the inspection results of July 17, 2004, among companies handling material prohibited in feed for ruminants, compliance rates remain greater than 99 percent.
For more information, visit: www.fda.gov/oc/opacom/hottopics/bse.html
or www.fsis.usda.gov/oa/topics/bse.htm.
REF: FDA Consumer September-October, 2004.
VETERINARY
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