Document zzzpYqqJn59m0z8J4GKdLry8B

A f . 2 . i > 6 f c/ exhibit a P-2 Weekly Morbidity and Mortality Weekly Report ___________May 5, 2006 /Vol. 55 / No. 17 State Prevalence of Self-Reported Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation -- United States, 2003 Arthritis is costly ($86 billion annually), highly prevalent (affecting 43 million U.S. adults), the leading cause of dis ability, and associated with substantial disparities in pain, activity limitations, and compromised quality of life (1- 3). State-based estimates of arthritis prevalence and impact help define the burden of arthritis and provide state arthritis pro grams with data for program planning. This report summa rizes results from the 2003 Behavioral Risk Factor Surveillance System (BRJFSS) survey on state-specific prevalence of self reported doctor-diagnosed arthritis and arthritis-attributable activity limitation in 50 states, the District o f Columbia (DC), and three territories. The findings indicated that the preva lence of adults with self-reported doctor-diagnosed arthritis ranged from 17.9% to 37.2% (state median: 27.0%) and with arthritis-attributable activity limitation ranged from 6.3% to 16.7% (state median: 9.9%); the proportion ofadults with arthritis-attributable activity limitation among those with self reported doctor-diagnosed arthritis ranged from 30.1% to 49.8% (state median: 37.4%). These high rates of arthritis prevalence and activity limitation are projected to increase with the aging of the population (4), requiring increased interven tion measures to reduce this impact. INSIDE 481 Parental Report of Diagnosed Autism in Children Aged 4-1 7 Years -- United States, 2 0 0 3 -2 0 0 4 4 86 Worker Illness Related to Ground Application of Pesticide -- Kem County, California, 2005 488 Respiratory Illness Associated with Boot Sealant Products_ Five States, 2005-2006 491 QuickStats DEPARTMENT OF HEALTH AND HUMAN SERVICES C EN TER S FOR D ISE A SE CONTROL AND PREVENTION p.3 488 MMWR May 5,2006 During 1998-2003 in California, 12% (297 of 2,470) of occupational pesticide illness reports were attributed to pesti cide drift (3). Because weather patterns are unpredictable, pesticide drift can occur even when applications are begun during calm periods. In this incident, pesticide drifted onto workers in a grape vineyard who had not been notified of a pesticide application in a neighboring citrus orchard. Inad equate com m unication between the applicators and farmworkers might have resulted in continued spraying de spite the presence of workers in the grape vineyard. Employers are required to give notification of cyfluthrin application only to their own employees. Neither the applica tors nor the citrus grower were required by law to provide notification to the farmworkers, who worked for a different employer. Even when not required, CDHS recommends that workers in adjacent areas should be notified about scheduled pesticide applications. Furthermore, pesticide applications should cease if workers are observed in neighboring areas. Pyrethroid pesticides are in widespread use for both agri cultural and structural applications. Although considered to be a safer alternative to many other pesticides, pyrethroid pes ticides such as cyfluthrin can cause pesticide illness even at low doses. Evaluating physicians should be knowledgeable regarding the potential for occupational illness caused by pes ticide exposure, signs and symptoms, and methods of treat ment. Nontoxic, sustainable methods of pest control should be encouraged for primary prevention of pesticide illness. References 1. CreDpoCrt.aCblaesetodethfieniNtioatniofnoarlacPuutbelipcesHtiecaidlteh-rSeulartveedilillalnncesesSaynsdteimnj.uCtyinccaisnes nati, O H: US Department o f Health and Human Services, CDC, National Institute for Occupational Safety and Health; 2005. Available AatPhRt2tp0:0//5w.pwdwf. .cdc.gov/niosh/topics/pesticides/pdls/casedef2003_rev 2. CDC. Severity index for use in state-based surveillance of acute pesti cide-related illness and injury. Cincinnati, OH: US Department of 3. CpSSHeaaaescflaetirifltadyotmhdraneeansinnad/tdpoDHd,HfeeCsupa/Amplat:rehatCs;mnt-a2Ssel0eine0fvrto1viornincAfdeiPevasxea,DsviClt6eaiDcbp.piladCedrefa,t.mRtNheeatgnttiuptol:ona//ftawiPloweInns.wtsiPtc.iceitdsdutectiec.Rgifdeooegvru/uOnlsaiceotcisrouehnpp/.atooAtriptoviinnacigasl./l 4. aEbcloebaitchhottnp:D//Jw. wTowx.iccdepffre.ccats.goofvp/edsoticcsi/dpeusr./Ipnu;rKmlaaianss.hcntmC.D, ed. Casarett and Doulls toxicology; the basic science of poisons. 6th ed. New York, NY; McGraw-Hill Medical Publishing; 2001:784-5. 5. Ray DE. Pyrethroid insecticides. In: Krieger R, ed. Handbook of pesti cide toxicology. Orlando, FL: Academic Press; 2001:1289 -1303. 6. sRoeniignagrsr.J5Rt.hRedo.bWertassJhRin.gRtoenc,oDgnCi:tiUonSaEnndvimroannmageenmtael nPtrootfepcetisotnicAidgeepncoyi, b1o9o9k9./hAavnadilbaboloelacthhtmttp. ://www.epi.gov/pesriddes/salM y/hexlchciir/hxiul7. 2tHi0oa0nr3d;ot7Jf6,:iA4n9sne2gc-et8rie.cridJ.alBpioyloregtihcarloimdos.niItnotrinAgrcohf wOocrckuerps aElntevrirthoen aHppelaicltah B rief Report Respiratory Illness Associated with Boot Sealant Products -- Five States, 2005-2006 During February 2005-February 2006, six regional poi son control centers in five states were consulted regarding 172 human and 19 animal (i.e., pet cat or dog) exposures to shoe or boot leather protection or sealant products resulting in respiratory illness. One product was associated with 126 cases o f human illness and another product with seven cases. An ongoing investigation, begun in December 2005, is be ing conducted by the poison centers. The majority of cases occurred in Michigan, where poison control centers are col laborating with the Michigan Department of Community Health to further document exposures and adverse health effects from the products. Results of the investigation of the 150 cases reported during 2005 underscore the continuing need to assess the magnitude of the problem, evaluate the toxic etiology of the products involved, and determine how tporopdruecvtesn. t further cases of illness resulting from use of the A case was defined as a report to a poison control center o f illness after exposure to an aerosol agent used for waterproof ing boots or shoes; reports were made directly by persons exposed, by family members or friends, or by health-care facilities where persons sought treatment. Specific illness symp toms were not required to meet the case definition. During 2005, the number of cases increased substantially with the onset of winter. One case was reported in February and one in July; five were reported in August, four in Septem ber, 11 (7%) in October, 36 (24%) in November, and 92 (61%) in December (Figure). Eighty-four (56%) cases were wreepsotertrendPeinnnMsyilcvhaingiaan, ,1225(8(%17) %in)ceinntrIanldOiahniao., 1a9nd(1130%(7)%in) in Kentucky. Ages o f the 150 patients ranged from one to 70 years (median: 33 years); 33 (22%) were aged <18 years. Among the patients, 50% were the persons in their households who most used the product; however, persons who did not use the product also were affected. The product was sprayed indoors in 131 (87%) of L50 cases; 19 (13%) of the patients were exposed when the product was used outdoors. No evidence was observed that substance abuse was related to the expo sures. Investigators determined that sprayed shoes and boots brought into the home from garages or outdoors continued to be a source of exposure to both humans and pets as the product evaporated. Five occupational exposures occurred. P-4 Vol. 55/ No. 17 MMWR 489 F IG U R E . N u m ber' o f ex p o su re s to boot sealant products reported to p o iso n control centers, by m onth of exposure -- five states, 2005-2006 four while spraying clothing items at work and one while dem onstrating a product to a customer. Preexisting respiratory risk f(1ac3to[r8s%w]e)reaniddensmtifoiekdinign 4(207(2[178%%) ]o).f the 150 patients: asthma A total of 144 patients were symptomatic, including 137 (95%) who reported symptoms of respiratory illness; all were encouraged to seek medical care. Among those who were symp tomatic, the most common symptoms were cough [(113 patients [78%])] and dyspnea [(86 [60%])]. Eighty (56%) were known to have been evaluated in hospitals or hospital emergency departm ents, including 15 (10%) who were admitted and had hospital stays of up to 5 days. Pulse oximerry of patients evaluated in hospitals ranged from 61% to 100% (median: 94.9%). Chest radiographs were positive for infiltrates in 13 of 47 patients for whom this finding was recorded. Eight patients met the case definition for chemical pneumonitis (i.e., bilateral infiltrates suggestive of chemical pneumonitis and pulse oximetry <95% on room air). One person lost consciousness and was in respiratory distress, but recovered; no human patient died. Among 134 persons whose treatment was known, treatment consisted of bronchodiiators alone in 28 (21%) patients, bronchodilators plus corticosteroids in 13 (10%) patients, and no intervention other than oxygen in 69 (51%) patients. The duration of illness was determined on the basis o f last follow up and ranged from 0.25-360 hours (median: 17.6 hours) in 116 patients for whom duration could be evaluated. Among the 19 pets with illness, four were evaluated by vet erinarians. Reported symptoms for the animals included dys pnea (13 [68%]), cough (three), and vomiting (three). Chest radiographs were positive for infiltrates in one animal, and one cat met the case definition for chemical pneumonitis. Treatment included bronchodilators in one animal, corticos teroids in one animal, diuretics with anti-inflammatory agent in one animal, and no treatment other than oxygen and sup portive care in 12 (8%) animals. Two cats died from respira tory failure. Two products were primarily associated with the 150 cases of human illness, both manufactured by Assured Packaging (Mississauga, Ontario, Canada) and distributed by the Manakey Group LLC (Grand Rapids, Michigan), llse of jobsite Heavy Duty Bootmate was cited by patients in 126 (84%) cases. Rocky Boot Weather and Stain Protector was named in seven (5%) cases. The two Assured Packaging prod ucts consist of45% heptane, 20% -30% petroleum distillates, 25%-30% isobutane propellant, 5%-10% propane propel lant, 0.33% fluoropolymer, and 0.33% silicone. Neither the product labels nor the material safety data sheets for the prod ucts list fluoropolymer or silicone. Previous outbreaks o facute pulmonary illness associated with exposure to waterproofing apgroednutscthsa(v1e- im 4). p licated fluoropolymer/hydrocarbon-based The Consumer Product Safety Commission is evaluating these exposures and boot sealant products. Local health de partments and emergency departments were alerted to report cases to their regional poison centers. The American Associa tion of Poison Control Centers has instituted 13 new product codes and three new generic codes for waterproofing agents to enable all poison centers to conduct surveillance on expo sures more readily. On January 3, 2006, at the request of the Michigan Department of Community Health, Manakey Group issued a recall ofJobsite Heavy Duty Bootmate and Rocky Boot Weather and Stain Protector from store shelves, but not from consum ers' homes. During January-February 2006, 22 additional ex posures were reported to the six regional poison centers. Among callers asked, all purchased the product before the recall date. No product defect has been identified. Consumers should be encouraged to use all products for waterproofing shoes and boots as directed, to apply them outdoors, and to leave the sprayed shoes and boots and any contaminated clothing out doors until all fumes have dissipated. Reported by: S Smolinske, PharmD, S W hile, M D , G P D aubert, M D . Childrens H ospitalo fM ichigan Regional Poison Control Center, D etroit; R Didrichsons, B Eiscnga, M D , DeVos Children's H ospital Regional Poison Center, G rand Rapids, M ichigan;J Mowry, PharmD. Indiana Poison Center. Indianapolis; R Mrvos, E Krenzelok, PharmD, Pittsburgh Poison Center, Pennsylvania; M Casavant. M D . D Baker, PharmD. Central Ohio Poison Center. Columbus; HA Spiller. MS. Kentucky Regional Poison Center. Louisville. P-5 490 MMWR M ay 5, 2006 This report is based,Aicnkpnaortw, olendtgecmhneinctasl assistance provided by ABronstein, MD. Rocky Mountain Poison and Drug Center, Den ver, Colorado; T Litovitz, MD, National Capital Poison Center, Washington DC; and M Lai, MD, American Association of Poison Control Centers, Washington DC. Assistance with the investiga tion was provided by M Stanbury, Div of Environmental and OSLaacfncesutiypnagBt,iroaMnncaichlh,EiOpgiadnnet;amraiionoldoMgGyin, iMLsitsircsy,hoiMgfaLDna,DboOeupcrtc,ouTfpoCartooimonntmoa,luCnHaietnyaalHdthae.aaltnhd, R1.eCfeDreCn.cAecsute respiratory illness linked to use of aerosol leather condi tioner--Oregon, December 1992. MMWR 1993;41:965-7. 2. CDC. Severe acute respiratory illness linked to use o f shoe sprays-- 3. CLaolliobreardtdo,MN,oSvaenmlabceorn1G99, 3B.laMisM, RW. ARcu1t9e9p3u;4lm2:o8n8a5r-y7.toxicity linked to use of a leather protector. Ann EmergMed 1995;25:841-4. 4. JnBaTurorykxhitcoaoxrlticCKitlKyin,fToBolrlxiotiwtcoAinl g1P9ee9xtr6pin;o3is4uG:r2e,1Ot-o2'D4a.onnaneerlolsSo,lizDeodnolevaatnheJrWp.roPcuelcmtoor. Errata: Volume 54, No. 12 In the report, "Tobacco Use, Access, and Exposure toTobacco in Media Among Middle and High School Students -- United States, 2004," an error was made in computing analytic weights for data in the 2004 National Youth Tobacco Survey (NYTS); consequendy, both estimates and standard errors were affected. The corrected report text and tables are available at http://www.cdc.gov/tobacco/nyts/correctionnotice.htm.