National Poisons Information Service

A service commissioned by Public Health England

 

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Members of the public

seeking specific

information on poisons

should contact:

 

In England and Wales:

NHS 111 - dial 111

 

In Scotland:

NHS 24 - dial 111

 

In N Ireland:

Contact your local GP or

pharmacist during

normal hours; click here

(www.gpoutofhours

.hscni.net/) for GP

services Out-of-Hours.

 

In Republic of Ireland:

01 809 2166

 

Healthcare

professionals seeking

poisons information

should consult:

www.toxbase.org

Pesticides

The NPIS pesticide surveillance system was established in 2004 under approval of the Pesticides Safety Directorate and funded by the UK Department for Environment, Food and Rural Affairs. The work was implemented to better describe the incidence and character of pesticide exposures in the UK that result in contact with health professionals (thereby selecting for more serious exposures). Surveillance data is collated and both quarterly and annual reports are submitted to the government’s Advisory Committee on Pesticides (ACP) via the Health and Safety Executive’s Chemicals Regulation Directorate (CRD).


Currently 1,579 TOXBASE entries for pesticides and biocides are being tracked, an increase from the 1,563 tracked during 2017/18. Incident information is obtained in two ways, from follow-up of TOXBASE enquiries by an online or postal questionnaire or from data collected during NPIS telephone enquiries.


During the year, there were 4,254 accesses to TOXBASE about pesticides of interest and information on 641 potential exposures was collected via the NPIS telephone enquiry service. From the TOXBASE accesses, 355 follow-up postal or email questionnaires were completed and returned. Cases involving animals or head lice treatment products, enquiry sessions from locations in the Republic of Ireland, identifiable duplicate sessions involving the same patient, and sessions that were later reported not to have involved a pesticide, were excluded from the analysis. Of note, TOXBASE is often used for educational purposes but it is unclear how many of the total accesses were for this use.


Overall, information was gathered on 1,056 potential exposures involving pesticides during 2018/19, giving an overall return rate from follow-up requests of 20.7% which is similar to previous years. Twenty-two exposures involved multiple patients.


Of the 1,056 potential exposures available for analysis, there were 30 cases where symptoms were not thought to be related to the pesticide exposure, e.g. where a pre-existing illness or concomitant infection was present. These cases were excluded, leaving 1,026 exposures for further analysis. Due to the use of combination products or multiple products, these exposures involved 1,031 agents. The results presented below include both unintentional acute (873 cases; 85.1%) and chronic (49; 4.8%) exposures and deliberate self-harm exposures (DSH) (82; 8.0%). The circumstances of exposure in 22 (2.1%) cases were unknown.


Most unintentional acute exposures were graded as PSS 0 (495 cases; 48.2%) or PSS 1 (303; 29.5%). Smaller proportions were graded moderate (PSS 2: 5; 0.5%), severe (PSS 3: 2; 0.3%) or of uncertain severity (34; 3.3%). One fatality was reported (compared with three in 2017/18). This case involved intentional ingestion of 20% paraquat.

 


Agents of interest
The agents most frequently involved in exposures are shown in Table 1. In addition, there were 130 cases involving unknown rodenticides, 30 cases of unknown herbicides, 26 of unknown ant killers, 22 of unknown insecticides and 5 of unknown pesticides.

 

 

Table 1. Pesticides most frequently reported by respondents in suspected pesticide exposures during 2018/19 compared with 2017/18, ordered by rank in 2018/19

 

 

In 2018/19, patients potentially exposed to pesticide products comprised 517 adults (13 years or older; 50.4%) and 460 children (12 years or younger; 44.8%), with 49 of unknown age (4.8%). There were 547 (53.8%) male patients and 448 (43.7%) female patients and 31 cases (3.0%) where the gender was not specified. 12 enquiries involving pregnant patients were reported (15 in 2017/18). All 12 exposures were unintentional and acute. Poisoning severity was graded as PSS 0 or PSS 1 in all cases.


The classes of product most commonly involved in exposures are shown in Figure 1.

 

 

Figure 1. Pesticide exposures by class of product (as reported by respondent) in 2018/19 (1,031 agents)

 


Information from the NPIS Annual Report 2018/19.

 

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