Sulfuryl Fluoride Exposure Calls to the Florida Poison Information Center Network, 2010-2015

BACKGROUND: Sulfuryl fluoride is a colorless, odorless, non-flammable gas commonly used in building fumigations to eliminate dry-wood termites, insect pests, and rodents. Very few epidemiologic studies have examined sulfuryl fluoride exposures in humans. Triggered by a report of major illness in a 9-year-old boy following a home fumigation, a review of Florida Poison Information Center Network (FPICN) data was completed to better understand the burden of sulfuryl fluoride poisonings in Florida.

METHODS: Sulfuryl fluoride exposure calls to FPICN were extracted from the statewide database for January 1, 2010 through October 31, 2015. Data reviewed included age, gender, county where the call originated, date of call, site of exposure, exposure reason, site where exposure was managed, exposure substances, signs or symptoms, and medical outcome.

RESULTS: FPICN received 166 calls related to sulfuryl fluoride exposure (average of 28 calls per year). Ages of exposed individuals ranged from <1 year old to 84 years old (average of 30 years, median of 31 years, and mode of 7 years). More calls reported exposures in females than males. Most calls occurred during the third quarter (July, August, and September) of 2013, 2014, and 2015. Most exposures were unintentional (94.6%), occurred at a residence (86.1%), and were managed at the call site (56%) without need for additional healthcare consultation. The largest number of exposures were reported in Miami-Dade (30.7%), Broward (17.5%), Palm Beach (12%), Pinellas (9%), and Hillsborough (7.8%) counties. Population adjusted rates were highest in Miami-Dade, Pinellas, Broward, Manatee, and Palm Beach counties.

Common clinical syndromes among 68 individuals who reported symptoms were gastrointestinal (57.4%), neurological (47.1%), respiratory (33.8%), and ocular (33.8%). Minor illness occurred in 35 individuals (51.5%) and moderate illness occurred in 10 individuals (14.7%). Major illness and death was reported in one individual.

CONCLUSIONS: FPICN received calls related to unintentional low-level sulfuryl fluoride exposures resulting in minimal symptoms. Inhalation of sulfuryl fluoride is hazardous and deaths have been attributed to poisonings. Other jurisdictions may benefit from reviewing poison center data to better understand the epidemiology of sulfuryl fluoride exposures and poisonings in their areas. Education related to the effects of sulfuryl fluoride should target homeowners, especially during the summer months, and should focus on safety precautions, preparation for home fumigations, and requesting test results of sulfuryl fluoride from the pesticide applicator to verify levels are low enough to safely return. Pesticide applicators should provide test results as a standard process.