BACKGROUND: In the United States the majority (80%) of pesticides are used in the agricultural industry. However, pesticide use is also commonplace in homes, gardens, schools, businesses, and public spaces. In order to monitor the extent and severity of acute pesticide-related illness and injury in North Carolina, the Occupational and Environmental Epidemiology Branch (OEEB) implemented the North Carolina Pesticide Incident Surveillance Program in 2007. This evaluation assesses how effectively and efficiently the surveillance system monitors pesticide-related illness and injury in North Carolina.
METHODS: Fifteen key stakeholders were interviewed in person or via phone to determine how they use the surveillance program, their perspectives on its functionality, and their suggestions for evaluating pertinent attributes. System attributes were evaluated according to the Centers for Disease Control and Prevention’s guidelines and include its usefulness, simplicity, data quality, and predictive value positive. Attributes were evaluated using surveillance system data, publications generated by stakeholders, direct stakeholder feedback, and literature reviews.
RESULTS: Surveillance data from this program have been used by state and federal agencies, universities, and non-profit organizations for research, education, and policy development. The automated form in which initial case reports are received is simple and timely. However, the breadth of information collected and amount of follow-up necessary per case detract from system simplicity. Approximately half of all occupational cases are lost to follow-up. In 2012, 11 (22%) case occupations and 15 (30%) exposure locations were unknown. Only serious injuries among non-occupational cases are investigated, introducing bias. While the surveillance system receives over one thousand reports each year, only one staff member evaluates all reports to classify each as a confirmed or unconfirmed case. Between 2007 and 2012, only 41% of cases reported to the surveillance system were subsequently confirmed.
CONCLUSIONS: More frequent and concise summaries of pertinent surveillance data distributed to stakeholders could strengthen partnerships and foster educational opportunities in the community. Plain language educational materials should be developed outlining the ways in which OEEB may and may not use information gathered during follow-up investigations in order to promote higher follow-up rates. Because persons under age 18 represent one-fourth of all non-occupational cases, a protocol should be developed to investigate more of these cases in order to better understand the causes behind acute pesticide poisoning in children.