Future actions and data development

Public Health Significance of Urban Pests 531 • Store clothes with moth repellents in separately ventilated areas, if possible. • Keep indoor spaces clean, dry and well ventilated to avoid pest and odour problems. Unless you have had special training and are certified, never use a pesticide that is res- tricted to use by state-certified pest control operators. In conclusion, indoor applications of pesticides, which are regulated by a complex risk assessment before and after they are put on the market, do not pose a high level of risk to human health if the application of the product and the management of the application take place according to proper and adequate procedures. This adherence to proper pro- cedures, together with recent efforts to produce pesticides with a lower overall toxicity, is able to reasonably assure the absence of any unacceptable risk to human health and the environment. To our knowledge, no studies have considered which risk is worse: the risk of disease from exposure to urban pests or the risk of pesticide exposure. These risk–risk and risk–benefit analyses would benefit greatly from more exposure studies on both of these topics.

14.11. Future actions and data development

A number of future actions would help reduce the risk posed by pesticides to consumers and the environment. Ten such actions follow. 1. Consumer applicators should be educated in pesticide use, including reading and fol- lowing the product label. Labels should be short and easy to read, with clear and concise first-aid instructions. Also, labels should always be written in the language of the target user population. 2. International harmonization of all pesticide labelling should be implemented. The use of international hazard, risk and use symbols should be employed whenever practical. 3. All pesticide products for consumer use should be packaged in child-resistant contai- ners, to avoid accidental poisoning. 4. Hazardous pesticides should not be sold to consumers. Only WHO Category IV or equivalent category products formulated as ready-to-use products should be sold for consumer use. 5. Sales of pesticide concentrates to consumers should be forbidden, to avoid exposing mixers or loaders and to avoid over-application of AIs to the environment. 6. More research on pesticide use in residential settings should be conducted, and this research should better quantify environmental concentrations of pesticides in residential Pesticides: risks and hazards 530 health professionals. Current risk assessment methods quantify cancer risk and probabi- lity at the population level, usually expressed as a value, such as the chance of one cancer occurring in one million people. Although most pesticides present little risk of cancer, people in occupations that handle them are likely to have significant exposures and must use PPE, as directed by the pesticide label, to mitigate such risks. To avoid an unacceptable risk to the consumer, the application of a pesticide must take place according to good application practices. The information necessary for good prac- tices are reported by the producer on the label: a careful reading provides the consumer with all the preventive measures that should be applied to avoid a risk to health. The use of PPE is one such measure. Moreover, the label reports data about pesticide toxicity, symptoms of poisoning and first aid. The application of a pesticide has to be rationally planned: application on surfaces that can represent sources of secondary exposure must be carefully evaluated, and subsequent pre- cautionary measures must be adopted. For instance, before applying a pesticide in a room where food is consumed or cooked, all food, utensils, and table crockery must be remo- ved. Floors and other touchable surfaces represent another source of secondary exposure. These contaminated areas should receive attention. Exposing children to pesticides is of special concern. As they spend most of their time toddling, crawling and playing on the floor, children have frequent hand-to-mouth or object-to-mouth activity. Because of this, they should not be allowed to move freely shortly after a pesticide application depen- ding on the specific substance applied. Also, pets can be a source of secondary exposure when treated for fleas and ticks. Several steps can be identified to reduce exposure and manage consumer risks. Among them are the following. • Read the label and follow the directions when working with a pesticide. It is illegal to use any pesticide in any manner inconsistent with the directions on its label. • Mix or dilute pesticides outdoors. • Apply the pesticide only in recommended quantities. • Increase ventilation when using pesticides indoors. Take plants or pets outdoors when applying pesticides or flea-and-tick treatments. • If you use a pest control company, select a company licensed to perform this service in your locality. • Do not store unneeded pesticides inside the home; dispose of unwanted containers safely. Public Health Significance of Urban Pests Pesticides: risks and hazards 533 532 References 6 Aldridge WN 1990. An assessment of the toxicological properties of pyrethroids and their neurotoxicity. Critical Reviews in Toxicology, 21:89–104. Birnbaum LS, Fenton SE 2003. Cancer and developmental exposure to endocrine dis- ruptors. Environmental Health Perspectives, 111:389–394. Bremmer HJ et al. 2006. Pest control products fact sheet. Bilthoven, National Institute for Public H ealth and the Environment RIVM, RIVM report 3200050022006; http:www.rivm.nlbibliotheekrapporten320005002.pdf; accessed 3 September 2007. CDC 1999. Illnesses associated with occupational use of flea-control products – California, Texas, and Washington, 1989–1997. Morbidity and Mortality Weekly Report, 48:443–447. CDC 2005. Third national report on human exposure to environmental chemicals. Atlanta, GA, National Center for Environmental H ealth, Centers for Disease Control and Prevention NCEH Publication No. 05-0570; http:www.cdc.govexposurereport3rdpdfthirdreport.pdf, accessed 28 December 2006. CEN 1995. Workplace atmospheres – guidance for the assessment of exposure by inhalation to chemical agents for comparison with limit values and measurement strategy. Brussels, European Committee for Standardization Standard reference: EN 689:1995. Chen SY et al. 1991. An epidemiological study on occupational acute pyrethroid poiso- ning in cotton farmers. British Journal of Industrial Medicine, 48:77–81. Cohen H ubal EA et al. 2000. Children’s exposure assessment: a review of factors influencing children’s exposure, and the data available to characterize and assess that exposure. Environmental Health Perspectives, 108:475–486. De Bleeker J, van den Neucker K, Colardyn F 1993. Intermediate syndrome in orga- nophosphate poisoning: a prospective study. Critical Care Medicine, 21:1706–1711. Debboun M, Frances SP, Strickman DA 2007. Insect repellents: principles, methods and uses . Boca Raton, FL, CRC Press, Taylor Francis Group. Delmaar JE, Park MVDZ, van Engelen JGM 2005. ConsExpo 4.0:consumer products and uptake manual . Bilthoven, National Institute for Public Health and the Environment RIVM RIVM report 3201040042005; http:rivm.openrepository.comrivmbit- stream1002973071320104004.pdf, accessed 23 September 2007. DFG 1993. Analysis of hazardous substances in air, Vol. 1–2. Weinheim, Wiley-VCH Verlag. 6 Information on pesticide risk assessment and risk management was obtained from sites of governmental agencies and outstanding international institutions involved in pesticide regulation and consumer protection, as well as sites of pesticide producers’ associa- tions. The sites visited included: EPA, European Commission, Joint Research Centre, WHO, FAO and the American Crop Protection Agency. Data on risk characterization was represented by the scientific literature obtained from PubMed and TOXNET. The cri- teria used for selection included: scientific relevance of the subject, impact factor of the journal and date of publication. Information was also obtained from the most recently published books in the field of pesticide toxicology. Information from sites of outstanding universities was also taken into consideration. environments, to increase the level of certainty associated with residential pesticide expo- sure assessment and risk characterization. 7. The precautionary principle should always be applied where uncertainty exists; howe- ver, regulatory decision-makers should rely on the results of quantitative risk assessments. Also, international harmonization of risk and exposure assessment efforts should conti- nue to increase the uniformity and scope of public health protection. 8. In residential environments, only substances with the least potential for causing can- cer should be registered authorized and used. 9. Data should be developed on the public health benefits of pesticide use, such as the role of pesticides in preventing disease transmission and pest or vector infestation. 10. The risk of disease from exposure to urban pests must be weighed against the risk of pesticide exposure. A comparison of these two risks must be developed and considered. These risk–risk and risk–benefit analyses would benefit greatly from more exposure stu- dies on urban pest and pesticide exposure to human beings. 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15. Integrated pest management

John P. Sarisky 1 , Randall B. Hirschhorn and Gregory J. Baumann Summary Vector-borne diseases have been responsible for much suffering and death throughout human history. Illnesses caused by arthropods, rodents and other pests affect all races, ethnicities, ages and cultures. Even in the most modern societies of the world today, vec- tor-borne diseases are a continuing threat, and efforts to prevent these illnesses must be undertaken to protect public health. The principles of integrated pest management IPM have been practised successfully throughout the world for half a century. As a continuously evolving practice, IPM has incorporated and will continue to incorporate new knowledge and technologies in the field of pest management and vector control. However, the foundation of IPM will remain the same: control pests’ access to food, water and shelter and you will control the pest. IPM is a common-sense approach to pest management. By using a hierarchy of control practices – including public education, sanitation, pest exclusion, and other biological and mechanical control methods, while limiting pesticide application – long-term pest management can be achieved while minimizing environmental and public health hazards. While establishing an IPM programme may prove more costly and time intensive at its onset, the success of such programmes, when compared with pest management pro- grammes that use a non-integrated approach, are well established. It is also likely that the long-term costs of using a proactive integrated approach to pest management will be far less than those of continuing reactive non-integrated programmes that rely on che- mical control. This chapter provides a basic introduction to the science of IPM. It is expected that by using the principles described in this chapter, effective control of pests can be achieved while minimizing the impact of pest-control measures on the environment. 1 Disclaimer: The findings and conclusions in this article are those of the author and do not necessarily reflect the views of the United States Department of Health and Human Services.