CDC and AAPCC act fast to track, investigate, and report on outbreaks of poisoning and emerging environmental health threats

Did you know CDC works with poison centers to protect the nation from public health threats? Roughly every 8 minutes, call data from poison centers across the country are uploaded into a national reporting database called the National Poison Data System (NPDS). NPDS, managed by the American Association of Poison Control Centers (AAPCC), is an electronic surveillance system that can identify, track and characterize outbreaks of poisoning and emerging environmental health threats.

CDC and AAPCC use NPDS to improve surveillance for chemical exposures, illness and other public health hazards. CDC and AAPCC scientists monitor NPDS every day. They watch for data irregularities that may represent incidents of potential public health significance such as an outbreak of chemical-associated illness. They are ready to spring into action to assist with further activities such as surveillance and/or conducting a public health investigation if needed.

“Using NPDS, CDC improves surveillance for possible public health threats and identifies early markers of incidents to ensure a quick public health response,” said Royal Law, PhD, an epidemiologist with the CDC’s National Center for Environmental Health who has worked with NPDS at CDC since 2010.

“CDC and AAPCC also work together to routinely convey important safety messages to the public about outbreaks and risks found from investigations that have resulted from NPDS surveillance activities,” Law said.

Success Stories

Through CDC’s work with AAPCC, scientists have uncovered a number of public health threats – some with national implications, and some more specific to particular states and communities. In some instances, these investigations influence public awareness of these threats, provide data to inform policy, and even help shape corporate decisions to improve the safety of products for consumers.

Improving Consumer Safety for Laundry pods

One notable success came in the form of an investigation that resulted from the discovery that children were becoming injured from exposure to laundry detergent pods. Pods are liquid-soap filled capsules that people drop into their washing machines. The pods, with their colorful, candy-like appearance, can be dangerous to small children who bite into them. From May 17, 2012–June 17, 2012, poison centers across the country reported 485 cases of children exposed to detergent-filled pods.

Some of these children experienced a range of signs and symptoms, including vomiting, respiratory problems, and in some cases, seizures. CDC partnered with AAPCC and poison centers in Charlotte and Philadelphia to investigate this emerging threat using poison center data in NPDS.

The results of this investigation helped contribute to the decision by the largest United States laundry detergent pod manufacturer in the United States to add a double latch lid safety feature. This made the pods more difficult for children to open. Manufacturers have also worked with poison centers to study risk factors and health outcomes associated with laundry detergent pod exposure. Check out CDC’s Morbidity and Mortality Weekly Report (MMWR) on the investigation here.

Reporting Poisoning from Electronic Cigarettes

E-cigarettes are a type of popular battery-powered electronic nicotine delivery systems (ENDS), also called vaping devices. ENDS include a diverse group of devices that allow users to inhale an aerosol, which typically contains nicotine, flavorings, and other additives. E-cigarettes can expose users to several chemicals, including nicotine, carbonyl compounds, and volatile organic compounds, known to have adverse health effects. Additionally, ingestion of e-cigarette liquids containing nicotine can cause acute toxicity and possibly death if the contents of refill cartridges or bottles containing nicotine are consumed. Scientists from CDC, AAPCC, and US Food and Drug Administration (FDA) published the results of an investigation into 2,405 e-cigarette exposures captured by NPDS from September 1, 2010 through March 1, 2014.

This work informed a number of public health-related actions, such as the Child Nicotine Poisoning Prevention Act of 2015, which was enacted into law in January 2016. This law requires any container of liquid nicotine that is sold, manufactured, distributed, or imported into the United States to be placed in packaging that is difficult to open by children under 5 years of age.

Check out the MMWR report on e-cigarettes here.

Increasing Awareness of Synthetic Cannabinoids

Synthetic cannabinoids, sometimes referred to as “fake weed,” include a number of fast-changing mixes of psychoactive chemicals sprayed onto plant material (often not cannabis). Although the product packaging usually states that it is not for consumption, users often smoke or ingest these products in an attempt to achieve a drug-induced euphoria. Unfortunately, these products can and have resulted in serious health effects including agitation, tachycardia (fast heart rate), drowsiness, vomiting, confusion and even death.

After being alerted to an increase in poison center calls related to synthetic cannabinoids, CDC launched an investigation using data from NPDS. During the study period (Jan 1-May 31, 2015), poison centers reported 3,572 calls related to synthetic cannabinoid use, a 229% increase from the 1,085 calls during the same January–May period in 2014. The number of calls in 2015 increased significantly in mid-April before decreasing to approximate 2014 levels by the end of May. These results, published in MMWR, led to a surge in media coverage that led to a broader awareness of issues and dangers of using synthetic cannabinoids.

Shedding Light on the Dangers of Hand Sanitizers

More recently, MMWR published a report that explored alcohol-based hand sanitizer exposures among children. Using poison center data stored in NPDS, CDC scientists uncovered a potential health risk from improper use of these products including the possibility that they might be a new emerging product of abuse for older children.

Their work focused on characterizing exposures to these products that occurred during January 1, 2011–December 31, 2014. The authors found that younger children (aged 0-5 years) were more likely to be unintentionally exposed to hand sanitizer products either by ingestion or via the eyes. They also found that, older children (aged 6-12 years) were more likely to intentionally ingest hand sanitizer.

These older children also reported having more symptoms and overall worse outcomes than younger children. These findings shed light on the potential dangers associated with improper hand sanitizer use among children and the need for proper safety precautions and supervision.

Learn More

Learn more about CDC’s National Chemical and Radiological Surveillance Program and their work with poison centers across the country: https://www.cdc.gov/nceh/hsb/chemicals/ncrs.htm.

CDC welcomes the opportunity to work with state and local health officials and health practitioners if they suspect an outbreak.