Prevalence of anticoagulant rodenticide poisoning in humans and animals in France and substances involved

Silent Bird Poisoning in Poland: Reconfirmation of Bromadiolone and Warfarin as the Proximal Causes Using GC-MS/MS-Based Methodology for Forensic Investigations

The extensive use of rodenticides poses a severe threat to non-target species, particularly birds of prey and scavengers. In this study, a GC-MS/MS-based method was used to unlock the cause of bird deaths in Poland. Organs (liver, heart, kidney, and lungs) collected during autopsies of two rooks (Corvus frugilegus) and one carrion crow (Corvus corone corone), as well as fecal samples, were analyzed for the presence of anticoagulant coumarin derivatives, i.e., warfarin and bromadiolone. As for warfarin, the highest concentration was found in crow samples overall, with concentrations in the feces and lungs at 5.812 ± 0.368 µg/g and 4.840 ± 0.256 µg/g, respectively. The heart showed the lowest concentration of this compound (0.128 ± 0.01 µg/g). In the case of bromadiolone, the highest concentration was recorded in the liver of a rook (16.659 ± 1.499 µg/g) and this concentration significantly exceeded the levels in the other samples. By revealing the reality of the threat, these discoveries emphasize the need to regulate and monitor the trade in rodenticides.

Suspected rodenticide exposures in humans and domestic animals: Data from inquiries to the Norwegian Poison Information Centre, 2005-2020

Rodent control is necessary to prevent damage and spread of disease, and the most common pesticides used for urban and rural rodent control are anticoagulant rodenticides. The aim of this present study was to present data on suspected exposure to rodenticides in humans and domestic animals in Norway based on inquiries to the Norwegian Poison Information Centre in the 16-year period from 2005 through 2020. A total of 4235 inquiries regarding suspected exposures to rodenticides were registered in the study period. Of these, 1486 inquiries involved humans and 2749 animals. Second generation anticoagulants were involved in 68% of human exposures and 79% of animal exposures. Dogs were the most frequent species involved in the animal exposures with 93% of the inquiries, while cats were second most frequent involved. Around 50% of the human inquiries concerned children at the age of 0-4 years. Only 2% of the cases were in the age group 10-19 years, while adults comprised 35% of the inquiries. Acute poisonings accounted for almost 100% of the inquiries among both humans and animals. The exposure was accidental in 99% of the animal exposures and in 85% of the human exposures. In humans, only 14 inquiries were regarding occupational related accidents. Misdeed or self-inflicted injury accounted for 15% of the human inquiries and were the cause of 79% of the severe poisonings. Severe poisoning was only assessed in 1% of the cases involving children under 5 years. In contrast, 17% of the inquiries concerning adults (≥20 years) were assessed as severe. Subsequently, to prevent human and animal rodenticide exposure, we urge the use of non-chemical methods such as sanitation, rodent proofing (a form of construction which will impede or prevent rodents access to or from a given space or building) and mechanical traps. Restricting the use of rodenticides to professional pest controllers (or other persons with authorisation), reinforcing high quality education of these persons, and securing compliance of the best codes of practice could be advocated to reduce accidental exposure to rodenticides in humans and animals.

Asymptomatic Anticoagulant Rodenticide Exposure in Dogs and Cats—A French and Belgian Rural and Urban Areas Study

Anticoagulant rodenticides (ARs) are important tools for controlling rodent pests, but they also pose a health threat to non-target species. ARs are one of the most common causes of pet poisoning. However, exposure of domestic animals to subclinical doses of ARs is poorly documented. To study the random exposure of dogs and cats to ARs, feces from animals showing no clinical signs of rodenticide poisoning were collected from a network of French and Belgian veterinarians. We analyzed fresh feces from 304 dogs and 289 cats by liquid chromatography-tandem mass spectrometry. This study showed a limited prevalence of AR exposure in dogs and cats of 2.6 and 4.5% respectively. In both species, access to the outdoors is a risk factor for ARs exposure. In contrast, the sex of the animals did not affect the ARs exposure status. The observation of the ratio of cis and trans isomers suggested primary exposure in dogs, but also in some cats. While primary exposure in dogs appears to be related to the use of ARs as plant protection products, primary exposure in cats may be malicious, as warfarin, an anticoagulant formerly used as a rodenticide and now used only in humans, was found in 4 of 13 exposed cats. Secondary exposure may also occur in cats.Our study showed reduced exposure in dogs and cats, compared to wildlife, which often has high exposure, especially in areas where rodent control is important.

Fast and simultaneous analysis of carbamate pesticides and anticoagulant rodenticides used in suspected cases of animal poisoning

Carbamate pesticides (CBs) are reported as one of the main causes of intentional or accidental poisoning of animals. Anticoagulant rodenticides (ARs) form the main class of poisons implicated in analyzed poisoned baits. These two groups of pesticide compounds include multiple substances, and thus, the development of a simple and rapid multiclass/multiresidue analytical method for simultaneous identification of both toxicant classes should be a useful strategy for analytical laboratories to reduce analysis time and cost. The present study aimed to elaborate and validate a rapid method to simultaneously determine 11 CBs and 8 ARs in samples of real matrices (bait, stomach content, and liver) from suspected animal poisoning cases. QuEChERS sample treatment and liquid chromatography coupled to hybrid high resolution mass spectrometry were used. The method resulted in good linearity (R2 ≥ 0.98) for all compounds, recovery was between 70% and 120% for CBs and 40-90% for ARs, and precision was ≤ 20% for all compounds. The method was successfully applied to the analysis of 871 real samples originating from suspected cases of animal poisoning, collected from April 2019 to October 2020. Furthermore, full scan dependent data acquisition allowed qualitative retrospective data analysis of an additional 15 compounds outside the scope of the method to be performed; these compounds could potentially be involved in unresolved poisoning cases.

Suspected environmental poisoning by drugs, household products and pesticides in domestic animals

Animal poisoning by chemicals (pesticides and household products) and drugs is a frequent occurrence and special attention should be paid to this phenomenon to improve prevention and treatment strategies and because of the fundamental role that animals may play as bioindicators. From January 2017 to March 2019 the Poison Control Centre of Milan (CAV) in collaboration with the University of Milan, collected and analyzed epidemiological data on animal poisoning. During this period, the CAV received a total of 442 enquiries on domestic animal poisoning episodes and, among these, 80.3 % were related to chemicals and drugs. Pesticides and drugs were the two major causes of poisoning (34.1 % and 33.5 %, respectively), followed by household products (29.3 %) and other causative agents (3.1 %, n = 11). In conclusion, these findings can provide useful information for the identification and monitoring of known and emerging toxicants, with positive repercussions on human, animal and environmental health.

Long-term increase in secondary exposure to anticoagulant rodenticides in European polecats Mustela putorius in Great Britain

As a result of legal protection and population recovery, European polecats (Mustela putorius) in Great Britain are expanding into areas associated with greater usage of second-generation anticoagulant rodenticides (SGARs). We analysed polecat livers collected from road casualties from 2013 to 2016 for residues of five SGARs. We related variation in residues to polecat traits and potential exposure pathways, by analysing stable isotopes of carbon (δ¹³C) and nitrogen (δ¹⁵N) in their whiskers. 54 of 68 (79%) polecats had detectable residues of at least one SGAR. Bromadiolone (71%) was the most frequently detected compound, followed by difenacoum (53%) and brodifacoum (35%). Applying historical limits of detection to allow comparison between these new data and previous assessments, we show that in the 25 years from 1992 to 2016 inclusive, the rate of detection of SGARs in polecats in Britain has increased by a factor of 1.7. The probability of SGAR detection was positively related to increasing values of δ¹⁵N, suggesting that polecats feeding at a higher trophic level were more likely to be exposed. Total concentrations of SGARs in polecats with detectable residues were higher in polecats collected in arable compared to pastoral habitats, and in the west compared to the east of Britain. The number of compounds detected and total concentrations of SGARs increased with polecat age. There was no evidence of regional or seasonal variation in the probability of detecting SGARs, suggesting that the current risk of exposure to SGARs does not vary seasonally and has increased (from that in the 1990s) throughout the polecat's range. We recommend quantification of current practices in rodenticide usage, particularly in the light of recent regulatory changes, to enable assessment and mitigation of the risks of secondary exposure to rodenticides in non-target wildlife.

The Epidemiology of Household Rodenticides Poisoning in Hong Kong and its Risk Factors for Developing Coagulopathy

Objective

To (1) describe the epidemiology of household rodenticides poisoning in Hong Kong, (2) evaluate the proportion of patients who have develop coagulopathy after rodenticide poisoning, (3) identify the risk factors for developing coagulopathy in rodenticide poisoning.

Design

Case series study.

Setting

Sixteen accident and emergency departments in Hong Kong.

Patients

Patients with household rodenticide ingestion who presented to accident and emergency departments during the period from July 2008 to February 2012.

Results

110 patients were reported to have rodenticide exposure during the study period. Eighty-seven patients were included in the final analysis. The mean age was 40.1 and the male-to-female ratio was 1.29:1 (49:38). Most patients (91%) took the rodenticide intentionally. Sixty-nine patients (79%) exposed to anticoagulants type of rodenticide based on history or laboratory findings. The ingredient of the rodenticide ingested in 18 patients (21%) was untraceable. The only clinically significant presentation reported after rodenticide exposure was coagulopathy. Thirty-one patients (36%) developed coagulopathy with an international normalised ratio greater or equal to 1.3. Clinical significant bleeding was only observed in one patient. Presence of coagulopathy in rodenticide poisoning was significantly associated with older patient, intentional ingestion, ingestion of warfarin, ingestion of more than one pack and presence of co-ingestion. Multiple logistic regression analysis showed that only two factors were independent predictor of coagulopathy: Ingestion of warfarin rodenticide (p=0.001, odds ratio [OR] = 18.20, 95% confidence interval [CI]=3.44-96.42), and ingestion of more than one pack of rodenticide (p=0.02, OR=10.01, 95% CI=1.43-69.87).

Conclusions

Clinically significant household rodenticide poisoning in Hong Kong is solely related to ingestion of anticoagulant type of rodenticide. Patients who have ingested warfarin rodenticide and higher ingestion dose are more likely in developing coagulopathy. (Hong Kong j.emerg.med. 2014;21:339-345)

Anticoagulant rodenticide intoxication in east China: a three-year analysis

The study was designed to analyze the incidence and pattern of anticoagulant rodenticide intoxication in east China and to discuss strategies of diagnosis based on laboratory analysis experience. A total of 117 patients with anticoagulant rodenticide poisoning confirmed by toxicological analysis in east China were included in this study from 2011 to 2013. The mean concentration of anticoagulant rodenticide, age, and gender of these patients, as well as the mode and type of poisoning, were discussed. The age ranged from less than 1 to 80 years with the feeble preponderance of males (M = 53.0%, F = 47.0%). The 0–9 age group covered the largest ratio of these anticoagulant rodenticide poisoning patients. Accidental or voluntary ingestion seems to be the most common cause of intoxication, with still the poisoning cause being unknown for a large number of positive analyses. Bromadiolone was the most commonly observed anticoagulant rodenticide found in the biological samples, followed by brodifacoum. The concentrations of bromadiolone and brodifacoum that were detected in the first collected whole blood from each patient ranged from 1 to 878 ng/mL (mean 97.9 ng/mL) and from 0.5 to 1566 ng/mL (mean 225.1 ng/mL), respectively. The data analysis shows a high incidence of anticoagulant rodenticide poisoning without awareness of the poisoned subjects, clearly emphasizing the need for toxicological analysis in patients with vitamin K-dependent coagulation disorder and restriction on availability of anticoagulant rodenticide.

Epidemiology of animal poisoning: An overview on the features and spatio-temporal distribution of the phenomenon in the north-eastern Italian regions

In the present paper we analyze and discuss about the records referring to animal poisonings and poisoned baits cases covering the period between 2007 and 2013 and submitted for diagnostic investigations to the Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe), which is the public veterinary health institute competent for the north eastern Italian regions. All data were gathered by a passive surveillance system based on voluntary reporting, which became mandatory in 2009 after a decree of the Italian Ministry of Health had come into force. This prohibited the use and detention of poisoned baits and ordered to selected institutions and professionals to carry out standardized surveys to assess suspect and/or confirmed reported cases; all the necessary anatomopathological and toxicological investigations to confirm the reported cases were then performed for free by public veterinary health institutes whenever a veterinarian diagnosis or clinical suspicion were provided. Totally, 1831 suspected animals poisoning and 698 cases of supposed poisoned baits recovery episodes were registered. 642/1831 (35.1%) animal poisoning cases were confirmed and the presence of toxic agents was verified in 292/698 baits (41.8%). The most severely affected territories were the ones with the highest level of urbanization and those most densely populated in the study area. Dogs and cats seemed to be greatly affected by poisoning cases and a characteristic seasonal trend was noticed, with an increase of episodes in late Winter/early Spring and in Autumn. Carbamate insecticides resulted to be the main cause for animal poisoning, while anticoagulants rodenticides played a primary role among toxicants found in poisoned baits. The presented results emphasize that malicious animal poisoning is a widespread problem in north-eastern Italy. The still relevant number of reported poisoning events caused by some banned pesticides poses the problem of identifying where these substances come from and brings to light the popular knowledge about the high toxicity of these compounds. Moreover, the noticeable increase of the number of episodes registered in 2009 pointed out how the above mentioned decree may have contributed to reveal a number of hidden cases which had not been investigated before, probably due to economic reasons related to the costs of toxicological analyses.

Outcomes of patients with rodenticide poisoning at a far east poison center

BACKGROUND

Rodenticide poisoning remains a major public health problem in Asian countries. Nevertheless, very few data are available in world literature regarding the outcomes of these patients. Therefore, the purpose of this study was to investigate the clinical outcomes of rodenticide poisonings in our hospital and to compare these data with published reports from other international poison centers.

FINDINGS

We retrospectively examined the records of 20 patients with rodenticide poisoning (8 brodifacoum, 12 bromadiolone) who were referred to Chang Gung Memorial Hospital between 2000 and 2011. It was found that most of the rodenticide patients were middle-aged adults. Both genders were equally affected and many patients had a past history of major depressive disorder or schizophrenia. Nevertheless, patients with bromadiolone were referred significantly sooner than patients with brodifacoum poisoning (0.1 ± 0.1 versus 5.5 ± 10.5, P < 0.001). Furthermore, it was found that patients with brodifacoum suffered higher incidences of ecchymosis (50.0% versus 0%, P = 0.006) and hematuria (50.0% versus 0%, P = 0.006) than patients with bromadiolone poisoning. Laboratory analysis also demonstrated a poorer hemostatic profile of patients with brodifacoum [prothrombin time (PT), international normalized ratio (INR), 4.3 ± 4.8 versus 1.0 ± 0.1, P = 0.032; PT prolongation, 50.0% versus 0%, P = 0.006; activated partial thromboplastin time (aPTT) prolongation, 50.0% versus 0%, P = 0.006] than patients with bromadiolone poisoning. At the end of analysis, no patient died of the poisoning.

CONCLUSION

The favorable outcome (zero mortality rate) is comparable to the published reports from other international poison centers. Further studies are warranted.

New validated multiresidue analysis of six 4-hydroxy-coumarin anticoagulant rodenticides in hen eggs

Anticoagulant rodenticides are frequently a cause of poisoning of domestic animals, wildlife, and human beings. A toxicosis in 6,000 laying hens caused by the malicious addition of unknown amounts of coumatetralyl bait as well as the insecticides aldicarb, methomyl, and imidacloprid in the drinking water, was investigated in the current study. In order to determine a possible carryover of coumatetralyl into eggs, a rapid and reliable analytical method was developed and fully validated for the simultaneous detection of 6 anticoagulant rodenticides (warfarin, coumatetralyl, coumachlor, bromadiolone, difenacoum, and brodifacoum) in yolk and albumen using high-performance liquid chromatography (HPLC) with fluorescence detection. The method developed was reproducible, sensitive, accurate, and linear within the range of 0.01-1 mg/kg, which is the concentration range of bromadiolone and warfarin found in yolk in previously reported studies. The coefficient of variations of within and between days was 1.0-8.5% for yolk and 0.6-3.8% for albumen, while recoveries from spiked albumen and yolk samples were all in the range of 79-99% and 51-95%, respectively. Limits of detection in yolk were 0.01 mg/kg for warfarin and 0.003 mg/kg for the remaining compounds; in albumen, the limit of detection was 0.003 mg/kg for warfarin, coumatetralyl, and coumachlor, and 0.0015 mg/kg for difenacoum and brodifacoum. The application of the validated method revealed the presence of coumatetralyl in the yolk only at levels of 0.0057 mg/kg and 0.0052 mg/kg on the second and fourth day of the poisoning. In conclusion, the HPLC method demonstrated suitability for application in official analysis of anticoagulants in hen eggs.

Primary and secondary poisoning by anticoagulant rodenticides of non-target animals in Spain

Anticoagulant rodenticide (AR) levels were studied in liver of 401 wild and domestic animals found dead in Spain with evidences of AR poisoning, including 2 species of reptiles (n=2), 42 species of birds (n=271) and 18 species of mammals (n=128). Baits (n=32) were also analyzed to detect the potential use of ARs in their intentional preparation to kill predators. AR residues were detected in 155 (38.7%) of the studied animals and 140 (34.9%) may have died by AR poisoning according to the clinical information, necropsy findings, residue levels and results of other toxicological analysis. Animals considered with sublethal AR exposure had total AR residues (geometric mean with 95% CI) in liver of 0.005 (0.003-0.007)μg/g wet weight (w.w.) and animals diagnosed as dead by AR poisoning had 0.706 (0.473-1.054)μg/g w.w. ARs were detected in 19% of baits illegally prepared to kill predators. In terms of the total incidents studied in our laboratory between 2005 and 2010 (n=1792 animals), confirmed poisonings represented 40.9% of the cases, and 21.1% of these were due to ARs (8.6% of the total sample). Nocturnal raptors (62%) and carnivorous mammals (38%) were amongst the secondary consumers with highest prevalence of AR exposure, especially to second generation ARs (SGARs). On the other hand, granivorous birds showed the highest prevalence of AR exposure (51%), especially to chlorophacinone in a region treated against a vole population peak in 2007. The presence of hemorrhages was significantly associated with AR levels in liver, but some animals (7.2%) with elevated residue levels (>0.2μg/g w.w.) showed no evidence of macroscopic bleeding. The use of accumulative SGARs and the application of baits on surface (i.e. treated grain by spreader machines) should be discontinued in future EU regulations on the use of rodenticides to prevent the poisoning of non-target wildlife species.