Epidemiology and Disease Surveillance Unit

Fifth Street, TX, United States

Epidemiology and Disease Surveillance Unit

Fifth Street, TX, United States

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Forrester M.B.,Epidemiology and Disease Surveillance Unit
Pediatric Emergency Care | Year: 2013

OBJECTIVES: Pediatric exposures to concentrated laundry detergent packs may result in serious adverse affects. This study compared pediatric exposures to laundry detergent packs and traditional laundry detergents. METHODS: Cases were exposures among patients 5 years or younger to laundry detergent packs during January to June 2012 and traditional laundry detergents during January to December 2011 reported to Texas poison centers. Comparisons between the 2 types of products were made for various variables. RESULTS: Of 187 laundry detergent pack and 452 traditional laundry detergent exposures, the patient was already at or en route to a health care facility in 21.4% of the laundry detergent pack and 9.3% of the traditional laundry detergent exposures. Of those exposures where the poison center could potentially influence where the patient was managed, 23.8% of laundry detergent pack and 3.7% of traditional laundry detergent exposures were referred to health care facilities. Potentially serious outcomes were reported in 12.3% of laundry detergent pack and 2.4% of traditional laundry detergent exposures. The most commonly reported clinical effects in laundry detergent pack and traditional laundry detergent exposures were vomiting (54.5% vs 17.0%), cough (11.2% vs 2.2%), ocular irritation (7.0% vs 6.4%), red eye (7.0% vs 5.3%), nausea (7.0% vs 2.7%), and oral irritation (7.0% vs 2.2%). CONCLUSIONS: Pediatric exposures to laundry detergent packs were more likely to be managed at a health care facility. Moreover, the laundry detergent pack exposures were more likely to result in serious outcomes and involve the most common clinical effects.© Copyright 2013 by Lippincott Williams & Wilkins.


Forrester M.B.,Epidemiology and Disease Surveillance Unit
Journal of Emergency Medicine | Year: 2015

Background Electronic cigarette use is increasing. There are concerns that pediatric exposures to these products may result in serious adverse affects. Objectives This study describes pediatric exposures to electronic cigarettes. Methods Cases were electronic cigarette exposures among patients age 5 years or less reported to Texas poison centers during January 2010-June 2014. The distribution by selected variables was determined. Results Of 203 exposures, two cases were reported in 2010, five in 2011, 20 in 2012, 70 in 2013, and 106 in January-June 2014. Fifty-one percent of the patients were male; 32% of the patients were aged 1 year, and 42% were 2 years of age. Ninety-six percent of the exposures occurred at the patient's own residence. The exposure routes were ingestion (93%), dermal (11%), ocular (3%), and inhalation (2%). Fifty-eight percent of the patients were managed on site. Of the patients seen at a health care facility, 69% were treated or evaluated and released. Eleven percent of the exposures were serious. The most commonly reported clinical effects were vomiting (24%), drowsiness/lethargy (2%), and cough/choke (2%). The most frequent treatments were dilution/irrigation/wash (65%) and food/snack (16%). Conclusions Electronic cigarette exposures involving young children reported to poison centers are increasing. Such exposures are likely to involve patients ages 2-3 years, occur at the child's own residence, and occur by ingestion. Further study is needed to determine which subgroups are at risk for serious outcomes and warrant evaluation at a health care facility. © 2015 Elsevier Inc.


Forrester M.B.,Epidemiology and Disease Surveillance Unit
Human and Experimental Toxicology | Year: 2013

1,3-Dimethylamylamine (DMAA) is an ingredient in a number of weight loss and exercise performance enhancing products. However, information on the safety of DMAA-containing products is limited. Exposures to DMAA-containing products reported to Texas poison centers during 2010-2011 were identified and selected factors were examined. A total of 56 exposures were found, of which 75.0% were reported during 2011. OxyElite Pro™ was the reported product in 80.4% of the exposures. The patients were 51.8% male and 55.4% age ≥5 years. The patient was managed on site (such as at home) in 57.1% of the cases, and the exposure was known or expected to result in an outcome that was classified as not serious in 80.4%. The most frequently reported clinical effects were tachycardia (28.6%), nausea (16.1%), and vomiting (12.5%). The most common treatments were dilution (41.1%), food (19.6%), and activated charcoal (14.3%). It should be noted that the adverse clinical effects may be due to other ingredients in the DMAA-containing products, such as caffeine. © The Author(s) 2013.


Forrester M.B.,Epidemiology and Disease Surveillance Unit
Pediatric Emergency Care | Year: 2012

OBJECTIVE: This study examined whether the withdrawal of over-the-counter cough and cold medication labeled for use in children younger than 2 years in October 2007 and the warning against use of the products in children younger than 4 years in October 2008 affected cough and cold medication ingestions by young children reported to a statewide poison system. METHODS: Cases were all cough and cold medication ingestions by children aged 0 to 5 years reported to the Texas Poison Center Network during October 1998 to September 2009. The annual number of ingestions was determined, and the percent change from the previous year calculated. RESULTS: During October 1998 to September 2007, the number of ingestions exhibited a mean annual increase of 2.5%. The number of ingestions declined by 16.0% during October 2007 to September 2008 and 9.3% during October 2008 to September 2009. During October 2007 to September 2008, the number decreased by 26.5% in children aged 0 to 1 years, 13.5% in those aged 2 to 3 years, 5.4% in those aged 4 to 5 years, 23.4% therapeutic errors or adverse drug reactions, and 11.5% in all other circumstances. CONCLUSIONS: The voluntary withdrawal and subsequent voluntary warning of over-the-counter cough and cold medications appear to have resulted in a decline in ingestions reported to Texas poison centers not only among children aged 0 to 1 and 2 to 3 years but also among children aged 4 to 5 years, although the degree of decline was greatest for the youngest age groups. The decrease was observed not only among therapeutic errors and adverse drug reactions, but also in other circumstances of ingestion, although the decrease was greater for the former circumstances. Copyright © 2012 by Lippincott Williams & Wilkins.


Forrester M.B.,Epidemiology and Disease Surveillance Unit
Human and Experimental Toxicology | Year: 2013

The pesticide Miraculous Insecticide Chalk™ is illegal in the United States but can be obtained through a variety of sources. Because it is a stick similar in appearance to common blackboard chalk, children might play with it and put it in their mouths. All Miraculous Insecticide Chalk exposures involving children 5 years or younger reported to Texas poison centers during 2000-2010 were identified. The distribution by selected demographic and clinical factors was calculated. Of the total 188 exposures, the mean age was 1.5 years (range 6 months-5 years) and 60.6% were male. Ingestions were reported in 97.3% of the exposures, and these were reported to involve at most one stick of the chalk. The lowest exposure rates per 100,000 population of 5 years or younger were reported in the Public Health Regions in northern and eastern Texas (0.00-2.30) and the highest rates in the Public Health Regions in southern and western Texas (19.08-39.50). Of the 187 exposures not involving other substances, 96.8% were known or expected to result in at most minor effects, and 71.1% were managed on site (at residence). © 2013 The Author(s).


Forrester M.B.,Epidemiology and Disease Surveillance Unit
International Journal of Adolescent Medicine and Health | Year: 2015

There had been reports of adolescents using hand sanitizers to obtain alcohol and ending up in emergency departments with alcohol poisoning. Objective: This study aimed to describe the pattern of adolescent ingestions of hand sanitizers reported to a statewide poison center system. Subjects: Our study subjects included patients aged 13-19 years who reported hand sanitizer ingestions as reported to Texas poison centers during 2000-2013. Materials and methods: The distribution of the ingestions was determined for various demographic and clinical factors. Results: Of 385 total cases, 61% of the patients were male, and the mean age was 15.3 years. The ingestion reason was unintentional (61%), intentional abuse/misuse (18%), and malicious (10%). Ingestion site was most frequently reported to be the patient's own residence (53%), followed by school (35%). About 77% of the patients were managed on site. The medical outcome was serious (moderate effect or unable to follow-potentially toxic) in 5% of the cases. The most frequently reported adverse clinical effects were vomiting (5%), abdominal pain (4%), nausea (4%), throat irritation (4%), and drowsiness (2%). Conclusion: Adolescents who ingested hand sanitizers were more likely to be male and younger. One-third of the ingestions occurred at school, suggesting that school personnel might be made aware of the potential problem of hand sanitizer ingestions by adolescents. Nevertheless, despite the potential for serious outcomes from adolescent hand sanitizer ingestion, most of the ingestions reported to poison centers are not likely to be serious and can be successfully managed outside of a healthcare facility. © 2015 by De Gruyter.


Forrester M.B.,Epidemiology and Disease Surveillance Unit
Human and Experimental Toxicology | Year: 2010

During serious influenza outbreaks, the number of oseltamivir exposures reported to poison centers might be expected to increase. This investigation describes the pattern of oseltamivir ingestions reported to Texas poison centers during 2000-2008. Of 298 total ingestions, 91.9% occurred in December-March, 76.8% involved patients aged 0-19 years, 72.5% resulted from therapeutic error, 90.0% were managed on-site, and 80.0% had no effect. The most frequently reported adverse clinical effects were vomiting (7.5%), nausea (3.8%), and abdominal pain (3.8%). Oseltamivir ingestions were reported to Texas poison centers primarily during periods of influenza outbreak. Most involved children, resulted from therapeutic error, and were managed on-site without serious outcome.


Forrester M.B.,Epidemiology and Disease Surveillance Unit
Pediatric Emergency Care | Year: 2013

Objectives: This study describes the pattern of adolescent synthetic cathinone exposures reported to a large, statewide poison center system. Methods: Synthetic cathinone exposures among patients younger than 20 years reported to Texas poison centers during 2010 to 2011 were identified. The distribution of exposures by various demographic and clinical factors was determined. Results: For 51 adolescent exposures, the mean age was 17.5 years (range, 12-19 years). The exposure was by inhalation in 66.7% of the cases and 60.8% involved male patients. The exposure site was the patient's own or another residence in 58.8% of the cases. The patient was already at or en route to a health care facility in 76.5% of the cases, and the medical outcome was known or suspected to be serious in 74.5%. The most frequently reported adverse clinical effects were agitation/irritability (43.1%), tachycardia (37.3%), drowsiness/lethargy (13.7%), hallucinations (9.8%), fever (9.8%), vomiting (9.8%), and hypertension (7.8%). Conclusions: Adolescent synthetic cathinone exposures reported to Texas poison centers were more likely to have occurred by inhalation. The adolescents were more likely to be male. The exposures more often occurred at the patient's own residence and were managed at a health care facility with a serious outcome. This pattern of exposures was similar to that observed among adults. Copyright © 2013 by Lippincott Williams & Wilkins.


Forrester M.B.,Epidemiology and Disease Surveillance Unit
Pediatric Emergency Care | Year: 2012

OBJECTIVE: This study describes the pattern of adolescent synthetic cannabinoid exposures reported to a large statewide poison center system. METHODS: Synthetic cannabinoid exposures among patients younger than 20 years reported to Texas poison centers during January 2010 to June 2011 were identified. The distribution of exposures by various demographic and clinical factors was determined. RESULTS: For 305 adolescent exposures, the mean age was 16.7 years (range, 12-19 y). The exposure was by inhalation in 77.4% of the cases, and 72.1% involved males. The exposure site was the patient's own residence in 70.5% of the cases, and a health care facility was the caller site in 68.9%. The patient was already at or en route to a health care facility in 80.3% of the cases, and the medical outcome was serious in 61.0%. The most frequently reported adverse clinical effects were tachycardia (41.6%), drowsiness/lethargy (24.3%), agitation/irritability (16.4%), vomiting (13.1%), hallucinations/delusions (11.5%), nausea (8.5%), confusion (8.2%), hypertension (7.5%), chest pain (6.9%), and dizziness/vertigo (5.2%). CONCLUSIONS: Adolescent synthetic cannabinoid exposures reported to Texas poison centers were more likely to involve inhalation. The adolescents were more likely to be male. The exposures more often occurred at the patient's own residence and managed at a health care facility with a serious outcome. This pattern of exposures was similar to that observed among adults. Copyright © 2012 by Lippincott Williams & Wilkins.


Forrester M.B.,Epidemiology and Disease Surveillance Unit
Journal of Emergency Medicine | Year: 2014

Background Concentrated laundry detergent packs are new products that may be more likely to cause adverse effects and serious medical outcomes among young children than traditional laundry detergent products. Objective The intent of this study was to examine whether certain factors might be associated with the referral of pediatric laundry detergent pack exposures by poison centers. Methods Cases were laundry detergent pack exposures involving patients age 5 years or younger reported to Texas poison centers during February 2012 to August 2013. The health care facility referral rate was calculated for selected factors. Results Of 912 exposures, 720 were managed on site and 192 were referred to a health care facility. The referral rate was 16.1% for patients with not serious outcomes and 71.6% for serious outcomes. The referral rate was 32.0% for patients age younger than 1 year and 14.3% to 22.1% for the older age groups. 31.0% of Purex™, 25.5% of All™, and 19.3% of Tide™ product exposures were referred. The referral rate was 33.3% for ocular exposures, 19.4% for dermal contact, and 20.2% for ingestions. The most common clinical effects and their referral rates were vomiting (30.5%), cough or choke (45.1%), ocular irritation (34.6%), red eye (25.4%), nausea (25.4%), drowsiness or lethargy (67.5%), oral irritation (16.7%), and dermal edema (68.4%). Conclusions Pediatric exposures to laundry detergent packs were more likely to be referred to health care facilities if the laundry detergent pack brand was Purex™, the exposure was ocular, or particular ocular, respiratory, dermal, or neurologic clinical effects were present. © 2014 Elsevier Inc.

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