Introduction

Time is important in responding to a chemical-exposure-related illness. The public health authorities can implement appropriate emergency response and public health action if they know about the event sooner. Florida Department of Health, Division of Environmental Health has developed the ‘Chemical Disease Surveillance Program’ as the main method for early detection and notification of chemical-exposure-related illness or poisoning.

The Chemical Disease Surveillance Program serves various functions to protect and promote the health of Florida citizens. The program provides education and consultation to County Health Departments and other stakeholders on chemical disease surveillance. Arsenic, mercury, carbon monoxide and pesticide poisonings are reportable conditions in Florida. Any reports of these chemical exposures are investigated and reported to the state. 

In addition to these reportable chemical diseases, the Chemical Disease Surveillance Program also monitors other chemicals in near real-time by using Florida Poison Information Center Network (FPICN) data and hospital emergency room chief complaint data. The program epidemiologists monitor data trends on disease syndromes such as respiratory or gastro-intestinal diseases to look for disease outbreaks. We also monitor increases in Florida Poison Information Center call volume due to specific substance and overdose of drugs such as cough and cold or anti-diarrheal medicines as an outbreak signal. These preliminary data are analyzed in near real time and serve to guide a timely outbreak response. 

What is Syndromic Surveillance?

Syndromic surveillance has been defined as the ongoing, systematic collection, analysis, interpretation, and application of real-time (or near-real-time) indicators of diseases and outbreaks that allow for their detection before public health authorities would otherwise note them. (CDC)

It has also been defined as "surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response." (Fricker, 2007)

What is Arsenic Poisoning?

Arsenic poisoning is the condition caused by exposure to arsenic in high enough dose to produce health effects. Organic arsenic is considered as less toxic form of arsenic.

Sources: Tobacco smoke, sea food, some agricultural pesticides, well water with high arsenic level, CCA-treated wood and some homeopathic and naturopathic preparations, and folk remedies are the sources of arsenic poisoning.

Health Effects:  The symptoms of arsenic poisoning begin with headaches, confusion and drowsiness. As the poisoning develops, convulsions and changes in fingernail pigmentation may occur. When the poisoning becomes acute, symptoms may include diarrhea, vomiting, cramping muscles, hair loss, stomach pain, and more convulsions. The organs of the body that are usually affected by arsenic poisoning are the lungs, skin, kidneys, and liver. The final result of arsenic poisoning is coma or death.

Laboratory Tests: Arsenic poisoning can be measured by testing hair, fingernail, blood or urine of the patient. The urine test is considered as most reliable for acute exposures. For surveillance and reporting, only 24 hour urine and urine creatinine tests are considered as valid test.

For more information visit CSEM- Arsenic toxicity and ATSDR- Arsenic FAQs website.

What is Mercury Poisoning?

Mercury poisoning is the condition caused by exposure to mercury in high enough dose to produce health effects. There are three forms of mercury (elemental, organic & inorganic) with distinct characteristics and health effects on toxic exposures. 

Sources: Exposure to mercury can occur by any method. Dental amalgam fillings and eating fish that has been exposed to mercury are the main cause of mercury poisoning. Mercury exposure can occur at home or even in hospital setting through broken thermometers and blood pressure monitors. These conditions are hazardous even without touching the mercury because it produces mercury vapors. Some folk medicines and cosmetics contain mercury. It is also used in paint industry, neon signs, outdoor lighting, cameras, electrical switches, and some batteries.

Health Effects: The signs and symptoms of acute exposure to mercury may vary depending on the form of mercury (elemental or inorganic). For elemental mercury, acute toxicity might result in fever, fatigue, and clinical signs of pneumonitis. For inorganic mercury, symptoms might include profuse vomiting and diarrhea that is often bloody, followed by hypovolemic shock, oliguric (decreased urine production) renal failure, and possibly death. Delayed toxicity symptoms (> 1 month) are typical of organic mercury poisoning and usually involve the central nervous system. These symptoms might include paresthesias, headaches, ataxia, dysarthria (motor speech disorder), visual field constriction, blindness, and hearing impairment.

Laboratory Tests: Blood, urine and hair can be tested for mercury.

For more information visit ATSDR-Mercury  and  ATSDR-Tox FAQs website.

Carbon monoxide (CO) is an odorless, colorless, poisonous gas that can cause sudden illness and death if present in sufficient concentration in the ambient air.

Sources: Carbon monoxide is found in combustion fumes produced by generators, Automobile/ RV, Boat, Kerosene/ gas space heater, power tools (include mover), fuel burning appliances (fixed stove/ boiler/ furnace), portable fuel burning grill/ stove, charcoal grills and fire, etc.  

Health Effects: The clinical presentation of acute carbon monoxide (CO) poisoning varies depending on the duration and magnitude of exposure. The most common signs and symptoms include headache, nausea, lethargy (or fatigue), weakness, abdominal discomfort/pain, confusion, and dizziness. Other signs and symptoms may include visual disturbances including blurred vision, numbness and tingling, ataxia, irritability, agitation, chest pain, dyspnea (shortness of breath), palpitations, seizures, and loss of consciousness.

Laboratory Tests: Blood carboxyhemogolbin (COHb) level  is useful in confirming the diagnosis of carbon monoxide poisoning. Environmental monitoring data collected by first responders is also useful in the detection of CO exposure.

For more information visit EPA- Carbon Monoxide  & CDC- CO Poisoning website.

Pesticide poisoning is an illness or injury resulting from exposure to a single or mixture of pesticides. Chemical Disease Surveillance Program monitors the surveillance activities of all the pesticide exposures. Please visit Pesticide Poisoning Surveillance Page for details on pesticide poisoning.

Contact Info:

Prakash R. Mulay, MBBS, MPH
Chemical Surveillance Coordinator
4052 Bald Cypress Way Bin A08
Tallahassee, Fl. 32399
Phone: (850) 245-4444 Ext. 4576
Fax: (850) 922-8473

Read more about Chemical Disease Surveillance Program

• Reporting guidelines for CHDs

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