Did St. John avoid a disaster almost one year ago when the toxic pesticide which severely injured a family of four in a two-unit condominium building above Cruz Bay in March 2015 was illegally used in a four-unit building in the same complex in October 2014?
Federal investigators determined that 20 people unknowingly were exposed to Methyl Bromide in the October 2014 incident which eerily mirrored the subsequent March 2015 poisoning that seriously injured a visiting family of four and exposed emergency first responders to what turned out to be their second exposure to various levels of the toxic pesticide in an island condominium in less than six months.
“An investigation by DPNR and EPA revealed that methyl bromide had also been used at the same condominium complex by the same pest control company on October 20, 2014, in four additional housing units,” apparently by the same manager of the St. Thomas Terminix corporate-owned franchise, according to a report from the Agency for Toxic Substances and Disease Registry (ATSDR) on the March illegal fumigation incident.
“In addition to the family of four (in the March 2015 poisoning), 37 persons were identified who had potentially been exposed to methyl bromide; 11 were potentially exposed after the March 2015 fumigation, 20 after the October 2014 fumigation, and one during both periods,” the federal report said. “Whether the remaining five persons were exposed during one or both periods is unknown.”
“No Contact” With 17 Exposed
“Contact information was unavailable for 17 of the 37 persons; among the 20 for whom contact information was available, 16 were surveyed,” the detailed report continued. “Of the 16, eight had been exposed after the March 2015 fumigation, seven after the October 2014 fumigation, and one during both periods.”
The March 2015 incident, while only involving two condominium units, apparently involved more severe exposure to the pesticide for members of the family staying in the condominium unit adjoining the one fumigated with the restricted-use pesticide.
“No persons exposed only after the October 2014 fumigation reported any adverse health effects,” according to the report, which did not elaborate on who was exposed. “Among the eight persons exposed after the March 2015 fumigation and the one person exposed during both periods, six had post-exposure symptoms. Among these nine persons, maximum exposure time was approximately 75 minutes after the March 2015 fumigation.”
“All six persons who had symptoms reported headache, and four reported fatigue. One person had shortness of breath, and another had a cough,” the report continued. “All symptoms resolved within (three) weeks of exposure except for certain symptoms experienced by two persons, one who had a persistent mild headache and another who had a mild cough that had been present before the exposure occurred.”
“This investigation also highlights the public health consequences of methyl bromide use in a residential setting,” the report emphasized. “Certain unsuspecting persons were exposed to this highly toxic chemical because of its non-permitted use.”
“Of note, most persons who experienced post-exposure symptoms were emergency responders to the scene,” the report continued. “At the time they responded, a chemical exposure was not known to be the definitive cause of the family’s illness. However, if a toxic chemical release is ever identified, subsequent prompt notification of potentially exposed emergency responders is recommended.”
“Use of methyl bromide is restricted to specified settings as required by U.S. law and international regulations,” the report explained. “Pest control companies should be aware of all rules regarding products they use and should ensure that all staff members receive proper education and training for application of these products in a safe manner, including use of personal protective equipment and appropriate signage.”
“As a result of the investigation, on March 25, 2015, DPNR issued an immediate stop-use order to the pest control company that had performed the fumigations; the stop-use order prevented any further use of methyl bromide by the company in any setting in the U.S. Virgin Islands,” the federal report stated. “Methyl bromide is a pesticide that has been banned in the United States for use in homes and other residential settings.”
EPA, in coordination with DPNR and VIDOH, subsequently performed monitoring and ventilation of the building fumigated in March 2015.
“An investigation conducted by the U.S. Virgin Islands Department of Health (VIDOH), the U.S. Virgin Islands Department of Planning and Natural Resources (DPNR), and EPA confirmed that methyl bromide had been used as a fumigant on March 18 in the building where the family had been residing two days before they were transported to the hospital,” the federal report on the incident stated. “Three family members had life-threatening illness.”
“Pest control companies should be aware that use of methyl bromide is banned in homes and other residential settings, and clinicians should be aware of the toxicologic syndrome that exposure to methyl bromide can cause,” the report asserted.
Specific and Technical Details
The report contained specific, technical details about the poisoning.
“On March 20, 2015, a family of four vacationing in the U.S. Virgin Islands was transported to a hospital with a 24-hour history of progressive neurologic symptoms, including generalized weakness, severe myoclonus, fasciculations, altered sensorium, and word-finding difficulty. Three of the four patients had vomiting and diarrhea; three required endotracheal intubation and mechanical ventilation.”
“Initial clinical suspicion included organophosphate toxicity and ciguatera fish poisoning; however, other persons who had consumed the same food as the patients had not become ill. Because chemical toxicity was considered as a possible etiology for the family’s illness, management at the condominium resort where the family had been residing was contacted.”
“A preliminary investigation revealed that an unoccupied housing unit below the one in which the family had been staying, but in the same building, had been fumigated with the pesticide methyl bromide on March 18, 2 days before the family sought medical care. The patients’ neurologic syndrome was consistent with acute methyl bromide toxicity.”
“The family consisted of two teens and two adults, with an age range from 14 to 49 years. All four patients were treated with benzodiazepines, phenobarbital, and propofol for sedation and symptom control. The two teens were treated with the neuromuscular blocking agent rocuronium because of symptom severity, and the two adults received pralidoxime because of the initial suspicion of possible organophosphate toxicity.”
“All four patients underwent two hemodialysis procedures when methyl bromide toxicity became the leading diagnostic consideration” after blood tests on March 20, the day the family was taken to the hospital,” according to the report. “Within three days, all four patients were transferred to hospitals in the continental United States for further care. As of June 30, all four patients had been discharged from acute-care hospitals. Three of the four patients were receiving inpatient physical rehabilitation for significant neurologic dysfunction.”
“VIDOH and ATSDR, working with EPA and condominium management, sought to identify persons in addition to the affected family who had potentially been exposed to methyl bromide at the condominium resort to more fully characterize health effects of the fumigations,” the re[port elaborated. “The identification process included any person who had been inside a fumigated building during the two weeks following the date of fumigation (or until the building was sealed off in the case of the March 2015 fumigation).”
“This two-week time frame was based on two primary considerations: 1) preliminary results of environmental sampling over time; and 2) expected decreases in the air concentration of methyl bromide in the affected housing units and in the associated risk of adverse health effects (6,9),” the report concluded.
“Potentially exposed persons included pest control company personnel, emergency responders, condominium staff members, and resort residents, vacationers, and visitors. A standardized questionnaire was used to interview exposed persons about possible exposure-related health effects.”