Green tobacco sickness

Toxic agent	Nicotiana tabacum (nicotine)
Exposure environment	Tobacco workers hand harvesting, cutting, or loading tobacco plants during harvest; usually (but not necessarily) in the early morning or after rainfall when tobacco plants are covered with moisture.
Exposure attributes	Skin exposure (hands, forearms, thighs, backs, and feet) to dissolved nicotine from wet tobacco leaves. Dew from tobacco leaves often saturates workers’ clothing within minutes of beginning field work.
Symptoms	Most common: weakness, headache, nausea, vomiting, dizziness
	Other: abdominal cramps, breathing difficulty, abnormal temperature, pallor, diarrhoea, chills, fluctuations in blood pressure or heart rate, increased perspiration and salivation
Illness onset	Range of onset 3–17 hours; median onset 10 hours.
Duration of illness (untreated)	Mean duration of the illness is 2.4 days.
Treatment	Self: change clothing, showering, work cessation, fluid intake, rest, time
	Medical facility (if needed): Intravenous rehydration, anti-emetics, dimenhydrinate, supportive care
Risk reduction	Protective, water-resistant clothing; chemical-resistant gloves, boots, socks; avoid harvesting during rain or in the early morning; change clothing if wet; wash clothes if soaked with tobacco sap; dimenhydrinate (treatment and prophylactic); employee awareness—inform physician about exposure to nicotine.
Public health response	Educational outreach (timed to coincide with tobacco harvest)—informational mailings, flyers, bulletins, and news stories aimed at tobacco workers and healthcare providers.
Economic impact	US$250 for outpatient treatment; $566 for hospital admission; $2041 for intensive care. Plus lost income and productivity.

Adapted from McKnight.7