Green tobacco sickness

Toxic agentNicotiana tabacum (nicotine)
Exposure environmentTobacco 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 attributesSkin 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 onsetRange 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 reductionProtective, 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 responseEducational outreach (timed to coincide with tobacco harvest)—informational mailings, flyers, bulletins, and news stories  aimed at tobacco workers and healthcare providers.
Economic impactUS$250 for outpatient treatment; $566 for hospital admission; $2041 for intensive care. Plus lost income and productivity.
  • Adapted from McKnight.7