• Journal of agricultural medicine and community health
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• v.26 no.2
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• pp.7-14
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• 2001

Cases of green tobacco sickness were described. During the cutting of tobacco plants throughout harvest, four cases of green tobacco sickness occurred in August 2001, Korea. The range of age was 42-55 years. The most frequent symptoms included dizziness, weakness, nausea, vomiting, abdominal cramps, headache, and difficulty breathing. All affected individuals worked in fields of wet tobacco, where their clothes became wet from moisture on the plants or sweating. They were all healthy, except one with hypertension. They are all non-smokers. They recovered after fluid and antiemetic administrations within two days. Most of doctors misdiagnosed their symptoms as a pesticide poisoning or heat injury. Green tobacco sickness is a condition that has long been known as an occupational health risk among tobacco harvesters. Nicotine poisoning by dermal absorption is reported to be the cause of green tobacco sickness. In Korea, there are many tobacco harvesters, and most of them may be sticken with green tobacco sickness. But, no case of green tobacco sickness has been reported. We report cases of green tobacco sickness occurred to the tobacco harvesters with a review of articles.

• Journal of The Korean Society of Clinical Toxicology
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• v.17 no.2
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• pp.132-134
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• 2019

Green tobacco sickness is an illness caused by dermal exposure to nicotine. The common symptoms of the disease include dizziness, headache, nausea, vomiting, severe general weakness, fluctuations of blood pressure or heartbeat, abdominal cramping, chills, increased sweating, salivation, and difficulty breathing. A 79-year-old female arrived at the emergency room for an evaluation of sudden onset dizziness. Magnetic resonance imaging and angiography of the brain did not show any relevant abnormal findings. Four days later, with supportive care, she said that she had harvested green tobacco for six hours on the day of admission and the tobacco harvest was the first time in her life. She sweated excessively during the hot and humid weather and the tobacco leaves were wet from rain the night before. The serum cotinine tested at five days of admission was 16ng/ml. She was diagnosed with acute nicotine poisoning by her clinical symptoms and the half-life of cotinine in the blood.

• Journal of Preventive Medicine and Public Health
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• v.37 no.1
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• pp.37-43
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• 2004

Objectives : This study was carried out to understand the prevalence and risk factors of green tobacco sickness (GTS) among Korean tobacco harvesters. Methods : The authors conducted a questionnaire among the tobacco harvesters (1,064 persons from 555 out of 723 tobacco harvesting households) in Cheongsong-gun for 4 days from May 7 to 10, 2002. Results : The study subjects were 550 males and 514 females. The recognition and experience of GTS up until 2001 were 96.4% and 61.9%, respectively. The prevalence of GTS in 2001 was 42.5%, and was significantly higher in females than in males (59.0% vs. 26.6%, p<0.01). The incidence density of GTS according to the number of workdays in 2001 was 12.3 spells/100 person..days. The GTS symptoms reported by the tobacco harvesters in 2001 were dizziness in 441 cases (97.6%), nausea in 414 (91.6%), headache in 349 (77.2%) and vomiting in 343 (75.9%). The use of gloves, hat and wristlets, sweating at work and the number of working hours significantly increased the prevalence of GTS (p<0.05). Multiple logistic re- gression analysis was used to determine the factors significantly associated with GTS. Odds ratios for smoking, working over 10 hours and sweating at work were 0.26 (95% CI:0.19-0.35), 1.64 (95% CI:1.26-2.14) and 1.60 (95% CI:1.14-2.25), respectively. Of those who reported GTS in 2001, 311 cases (68.8%) underwent treatment from their local medical facilities. Conclusions : In Korea, there are many tobacco-harvesting households, and most may be stricken with GTS. More extensive epidemiological studies, including the incidence and associated risk factors, are expected and a surveillance system including measurements of cotinine in urine should be conducted.

• Safety and Health at Work
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• v.9 no.1
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• pp.71-74
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• 2018

Background: Green tobacco sickness (GTS), an occupational disease in tobacco harvesters, is a form of acute nicotine intoxication by nicotine absorption through the skin from the wet green tobacco plant. We carried out a questionnaire survey and measured cotinine concentration, the metabolic product of nicotine, to determine the prevalence, incidence, and risk factors of GTS in Korean tobacco harvesters. Methods: We measured cotinine concentrations, and administered a questionnaire survey to tobacco harvesters in Cheongsong-gun, Gyeongsangbuk-do, Korea. We repeatedly measured urine cotinine concentration five times with a questionnaire survey. Results: Cotinine concentration at dawn was significantly higher than that at other times; it was significantly lower during the nonharvesting period than during the harvesting period. However, little change in cotinine concentration was detected in the daytime during the harvesting period. Study participants included 20 men and 20 women. The prevalence of GTS was 37.5% and was significantly higher in women than in men (55.0% vs. 20.0%, p < 0.01). GTS incidence according to number of workdays was 3.4 occurrences/100 person days. Conclusion: In this study, nicotine exposure and metabolism were experimentally determined from the time of cotinine exposure, and biological monitoring was performed in each season. In the future, this information may be valuable for medical decision-making in GTS prevention.

• Journal of Environmental Health Sciences
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• v.36 no.3
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• pp.208-214
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• 2010

Green tobacco sickness (GTS) is an illness associated with nicotine exposures among tobacco harvesters. The purposes of this study were to measure the concentration of nicotine residues on the hands and forearms of tobacco harvesters, and to compare the concentrations according to the harvesting task. Wipe samples from the both hands and forearms were obtained from 16 workers at three sampling times (before work, in the morning after harvesting leaves, and in the afternoon after binding leaves). The geometric means of the right and left hand nicotine levels in harvesting work were 0.70 and $0.61\;{\mu}g/cm^2$, respectively, which were substantial, if significantly lower than the corresponding levels in binding work of 5.19 and $1.50\;{\mu}g/cm^2$ (p=0.016). The overall combined nicotine levels for the hands (i.e., left and right) were significantly higher than those for the forearms (p=0.013). The results of this study therefore indicate that, for GTS prevention, waterproof gloves should be worn while harvesting.

• 월간산업보건
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• s.343
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• pp.13-17
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• 2016

• Journal of Preventive Medicine and Public Health
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• v.47 no.3
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• pp.144-149
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• 2014

Objectives: Nicotine is a natural alkaloid and insecticide in tobacco leaves. Green tobacco sickness (GTS) is known as a disease of acute nicotine intoxication among tobacco farmers. Until now, GTS has been recognized globally as a disease that results from nicotine absorption through the skin. However, we assumed that GTS might also result from nicotine inhalation as well as absorption. We aimed to measure the airborne nicotine concentrations in various work environments of Korean tobacco farmers. Methods: We measured the nicotine concentrations in the tobacco fields, private curing barns, and joint curing barns of farmers from July to October 2010. All sampling and analyses of airborne nicotine were conducted according to the National Institute for Occupational Safety and Health manual of analytic methods. Results: The airborne nicotine concentrations (geometric mean [geometric standard deviation]) in the tobacco field were $83.4mg/m^3$ (1.2) in the upper region and $93.3mg/m^3$(1.2) in the lower region. In addition, the nicotine concentration by personal sampling was $150.1mg/m^3$. Similarly, the nicotine concentrations in the private curing barn, workers in curing barns, the front yard of the curing barn, and in the joint curing barn were $323.7mg/m^3$(2.0), $121.0mg/m^3$(1.5), $73.7mg/m^3$(1.7), and $610.3mg/m^3$(1.0), respectively. Conclusions: The nicotine concentration in the workplaces of tobacco farmers was very high. Future studies should measure the environmental concentration of nicotine that is inhaled by tobacco farmers.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.20 no.1
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• pp.47-52
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• 2010

Green tobacco sickness (GTS) is known as an occupational disease among tobacco harvesters, and a form of acute nicotine intoxication by the absorption of nicotine through the skin from the wet green tobacco plant. On the assumption that GTS may occur by inhalation as well as absorption of nicotine, we measured the airborne nicotine concentration in tobacco field and the processing room of tobacco leaves. We measured the airborne nicotine concentrations in the tobacco field and processing room between 13 and 30 July 2008. All sampling and analyses of airborne nicotine were conducted according to the manual of analytic methods of NIOSH 2551, and we sampled 2 times at 11 points in the tobacco field by area sampling. The sampling in the processing room of tobacco leaves was conducted at 3 points, and earlymorning dew was collected from the tobacco by wringing the moisture into specimen bottles. The airborne nicotine concentration [geometric mean (geometric standard deviation)] in the tobacco field in the P.M. was higher [49.2 mg/$m^3$ (1.3)] than the A.M. concentration [43.4 mg/$m^3$ (1.4)]. Similarly, the nicotine concentration in the processing room of tobacco leaves was 224.4 mg/$m^3$ (1.2), and the concentration of nicotine in the dew was 64.7 mg/${\ell}$ (1.7). Based on our results, the airborne nicotine concentration in the tobacco field and the processing room of tobacco leaves were 100 and 400 times higher than the occupational recommended values (TLV-TWA of 0.5 mg/$m^3$), respectively. In the future, it is hoped that epidemiologic studies and environmental measurements will be conducted for GTS which occurs by inhalation of nicotine. If GTS is confirmed to occur by inhalation of nicotine, respiratory and dermal protective equipment must be distributed.