Vol 71, No 3 (2020)
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Published online: 2020-09-28

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Acute occupational phosphine intoxications in the maritime shipping sector: Belgian and French reported cases

Petra Van de Sijpe12, David Lucas1, Maria Luisa Canals3, Olaf Jensen4
Pubmed: 33001425
IMH 2020;71(3):151-159.


Background: During ship transport of organic cargo e.g. soybeans in bulk or textiles in containers, there is a risk of pests damaging the cargo during transport as well as of unwanted global spread of organisms. Consequently, fumigation of the shipped goods is recommended. While aiming to protect the cargo from being damaged by pests during the transport time, fumigation constitutes a risk to the health of seafarers and port workers and even fatal cases are seen. Phosphine gas is increasingly applied for fumigation. Based on former experiences this article aims to describe the risk and to provide recommendations for prevention.
Materials and methods: All reports of acute occupational exposures to phosphine in the maritime shipping industry to the Belgian Poison Centre were analysed and compared to reports in a study by ANSES (Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail), which collected data from the French Poison Centres. Data were registered and analysed between the 1st of January 1999 and the 31 of December 2018.
Results: The reported incidents have so far been rather few but seem to have increased over the last years. Symptoms are gastro-intestinal, neurologic and respiratory and often seem “vague” and non-specific and are often difficult to recognise for first responders. In the cases where the aetiology of the incident is known, there often seems to be a lack of clear information about the risk and options for mitigation in workplaces and among the workers. Twelve publications of case reports were included from the literature review that showed the same patterns as found in the registered incident reports.
Conclusions: There seems to be an increase in incidents of acute poisoning from phosphine worldwide. This increase could be linked to the phasing out of methyl bromide in the Montreal Protocol but may also have other explanations. Strict precautions are needed when using phosphine for fumigation of ship cargoes and containers. Since symptoms are often vague, first-responders need to pay attention to the possible occurrence of acute phosphine intoxication as it may be life threatening. Phosphine intoxication remains a diagnosis nor to underestimate not to miss. Further monitoring and research is needed. Preventive actions are mandatory. It is essential to implement in a strict way the existing legislation of an in-transit fumigation with phosphine. Training of the crew and good communication between the different actors during an in-transit fumigation (ship-owner, captain, fumigator, crew, longshoremen) is the key of a good prevention of accidents.

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  1. Ec.europa.eu. Data – Eurostat maritime transport. https://ec.europa.eu/eurostat/web/transport/data (Accessed 2 December 2019).
  2. The United Nations Conference on Trade and DevelopmentUnctad.org. UNCTAD | Statistics. https://unctad.org/en/Pages/Statistics.aspx (Accessed 2 December 2019).
  3. International Chamber of Shipping ICS. Shipping Facts. http://www.ics-shipping.org/shipping-facts/shipping-facts (Accessed 2 December 2019).
  4. Food and Agriculture Organization. Manual of fumigation for insect control-Space fumigation at atmospheric pressure. http://www.fao.org/3/x5042e/x5042E0L.HTM#Fumigation%20of%20bagged%20goods%20in %20ships%20and%20barges (Accessed 2 December 2019).
  5. Lucas D, Mauguen G, Lesné P, et al. Exposure to phosphine in maritime transport: a real and important occupational risk: a report of three cases. Int Marit Health. 2018; 69(3): 181–183.
  6. International Maritime Organisation IMO. Recommendations on the Safe use of Pesticides in Ships applicable to the fumigation of cargo transport units. http://www.imo.org/blast/blastDataHelper.asp?data_id=22227&filename=1265.pdf (Accessed 2 December 2019).
  7. Low A, Hüsing UP, Preisser A, et al. Regulations and control of in-transit fumigated containers as well as of fumigated cargo ships. Int Marit Health. 2003; 54(1-4): 77–85.
  8. Knol-de Vos T. Measuring the amount of gas in import containers – Report 609021025/2003 Bilthoven. Dutch National Institute for Public Health and the Environment. 2002. https://www.rivm.nl/bibliotheek/rapporten/609021024.pdf (Accessed 2 December 2019).
  9. Baur X, Poschadel B, Budnik LT. High frequency of fumigants and other toxic gases in imported freight containers--an underestimated occupational and community health risk. Occup Environ Med. 2010; 67(3): 207–212.
  10. Spijkerboer H, Vries Ide, Meulenbelt J. Use of fumigants in sea containers can lead to serious human poisonings. Toxicol Lett. 2008; 180: S139–S140.
  11. Scholtens EJ, De Vr, Meulenbelt J. International transport of fumigated containers, a risk for dock workers. Clin Toxicol. 2009; 47/5(494): 1556–3650.
  12. Preisser AM, Heblich F, Budnik LT, et al. Health disorders due to fumigants : Occupational health aspects and long-term findings. Zentralblatt für Arbeitsmedizin, Arbeitsschutz und Ergonomie. 2009; 59: 180–184.
  13. Baur X, Budnik LT, Preisser AM. [Health risks of residual fumigants in international transport containers]. Dtsch Med Wochenschr. 2010; 135(11): 516–521.
  14. Baur X, Poschadel B, Budnik LT. High frequency of fumigants and other toxic gases in imported freight containers--an underestimated occupational and community health risk. Occup Environ Med. 2010; 67(3): 207–212.
  15. Svedberg U, Johanson G. Work inside ocean freight containers--personal exposure to off-gassing chemicals. Ann Occup Hyg. 2013; 57(9): 1128–1137.
  16. European Union- Occupational and Safety Health Agency. Handling fumigated containers in ports — health risks and prevention practices - Safety and health at work - EU-OSHA. https://osha.europa.eu/en/tools-and-publications/publications/health-risks-and-prevention- practices-during-handling-fumigated/view (cited 2 Dec 2019).
  17. Nicholls SG, Quach P, von Elm E, et al. The REporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) Statement: Methods for Arriving at Consensus and Developing Reporting Guidelines. PLoS One. 2015; 10(5): e0125620.
  18. World Health Organisation. Poison Severity Score. https://www.who.int/ipcs/poisons/pss.pdf (Accessed 19 dec 2019).
  19. Agence Nationale de Sécurité Sanitaire de l’alimentation, de l’environnement et du travail ANSES. Expositions à des préparations contenant des phosphures dans le cadre d’une activité portuaire ou maritime, ou lors de l’ouverture d’un conteneur. Étude rétrospective des observations enregistrées par les Centres antipoison et de toxicovigilance français (1999-2017). ANSES sept 2018. https://www.anses.fr/fr/system/files/Toxicovigilance2018SA0290Ra.pdf (Accessed 5 December 2019).
  20. World Health Organisation WHO . The French imputability method . https://www.who.int/medicines/areas/quality_safety/safety_efficacy/trainingcourses/2imputabilitefr.pdf (Accessed 19 May 2019).
  21. Phosphine (FT 179). Généralités - Fiche toxicologique - INRS. http://www.inrs.fr/publications/bdd/fichetox/fiche.html?refINRS=FICHETOX_179 (Accessed 5 December 2019).
  22. Hoffman RS, Howland MA, Lewin MA, Nelson LS. Goldfrank’s Toxicologic Emergencies, 10th edition. McGraw-Hill Education, Europe 2015: 1381–1383.
  23. International Labour Organisation. ICSC 0694 - PHOSPHINE . https://www.ilo.org/dyn/icsc/showcard.display?p_version=2&p_card_id=0694 (Accessed 19 March 2019).
  24. The Emergency Response Safety and Health Database: Lung Damaging Agent: PHOSPHINE - NIOSH. https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750035.html (Accessed 19 March 2019).
  25. Occupational Cancer – Carcinogen List – NIOSH Safety and Health Topic . https://www.cdc.gov/niosh/topics/cancer/npotocca.html (Accessed 19 March 2019).
  26. Baur X, Budnik LT, Zhao Z, et al. Health risks in international container and bulk cargo transport due to volatile toxic compounds. J Occup Med Toxicol. 2015; 10: 19.
  27. Lucas D, Loddé B, Jegaden D, et al. Phosphine exposure in maritime foodstuff transportation: a recent case along logistic chain. Proceedings of the 2nd International DiMoPEx conference. Journal of Health and Pollution. 2018; 8(17): S1–S77.
  28. Pedersen R, Jepsen J, Ádám B. Regulation and practice of workers’ protection from chemical exposures during container handling. J Occupat Med Toxicol. 2014; 9(1).
  29. Rapport 10/2014 Omvang, aard en ernst van incidenten met blootstelling van werknemers aan schadelijke gassen uit (gegaste) containers. NVIC. Umcutrecht.nl. 2014 . https://www.umcutrecht.nl/getmedia/1b18d8b2-ed36-4238-a472-34fa113179a1/Incidenten-met-blootstelling-aan-containergassen.pdf.aspx?ext=.pdf (Accessed 19 March 2019).
  30. Preisser AM, Budnik LT, Baur X. Health effects due to fumigated freight containers and goods: how to detect, how to act. Int Marit Health. 2012; 63(3): 133–139.
  31. Preisser AM, Budnik LT, Hampel E, et al. Surprises perilous: toxic health hazards for employees unloading fumigated shipping containers. Sci Total Environ. 2011; 409(17): 3106–3113.
  32. Verschoor A, Leeuwen Hv, Verschoor L. Health problems in handling gassed containers. Zentralblatt für Arbeitsmedizin, Arbeitsschutz und Ergonomie. 2014; 60(7): 246–247.