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Acute phosphine poisoning aboard a grain freighter. Epidemiologic, clinical, and pathological findings
Insights
A shipboard fumigation incident involving phosphine gas led to acute illness in 31 individuals, including two children, resulting in one fatality. This outbreak highlights the significant risks of using toxic fumigants in enclosed maritime environments.
Area of Science:
- Occupational Health
- Toxicology
- Maritime Safety
Background:
- Shipboard fumigation with toxic substances poses risks to crew and others.
- Accidental release of fumigants can lead to acute poisoning incidents.
Purpose of the Study:
- To investigate an outbreak of acute illness on a grain freighter.
- To identify the causative agent, exposure routes, and health effects.
- To assess the contributing factors and hazards of shipboard fumigation.
Main Methods:
- Clinical observation and symptom documentation of affected individuals.
- Postmortem examination of a deceased child.
- Gas detection and source identification of phosphine leakage.
- Correlation of illness with location on the vessel.
Main Results:
- 31 individuals (2 children, 29 crew) developed acute illness after phosphine inhalation.
- Symptoms included headache, fatigue, nausea, vomiting, cough, and shortness of breath.
- Postmortem revealed myocardial necrosis, pulmonary edema, and small-vessel injury; surviving child had cardiac injury markers.
Conclusions:
- Accidental phosphine gas release from fumigated holds caused widespread acute illness.
- Exposure was linked to living/working areas near gas escape points.
- This incident underscores the severe hazards of shipboard fumigation and the need for stringent safety protocols.
Abstract:
Two children and 29 of 31 crew members aboard a grain freighter became acutely ill after inhaling the toxic fumigant phosphine; one child died. Predominant symptoms were headache, fatigue, nausea, vomiting, cough, and shortness of breath. Abnormal physical findings included jaundice, paresthesias, ataxia, intention tremor, and diplopia. Focal myocardial infiltration with necrosis, pulmonary edema, and widespread small-vessel injury were found at postmortem examination of the dead child. The surviving child showed ECG and echocardiographic evidence of myocardial injury and transient elevation of the MB fraction of serum creatinine phosphokinase. Illness was significantly associated with living or working amidships or on the forward deck areas of the vessel. Phosphine gas was found to have escaped from the holds through a cable housing located near the midships ventilation intake and around hatch covers on the forward deck. The outbreak illustrates the hazards associated with shipboard fumigation.