Article Text

Download PDFPDF
Original article
Epidemiologic investigation of an occupational illness of tobacco harvesters in southern Brazil, a worldwide leader in tobacco production
  1. Patrícia Bartholomay1,
  2. Betine Pinto Moehlecke Iser1,
  3. Patrícia Pereira Vasconcelos de Oliveira1,2,
  4. Tania Esther Herc Holmer dos Santos3,
  5. Deborah Carvalho Malta2,
  6. Jeremy Sobel4,
  7. Lenildo de Moura1,2
  1. 1Field Epidemiology Training Program EPISUS, Health Surveillance Secretariat, Ministry of Health - Brazil, Brasilia, Distrito Federal, Brazil
  2. 2Non-communicable Diseases Coordination, Health Surveillance Secretariat, Ministry of Health - Brazil, Brasília, Distrito Federal, Brazil
  3. 3Non-communicable Diseases Coordination, State Center for Health Surveillance, State Health Secretariat, Porto Alegre, Rio Grande do Sul, Brazil
  4. 4Center for Global Health Center, Centers for Disease Control and Prevention - CDC, Atlanta, Georgia, USA
  1. Correspondence to Patrícia Bartholomay, Health Surveillance Secretariat, Ministry of Health - Brazil, Setor Comercial Sul, Quadra 4, Bloco A, Edifício Principal, 1 andar, CEP:70304-000, Brasilia, Distrito Federal 70304000, Brazil; patricia.bartholomay{at}


Objectives As part of smoking surveillance, the authors conducted an epidemiologic investigation in southern Brazil to identify the occurrence of Green Tobacco Sickness and risk factors for illness and to recommend control and prevention measures.

Methods A 1:2 case–control study matched by subjects' smoking habits. The study population was residents of Candelária, Rio Grande do Sul state, who farm tobacco and provided a urine sample for cotinine measurement by high-performance liquid chromatography. Confirmed cases were persons with compatible clinical presentation (headache, nausea, vomit, dizziness or weakness) and cotinine level >10 ng/ml. Controls were persons without compatible signs or symptoms. The association measure was the matched OR with 95% CIs and p<0.05.

Results Of 33 confirmed cases, 64% were men, average age was 33 years (SD ±11.8 years) and 57% were landowners. Cases have had similar illness in the past and were likelier to be workers hired by farmers–landowners than controls. Multivariate analysis yielded independent association between these variables and illness, controlled for age and sex. Contact with pesticides and working with wet tobacco leaves were not associated with illness.

Conclusions The authors confirmed Green Tobacco Sickness in southern Brazil; the authors recommend investigation of its prevalence in tobacco-growing regions and monitoring of and education about the disease and its prevention by occupational health authorities.

  • Public health
  • health surveillance
  • nicotine
  • epidemiology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interest None declared.

  • Patient consent The work described in this paper was conducted as part of a public health response to an outbreak of acute toxicity in tobacco workers. Oral consent was required for all individuals at the moment of the interviews.

  • Ethics approval A public health response to an outbreak of acute toxicity in tobacco workers. These activities were reviewed in advance by the officials within the Ministry of Health of Brazil charged with determining whether actions by public health workers fall under the jurisdiction of a research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.