SETTING: All glyphosate-related data of the Malaysia National Poison Centre from 2006 to 2023.
PARTICIPANTS: Telephone inquiries of incidents involving glyphosate made by healthcare professionals across Malaysia. Information received was recorded according to WHO guidelines.
OUTCOMES: The outcome is to provide an overview of national glyphosate poisoning epidemiology, including identifying risk factors and high-risk groups to strategise appropriate measures.
RESULTS: A total of 4548 glyphosate poisoning cases were reported, with males comprising 67.3% of cases. The most affected age groups were 21-30 years (25.5%) and 31-40 years (23.5%). Ingestion was the primary exposure route (93.0%). Intentional poisonings, mainly suicides, accounted for 68.4% (n=3078) of cases. Among the 1420 unintentional cases, 78.2% resulted from ingestion exposures. The incidence rate declined from 1.17 per 100 000 in 2011 to 0.61 in 2023. Significant associations were found between intentional ingestion and sociodemographic factors. From 2013 to 2023, 73.7% of cases were minor, 11.5% moderate, 0.8% severe and 0.1% fatal.
CONCLUSIONS: In Malaysia, the reported intentional glyphosate poisoning most commonly affects young adults, resulting in generally minor to moderate symptoms. The study highlights the need for stricter regulations on glyphosate use and improved mental health support, to mitigate poisoning risks. Continued surveillance and public education are essential to address this public health issue.
METHODS: Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy.
RESULTS: Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: "early" during the second and "late" during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy.
CONCLUSIONS: Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses.