Chemical poisoning related injury in China. Rongzhang Hao, Peng Li, Yong Wang, Zhihao Wu, *Hongbin Song hongbinsong@263.net . www.thelancet.com Vol 382 October 19, 2013 (See). Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing 100071, China Chemical poisoning is an important cause of mobidity and mortality worldwide. In China, 2 million chemical poisonings are reported annually, leading to more than 150 000 deaths annually.(1) Intentional chemical poisoning is not only a complex social issue, but also a serious public health problem. In China, suicides result in 195 000 deaths annually,(2) and 60% of suicides are through consumption of pesticides.(3)

Three factors are important to understand chemical injuries in China. First, more than 45 000 chemical products, including about 770 approved pesticides, are available in China.(4) Although China has comprehensive laws for managing these chemicals, they are not strictly enforced by relevant authorities. In rural areas, many pesticides (70%) are stored at home unlocked;3 and roughly 60% of farmers still use WHO category 1 organophosphates, although their use has been banned for more than 10 years.(3) Potentially poisonous chemicals can be purchased online, such as thallium, used in a chemical poisoning at China University of Mining and  Technology in 2007.(5)Second, physicians might lack adequate training to make an accurate and timely diagnosis of chemical poisoning and provide appropriate treatment.1 Third, easy access and absence of traceability might be important factors to explain criminal use of poisons, and also for suicides.To reduce these poisoning tragedies, strict enforcement of regulations is urgently needed to control access to toxic chemicals in China. Prohibition of the most toxic pesticides, control of highly toxic pesticides, and development of effective, less toxic pesticides are necessary to reduce the risks for farmers. Moreover, education on chemical safety and adequate training of primary care health workers in rural areas could reduce the injury and death caused by chemical poisoning.
We declare that we have no confl icts of interest. We thank John D Klena (International Emerging Infections Program, Centers for Disease Control and Prevention) for his comments.
References

1.  Li Y, Sun C, Qiu Z, et al. Clinical toxicology in China: current situation and future development. Clin Toxicol 2009; 47: 263–69.
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3. Wang SY, Li YH, Chi GB, et al. Injury-related fatalities in China: an under-recognised publichealth problem. Lancet 2008; 372: 1765–73.
4. Wu YQ, Sun CY. Poison control services in China. Toxicology 2004; 198: 279–84.
5. China Internet Information Center. Thallium poisoning case.  http://www.china.org.cn/english/China/214678.htm (accessed Sept 24, 2013).