Surveillance for Harmful Algal Bloom Events and Associated Human and Animal Illnesses - One Health Harmful Algal Bloom System, United States, 2016-2018

Streptomyces chengbuensis sp. nov., isolated from the rhizosphere soil of Cathaya argyrophylla

Strain HUAS CB01T was a novel actinobacterium which was isolated from the rhizosphere soil of Cathaya argyrophylla, Chengbu Miao Autonomous County of Hunan Province, China. The strain formed well-growing substrate mycelium, diffusible pigments, and aerial mycelium, and differentiated into spiral-type spore chains composed of smooth-surface rod-shaped spores. Phylogenetic analysis on account of 16 S rRNA gene sequence demonstrated the strain HUAS CB01T was a member of the genus Streptomyces and had a close relationship with Streptomyces wuyuanensis CGMCC 4.7042 T (100%) and Streptomyces marianii ICN19T (99.86%). Genome-based comparisons indicated that strain HUAS CB01T could be distinctly different from its closest species, Streptomyces wuyuanensis CGMCC 4.7042 T, Streptomyces marianii ICN19T, with ANIm and dDDH results of 92.78% and 45.90%, 92.22% and 43.30%, respectively, far less than 96.7 and 70% cut-off points recommended for delineating species. The main cellular fatty acids concluded anteiso-C15:0, iso-C14:0, iso-C16:0, C16:0 and C16:1 2OH. The menaquinones were MK-9(H4), MK-9(H6) and MK-9(H8) and the whole-cell sugars consisted of ribose and mannose. The polar lipids included phosphatidyl ethanolamine, diphosphatidylglycerol, phosphatidylglycerol, mannosides and unidentified phospholipids. According to these genotypic and phenotypic characteristics, strain HUAS CB01T can be distinguished and representative to be a novel species of the genus Streptomyces, for which the name Streptomyces chengbuensis is proposed. The type strain is HUAS CB01T ( = MCCC 1K08666T = JCM 36277 T).

Assessing the relationship between cyanobacterial blooms and respiratory-related hospital visits: Green bay, Wisconsin 2017-2019

Potential acute and chronic human health effects associated with exposure to cyanobacteria and cyanotoxins, including respiratory symptoms, are an understudied public health concern. We examined the relationship between estimated cyanobacteria biomass and the frequency of respiratory-related hospital visits for residents living near Green Bay, Lake Michigan, Wisconsin during 2017-2019. Remote sensing data from the Cyanobacteria Assessment Network was used to approximate cyanobacteria exposure through creation of a metric for cyanobacteria chlorophyll-a (ChlBS). We obtained counts of hospital visits for asthma, wheezing, and allergic rhinitis from the Wisconsin Hospital Association for ZIP codes within a 3-mile radius of Green Bay. We analyzed weekly counts of hospital visits versus cyanobacteria, which was modelled as a continuous measure (ChlBS) or categorized according to World Health Organization's (WHO) alert levels using Poisson generalized linear models. Our data included 2743 individual hospital visits and 114 weeks of satellite derived cyanobacteria biomass indicator data. Peak values of ChlBS were observed between the months of June and October. Using the WHO alert levels, 60% of weeks were categorized as no risk, 19% as Vigilance Level, 15% as Alert Level 1, and 6% as Alert Level 2. In Poisson regression models adjusted for temperature, dewpoint, season, and year, there was no association between ChlBS and hospital visits (rate ratio [RR] [95% Confidence Interval (CI)] = 0.98 [0.77, 1.24]). There was also no consistent association between WHO alert level and hospital visits when adjusting for covariates (Vigilance Level: RR [95% CI] 0.88 [0.74, 1.05], Alert Level 1: 0.82 [0.67, 0.99], Alert Level 2: 0.98 [0.77, 1.24], compared to the reference no risk category). Our methodology and model provide a template for future studies that assess the association between cyanobacterial blooms and respiratory health.

Analysis of Microcystis aeruginosa physiology by spectral flow cytometry: Impact of chemical and light exposure

M. aeruginosa fluorescent changes were observed using a Cytek Aurora spectral flow cytometer that contains 5 lasers and 64 narrow band detectors located between 365 and 829 nm. Cyanobacteria were treated with different concentrations of H2O2 and then monitored after exposure between 1 and 8 days. The red fluorescence emission derived from the excitation of cyanobacteria with a yellow green laser (550 nm) was measured in the 652-669 nm detector while green fluorescence from excitation with a violet laser (405 nm) was measured in the 532-550 nm detector. The changes in these parameters were measured after the addition of H2O2. There was an initial increase in red fluorescence intensity at 24 hours. This was followed by a daily decrease in red fluorescence intensity. In contrast, green fluorescence increased at 24 hours and remained higher than the control for the duration of the 8-day study. A similar fluorescence intensity effect as H2O2 on M. aeruginosa fluorescence emissions was observed after exposure to acetylacetone, diuron (DCMU), peracetic acid, and tryptoline. Minimal growth was also observed in H2O2 treated cyanobacteria during exposure of H2O2 for 24 days. In another experiment, H2O2-treated cyanobacteria were exposed to high-intensity blue (14 mW) and UV (1 mW) lights to assess the effects of light stress on fluorescence emissions. The combination of blue and UV light with H2O2 had a synergistic effect on M. aeruginosa that induced greater fluorescent differences between control and treated samples than exposure to either stimulus individually. These experiments suggest that the early increase in red and green fluorescence may be due to an inhibition in the ability of photosynthesis to process photons. Further research into the mechanisms driving these increases in fluorescence is necessary.

Linking coastal environmental and health observations for human wellbeing

Coastal areas have long been attractive places to live, work, and recreate and remain so even in the face of growing threats from global environmental change. At any moment, a significant portion of the human population is exposed to both positive and negative health effects associated with coastal locations. Some locations may be "hotspots" of concern for human health due to ongoing climatic and other changes, accentuating the need for better understanding of coastal environment-human health linkages. This paper describes how environmental and health data could be combined to create a coastal environmental and human health observing system. While largely based on information from the US and Europe, the concept should be relevant to almost any coastal area. If implemented, a coastal health observing system would connect a variety of human health data and environmental observations for individuals and communities, and where possible cohorts. Health data would be derived from questionnaires and other personal sources, clinical examinations, electronic health records, wearable devices, and syndromic surveillance, plus information on vulnerability and health-relevant community characteristics, and social media observations. Environmental data sources would include weather and climate, beach and coastal conditions, sentinel species, occurrences of harmful organisms and substances, seafood safety advisories, and distribution, proximity, and characteristics of health-promoting green and blue spaces. Where available, information on supporting resources could be added. Establishment of a linked network of coastal health observatories could provide powerful tools for understanding the positive and negative health effects of coastal living, lead to better health protections and enhanced wellbeing, and provide significant benefits to coastal residents, including the historically disadvantaged, as well as the military, hospitals and emergency departments, academic medical, public health, and environmental health programs, and others. Early networks could provide best practices and lessons learned to assist later entries.

Harmful algal bloom aerosols and human health

Harmful algal blooms (HABs) are increasing across many locations globally. Toxins from HABs can be incorporated into aerosols and transported inland, where subsequent exposure and inhalation can induce adverse health effects. However, the relationship between HAB aerosols and health outcomes remains unclear despite the potential for population-level exposures. In this review, we synthesized the current state of knowledge and identified evidence gaps in the relationship between HAB aerosols and human health. Aerosols from Karenia brevis, Ostreopsis sp., and cyanobacteria were linked with respiratory outcomes. However, most works did not directly measure aerosol or toxin concentrations and instead relied on proxy metrics of exposure, such as cell concentrations in nearby waterbodies. Furthermore, the number of studies with epidemiological designs was limited. Significant uncertainties remain regarding the health effects of other HAB species; threshold dose and the dose-response relationship; effects of concurrent exposures to mixtures of toxins and other aerosol sources, such as microplastics and metals; the impact of long-term exposures; and disparities in exposures and associated health effects across potentially vulnerable subpopulations. Additional studies employing multifaceted exposure assessment methods and leveraging large health databases could address such gaps and improve our understanding of the public health burden of HABs.

Co-occurrence of freshwater and marine phycotoxins: A record of microcystins and domoic acid in Bogue Sound, North Carolina (2015 to 2020)

Harmful algal blooms (HABs) create issues both environmentally and economically in coastal regions, especially if algal growth is linked to the production of toxins which can affect ecosystems, wildlife, and humans. This study is the first to confirm near year-round presence and co-occurrence of microcystins (MCs) and domoic acid (DA) within the outskirts of the largest lagoonal US estuary, the Pamlico-Albemarle Sound System (PASS). Monthly sampling at a time-series location in Bogue Sound, located within the eastern part of the PASS, showed DA and MCs were commonly present and detected together 50% of the time based on an in situ toxin tracking approach over a 6-year time period (2015-2020). Particulate toxin concentrations based on monthly grab sampling remained well below regulatory thresholds for MCs and below DA concentrations associated with animal sickness and mortality elsewhere. Time-integrated levels for dissolved MCs and DA, however, indicated a continuous presence of both toxins within Bogue Sound where high flushing rates (∼2-day average residence time) presumably alleviate potential issues linked to nutrient inputs, subsequent algal growth, or toxin accumulation. Pseudo-nitzschia spp. contributed 0 to 19% to the resident microplankton community. Light microscopy analyses did not reveal the source of MCs production in the sound but suggested potential downstream transport and/or autochthonous production due to taxa not accounted for in this study (e.g., picocyanobacteria). Nitrate+nitrite (NO_x) concentrations, wind speed, and water temperature explained a third of the variations in accumulated dissolved MCs, but no relationship was seen for DA concentrations based on monthly sampling within this highly dynamic system. This study emphasizes the importance of continued algal toxin monitoring in systems like Bogue Sound which might experience decreases in water quality similar to adjacent, nutrient-impaired regions within the PASS.

Harmful algae blooms: an analysis of recent spatiotemporal trends on California's inland waterbodies

Harmful algae blooms (HABs) are unwelcome annual events on waterbodies in California (USA). The unseemly sights of lifeless fish drifting ashore and the mammalian illnesses resulting from close contacts with HABs once in ahile are telltale signs of their presence. California as such tracks HABs closely for immediate public warnings. That said, a lack of statewide monitoring standards for producing comparable and high-quality data, however, hinders a deeper insight into HABs on California's inland waterbodies. In their absence, the current study demonstrates the utility of empirical dataset in advancing an understanding of spatiotemporal distribution of HABs on inland waterbodies. With a 2016-2021 mostly observational data, the questions asked are whether HABs incidences are expanding in California with time, whether there are localities more prone to HABs than others, and whether bivariate relationships exist between HABs reports and population density, or waterbody size, land area and geographical location. Overall, the frequency with which HABs are observed is found to increase statewide, an increase not correlated with population density, but with land area and inland waterbody size. Results also show that North Coast, Central Valley, and San Diego are the most affected regions of California. Also revealed by this mostly observational data were recent HABs spikes in the January months (California winter) which, if proven, may be signaling an emerging year-round problem that California will have to contend with.

Permanganate preoxidation affects the formation of disinfection byproducts from algal organic matter

During harmful algal blooms (HABs), permanganate may be used as a preoxidant to improve drinking water quality by removing algal cells and degrading algal toxins. However, permanganate also lyses algal cells, releasing intracellular algal organic matter (AOM). AOM further reacts with permanganate to alter the abundance of disinfection byproduct (DBP) precursors, which in turn affects DBP formation during disinfection. In this study, we evaluated the impacts of preoxidation by permanganate applied at commonly used doses (i.e., 1-5 mg/L) on DBP generation during chlorination and chloramination of AOM. We found that permanganate preoxidation increased trichloronitromethane (TCNM) formation by up to 3-fold and decreased dichloroacetonitrile (DCAN) formation by up to 40% during chlorination, indicating that permanganate oxidized organic amines in AOM to organic nitro compounds rather than organic nitrile compounds. To test this proposed mechanism, we demonstrated that permanganate oxidized organic amines in known DBP precursors (i.e., tyrosine, tryptophan) to favor the production of TCNM over DCAN during chlorination. Compared to the decreased formation of DCAN during chlorination, permanganate increased DCAN formation by 30-50% during chloramination of AOM. This difference likely arose from monochloramine's ability to react with non-nitrogenous precursors (e.g., organic aldehydes) that formed during permanganate preoxidation of AOM to generate nitrogen-containing intermediates that go on to form DCAN. Our results also showed that permanganate preoxidation favored the formation of dichlorobromomethane (DCBM) over trichloromethane (TCM) during chlorination and chloramination. The increased formation of DBPs, especially nitrogenous DBPs that are more toxic than carbonaceous DBPs, may increase the overall toxicity in finished drinking water when permanganate preoxidation is implemented.

Cyanophage technology in removal of cyanobacteria mediated harmful algal blooms: A novel and eco-friendly method

Cyanophages are highly abundant specific viruses that infect cyanobacterial cells. In recent years, the cyanophages and cyanobacteria interactions drew attention to environmental restoration due to their discovery in marine and freshwater systems. Cyanobacterial harmful algal blooms (cyanoHABs) are increasing throughout the world and contaminating aquatic ecosystems. The blooms cause severe environmental problems including unpleasant odors and cyanotoxin production. Cyanotoxins have been reported to be lethal agents for living beings and can harm animals, people, aquatic species, recreational activities, and drinking water reservoirs. Biological remediation of cyanoHABs in aquatic systems is a sustainable and eco-friendly approach to increasing surface water quality. Therefore, this study compiles the fragmented information with the solution of removal of cyanoHABs using cyanophage therapy techniques. To date, scant information exists in terms of bloom formation, cyanophage occurrence, and mode of action to remediate cyanoHABs. Overall, this study illustrates cyanobacterial toxin production and its impacts on the environment, the mechanisms involved in the cyanophage-cyanobacteria interaction, and the application of cyanophages for the removal of toxic cyanobacterial blooms.

Detection of β-N-methylamino-l-alanine in postmortem olfactory bulbs of Alzheimer's disease patients using UHPLC-MS/MS: An autopsy case-series study

Introduction

Cyanobacterial blooms produce toxins that may become aerosolized, increasing health risks through inhalation exposures. Health related effects on the lower respiratory tract caused by these toxins are becoming better understood. However, nasal exposures to cyanotoxins remain understudied, especially for those with neurotoxic potential. Here, we present a case series study evaluating exposure to β-N-methylamino-l-alanine (BMAA), a cyanobacterial toxin linked to neurodegenerative disease, in postmortem olfactory tissues of individuals with varying stages of Alzheimer's disease (AD).

Methods

Olfactory bulb (Ob) tissues were collected during autopsies performed between 2014 and 2017 from six South Florida brain donors (ages 47-78) with residences less than 140 m from a freshwater body. A triple quadrupole tandem mass spectrometry (UHPLC-MS/MS) method validated according to peer AOAC International guidelines was used to detect BMAA and two BMAA isomers: 2,4-diaminobutyric acid (2,4-DAB) and N-(2-aminoethyl)glycine (AEG). Quantitative PCR was performed on the contralateral Ob to evaluate the relative expression of genes related to proinflammatory cytokines (IL-6 & IL-18), apoptotic pathways (CASP1 & BCL2), and mitochondrial stress (IRF1 & PINK1). Immunohistochemistry was also performed on the adjacent olfactory tract (Ot) to evaluate co-occurring neuropathology with BMAA tissue concentration.

Results

BMAA was detected in the Ob of all cases at a median concentration of 30.4 ng/g (Range <LLOQ - 488.4 ng/g). Structural isomers were also detected with median concentrations of 28.8 ng/g (AEG) and 103.6 ng/g (2,4-DAB). In addition, we found that cases with BMAA tissue concentrations above the <LLOQ also displayed increased expression of IL-6 (3.3-fold), CASP1 (1.7-fold), and IRF1 (1.6-fold). Reactive microglial, astrogliosis, myelinopathy, and neuronopathy of axonal processes in the Ot were also observed in cases with higher BMAA tissue concentrations.

Conclusion

Our study demonstrates that the cyanobacterial toxin BMAA can be detected in the olfactory pathway, a window to the brain, and its presence may increase the occurrence of proinflammatory cytokines, reactive glia, and toxicity to axonal processes. Further studies will be needed to evaluate BMAA's toxicity via this route of exposure and factors that increase susceptibility.

Review of harmful algal bloom effects on birds with implications for avian wildlife in the Chesapeake Bay region

The Chesapeake Bay, along the mid-Atlantic coast of North America, is the largest estuary in the United States and provides critical habitat for wildlife. In contrast to point and non-point source release of pesticides, metals, and industrial, personal care and household use chemicals on biota in this watershed, there has only been scant attention to potential exposure and effects of algal toxins on wildlife in the Chesapeake Bay region. As background, we first review the scientific literature on algal toxins and harmful algal bloom (HAB) events in various regions of the world that principally affected birds, and to a lesser degree other wildlife. To examine the situation for the Chesapeake, we compiled information from government reports and databases summarizing wildlife mortality events for 2000 through 2020 that were associated with potentially toxic algae and HAB events. Summary findings indicate that there have been few wildlife mortality incidents definitively linked to HABs, other mortality events that were suspected to be related to HABs, and more instances in which HABs may have indirectly contributed to or occurred coincident with wildlife mortality. The dominant toxins found in the Chesapeake Bay drainage that could potentially affect wildlife are microcystins, with concentrations in water approaching or exceeding human-based thresholds for ceasing recreational use and drinking water at a number of locations. As an increasing trend in HAB events in the U.S. and in the Chesapeake Bay have been reported, additional information on HAB toxin exposure routes, comparative sensitivity among species, consequences of sublethal exposure, and better diagnostic and risk criteria would greatly assist in predicting algal toxin hazard and risks to wildlife.

Relationship between freshwater harmful algal blooms and neurodegenerative disease incidence rates in South Korea

BACKGROUND

Due to anthropogenic activities and global warming, the severity and distribution of harmful algal blooms (HABs) have been increasing steadily worldwide, including in South Korea (S. Korea). Previous studies reported that exposure to HABs could increase the risk of HAB-related diseases. However, very few studies examined the linkage between HABs and disease occurrence, particularly in S. Korea. The objective of this study was to evaluate the potential impact of HABs on neurodegenerative diseases (NDs), including Alzheimer's disease, Parkinson's disease, and motor neuron disease, at a population level.

METHODS

Thirteen-year data (2005-2017) for chlorophyll-a (chl-a) concentrations as a bloom-related parameter, annual numbers of NDs, and population information were collected. First, the entire area of S. Korea was divided into a grid of 1 km, and the population number in each 1-km grid was collected using the Statistical Geographic Information Service Plus system. Cross-sectional time series data were analyzed with two statistical models, a generalized linear mixed model and a generalized linear model.

RESULTS

The results show a general trend of increasing chl-a concentration and NDs year by year. We observed positive correlations between HAB intensity and the incidence rate of NDs. Particularly, HABs seem to have the most long-term carry-over effect on Parkinson's disease. Another key finding was that a 5-km radius from the HAB location was the boundary that showed the most significant associations with three NDs.

CONCLUSIONS

This study provides statistical evidence that supports the potential risk of NDs from the exposure to HAB. Thus, it is recommended to monitor a broad spectrum of cyanotoxins, including neurotoxins, in bloom-affected regions in S. Korea and epidemiological studies in the future.

Measurement of Microcystin Activity in Human Plasma Using Immunocapture and Protein Phosphatase Inhibition Assay

Microcystins are toxic chemicals generated by certain freshwater cyanobacteria. These chemicals can accumulate to dangerous levels during harmful algal blooms. When exposed to microcystins, humans are at risk of hepatic injury, including liver failure. Here, we describe a method to detect microcystins in human plasma by using immunocapture followed by a protein phosphatase inhibition assay. At least 279 microcystins have been identified, and most of these compounds share a common amino acid, the Adda side chain. We targeted this Adda side chain using a commercial antibody and extracted microcystins from human samples for screening and analysis. To quantitate the extracted microcystins, we fortified plasma with microcystin-LR, one of the most well-studied, commonly detected, and toxic microcystin congeners. The quantitation range for the detection of microcystin in human plasma using this method is 0.030-0.50 ng/mL microcystin-LR equivalents. This method detects unconjugated and conjugated forms (cysteine and glutathione) of microcystins. Quality control sample accuracies varied between 98.9% and 114%, with a precision of 7.18-15.8%. Finally, we evaluated plasma samples from a community health surveillance project of Florida residents living or working near harmful algae blooms.

Variability of Microcystin-LR Standards Available from Seven Commercial Vendors

Microcystins (MCs) are a large group of heptapeptide cyanobacterial toxins commonly produced in harmful algal blooms (HABs) and associated with adverse health effects in wildlife, livestock, pets, and humans. MC chemical standards are extracted from cyanobacteria biomass rather than produced synthetically and are used in water assessment methods and toxicological studies. MC standards are generally supplied in less than 1 mg quantities, and verification of the mass can only be accomplished by analytical chemistry methods using a certified reference of the specific MC for comparison. Analytical quantification of MCs in environmental samples and toxicology studies using accurate doses of test chemicals administered to experimental animals rely on the availability and accuracy of chemical standards. To check the accuracy and purity of available standards, seven individual microcystin-LR (MCLR) standards were purchased from separate commercial vendors and analyzed to determine the actual mass supplied and identify the presence of potential contaminants. To determine the effect of varying toxin mass in toxicological studies, each MCLR standard was administered to CD-1 mice in doses based on mass purchased, by a single 40 µg/kg intraperitoneal injection. The measured mass purchased varied from the vendor label mass by more than 35% for two of the seven MCLR standards. Contaminants, including trifluoroacetic acid (TFA), were identified in four of the seven samples. Comparative in vivo hepatotoxicity between vendor samples closely reflected the actual amount of MCLR present in each standard and demonstrated the toxicological impact of varying cyanotoxin mass.

Recreational water illness in Canada: a changing risk landscape in the context of climate change

Swimming and other recreational water activities at public beaches are popular outdoor leisure activities among Canadians. However, these activities can lead to increased risks of acquiring acute gastrointestinal illness and other illnesses among beachgoers. Young children have much higher rates of exposure and illness than other age groups. These illnesses have a significant health and economic burden on society. Climate change is expected to influence both the risk of exposure and illness. A warming climate in Canada, including more severe summer heatwave events, will likely lead to increased recreational water use. Warmer temperatures will also contribute to the growth and increased range of harmful algal blooms and other climate-sensitive pathogens. Increased precipitation and heavy rainfall events will contribute to fecal and nutrient contamination of beach waters, increasing risks of gastrointestinal illness and harmful algal bloom events. There is a need to enhance recreational water research and surveillance in Canada to prepare for and adapt to these changing risks. Key research and policy needs are suggested and discussed, including evaluating and monitoring risks of recreational water illness in Canadian contexts, improving timely reporting of recreational water quality conditions, and enhancing approaches for routine beach water surveillance.

As We Drink and Breathe: Adverse Health Effects of Microcystins and Other Harmful Algal Bloom Toxins in the Liver, Gut, Lungs and Beyond

Freshwater harmful algal blooms (HABs) are increasing in number and severity worldwide. These HABs are chiefly composed of one or more species of cyanobacteria, also known as blue-green algae, such as Microcystis and Anabaena. Numerous HAB cyanobacterial species produce toxins (e.g., microcystin and anatoxin—collectively referred to as HAB toxins) that disrupt ecosystems, impact water and air quality, and deter recreation because they are harmful to both human and animal health. Exposure to these toxins can occur through ingestion, inhalation, or skin contact. Acute health effects of HAB toxins have been well documented and include symptoms such as nausea, vomiting, abdominal pain and diarrhea, headache, fever, and skin rashes. While these adverse effects typically increase with amount, duration, and frequency of exposure, susceptibility to HAB toxins may also be increased by the presence of comorbidities. The emerging science on potential long-term or chronic effects of HAB toxins with a particular emphasis on microcystins, especially in vulnerable populations such as those with pre-existing liver or gastrointestinal disease, is summarized herein. This review suggests additional research is needed to define at-risk populations who may be helped by preventative measures. Furthermore, studies are required to develop a mechanistic understanding of chronic, low-dose exposure to HAB toxins so that appropriate preventative, diagnostic, and therapeutic strategies can be created in a targeted fashion.

Development of a Risk Characterization Tool for Harmful Cyanobacteria Blooms on the Ohio River

A data-driven approach to characterizing the risk of cyanobacteria-based harmful algal blooms (cyanoHABs) was undertaken for the Ohio River. Twenty-five years of river discharge data were used to develop Bayesian regression models that are currently applicable to 20 sites spread-out along the entire 1579 km of the river’s length. Two site-level prediction models were developed based on the antecedent flow conditions of the two blooms that occurred on the river in 2015 and 2019: one predicts if the current year will have a bloom (the occurrence model), and another predicts bloom persistence (the persistence model). Predictors for both models were based on time-lagged average flow exceedances and a site’s characteristic residence time under low flow conditions. Model results are presented in terms of probabilities of occurrence or persistence with uncertainty. Although the occurrence of the 2019 bloom was well predicted with the modeling approach, the limited number of events constrained formal model validation. However, as a measure of performance, leave-one-out cross validation returned low misclassification rates, suggesting that future years with flow time series like the previous bloom years will be correctly predicted and characterized for persistence potential. The prediction probabilities are served in real time as a component of a risk characterization tool/web application. In addition to presenting the model’s results, the tool was designed with visualization options for studying water quality trends among eight river sites currently collecting data that could be associated with or indicative of bloom conditions. The tool is made accessible to river water quality professionals to support risk communication to stakeholders, as well as serving as a real-time water data monitoring utility.

Evaluation of Syndromic Surveillance Data for Studying Harmful Algal Bloom-Associated Illnesses - United States, 2017-2019

Harmful algal and cyanobacterial blooms (harmful algal blooms) are large colonies of algae or cyanobacteria that can harm humans, animals, and the environment (1-3). The number of algal blooms has been increasing in the United States, augmented by increasing water temperatures and nutrients in water from industry and agricultural run-off (4,5). The extent to which harmful algal bloom exposures cause human illness or long-term health effects is unknown. As the number of blooms increases annually, the likelihood of negative health outcomes (e.g., respiratory or gastrointestinal illness) from exposure also increases (4,5). To explore the utility of syndromic surveillance data for studying health effects from harmful algal bloom exposures, CDC queried emergency department (ED) visit data from the National Syndromic Surveillance Program (NSSP) for harmful algal bloom exposure-associated administrative discharge diagnosis codes and chief complaint text terms related to harmful algal bloom exposure (6). A total of 321 harmful algal bloom-associated ED visits were identified during January 1, 2017-December 31, 2019. An increase in harmful algal bloom-associated ED visits occurred during warmer months (June-October), consistent with seasonal fluctuations of blooms and recent publications (6,7). Although syndromic surveillance data are helpful for understanding harmful algal bloom-associated ED visits in the United States, exposures were documented infrequently with discharge diagnosis codes; 67% of harmful algal bloom-associated ED visits were identified through querying chief complaint text. Improving the documentation of harmful algal bloom exposures in medical records would further benefit future health studies.

Twenty years of waterborne and related disease reports in Florida, USA

Florida represents a unique challenge for preventing and responding to infectious disease associated with water. This study cataloged the prevalence of reportable waterborne and water-related disease within Florida residents over the last twenty years and identified relationships between confirmed cases by location and additional risk factors. Data was collected through FLHealthCHARTS for confirmed cases between January 1, 1999 and December 31, 2019. Case records were compiled and analyzed by year, county, pathogen name and disease category, patient age, and where the infection was acquired. During this time, 218,707 cases of water-related disease were recorded with 214,745 due to waterborne disease, 3255 cases of water-related vector-borne disease, and 707 cases caused by a water-based toxin. Children aged 0–4 and the elderly demonstrated a higher proportion of waterborne disease while 45–49 year olds had increased rates of water-based toxins and water-related vector-borne disease. Most cases were reported in the southeast region. Across the state, opportunities for water contact have led to high rates of water-related infectious disease. Public health initiatives and response efforts should target the pathogens of greatest impact for each region, largely zoonotic waterborne diseases, using a One Health approach.

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Over 200,000 cases of water-related disease have been reported to the Florida Department of Health over the last 20 years

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Most reported disease is due to waterborne pathogens followed by water-related vector-borne disease and water-based toxins

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Salmonellosis makes up the largest reported water-related disease burden for Florida

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Children and seniors have higher risk for waterborne disease; adults have higher risk for toxins and vector-borne disease

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Water disease prevention and response must use a One Health model for collaboration with human and animal health providers

Harmful algal bloom resources for livestock veterinarians

Harmful algal blooms can have deleterious effects on animal and human health as well as the environment and are anticipated to become more frequent and intensified in the future because of climate change. Veterinarians are well positioned to diagnose and treat animals affected by HABs and to educate livestock owners and the public about health risks and environmental issues associated with those toxic events. Pets, livestock, wildlife, and marine life can all be affected by HABs. Information about HABs is becoming increasingly assessable as a result of ongoing research into the structure, properties, toxic mechanisms, and geographic distribution of toxins found in HABs. The AVMA's multi-entity working group on HABs is comprised of members from the Aquatic Veterinary Medicine Committee, Committee on Environmental Issues, and Council on Public Health and is working to make more information and resources regarding HABs available to practicing veterinarians. The present article is the first of those resources and provides a review of HABs, with a focus on livestock. It includes background material about bloom formation, appearance, and persistence as well as descriptions of clinical observations from early field cases and more recent information about the causative organisms and toxins to provide livestock veterinarians a foundation for understanding HABs. Reporting of HABs and prevention and mitigation strategies for livestock owners are also discussed.

Assessing Environmental Factors within the One Health Approach

Background: One Health is a comprehensive and multisectoral approach to assess and examine the health of animals, humans and the environment. However, while the One Health approach gains increasing momentum, its practical application meets hindrances. This paper investigates the environmental pillar of the One Health approach, using two case studies to highlight the integration of environmental considerations. The first case study pertains to the Danish monitoring and surveillance programme for antimicrobial resistance, DANMAP. The second case illustrates the occurrence of aflatoxin M1 (AFM1) in milk in dairy-producing ruminants in Italian regions. Method: A scientific literature search was conducted in PubMed and Web of Science to locate articles informing the two cases. Grey literature was gathered to describe the cases as well as their contexts. Results: 19 articles and 10 reports were reviewed and informed the two cases. The cases show how the environmental component influences the apparent impacts for human and animal health. The DANMAP highlights the two approaches One Health and farm to fork. The literature provides information on the comprehensiveness of the DANMAP, but highlights some shortcomings in terms of environmental considerations. The AFM1 case, the milk metabolite of the carcinogenic mycotoxin aflatoxin B1, shows that dairy products are heavily impacted by changes of the climate as well as by economic drivers. Conclusions: The two cases show that environmental conditions directly influence the onset and diffusion of hazardous factors. Climate change, treatment of soils, water and standards in slaughterhouses as well as farms can have a great impact on the health of animals, humans and the environment. Hence, it is important to include environmental considerations, for example, via engaging environmental experts and sharing data. Further case studies will help to better define the roles of environment in One Health scenarios.