Health Effects Related to Harmful Presentation Title Algal Bloom - - PowerPoint PPT Presentation

Presentation Title

Sarah Koske, D.V.M., M.P.H.

CDC/CSTE Applied Epidemiology Fellow - Waterborne Diseases Wisconsin Department of Health Services, Division of Public Health Lake Wisconsin Alliance Meeting, July 9, 2015, Okee, WI

Health Effects Related to Harmful Algal Bloom Exposure

Wisconsin Division of Public Health (DPH), Harmful Algal Bloom (HAB) Surveillance Program

Established in 2009. Surveillance for health effects

related to HAB exposure.

Investigate reports of human

and animal illnesses.

Coordinate water sampling

and analysis.

Coordinate health advisories

with local public health agencies.

Provide education and

• utreach.
• 2

HAB-Associated Illness Reporting

Reporting pathways:

Online case reporting tool

• n DPH Blue-Green Algae

website.

Direct contact with staff

(email, phone).

• Dept. of Natural Resources

(DNR), local health depts., lake association referrals.

Wisconsin Poison Center.

3

How are people exposed?

Swimming Water skiing Boating Wading Using lake water for drinking

• r irrigation

Routes of exposure determine clinical signs/symptoms

Ingestion of water or algal scum material Skin contact with bloom material Inhalation of toxins or gases from decaying bloom mats Fish consumption may be a valid exposure pathway

Harmful Algal Blooms (HABs)

• 4

Skin Contact

Rash, hives, or skin blisters (especially in areas under swimsuits)

Ingestion

Abdominal pain Diarrhea Vomiting Nausea Numb lips, tingling fingers and toes, or dizziness

Inhalation

Influenza-like illness Respiratory irritation (e.g., runny eyes, nose, sore throat) Asthma-like symptoms

Routes of Exposure and Symptoms

5

How are animals exposed?

Dogs are common victims. Eating scum material, drinking lake water, licking algae from coat.

Harmful Algal Blooms (HABs)

• 6

Algal Toxins and Animal Health

Symptoms in Animals

Lethargy Vomiting, drooling Diarrhea Difficulty breathing Weakness Seizures

• 7

HAB-Related Illness Complaints in Wisconsin

Health Complaints Overview 2009-2014 Year # of Health Complaints 2009 37 2010 27 2011 36 2012 33 2013 13 2014 27 Total 173 Symptom Profile (2009-2013)** # of Reports Gastrointestinal Distress 56 Cold/Flu-like Illness 37 Dermal Rash 31 Respiratory Irritation 24

**Many cases included multiple symptom profiles, thus total number of symptoms exceeds total number of reports. 8

Frequency of Reported Primary Human and Animal Health Complaints, Wisconsin, 2009-2013 (n=121)

5 10 15 20 25 30 35 Diarrhea Rash Sore Throat Nausea Headache Vomiting Fever Shortness of Breath Fatigue Anorexia Chest Tightness Cough Malaise Muscle Pain Seizure Wheezing Itchy eyes Stomach ache

Number of complaints Primary complaint

9

HAB-Related Illness in Wisconsin

5 10 15 20 25 30 35 40 45

<1 hr 1-6 hrs 6-24 hrs 1-7 days Don't know Number of complainants Incubation period Incubation Period of Primary Health Complaint, 2009-2013 (n=108)

5 10 15 20 25 30 35 40

Duration of Primary Health Complaint, 2009-2013 (n=110) Duration Number of complainants

10

Emerging public health problem worldwide. Ability to affect large numbers of people when

drinking water is involved.

Projected increases in severity and magnitude. Health impacts still poorly understood.

Public Health Importance

11

The number of HAB-related illnesses is likely

underestimated.

Under-reporting of cases to the HAB Surveillance

Program due to:

Voluntary reporting. Variable knowledge of symptoms and ability to

associate illness with HAB exposure.

Challenging diagnosis.

Non-specific symptoms that mimic other common illnesses

(e.g., food poisoning, swimmer’s itch, seasonal allergies).

Most ill individuals do not seek medical attention. Variable case recognition among doctors and veterinarians. No clinical diagnostic test to confirm exposure.

Public Health Importance

12

What does a case of HAB-related illness sound like?

13

HAB Case Study 1:

Lake Kegonsa, Dane County

On July 15, 2009, a 31

year old male awoke at 2AM with symptoms of nausea, diarrhea and vomiting.

Later that day, the

patient developed burn- like lesions on his lower left arm.

The previous evening, he

had caught and eaten fish from Lake Kegonsa.

• 14

Patient reported:

Lake water was green and cloudy with a strong manure-

like odor.

Heavy algal mat present. Left arm was exposed to algal material up to his elbow

when he reached into the lake.

While cleaning the fish, he accidentally severed the liver,

possibly contaminating the fillet with algal toxins that can be concentrated in the bile.

Water sample collected two days later showed:

Two cyanobacteria species Microcystin-LR present

HAB Case Study 1:

Lake Kegonsa, Dane County

15

HAB Case Study 2:

Lake Tomahawk, Oneida County

August 14, 2009 A 15 lb. rat terrier collapsed

30 minutes after swimming and playing fetch near a beach

• n Lake Tomahawk.

The dog’s owner immediately

took it to a local veterinarian.

On admission, the dog was

comatose, with dilated pupils, blue-gray mucous membranes and a heart rate of 180-200 beats per minute.

• 16

Dog died within 90 minutes of onset. Inspection of the water at this beach conducted

August 17 (three days later) found no visible evidence of an algal bloom.

Water samples contained two cyanobacteria species

at concentrations considered low risk for adult humans.

Toxin analysis was not conducted. The presumptive cause of death was exposure to

blue-green algae.

HAB Case Study 2:

Lake Tomahawk, Oneida County

17

HAB Case Study 3:

Lakes Mendota and Monona, Dane County

25 year-old female

developed a rash on her chest and abdomen within one hour of tubing

• ver 4th of July weekend,

2009.

Within 12 hours she

developed severe nasal congestion, earache, sore throat, conjunctivitis, headache, and malaise.

http://msbonnersinil.blogspot.com/

18

Routine monitoring of beaches by County Health

Department detected four toxin-producing species

• f cyanobacteria at four different beaches.

Samples from Lake Mendota contained several

microcystin variants at high risk concentrations as well as cylindrospermopsin.

HAB Case Study 3:

Lakes Mendota and Monona, Dane County

19

Become familiar with the signs and symptoms and

relevant water conditions.

DHS, DNR, CDC websites

Educate others.

Posters, pamphlets, materials available for download

Report suspected illnesses to the WI Division of

Public Health HAB Surveillance Program.

Encourage others to report suspected illnesses. Report suspected blooms to your local health

department.

How Can I Help?

20

Contact Information

Gina LaLiberte Wisconsin Dept. of Natural Resources Gina.LaLiberte@wisconsin.gov Sarah Koske, DVM, MPH Wisconsin Division of Public Health Sarah.Koske@dhs.wi.gov TO REPORT A HAB-RELATED ILLNESS: Online report form: https://www.dhs.wisconsin.gov/water/bg- algae/index.htm Visit www.dhs.wisconsin.gov and search for “blue-green algae” By phone: (608) 266-1120

21